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PubMed2004

[Bibliometric analysis of systematic reviews in the Neonatal Cochrane Collaboration. Its role in evidence-based decision making in neonatology].

INTRODUCTION: The Cochrane Neonatal Collaborative Review Group (CNRG) is one of the most important collaborative review groups registered in the Cochrane Collaboration (CC) and provides a growing and readily accessible source of information to help neonatologists base their care on detailed, critical, and up-to-date reviews of the best available evidence. The objective of this article was to perform a bibliometric analysis (quantitative and qualitative) of the systematic reviews (SR) published in the Neonatal Cochrane Collaboration (NCC) and to identify the subject areas studied by the CNRG in which decision-making in clinical practice is based on the best available evidence. METHODS: We performed a bibliometric analysis of the Cochrane Database of Systematic Reviews in Neonatology, Issue 2, 2003 (n = 147 SR). The following variables were registered in each SR: subject area of the study, authors (number and country), dates (last review and update), characteristics of the clinical trials included (number and type), characteristics of included newborns (number and gestational age), reviewers' conclusions and potential conflicts of interest. RESULTS: The main subject areas of studies in the NCC were respiratory diseases (69 SR) and gastroenterology-nutrition (23 SR). Reviews were relatively scarce on some subjects that are very important in clinical practice in neonatology, such as cardiovascular diseases (10 SR), neurology (10 SR) and infectious diseases (6 SR). All the SR dealt with interventions for the treatment or prevention of diseases of the newborn infant (mainly preterm) and we found no reviews on diagnostic tests. Eighty-two per cent of the SR were signed by 2 or 3 authors, and we found four Bradford's zones of productivity. Ninety-two percent of the authors of SR were from four countries (Australia, United States, United Kingdom and Canada). Seventy-nine percent of all SR were published between 2000 and 2002, and 48 % have been updated. The median number of clinical trials per SR was 5 (range 0-30) and the median number of newborns included per SR was 559 (range 0-5448). Sixty percent of SR also included quasi-randomized clinical trials, and 67 % of SR included only preterm infants. In 54 % of the SR, the reviewers' conclusion was sufficient to infer probable effects (favorable or unfavorable) in clinical practice, and potential conflicts of interest were registered in 22 %. DISCUSSION: Although CC reviews are based on specific guidelines, errors and biases occur, suggesting the need to "review the reviews". The bibliometric analysis of the NCC shows that the quality of published SR varies, and the main conclusion is that almost half of the reviewers' conclusions are insufficient to infer probable effects in clinical practice. There is a lack of scientific evidence on many therapies in neonatology and, at the moment, the SR published in the NCC enable evidence-based decision making mainly in the subject area of respiratory diseases and gastroenterology-nutrition. Challenges for the future include the need for bigger and better clinical trials in this field (with long-term outcomes among surviving children), the preparation of systematic reviews on topics not yet covered, and keeping an increasing number of reviews up-to-date. Every decision in neonatology should be based on a systematic appraisal of the best evidence available in the context of the prevailing values and resources at our disposal.

Bibliometrics↗
PubMed2006

[From the Cochrane Library: topical antibiotic treatment is more effective than systemic antibiotic treatment for chronic otitis media with eardrum perforation and purulent discharge].

Chronic suppurative otitis media with underlying persistent eardrum perforation is a common cause of preventable hearing impairment. A Cochrane systematic review compared topical treatment (antibiotics or antiseptics) with systemic antibiotics to identify which is best. Nine randomised controlled trials were included (833 randomised patients; 842 analysed patients or ears). Topical treatment with quinolones was more effective in stopping (purulent) discharge than systemic treatment with quinolones or non-quinolones. No benefit from adding systemic treatment to topical antibiotics was detected. The effects of topical non-quinolone antibiotics or antiseptics were not clear. Little is known about secondary outcomes (prevention of complications, healing the eardrum, and improving hearing) or about the efficacy and safety of topical antibiotics in the long term.

Administration, Topical↗
PubMed2000

Scope and organization of the Guide to Community Preventive Services. The Task Force on Community Preventive Services.

BACKGROUND: The diverse nature of the target audience (i.e., public health decision-makers) for the Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (the Guide) dictates that it must be broad in scope. In addition, for the Guide to be most useful for its target audience, its organization and format must be carefully considered. DETERMINING THE SCOPE OF THE GUIDE: Healthy People objectives and actual causes of death were used to determine the contents of the Guide. A priority setting exercise resulted in the selection of 15 topics for systematic reviews using the following criteria: burden of the problem, preventability, relationship to other public health initiatives, usefulness of the package of topics selected and level of current research and intervention activity in public and private sectors. Interventions within each topic target state and local levels and include population-based strategies, individual strategies in other than clinical settings and group strategies. ORGANIZATION OF THE GUIDE: The Guide is organized into: Introduction, Reviews and Recommendations (three sections: Changing Risk Behaviors, Reducing Diseases, Injuries, or Impairments, and Addressing Environmental and Ecosystem Challenges), Appendixes, and Indexes. DISCUSSION: The scope and organization of the Guide were determined using relevant public health criteria and expert opinion to provide a useful and accessible document to a broad target audience. While the final contents of the Guide may change during development, the working table of contents described in this paper provides a framework for development of the Guide and conveys its scope and intention.

Decision Making↗
PubMed2005

Comparative efficacy and costs of various topical anesthetics for repair of dermal lacerations: a systematic review of randomized, controlled trials.

STUDY OBJECTIVES: To compare the efficacy of infiltrated local anesthesia with topical anesthesia for repair of dermal laceration, to analyze the efficacy of single or multicomponent topical anesthetics, and to identify topical formulations that are potentially less costly and equally efficacious as cocaine-containing topical anesthetics. DESIGN: Systematic review of randomized controlled trials. SETTING: University-affiliated hospital. PATIENTS: Pediatric and adult subjects. MEASUREMENTS AND MAIN RESULTS: Twenty-two trials that randomized more than 3000 patients were identified. The majority of studies demonstrated equivalent or superior analgesic efficacy for topical formulations compared with conventional intradermal infiltration. We found that cocaine is not a mandatory component of topical anesthesia. The literature discloses no significant difference in anesthetic efficacy between topical tetracaine-epinephrine-cocaine and each of the following 6 cocaine-free formulations: lidocaine-epinephrine-tetracaine, lidocaine-epinephrine, tetracaine-phenylephrine, tetracaine-lidocaine-phenylephrine, bupivicaine-norepinephrine, or prilocaine-phenylephrine. CONCLUSION: Topical anesthetics are an efficacious, noninvasive means of providing analgesia before suturing of dermal lacerations. The use of cocaine-containing topical anesthetics can no longer be justified in light of its high cost and potential adverse effects. We have summarized the evidence, mostly favorable, supporting the use of various non-cocaine-containing topical anesthetics.

Anesthetics, Local↗
PubMed2002

Evaluating primary care behavioral counseling interventions: an evidence-based approach.

Risky behaviors are a leading cause of preventable morbidity and mortality, yet behavioral counseling interventions to address them are underutilized in healthcare settings. Research on such interventions has grown steadily, but the systematic review of this research is complicated by wide variations in the organization, content, and delivery of behavioral interventions and the lack of a consistent language and framework to describe these differences. The Counseling and Behavioral Interventions Work Group of the United States Preventive Services Task Force (USPSTF) was convened to address adapting existing USPSTF methods to issues and challenges raised by behavioral counseling intervention topical reviews. The systematic review of behavioral counseling interventions seeks to establish whether such interventions addressing individual behaviors improve health outcomes. Few studies directly address this question, so evidence addressing whether changing individual behavior improves health outcomes and whether behavioral counseling interventions in clinical settings help people change those behaviors must be linked. To illustrate this process, we present two separate analytic frameworks derived from screening topic tools that we developed to guide USPSTF behavioral topic reviews. No simple empirically validated model captures the broad range of intervention components across risk behaviors, but the Five A's construct-assess, advise, agree, assist, and arrange-adapted from tobacco cessation interventions in clinical care provides a workable framework to report behavioral counseling intervention review findings. We illustrate the use of this framework with general findings from recent behavioral counseling intervention studies. Readers are referred to the USPSTF (www.ahrq.gov/clinic/prevenix.htm or 1-800-358-9295) for systematic evidence reviews and USPSTF recommendations based on these reviews for specific behaviors.

Adult↗
PubMed2004

Clinical and cost-effectiveness of once-daily versus more frequent use of same potency topical corticosteroids for atopic eczema: a systematic review and economic evaluation.

OBJECTIVES: To assess the clinical and cost-effectiveness of once-daily use of topical corticosteroids versus more frequent use of same-potency topical corticosteroids in the treatment of people with atopic eczema. DATA SOURCES: Electronic databases. Bibliographies of included studies and related papers. Experts in the field. Manufacturer submissions to the National Institute for Clinical Excellence. REVIEW METHODS: Studies were assessed for inclusion according to predefined criteria by two reviewers. Data extraction and quality assessment were undertaken by one reviewer and checked by a second reviewer. Clinical effectiveness data were synthesised through a narrative review with full tabulation of results. RESULTS: One RCT comparing moderately potent corticosteroids, eight RCTs comparing potent corticosteroids and one RCT comparing very potent corticosteroids were included. No RCTs or CCTs of mild corticosteroids were eligible. Most RCTs were of poor methodological quality, although two were judged to be of good quality. The only study that compared moderately potent corticosteroids found no significant difference between once- and twice-daily application. For potent corticosteroids, some statistically significant differences in numbers of patients responding to treatment were identified favouring twice-daily treatment, but these were inconsistent between physician and patient assessment and outcomes selected for analysis. Two studies found a significant improvement in some symptoms with once-daily mometasone furoate compared with twice-daily application of a different active compound, while a third study found no significant differences. One good-quality study favoured twice-daily application of fluticasone propionate ointment, while other studies found no significant difference or an improvement in one symptom but not others. The only study comparing very potent corticosteroids found a statistically significant difference in comparative clinical response in favour of three-times daily treatment, but no difference in number of patients with at least a good response. There appears to be little difference in the frequency or severity of short-term events, however data are limited. No published economic evaluations were identified. Given findings on clinical effectiveness, where outcomes from the comparators are similar, the relative cost-effectiveness of once-daily versus more frequent application of topical corticosteroids becomes a case of cost-minimisation, where the least-cost alternative should be favoured, all else being equal. Topical corticosteroid products included in this review have a wide variation in price; the cost per 30 g/30 ml varies between GBP0.60 and GBP4.88. Specific decisions on the least-cost alternative, between once-daily and more frequent application of products, will be determined by the relative price of the products being compared. Where patients can be appropriately prescribed once-daily treatment of a similarly priced product, a reduction in the quantity of topical corticosteroid used will be expected. However, issues related to pack size for prescribed products and subsequent waste (unused product) could easily erode any potential saving. The potential cost-savings on prescribed products are very small at a patient level; although given the large numbers of patients with atopic eczema, cost savings in theory could be substantial. The presence of specifically marketed 'once-daily' topical corticosteroids, which are relatively expensive (per unit price), may result in additional costs should there be a general recommendation in favour of once-daily use of topical corticosteroids, compared to more frequent use. CONCLUSIONS: The literature is very limited; that available indicates the clinical effectiveness of once-daily and more frequent application of potent topical corticosteroids is very similar, but it does not offer a basis for favouring either option. The cost-effectiveness of once-daily versus more frequent use will depend on the generalisability of the findings to the specific treatment decision and the relative product prices. The trials included in this review generally refer to moderate to severe atopic eczema, whereas most patients have mild disease, and furthermore most of the included trials report on potent topical corticosteroids (eight of 10 RCTs); therefore the generalisability of the findings is limited. Further research is required on the clinical and cost-effectiveness of once-daily versus more frequent use of same potency corticosteroids, specifically on mild potency products for mild to moderate atopic eczema. Outcomes should include quality of life and compliance.

Administration, Topical↗
PubMed2004

An active and socially integrated lifestyle in late life might protect against dementia.

The recent availability of longitudinal data on the possible association of different lifestyles with dementia and Alzheimer's disease (AD) allow some preliminary conclusions on this topic. This review systematically analyses the published longitudinal studies exploring the effect of social network, physical leisure, and non-physical activity on cognition and dementia and then summarises the current evidence taking into account the limitations of the studies and the biological plausibility. For all three lifestyle components (social, mental, and physical), a beneficial effect on cognition and a protective effect against dementia are suggested. The three components seem to have common pathways, rather than specific mechanisms, which might converge within three major aetiological hypotheses for dementia and AD: the cognitive reserve hypothesis, the vascular hypothesis, and the stress hypothesis. Taking into account the accumulated evidence and the biological plausibility of these hypotheses, we conclude that an active and socially integrated lifestyle in late life protects against dementia and AD. Further research is necessary to better define the mechanisms of these associations and better delineate preventive and therapeutic strategies.

Aged↗
PubMed2005

Challenges in systematic reviews of complementary and alternative medicine topics.

The use of complementary and alternative medicine (CAM) continues to grow in the United States. The Agency for Healthcare Research and Quality has devoted a substantial proportion of the Evidence-based Practice Center (EPC) program to systematic reviews of CAM. Such syntheses present different challenges from those conducted on western medicine topics, and in many ways are more difficult. We discuss 3 challenges: identifying evidence about CAM, assessing the quality of individual studies, and addressing rare serious adverse events. We use illustrations from EPC evidence reports to show readers approaches to the 3 areas and then present specific recommendations for each issue.

Biomedical Research↗
PubMed2002

An updated systematic review of interventions to improve health professionals' management of obesity.

The objective of this article was twofold (1) to determine the existence and effectiveness of interventions to improve health professionals' management of obesity or the organization of care for overweight and obese people; and (2) to update a previous systematic review on this topic with new or additional studies. The study design was a systematic review of intervention studies, undertaken according to standard methods developed by the Cochrane Effective Practice and Organization of Care (EPOC) Group. Participants were trained health care professionals and overweight and obese patients. The measurements were objective measures of health professionals' practice and behaviours, and patient outcomes including satisfaction, behaviour, psychological factors, disease status, risk factors and measures of body weight, fat, or body mass index (BMI). Twelve studies were included in the original review. A further six were included in this update. Six of the 18 studies were randomized controlled trials of health professional-oriented interventions (such as the use of reminders and training) and one was a controlled before-and-after study to improve collaboration between a hospital clinic and general practitioners (GPs). Ten randomized controlled trials and two controlled clinical trials of interventions comparing either the deliverer of weight-loss interventions or the setting of the delivery of the intervention, were identified. The heterogeneity and generally limited quality of identified studies make it difficult to provide recommendations for improving health professionals' obesity management. To conclude, at present, there are few solid leads about improving obesity management, although reminder systems, brief training interventions, shared care, inpatient care and dietitian-led treatments may all be worth further investigation. Therefore, decisions for the improvement of provision of services must be based on the existing evidence on interventions with patients and good clinical judgement. Further research is needed to identify cost-effective strategies for improving the management of obesity. A full version of this review (including detailed descriptions of the included studies and their methodological quality, and results and excluded studies tables) is available in the Cochrane Library. The Cochrane Library is a database of systematic review and other evidence on the effects of health care, continuously updated as new information emerges. It is available on CD ROM from Update Software. For further information see: http://www.update-software.com/cochrane.

Clinical Competence↗
PubMed2001

State of the evidence base for medically necessary oral health care.

OBJECTIVE: The purpose of this article was to highlight the recent call for an evidence-based approach to public policy decision making with respect to funding dental services and the need this creates for enhanced clinical research activities. STUDY DESIGN: Systematic reviews on topics of importance to oral health care practitioners are being conducted and published by various national and international groups. Recent activities to assess evidence to support medically necessary dental services were reviewed. RESULTS: An Institute of Medicine Committee on Medicare Coverage Extensions found little published scientific evidence that directly assessed the effectiveness of dental services in preventing or managing systemic health outcomes for patients with head and neck cancer, lymphoma, leukemia, organ transplantation, and heart valve repair or replacement. CONCLUSIONS: The scientific community must strive to meet the challenge of conducting well-designed randomized, controlled trials that test the impact of dental treatment interventions on systemic health to meet the growing need for evidence to support or refute widely accepted dental treatment protocols for medically complex patients.

Clinical Protocols↗
PubMed2005

The effect of topical fluorides on decalcification in patients with fixed orthodontic appliances: a systematic review.

INTRODUCTION: Decalcification is a significant problem during fixed orthodontic treatment. Topical Fluorides can reduce or eliminate the problem, but the relative effectiveness of different treatments or combinations of topical fluoride preparations is unknown. This systematic review was undertaken to determine the effectiveness of topical fluoride preparations in preventing decalcification during fixed orthodontic treatment. METHODS: A wide search of published and unpublished material in any language was undertaken by using general and specialist databases; key dental journals were searched by hand. Predefined inclusion criteria based on objective outcome measures of decalcification, duration of treatment, presence of a comparison group, and study design were applied to determine study selection. Included studies were double extracted onto pre-designed data extraction sheets. RESULTS AND CONCLUSIONS: By screening titles and abstracts, we identified 143 articles; after the inclusion criteria were applied, 7 reports (of 6 studies) remained. Differences in the methodologies and reporting made statistical analysis impossible. However, the use of topical fluorides in addition to fluoride toothpaste reduced the incidence of decalcification in populations with both fluoridated and non-fluoridated water supplies. Different preparations and formats appear to decrease decalcification, but there was no evidence that any 1 method was superior. There was some evidence that the potency of fluoride preparations might be important.

Cariostatic Agents↗
PubMed2005

A nursing qualitative systematic review required MEDLINE and CINAHL for study identification.

OBJECTIVE: Analyze the number and the relevance of references retrieved from CINAHL, MEDLINE, and EMBASE to perform a nursing systematic review. STUDY DESIGN: A search strategy for the review topic was designed according to thesaurus terms. The study analyzes (1) references with abstract, (2) overlap between databases, (3) reference relevance, (4) relevance agreement between experts, and (5) reference accessibility. RESULTS: Bibliographic search retrieved 232 references: 16% (37) in CINAHL, 68% (157) in MEDLINE, and 16% (38) in EMBASE. Of these, 72% (164) were references retrieved with an abstract: 14% (23) in CINAHL, 70% (115) in MEDLINE, and 16% (26) in EMBASE. Overlap was observed in 2% (5) of the references. Relevance assessment reduced the number of references to 43 (19%): 12 (34.3%) in CINAHL, 31 (19.7%) in MEDLINE, and none in EMBASE (Z=-1.97; P=.048). Agreement between experts achieved a maximum Cohen's kappa of 0.76 (P < .005). References identified in CINAHL were the most difficult to obtain (chi(2)=3.9; df=1; P=.048). CONCLUSIONS: To perform a quality bibliographic search for a systematic review on nursing topics, CINAHL and MEDLINE are essential databases for consultation to maximize the accuracy of the search.

Bibliometrics↗
PubMed2005

Topical antibiotics for acute bacterial conjunctivitis: Cochrane systematic review and meta-analysis update.

BACKGROUND: Uncertainty remains about the extent to which findings from our previously published systematic review and meta-analysis of double-blind, randomised controlled trials of topical antibiotics compared with placebo in the management of patients with acute bacterial conjunctivitis treated in secondary care outpatient settings are generalisable to the management of the condition in primary care settings. We updated our review, undertaking searches, methodological assessment, data extraction and analysis according to a pre-defined protocol. In addition to the previous three included studies, we identified two additional double-blind primary care trials, one which compares fusidic acid gel with placebo gel and one which compares chloramphenicol eye drops with placebo eye drops in children. Meta-analyses of clinical and microbiological remission data reveal that topical antibiotics are of benefit in improving early (days 2-5) clinical (relative risk [RR] = 1.24, 95% confidence interval [CI] = 1.05 to 1.45) and microbiological (RR = 1.77, 95% CI = 1.23 to 2.54) remission rates; later (days 6-10) data reveal that these early advantages in clinical (RR = 1.11, 95% CI = 1.02 to 1.21) and microbiological cure rates are reduced (RR 1.56, 95% CI = 1.17 to 2.09), but persist. Most cases of acute bacterial conjunctivitis resolve spontaneously. While topical antibiotics are associated with significantly improved rates of early (days 2-5) clinical remission, this benefit is marginal for later remission (days 6-10).

Acute Disease↗
PubMed2004

The effectiveness of topical preparations for the treatment of earwax: a systematic review.

BACKGROUND: Earwax is a common problem in both primary and secondary care. There is uncertainty as to the most effective topical treatment. AIM: To assess the evidence concerning the efficacy of topical preparations used for treating earwax. DESIGN OF STUDY: Systematic review and meta-analysis. METHOD: Searching for randomised controlled trials (RCTs) of relevant studies. Classification of preparations into three groups, enabling pooling of data and meta-analysis. RESULTS: Of the 18 RCTs included in the review, four were judged to be of high quality. Fifteen preparations including saline and plain water were studied. Oil-based and water-based preparations were equally effective at clearing earwax without syringing (odds ratio [OR] = 0.9, 95% confidence interval [CI] = 0.4 to 2.3) and facilitating successful syringing (OR = 1.0, 95% CI = 0.6 to 1.6). A non-water-, non-oil-based preparation appeared more effective than an oil-based preparation at both clearing earwax without syringing, and facilitating successful syringing. Immediate syringing after application of a preparation may be as effective as using eardrops for several days and delaying syringing. CONCLUSIONS: On current evidence, there is little to choose between water-based and oil-based preparations; non-water-, non-oil-based preparations appear promising at both clearing earwax and facilitating successful syringing, but further large trials are needed. Although immediate ear syringing is effective and convenient for patients, it may be less cost-effective than using eardrops and perhaps avoiding syringing. Most of the evidence regarding such a common and time-consuming problem is not of high quality.

Administration, Topical↗
PubMed1997

Do authors of review articles use systematic methods to identify, assess and synthesize information?

PURPOSE: Review articles are an important source of summary information for practising clinicians to assist them in remaining current with the rapidly expanding medical literature. Consequently it is essential that these be of the highest quality. In this study we evaluate, according to published criteria, the methodological quality of review articles (R) including meta-analysis (MA) appearing in a major cancer journal, Journal of Clinical Oncology (JCO), 1983-1995. METHODS: A hand-search of JCO was performed, from the first issue January 1983 through December 1995, to identify R, defined as publications that describe and comment on studies relevant to a specific topic or clinical intervention. Only those dealing with aspects of treatment of human cancer were considered further. Methodological quality was first assessed using 8 criteria proposed by Mulrow, rated independently by two medical oncologists as: specified, unclear or not specified. MA, including studies of dose intensity, were further analyzed according to 23 more detailed criteria proposed by Sacks et al. and rated as adequate, partial or no/unknown compliance. RESULTS: Of 176 review articles, 122 dealt with aspects of treatment of cancer. Compliance with four of Mulrow's eight criteria was generally good, in that 99% clearly stated a purpose, all attempted qualitative synthesis of data. 95% presented a summary and 76% considered future directions. However, in the 106 qualitative reviews (QR), authors rarely gave information on methods of data identification (11.3%), data selection (10.4%) and assessment of validity (8.4%). Structured abstracts seemed to improve the focus and clarity of QR and there was a minor improvement in deficient areas in the later time cohort (1990-1995). Based on 'adequate' compliance with each of the 23 criteria identified by Sacks et al., six dose intensity studies scored 7-12, seven literature data MA scored 10-15 and three individual patient data MA scored 16-18. The highest scores were in the sections relating to prospective design, combinability and statistical analysis. Factors relating to control of bias, sensitivity analysis and application of results were addressed less consistently. CONCLUSIONS: With the exception of MA, the majority of authors contributing reviews to a major cancer journal, JCO, did not use systematic methods to identify, assess and synthesize information. Initiatives such as the Cochrane Collaboration Cancer Network can support and educate clinicians who wish to perform systematic reviews, but quality of reviews would also improve if author, editors and readers systematically applied any of the sets of criteria now available in the literature.

Humans↗
PubMed2004

Topical NSAIDs for acute pain: a meta-analysis.

BACKGROUND: A previous systematic review reported that topical NSAIDs were effective in relieving pain in acute conditions like sprains and strains, with differences between individual drugs for efficacy. More trials, a better understanding of trial quality and bias, and a reclassification of certain drugs necessitate a new review. METHODS: Studies were identified by searching electronic databases and writing to manufacturers. We selected randomised double blind trials comparing topical NSAID with either placebo or another active treatment in adults with acute pain, and extracted dichotomous information approximating to a 50% reduction in pain at one week, together with details of adverse events and withdrawals. Relative benefit and number-needed-to-treat (NNT), and relative risk and number-needed-to-harm (NNH) were calculated, with sensitivity analyses where appropriate to investigate differences between individual drugs and aspects of trial design. RESULTS: Twenty-six double blind placebo controlled trials had information from 2,853 patients for evaluation of efficacy. Topical NSAID was significantly better than placebo in 19 of the 26 trials, with a pooled relative benefit of 1.6 (95% confidence interval 1.4 to 1.7), and NNT of 3.8 (95% confidence interval 3.4 to 4.4) compared with placebo for the outcome of half pain relief at seven days. Results were not affected by outcome reported, or condition treated, but smaller trials yielded a larger estimate of efficacy. Indirect comparisons of individual topical NSAIDs showed that ketoprofen was significantly better than all other topical NSAIDs, while indomethacin was barely distinguished from placebo. Three trials, with 433 patients, compared topical with oral NSAID (two trials compared the same drug, one compared different drugs) and found no difference in efficacy. Local adverse events, systemic adverse events, or withdrawals due to an adverse event were rare, and no different between topical NSAID and placebo. CONCLUSIONS: Topical NSAIDs were effective and safe in treating acute painful conditions for one week.

Acute Disease↗