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Cited by 68Meta-analysis and systematic reviewsMusculoskeletal pain and rehabilitationDelphi Technique in Research

Impact of quality scales on levels of evidence inferred from a systematic review of exercise therapy and low back pain

Colle, Florence, Rannou, François, Revel, Michel, Fermanian, Jacques, Poiraudeau, Serge·2002·Archives of Physical Medicine and Rehabilitation
DOI 10.1053/apmr.2002.35657
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Abstract

Objective To assess whether the scale used affects levels of evidence inferred from a systematic review of studies on exercise therapy and chronic low back pain (LBP).Design Twenty trials previously analyzed in a systematic review were assessed by 2 readers using 16 different scales.Setting Tertiary care teaching hospital in France.Participants Chronic LBP patients.Interventions Not applicable.Main outcome measure For the scales allowing classification into high- and low-quality trials, a rating system with 4 levels of evidence was used to summarize conclusions drawn. The Spearman rank correlation coefficient was used to assess correlations between the scores obtained with the different scales. Interrater reliability of the scales was assessed with the intraclass correlation coefficient and the Bland and Altman method, and the degree of agreement between the readers was calculated using the kappa coefficient.Results Two of the 3 main results of the systematic review (conflicting evidence on the effectiveness of exercise therapy compared with inactive treatments; strong evidence that exercise therapy is more effective than usual care by a general practitioner) were influenced by the scale used. The range of the Spearman rank correlation coefficients between the different scales was wide (range,.49-.94), the interreader reliability of the scales was heterogeneous, and the interreader agreement was often low (kappa<or=.60 for 7/10 tests).Conclusions The use of summary scores to identify physical therapy trials of high quality is questionable. Different quality assessment scales should probably be used to assess pharmacologic interventions and physical therapies. Development and validation of quality scales specific to physical treatments are needed.

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Authors
Colle, F., Rannou, F., Revel, M., Fermanian, J., & Poiraudeau, S.
Affiliations
  • Inserm (FR)
  • Hôpital Necker-Enfants Malades (FR)
ORCID
Venue
Archives of Physical Medicine and Rehabilitation
Publisher
Elsevier BV
Published
2002-12
Volume
83
Issue
12
Pages
1745-1752
ISSN
0003-9993 (ISSN-L)
DOI
10.1053/apmr.2002.35657
OpenAlex
W2056537869
Cited by
68
References
61
Citations by year
2025: 2 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 4 · 2018: 3 · 2017: 1 · 2016: 3 · 2015: 2 · 2014: 7 · 2013: 4 · 2012: 7
FWCI
1.11
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Archives of Physical Medicine and Rehabilitation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Social Sciences › Sociology and Political Science › Delphi Technique in Research
Keywords
quality assessment scale, level of evidence, exercise therapy, chronic low back pain, inter-rater reliability
MeSH terms
Chronic Disease, Exercise Therapy, Humans, Quality of Health Care, Meta-Analysis as Topic, Observer Variation, Randomized Controlled Trials as Topic, Low Back Pain

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