Best Evidence Topics

Review or meta-analysis

McDonald S, Hetrick S, Green S,
Pre-operative education for hip or knee replacement
The Cochrane Collaboration
26 January 2004 1-23
  • Submitted by:Stephanie Purcell - Senior OT
  • Institution:MRI
  • Date submitted:21st February 2007
Before CA, i rated this paper: 9/10
1 Objectives and hypotheses
1.1 Are the objectives of the study clearly stated?
2 Design
2.1 Is the study design suitable for the objectives?
2.2 Were the search methods used to locate relevant studies comprehensive?
  Yes - Clearly stated search terms
2.3 Was this the right sample to answer the objectives?
  Yes. Cochrane comments that trial populations were generally moderate in size (median size n=78, range 42-170)
2.4 Is the study large enough to achieve its objectives?
  782 participants in 9 studies but evidence of sample size estimates were not clear in the review.
2.5 Were all the studies accounted for?
  No, there was a discrepancy in one study (Doering 2000) between the control group sample size reported in the paper and the number in the results.
2.6 Were all appropriate outcomes considered?
  Yes - the effect of the intervention on length of stay was reported in 4 papers.
2.7 Has ethical approval been obtained if appropriate?
  Not Applicable
3 Measurement and observation
3.1 Is it clear what was measured, how it was measured and what the outcomes were?
  Yes, length of hospital stay recorded in days.
3.2 Were explicit methods used to determine which studies to include in the review?
3.3 Was the selection of primary studies re-producible and free from bias?
  Unknown. Possible bias due to six studies where allocation concealment was unclear
3.4 Was the methodologic quality of the primary studies assessed?
3.5 Are the measurements valid?
  Valid measurements in 8 out of 9 studies but one study only used patient satisfaction
3.6 Are the measurements reliable?
3.7 Are the measurements reproducible?
4 Presentation of results
4.1 Are the basic data adequately described?
4.2 Were the differences between studies adequately described?
4.3 Are the results presented clearly, objectively and in sufficient detail to enable readers to make their own judgement?
4.4 Are the results internally consistent, i.e. do the numbers add up properly?
  One mistake found in Doering 2000 where 54 participants were in the control group in the description of studies (p12) but in the results section (p20) there was 53 in the control group.
5 Analysis
5.1 Were the results of primary studies combined appropriately?
5.2 Has a sensitivity analysis been performed?
  No - because of insufficient studies
5.3 Were all the important outcomes considered?
5.4 Are the data suitable for analysis?
  Yes, meta analysis performed on length of stay
5.5 Are the methods appropriate to the data?
5.6 Are any statistics correctly performed and interpreted?
6 Discussion
6.1 Are the results discussed in relation to existing knowledge on the subject and study objectives?
6.2 Is the discussion biased?
7 Interpretation
7.1 Are the author's conclusions justified by the data?
7.2 What level of evidence has this paper presented?
7.3 Does this paper help me to answer my problem?
  The paper did support our hypothesis, however, the level of available evidence to review was limited. Whilst there were a number of variables, length of hospital stay was analysed from five studies
After CA, i rated this paper: 9/10
8 Implementation
8.1 Can any necessary change be implemented in practice?
  Although there is some "silver" level evidence in the Cochrane that pre-op education for THR and TKR does not decrease the length of hospital stay there is no gold or platinum evidence.
8.2 What aids to implementation exist?
  Not Applicable
8.3 What barriers to implementation exist?
  Not Applicable