Open AccessSystematic Assessment of the Quality of Research Studies of Conventional and Alternative Treatment(s) of Primary Headache State of the Data at the Mid-Point of the Decade of Pain Control and Research
Author(s) -
Cindy Crawford,
Mylene T Huynh,
Alyson Kepple,
Wayne B. Jonas
Publication year - 2009
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2009/12/461
Subject(s) - medicine , jadad scale , cochrane library , medline , physical therapy , migraine , randomized controlled trial , systematic review , psycinfo , cluster headache , alternative medicine , pathology , political science , law
Background: Diversity of treatments used for headache, and varied quality of research conduct and reporting make it difficult to accurately assess the literature and to determine thebest treatment(s) for patients.Objectives: To compare the quality of available research evidence describing the effects andoutcomes of conventional, and complementary and alternative medicine (CAM) approachesto treating primary (migraine, tension, and/or cluster-type) headache.Study Design: A systematic review of quality of research studies of conventional and alternative treatment(s) of primary headache.Methods: Randomized, controlled clinical trials (RCTs) of treatment(s) of chronic primaryheadache (in English between 1979 to June 2004) were searched through MEDLINE, PsycInfo, EMBASE, Cochrane Library, and the NIH databases. Studies were evaluated using standard approaches for assessing and analyzing quality indicators.Results: 125 studies of conventional, and 121 CAM treatments met inclusion criteria. 80%of studies of conventional treatment(s) reported positive effects (P<0.05), versus 73% ofstudies of CAM approaches (chi2 = 3.798, 1 df, p=0.051). Overall, the literature addressingthe treatment of primary headache received a mean Jadad score of 2.72 out of 5 (SD 1.1).The mean Jadad score for studies of conventional therapeutics was significantly better thanfor those studies of CAM approaches: 3.21 ± 0.9 vs 2.23 ± 1.1 (t=7.72, 246 df, mean difference 0.98, p < 0.0005).Conclusions: Studies of conventional treatments scored higher on reporting quality thanstudies of CAM approaches. It is possible that these differences may reflect distinctions in1) methodologic integrity, 2) therapeutic paradigm(s), and/or 3) bias(es) in the approach(es)used to evaluate certain types of therapies. Each of these possibilities — and the implications— is addressed and considered.Key words: chronic headache, complementary and alternative medicine, research quality,randomized controlled trial, Jadad scores