Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Apr 26, 2015; 3(2): 93-96
Published online Apr 26, 2015. doi: 10.13105/wjma.v3.i2.93
Low back pain-related meta-analysis: Caution is needed when interpreting published research results
Christophe Demoulin, Olivier Bruyère, Pierre-René Somville, Marc Vanderthommen
Christophe Demoulin, Olivier Bruyère, Marc Vanderthommen, Department of Sport and Rehabilitation Sciences, University of Liege, 4000 Liege, Belgium
Christophe Demoulin, Pierre-René Somville, Marc Vanderthommen, Department of Physical Medicine and Rehabilitation, University Hospital Center of Liege (CHU), 4000 Liege, Belgium
Olivier Bruyère, Department of Public Health, Epidemiology and Health Economics, University of Liege, 4000 Liege, Belgium
Author contributions: All the authors contributed substantially to the writing and revising the manuscript.
Conflict-of-interest: The authors declare that there are no conflicts of interest.
Open-Access: This article is an open-access article which selected by an in-house editor and fully peer-reviewed by external reviewers. It distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Christophe Demoulin, PT, PhD, Department of Sport and Rehabilitation Sciences, University of Liege, ISEPK, Bat B21, Allée des Sports, 4000 Liege, Belgium. christophe.demoulin@ulg.ac.be
Telephone: +32-43-663895 Fax: +32-43-662901
Received: January 20, 2015
Peer-review started: January 24, 2015
First decision: February 7, 2015
Revised: February 21, 2015
Accepted: April 1, 2015
Article in press: April 7, 2015
Published online: April 26, 2015
Processing time: 97 Days and 16.9 Hours
Abstract

The systematic reviews (SRs) including a meta-analysis are considered as the top level of evidence. Although the existence of more than a hundred of low back pain (LBP)-related SRs seems very appealing and might therefore suggest significant evidence on the topic, a deep analysis indicates that several of these SRs included only very few studies. Other SRs raise concerns because they included some randomized controlled trials which had a low methodological quality, or some studies which differed significantly regarding the studied populations and/or the experimental procedure. The sometimes controversial results of different SRs conducted on the same topic also highlight the significant influence of the inclusion/exclusion criteria used in the SRs to select the articles. To conclude, although meta-analysis is at the top of the evidence pyramid and have several strengths, the conclusions drawn from SRs should always be interpreted with caution because they can also have weaknesses. This is true, whether it be for LBP-related SRs including a meta-analysis, or any other. Therefore a critical analysis of any SR is always needed before integrating the results of the SR in its own clinical practice. Furthermore, clinical reasoning remains crucial, especially to consider the potential differences between one’s patient and the patients included in the meta-analysis.

Keywords: Meta-analysis; Systematic review; Spine; Back pain; Limitations; Recommendations; Evidence-based practice

Core tip: Although meta-analysis are at the top of the evidence pyramid and have several strengths, the conclusions drawn from systematic reviews combined to a meta-analysis should always be interpreted with caution because they can also have weaknesses. This is true, whether it be for low back pain-related systematic reviews including a meta-analysis, or any other. Therefore, a critical analysis of a systematic review is always needed before integrating the results in its own clinical practice. Furthermore, clinical reasoning remains crucial, especially to consider the potential differences between one’s patient and the patients included in the meta-analysis.