To the Editor:
In “Doubling the Impact: Publication of Systematic Review Articles in
Orthopaedic Journals” ,Bhandari et al. (1) reveal the
unsatisfactory nature of the majority of reviews published in fifteen
orthopaedic journals. They refer to their previous study of the
methodological rigor of orthopaedic meta-analyses[1], where the findings
of generally poor methodological quality applied to reviews published in
journals but not to Cochrane reviews[2,3].
Obviously, Cochrane reviews could not be included in Bhandari et al.,
despite the frequency with which they are cited, as these are not
currently indexed in the citation indexes. However the authors did allude
to the fact that “The Cochrane Collaboration… has published in excess of
1000 systematic reviews since its inception"[4].
The number of rigorously
conducted and maintained systematic reviews in the Cochrane Database of
Systematic Reviews now approximates 2000[5]. At least
155 of these systematic reviews generated by members of the Back, Musculoskeletal,
and Musculoskeletal Injuries Collaborative Review Groups are of direct
relevance to orthopaedics. This contrasts to the seventeen systematic
reviews identified by Bhandari et al. in the fifteen journals with high
Science Citation Index impact factors for orthopaedics. It should be noted
that four out of the eight systematic reviews identified in Spine are
print versions of Cochrane reviews.
As acknowledged by Bhandari et al. impact factors are an imperfect
measure[6]. While we endorse Bhandari et al's call for improvements in
the methodological rigor in the conduct and reporting of reviews in
journals, we caution against the use of impact factors as a major
determinant of quality of individual reviews/papers[6]. Finally, we would
like to encourage authors and journal editors alike to improve not only
the quality of the design and reporting of review articles[7] but also of
the primary research underpinning these reviews.
Helen H. Handoll, DPhil
Lesley D. Gillespie, MMedSci
William J. Gillespie, FRACS
Rajan Madhok, FRCS
Martyn J. Parker, MD
We are all members of the Cochrane Musculoskeletal Injuries
Collaborative Review Group
Teesside Centre for Rehabilitation Sciences,
The James Cook University Hospital,
Marton Road,
Middlesbrough,
TS4 3BW,
UK.
E-mail address: h.handoll@ed.ac.uk
1. Bhandari M, Morrow F, Kulkarni AV, Tornetta P 3rd. Meta-analyses
in orthopaedic surgery. A systematic review of their methodologies. J Bone
Joint Surg Am. 2001; 83:15-24.
2. Parker M, Gillespie L, Gillespie W, Handoll H, Madhok R, Morton L
et al. Systematic reviews, meta-analyses, and methodology. J Bone Joint
Surg Am. 2001; 83:1433-4.
3. Bhandari M, Morrow F, Kulkarni AV, Tornetta P 3rd. Systematic
reviews, meta-analyses, and methodology. J Bone Joint Surg Am. 2001;
83:1434-5.
4. Chalmers I. The Cochrane Collaboration: preparing, maintaining,
and disseminating systematic reviews on the effects of health care. Ann NY
Acad Sci. 1993;703:156-65.
5. The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley
& Sons, Ltd.
6. Kurmis AP. Understanding the limitations of the journal impact
factor. J Bone Joint Surg Am. 2003; 85:2449-54.
7. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF et al.
Improving the quality of reports of meta-analyses of randomised controlled
trials: the QUOROM statement. Lancet 1999; 354:1896-1900.
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