Risk of bias in systematic reviews of tendinopathy management: Are we comparing apples with oranges?

Abstract

We aimed to provide an overview of the use of risk of bias (RoB) assessment tools in systematic reviews (SRs) in tendinopathy management given increased scrutiny of the SR literature in clinical decision making. A search was conducted in Medline from inception to June 2020 for all SRs of randomized controlled trials (RCTs) assessing the effectiveness of any intervention(s) on any location(s) of tendinopathy. Included SRs had to use one of (a) Cochrane Collaboration tool, (b) PEDro scale, or (c) revised Cochrane Collaboration tool (RoB 2) for their RoB assessment. A total of 46 SRs were included. Around half of SRs (46%) did not use an RoB assessment in data synthesis, and only 30% used it to grade the certainty of evidence. The RoB 2 tool was the most likely to determine “overall high RoB” (52%) followed by the Cochrane Collaboration tool (34.6%) and the PEDro scale (18.6%) as determined by the authors of the SRs. We have demonstrated substantial problems associated with the use of RoB assessments in tendinopathy SRs. The universal use of a single RoB assessment tool should be promoted by journals and SR guidance documents.