Evidence map›Paper›PMID 26882927›Full record

SynthesisAnnals of the rheumatic diseases2016

Examination of overall treatment effect and the proportion attributable to contextual effect in osteoarthritis: meta-analysis of randomised controlled trials.

Kun Zou, Jean Wong, Natasya Abdullah, Xi Chen, Toby Smith, Michael Doherty, Weiya Zhang

Open access · hybridAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Annals of the rheumatic diseases, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 93 papers, 19 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
93citing papers in PubMed, 19 pooled it
14.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

93 citing papers in PubMed, 19 syntheses or guidelines pooled it, 206 citations in OpenAlex.

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  5. Non-surgical interventions for treating osteoarthritis of the big toe joint.The Cochrane database of systematic reviews · 2024
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33 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 2 countries.

Kun ZouDivision of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu, China.
Jean WongPinfold Medical Practice, Loughborough, UK.
Natasya AbdullahDivision of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK.
Xi ChenDivision of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK.
Toby SmithSchool of Health Sciences, University of East Anglia, Norwich, UK.
Michael DohertyDivision of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK.
Weiya ZhangDivision of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK.
University of Nottingham · GBSichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital · CNUniversity of East Anglia · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo examine the overall treatment effect and the proportion attributable to contextual effect (PCE) in randomised controlled trials (RCTs) of diverse treatments for osteoarthritis (OA).

methodsWe searched Medline, Embase, Central, Science Citation Index, AMED and CINAHL through October 2014, supplemented with manual search of reference lists, published meta-analyses and systematic reviews. Included were RCTs in OA comparing placebo with representative complementary, pharmacological, non-pharmacological and surgical treatments. The primary outcome was pain. Secondary outcomes were function and stiffness. The effect size (ES) of overall treatment effect and the PCE were pooled using random-effects model. Subgroup analyses and meta-regression were conducted to examine determinants of the PCE.

resultsIn total, 215 trials (41 392 participants) were included. The overall treatment effect for pain ranged from the smallest with lavage (ES=0.46, 95% CI 0.24 to 0.68) to the largest with topical non-steroidal anti-inflammatory drugs (ES=1.37, 95% CI 1.19 to 1.55). On average, 75% (PCE=0.75, 95% CI 0.72 to 0.79) of pain reduction was attributable to contextual effect. It varied by treatment from 47% (PCE=0.47, 95% CI 0.32 to 0.70) for intra-articular corticosteroid to 91% (PCE=0.91, 95% CI 0.60 to 1.37) for joint lavage. Similar results were observed for function and stiffness. Treatment delivered by needle/injection and other means than oral medication, longer duration of treatment, large sample size (≥100 per arm) and public funding source were associated with increased PCE for pain reduction.

conclusionsThe majority (75%) of the overall treatment effect in OA RCTs is attributable to contextual effects rather than the specific effect of treatments. Reporting overall treatment effect and PCE, in addition to traditional ES, permits a more balanced, clinically meaningful interpretation of RCT results. This would help dispel the frequent discordance between conclusions from RCT evidence and clinical experience-the 'efficacy paradox'.

Indexed as

ArthralgiaFemaleHumansInjections, Intra-ArticularMaleMiddle AgedOsteoarthritisPain ManagementRandomized Controlled Trials as TopicTherapeutic IrrigationTreatment OutcomeEpidemiologyOsteoarthritisTreatment

Identifiers

PMID26882927
PMCPMC5099197
OpenAlexW2314251210

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.