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Should this systematic review and meta-analysis change my practice? Part 1: exploring treatment effect and trustworthiness
  1. Mervyn J Travers1,2,
  2. Myles Calder Murphy1,3,
  3. James Robert Debenham1,
  4. Paola Chivers4,
  5. Max K Bulsara4,
  6. Matthew K Bagg5,6,
  7. Thorvaldur Skulli Palsson7,
  8. William Gibson1
  1. 1School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
  2. 2School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  3. 3Sports Science Sports Medicine Department, Western Australian Cricket Association, Perth, Western Australia, Australia
  4. 4Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
  5. 5Pain Research, Education and Management Program, Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
  6. 6UNSW Prince of Wales Clinical School, Sydney, New South Wales, Australia
  7. 7Laboratory for Musculoskeletal Pain and Motor Control, Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
  1. Correspondence to Dr Mervyn J Travers, School of Physiotherapy, University of Notre Dame Australia, Fremantle, WA 6160, Australia; mervyn.travers{at}nd.edu.au

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Introduction

As a service to its readership, BJSM publishes educational editorials in order to provide methodological guidance and direction to clinicians and researchers.1 For example, a recent BJSM invited commentary outlined important methodological aspects of randomised controlled trials (RCTs) in order to help readers better understand and interpret findings.2 Similarly, a recent BJSM editorial written for clinicians has outlined five essential methodological considerations or ‘hacks’ to consider when reading a systematic review (SR), while another editorial has outlined common pitfalls for authors conducting a SR.3 4 In light of recent suggestions of untrustworthiness of systematic review and meta-analyses (SRMA) findings,5–7 researchers are encouraged to maximise the transparency of their work. Similarly, clinicians and policymakers are encouraged to scrutinise SRMA in order to decide if the findings should influence clinical decisions or policies. The purpose of our two-part educational editorial series is to highlight important methodological aspects of SRMA of the effects of interventions and thus help clinicians make judicious choices when considering whether to accept the findings. By using a worked example, we hope this resource serves as a guide for clinicians when critically appraising SRMA findings and deciding whether (or not) to accept the reported findings or the interpretation of the authors.

What is a systematic review and meta-analysis and how should it inform my practice?

A SR attempts to collate all empirical evidence that fits prespecified eligibility criteria in order to answer a specific research question.8 An interventional SR specifically assesses the benefits and harms of an intervention and should provide an unbiased, robust, transparent and reproducible overview of the effect of an intervention and the quality of the evidence from identified clinical studies.9 Should the SR contain sufficient and appropriate quantitative data from the included studies, a meta-analysis (MA) can be conducted to provide a pooled estimate of effect, and to examine variation among individual study …

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