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Evaluation of the Cochrane tool for assessing risk of bias in randomized clinical trials: overview of published comments and analysis of user practice in Cochrane and non-Cochrane reviews

Overview of attention for article published in Systematic Reviews, May 2016
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  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (93rd percentile)
  • High Attention Score compared to outputs of the same age and source (91st percentile)

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Title
Evaluation of the Cochrane tool for assessing risk of bias in randomized clinical trials: overview of published comments and analysis of user practice in Cochrane and non-Cochrane reviews
Published in
Systematic Reviews, May 2016
DOI 10.1186/s13643-016-0259-8
Pubmed ID
Authors

Lars Jørgensen, Asger S. Paludan-Müller, David R. T. Laursen, Jelena Savović, Isabelle Boutron, Jonathan A. C. Sterne, Julian P. T. Higgins, Asbjørn Hróbjartsson

Abstract

The Cochrane risk of bias tool for randomized clinical trials was introduced in 2008 and has frequently been commented on and used in systematic reviews. We wanted to evaluate the tool by reviewing published comments on its strengths and challenges and by describing and analysing how the tool is applied to both Cochrane and non-Cochrane systematic reviews. A review of published comments (searches in PubMed, The Cochrane Methodology Register and Google Scholar) and an observational study (100 Cochrane and 100 non-Cochrane reviews from 2014). Our review included 68 comments, 15 of which were categorised as major. The main strengths of the tool were considered to be its aim (to assess trial conduct and not reporting), its developmental basis (wide consultation, empirical and theoretical evidence) and its transparent procedures. The challenges of the tool were mainly considered to be its choice of core bias domains (e.g. not involving funding/conflicts of interest) and issues to do with implementation (i.e. modest inter-rater agreement) and terminology. Our observational study found that the tool was used in all Cochrane reviews (100/100) and was the preferred tool in non-Cochrane reviews (31/100). Both types of reviews frequently implemented the tool in non-recommended ways. Most Cochrane reviews planned to use risk of bias assessments as basis for sensitivity analyses (70 %), but only a minority conducted such analyses (19 %) because, in many cases, few trials were assessed as having "low" risk of bias for all standard domains (6 %). The judgement of at least one risk of bias domain as "unclear" was found in 89 % of included randomized clinical trials (1103/1242). The Cochrane tool has become the standard approach to assess risk of bias in randomized clinical trials but is frequently implemented in a non-recommended way. Based on published comments and how it is applied in practice in systematic reviews, the tool may be further improved by a revised structure and more focused guidance.

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X Demographics

The data shown below were collected from the profiles of 59 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 305 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United States 1 <1%
Canada 1 <1%
Brazil 1 <1%
Unknown 302 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 64 21%
Student > Bachelor 37 12%
Student > Ph. D. Student 25 8%
Researcher 24 8%
Student > Postgraduate 16 5%
Other 40 13%
Unknown 99 32%
Readers by discipline Count As %
Medicine and Dentistry 61 20%
Nursing and Health Professions 55 18%
Psychology 16 5%
Social Sciences 9 3%
Biochemistry, Genetics and Molecular Biology 6 2%
Other 40 13%
Unknown 118 39%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 33. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 08 June 2023.
All research outputs
#1,224,564
of 25,584,565 outputs
Outputs from Systematic Reviews
#167
of 2,241 outputs
Outputs of similar age
#20,972
of 319,542 outputs
Outputs of similar age from Systematic Reviews
#5
of 47 outputs
Altmetric has tracked 25,584,565 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 95th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 2,241 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 13.2. This one has done particularly well, scoring higher than 92% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 319,542 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 93% of its contemporaries.
We're also able to compare this research output to 47 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 91% of its contemporaries.