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One randomised controlled trial (RCT) of a treatment does not revolutionise clinical practice. Clinician readers of BJSM will have noticed the increasing frequency of meta-analysis of treatment studies—valuable synthesis from many RCTs. The classic pairwise meta-analysis compares two treatments—most commonly one treatment over a control. The meta-analysis reports that exercise treatment reduces pain in osteoarthritis versus an education programme (control). Boom! Done.
But what about when there are many treatment options? We can immediately think of at least eight treatments for Achilles tendinopathy. Some of those treatments have not been compared against each other in RCTs (eg, heel raise inserts vs plasma-rich protein). This is where it is time for the clinician to call 1-800 Network Meta-Analysis. Network meta-analysis (NMA) is a clever and popular statistical method to compare numerous treatments for a condition. An NMA allows two treatments to be compared statistically, even if they have not been compared directly in any previous randomised controlled trial, via a common comparator. NMA methods also allow researchers to rank a series of treatments by their effectiveness.1
The Enhancing the Quality and Transparency of health Research reporting guidelines such as the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklists are extremely helpful for conducting NMAs1 and reporting the results,2 …
Contributors All authors had contributed in planning and reporting the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.