Poor description of non-drug interventions: a remediable barrier to usage of evidence in practice?

Article type
Authors
Hoffmann T1, Glasziou P1, Erueti C1
1Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Australia
Abstract
Background: Poorly described interventions are one remediable barrier to the use of research in practice. In particular, non-drug interventions often appear to be poorly described and consequentially underused.

Objectives: We aimed to assess the frequency of inadequate descriptions of non-drug interventions in randomised trials and identify which elements are missing.

Methods: The interventions in all randomised trials on non-drug interventions published in 6 major general medical journals (JAMA, BMJ, Lancet, NEJM, Annals of Internal Medicine, and PLoS Medicine) in 2009 were assessed with a standardised checklist by two reviewers independently using the primary paper and any references, appendices or websites provided in the paper.

Results: We identified 134 trials evaluating 138 non-drug interventions, including devices (17%), education and training (15%), surgery (13%), mixed or complex interventions (13%), diet (12%), and exercise (9%). Overall, 53 of the 138 interventions (38%) had sufficiently described all the necessary elements of the intervention. Of the remaining interventions, common missing elements were: materials necessary to provide the intervention (missing in 51% of the interventions), details about intervention-related procedures (46% missing), and details about the schedule of sessions involved in the intervention (17% missing). For several articles, necessary appendices were missing from the journal website; for others, details of the intervention were only published subsequent to the trial report and hence were not referenced.

Conclusions: The majority of non-drug interventions are inadequately described in standard publications and therefore they cannot be implemented in practice. Readers, authors, editors, and funders need to better address the issue of intervention descriptions if research on non-drug interventions is not to be wasted.