Cervical disc arthroplasty: do conflicts of interest influence the outcome of clinical studies?. Narain, A. S., Hijji, F. Y., Yom, K. H., Kudaravalli, K. T., & Singh, K. The Spine Journal, 17(7):1026–1032, July, 2017.
Cervical disc arthroplasty: do conflicts of interest influence the outcome of clinical studies? [link]Paper  doi  abstract   bibtex   
Background Context Cervical disc arthroplasty (CDA) is an emerging technique for the treatment of cervical degenerative disease. Multiple studies have investigated the outcomes of CDA, particularly in comparison with cervical arthrodesis techniques such as anterior cervical discectomy and fusion (ACDF). As many entities have financial interests in CDA implants, it is imperative to consider the influence of conflicts of interest on the results of studies investigating the efficacy of CDA. Purpose This study aimed to determine if there is an association between the presence of conflicts of interest among study authors and the reported outcome of studies involving CDA. Study Design This is a systematic review of clinical CDA publications until October 2016. Outcome Measure The outcome measures are presence of conflicts of interest, level of evidence, and outcome for all included studies. Methods PubMed and MEDLINE databases were searched for articles presenting clinical, radiographic, and cost outcomes of CDA. Data extracted from each article included title, authors, publication year, level of evidence, prosthesis type, number of operative levels, presence of conflicts of interest, and outcome. Conflicts of interest were determined by the presence of any conflicts for any author within manuscript disclosure sections or through Open Payments reporting. Outcomes of each study were graded as either favorable, unfavorable, or equivocal. The presence of conflicts of interest was tested for an association with the level of evidence and study outcome using Pearson chi-square analysis, Fisher exact test, or logistic regression for categorical variables. The authors report no conflicts of interest directly related to this work, and have not received any funds in support of this work. Results A total of 98 articles were included in this analysis. In total, 44.9% (44) of articles had the presence of a conflict of interest, whereas 55.1% (54) of articles did not. Conflicted studies were more likely to present level I evidence and less likely to present level IV evidence than non-conflicted studies (p\textless.001). Furthermore, conflicted studies were more likely to report favorable outcomes after CDA than non-conflicted studies (90.9% vs. 74.1%, p=.040). Conclusions The results of this study suggest that the majority of conflicted and non-conflicted studies report favorable results in patients undergoing CDA. However, conflicted studies were also more likely to report favorable outcomes compared with non-conflicted studies. Individual clinicians must critically review published studies for potential conflicts of interest before incorporating CDA into their practice.
@article{narain_cervical_2017,
	title = {Cervical disc arthroplasty: do conflicts of interest influence the outcome of clinical studies?},
	volume = {17},
	issn = {1529-9430},
	shorttitle = {Cervical disc arthroplasty},
	url = {http://www.sciencedirect.com/science/article/pii/S1529943017301134},
	doi = {10.1016/j.spinee.2017.03.018},
	abstract = {Background Context
Cervical disc arthroplasty (CDA) is an emerging technique for the treatment of cervical degenerative disease. Multiple studies have investigated the outcomes of CDA, particularly in comparison with cervical arthrodesis techniques such as anterior cervical discectomy and fusion (ACDF). As many entities have financial interests in CDA implants, it is imperative to consider the influence of conflicts of interest on the results of studies investigating the efficacy of CDA.
Purpose
This study aimed to determine if there is an association between the presence of conflicts of interest among study authors and the reported outcome of studies involving CDA.
Study Design
This is a systematic review of clinical CDA publications until October 2016.
Outcome Measure
The outcome measures are presence of conflicts of interest, level of evidence, and outcome for all included studies.
Methods
PubMed and MEDLINE databases were searched for articles presenting clinical, radiographic, and cost outcomes of CDA. Data extracted from each article included title, authors, publication year, level of evidence, prosthesis type, number of operative levels, presence of conflicts of interest, and outcome. Conflicts of interest were determined by the presence of any conflicts for any author within manuscript disclosure sections or through Open Payments reporting. Outcomes of each study were graded as either favorable, unfavorable, or equivocal. The presence of conflicts of interest was tested for an association with the level of evidence and study outcome using Pearson chi-square analysis, Fisher exact test, or logistic regression for categorical variables. The authors report no conflicts of interest directly related to this work, and have not received any funds in support of this work.
Results
A total of 98 articles were included in this analysis. In total, 44.9\% (44) of articles had the presence of a conflict of interest, whereas 55.1\% (54) of articles did not. Conflicted studies were more likely to present level I evidence and less likely to present level IV evidence than non-conflicted studies (p{\textless}.001). Furthermore, conflicted studies were more likely to report favorable outcomes after CDA than non-conflicted studies (90.9\% vs. 74.1\%, p=.040).
Conclusions
The results of this study suggest that the majority of conflicted and non-conflicted studies report favorable results in patients undergoing CDA. However, conflicted studies were also more likely to report favorable outcomes compared with non-conflicted studies. Individual clinicians must critically review published studies for potential conflicts of interest before incorporating CDA into their practice.},
	number = {7},
	urldate = {2019-05-14},
	journal = {The Spine Journal},
	author = {Narain, Ankur S. and Hijji, Fady Y. and Yom, Kelly H. and Kudaravalli, Krishna T. and Singh, Kern},
	month = jul,
	year = {2017},
	keywords = {7 Ignorance and funding bias, Biais de financement, Cervical disc arthroplasty, Cervical fusion, Conflict of interest, Industry, Level of evidence, Open Payments reporting},
	pages = {1026--1032},
}
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