Tackling research inefficiency and imprecision - literature reviews & meta-analyses in degenerative cervical myelopathy
EANS Academy. Khan D. 09/27/19; 276066; EP02072
Mr. Danyal Zaman Khan
Mr. Danyal Zaman Khan

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Background: Degenerative cervical myelopathy (DCM) is widely accepted as the most common cause of adult myelopathy worldwide. However, no ICD-11 category or medical subject heading (MeSH) exists for DCM. This makes searching the literature and thus, conducting systematic reviews and/or meta-analyses (SR/MA) imprecise and inefficient.
Methods: To identify the key sources of imprecision and quantify their impact, an illustrative search strategy was formed using a validated DCM HEDGE combined with strategies used previously by authors conducting SR/MA. MEDLINE and EMBASE databases were searched, looking for DCM SR/MA published within the last 5 years.
Results: The MEDLINE search strategy (Figure 1) returned 24,166 results, refined to 534 after application of study criteria. 176 (32.96%) results were about DCM, 97 (18.16%) of these were DCM SR/MA (Figure 2). Non-DCM results were organized into imprecision categories (spinal 50.2%, non-spinal 15.5%, non-human 1.5%). The largest subcategories were spinal cord injury (13.67%), spinal neoplasms (8.24%), spinal infectious diseases (3.37%) and non-cervical spinal levels (3.37%). Counterintuitively, the use of 'human' and 'adult' MEDLINE filters was found to exclude a large number of relevant articles. Searching a second database (EMBASE), added 12 extra DCM SR/MA articles.
Discussion: As the rate of primary research production exceeds our ability to review it, it is imperative literature review methods emphasize efficiency. Less than 20% of our results were DCM SR/MA, the identification of which would be an important initial step in further research synthesis. Principal sources of imprecision identified were heterogenous, overlapping terms and poor use of available technology. SR/MA are crucial in reducing research wastage. A consensus-derived DCM index term and MeSH labelling of past and future DCM literature will be important next steps to address this issue.

[Figure 1: MEDLINE search strategy with most common imprecision categories]

[Figure 2: Phase 2 Search Results Categorisation - guided by ICD-11 Classification]

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