Paul is a Board member of the Swedish Quality Registry for Pain Rehabilitation (SQRP).Yuexin Tong 1 Yuekai Cui 2 Liming Jiang 1 Yangwei Pi 1 Yan Gong 1 Dongxu Zhao 1 * His research is mostly focused on musculoskeletal disorders, amongst others a recent project to study the implementation of guidelines for low back pain ( BetterBack Model of Care) in primary care. Paul Enthoven, Registered Physical Therapist, is Senior Lecturer at the Department of Medical and Health Sciences at Linköping University in Linköping, Sweden. She is linked to two research groups, one in Stockholm Karolinska Institutet ’Musculoskeletal disorders from a biopsychosocial perspective’ and one in Falun, Dalarna University REPS, also in Sweden. Her dissertation research on multidisciplinary rehabilitation in chronic pain focuses on effectiveness and predictors of treatment outcome. He is the research group leader of ’Musculoskeletal disorders from a biopsychosocial perspective’ at the Division of Physical Therapy and his research focus is within pain rehabilitation, biomechanics, ergonomics, sports medicine, orthopedics and neurology.Įlena Tseli, is a doctoral student at the Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physical Therapy. Wim Grooten, is an associate professor at the Karolinska Institutet, Department of Neurobiology, Care Sciences and Society. Finally, calculate Kappa early, as a way of identifying domains that may be in need of harmonization. Secondly, plan for an early tuning-discussion with the team (after 5-10 articles) to help resolve dilemmas and disagreements that have arisen in praxis. Among these tips, we first highlight the importance of agreeing on the judgment of the prompting items in advance, an initial pilot on 2-3 articles can help identify areas in need of clarification. In our paper, we have provided tips that can be used for researchers using QUIPS in the field of rehabilitation medicine. Whether it is easy to have agreement or not depends partly on which type of study is assessed some studies investigate specific delimited factors and outcomes, whereas more complex contexts may require a lot more preparatory work. In our second set of RoB assessment, we were more prepared from the dilemmas we had previously encountered and dissolved in the first round. When we used QUIPS in the research field of chronic pain and complex interventions, we came up with a rather weak agreement in our judgements of RoB of individual domains. The final judgement should be the result of these informed discussions as the assessment is not merely deterministic, but also to some degree subjective. For instance, in our field the outcome and prognostic measures are often established instruments, where as we have much more problems with response rate and attrition (as we evaluate long term effects) and statistical approaches vary a lot. We believe that the foremost gain of such a systematic process is that it initiates a discussion on important validity aspects. The QUIPS tool facilitates a structured assessment and the worksheet is easily adapted for specific needs, which is helpful when disagreements are to be resolved. The degree of interrater agreement was evaluated by Kappa statistics. The results from these ratings and especially non-agreement are then the basis for discussion and a final consensus is made. Preferably, the RoB – assessment is made by at least two persons independently. Based on the ratings of the included items, a conclusive judgment of the risk of bias within each domain is made and expressed on a three-grade scale (high, moderate or low RoB). The QUIPS tool uses six important domains that should be critically appraised when evaluating validity and bias in studies of prognostic factors: (see figure 1).Įach domain includes multiple items that are judged separately. The Cochrane Prognosis Methods Group recommends the use of the Quality In Prognosis Studies ( QUIPS) tool to assess RoB in prognostic factor studies. This process is called risk of bias assessment (RoB). In this process, it is necessary to assess the quality of the included papers in order to decide if and to what extent a paper may contribute to the review (and synthesis). It is therefore of great interest to perform a systematic review of existing data, to look at whether a potential prognostic factor is associated with treatment outcome and to estimate the strength of the association through a meta-analysis. However, in the field of pain rehabilitation, the literature reports diverse information on specific factors and there is little consensus on what factor is important for the prognosis. Knowledge on prognostic factors can indicate the course of a certain condition and help clinicians to make appropriate treatment decisions based on the prognosis for separate groups of people.
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