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      Uses and misuses of the STROBE statement: bibliographic study

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          Abstract

          Objectives

          Appropriate reporting is central to the application of findings from research to clinical practice. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations consist of a checklist of 22 items that provide guidance on the reporting of cohort, case–control and cross-sectional studies, in order to facilitate critical appraisal and interpretation of results. STROBE was published in October 2007 in several journals including The Lancet, BMJ, Annals of Internal Medicine and PLoS Medicine. Within the framework of the revision of the STROBE recommendations, the authors examined the context and circumstances in which the STROBE statement was used in the past.

          Design

          The authors searched the Web of Science database in August 2010 for articles which cited STROBE and examined a random sample of 100 articles using a standardised, piloted data extraction form. The use of STROBE in observational studies and systematic reviews (including meta-analyses) was classified as appropriate or inappropriate. The use of STROBE to guide the reporting of observational studies was considered appropriate. Inappropriate uses included the use of STROBE as a tool to assess the methodological quality of studies or as a guideline on how to design and conduct studies.

          Results

          The authors identified 640 articles that cited STROBE. In the random sample of 100 articles, about half were observational studies (32%) or systematic reviews (19%). Comments, editorials and letters accounted for 15%, methodological articles for 8%, and recommendations and narrative reviews for 26% of articles. Of the 32 observational studies, 26 (81%) made appropriate use of STROBE, and three uses (10%) were considered inappropriate. Among 19 systematic reviews, 10 (53%) used STROBE inappropriately as a tool to assess study quality.

          Conclusions

          The STROBE reporting recommendations are frequently used inappropriately in systematic reviews and meta-analyses as an instrument to assess the methodological quality of observational studies.

          Article summary

          Article focus
          • Appropriate reporting is central for the proper application of findings from clinical research into clinical practice.

          • The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations aim to provide guidance to authors on how to improve the reporting of observational studies to facilitate critical appraisal and interpretation of results.

          • We examined the reasons for citing STROBE and found that most observational studies used STROBE as a reporting guideline, while about half of systematic reviews used STROBE as a tool to assess the methodological quality of the studies.

          Key messages
          • Our study provides further evidence that authors of systematic reviews inappropriately use reporting guidelines to assess methodological study quality. Given the identified common misuse of STROBE, we discuss possible reasons and potential pitfalls of such misuse.

          Strengths and limitations of this study
          • We conducted a systematic review of the literature to address a relevant and insufficiently discussed issue concerning misuses of reporting guidelines. One of the main concerns of such misuse is the potential introduction of bias into systematic reviews and meta-analysis.

          • A limitation of our findings is the fact that we included only articles which cited STROBE. This may have resulted in a selection bias, since some researchers may use STROBE in their study and mention it in their manuscript but do not formally cite it.

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          Most cited references 19

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          Systematic reviews in health care: Assessing the quality of controlled clinical trials.

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            What is missing from descriptions of treatment in trials and reviews?

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              Use of the CONSORT statement and quality of reports of randomized trials: a comparative before-and-after evaluation.

               D Moher,  ,  L Lepage (2001)
              The Consolidated Standards for Reporting of Trials (CONSORT) statement was developed to help improve the quality of reports of randomized controlled trials (RCTs). To date, a paucity of data exists regarding whether it has achieved this goal. To determine whether use of the CONSORT statement is associated with improvement in the quality of reports of RCTs. Comparative before-and-after evaluation in which reports of RCTs published in 1994 (pre-CONSORT) were compared with RCT reports from the same journals published in 1998 (post-CONSORT). We included 211 reports from BMJ, JAMA, and The Lancet (journals that adopted CONSORT) as well as The New England Journal of Medicine (a journal that did not adopt CONSORT and was used as a comparator). Number of CONSORT items included in a report, frequency of unclear reporting of allocation concealment, and overall trial quality score based on the Jadad scale, a 5-point quality assessment instrument. Compared with 1994, the number of CONSORT checklist items in reports of RCTs increased in all 4 journals in 1998, and this increase was statistically significant for the 3 adopter journals (pre-CONSORT, 23.4; mean change, 3.7; 95% confidence interval [CI], 2.1-5.3). The frequency of unclear reporting of allocation concealment decreased for each of the 4 journals, and this change was statistically significant for adopters (pre-CONSORT, 61%; mean change, -22%; 95% CI, -38% to -6%). Similarly, 3 of the 4 journals showed an improvement in the quality score for reports of RCTs, and this increase was statistically significant for adopter journals overall (pre-CONSORT, 2.7; mean change, 0.4; 95% CI, 0.1-0.8). Use of the CONSORT statement is associated with improvements in the quality of reports of RCTs.
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                Author and article information

                Journal
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2011
                26 February 2011
                26 February 2011
                : 1
                : 1
                Affiliations
                [1 ]Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
                [2 ]Clinical Trials Unit Bern, Bern University Hospital, Bern, Switzerland
                [3 ]Centre for Statistics in Medicine, University of Oxford, Oxford, UK
                Author notes
                Correspondence to Dr Bruno R da Costa; bdacosta@ 123456ispm.unibe.ch
                Article
                bmjopen-2010-000048
                10.1136/bmjopen-2010-000048
                3191404
                22021739
                © 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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                Categories
                Epidemiology
                Research
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