Frequently Asked Questions

  1. How are trials, reviews and guidelines located?
  2. How far back in time does the database go?
  3. How often is the database updated?
  4. What can I do if I find a trial, review or guideline that is not on the database?
  5. How are trials rated?
  6. What can I do if I disagree with the quality rating of a particular trial?
  7. What can I do if I find an error in the indexing of a particular record?

1. How are trials, systematic reviews and clinical practice guidelines located?

Specific criteria are used to define which clinical trials, systematic reviews and evidence-based clinical practice guidelines are archived in Physiotherapy Choices. We have located (and are still locating) trials, reviews and guidelines in a number of ways:

  1. Drs Rob de Bie and Riekie de Vet of the Rehabilitation and Related Therapies Field of the Cochrane Collaboration generously gave us their pre-existing database of randomised trials in rehabilitation. More recently they have sent us copies of Dutch guidelines.
  2. These were combined with personal databases of the Directors of the Centre for Evidence-Based Physiotherapy.
  3. Then we performed optimised searches of four databases of the serials literature (Medline, Embase, Cinahl and PsycInfo). Now we prospectively search these databases using automated (SDI) optimised searches.
  4. We search each new release of the Cochrane Database of Systematic Reviews, the Cochrane Clinical Trials Register, and the Database of Abstracts of Reviews of Effectiveness (DARE).
  5. We search the internet for practice guidelines. The general strategy is to search databases of clinical practice guidelines (such as the database of the National Guideline Clearinghouse in the USA) and to follow links from there. The National Guideline Clearinghouse provides us with weekly notification of new guidelines.
  6. An additional source of trials is the useful Physiotherapy Effectiveness Bulletins produced by the Chartered Society of Physiotherapy.
  7. Recently the wonderful folk at the Cochrane Rehabilitation & Related Therapies Field have agreed to send us details of trials on physiotherapy identified by handsearches of approximately 200 allied health journals conducted by Nederlands Paramedisch Institut (a list of these journals can be found at the web site of the the Nederlands Paramedisch Institut at http://www.doconline.nl).
  8. We track citations in systematic reviews on the PEDro database.
  9. Lastly, "Friends of PEDro" and users of Physiotherapy Choices notify us of trials that are not on Physiotherapy Choices by email.

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2. How far back in time does the database go?

We will include any trial, review or guideline that satisfies the criteria for inclusion on the database (see above), regardless of how long ago it was published. Plain English summaries are a recent addition to research publications. At the time of writing, the oldest record on the database with a plain English summary was published in 1999.

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3. How often is the database updated?

The database is updated once each month, usually on the first Monday of the month.

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4. What can I do if I find a trial, review or guideline that is not on the database?

If you know of a trial, review or guideline which you think ought to be on Physiotherapy Choices but is not, please let us know. First, check that it meets the criteria for inclusion. If it does, email us with the details. The more details you can provide, the more likely it is that we will be able to find it. If you are the author of a paper that you think ought to be on Physiotherapy Choices but is not, please mail us a reprint. Click here for our address.

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5. How are trials rated?

Trials (but not reviews or guidelines) are rated with a checklist (called the "PEDro scale"). The PEDro scale considers two aspects of trial quality, namely the "believability" of the trial and whether the trial contains sufficient statistical information to make it interpretable. It does not rate the "generalisability" of the trial or the size of the treatment effect.

All but two of the PEDro scale items are based on the Delphi list, developed by Verhagen and colleagues. The Delphi list is a list of trial characteristics that was thought to be related to trial "quality" by a group of clinical trial experts (for details see Verhagen et al, Journal of Clinical Epidemiology 51: 1235-41, 1998). The PEDro scale contains additional items on adequacy of follow-up and between-group statistical comparisons. One item on the Delphi list (the item on eligibility criteria) is related to external validity, so it does not reflect the dimensions of quality assessed by the PEDro scale. This item is not used to calculate the method score that is displayed in the search results (which is why the 11 item scale gives a score out of 10). This item has, nevertheless, been retained so that all Delphi list items are represented on the PEDro scale.

The "PEDro score" is determined simply by counting the number of checklist criteria that are satisfied in the trial report. When the Physiotherapy Choices database is searched, the PEDro score is used to sort clinical trials on the "search results" page. Reviews and guidelines are not rated for quality (they get a quality score of "N/A", meaning "not applicable"). In the search results, guidelines are presented first, sorted by year of publication (most recent guidelines first). These are followed by reviews, also sorted by year.

Rating of trials is carried out by raters who are either casual staff of the Centre for Evidence-Based Physiotherapy or volunteer physiotherapists. All raters undergo training, which involves practice with feedback. Three other mechanisms are used to ensure the quality of ratings. First, we aim to rate all trials twice. A third rater resolves any disagreements. We say that ratings are "not confirmed" until the trial has been rated twice and disagreements have been resolved by the third rater. When this has been done we say ratings are "confirmed". Second, we perform informal and non-systematic checks of the quality of some ratings (not all). Lastly, a mechanism has been provided for users of Physiotherapy Choices to dispute trial ratings (see "What can I do if I disagree with the quality rating on a particular trial?" below). A paper describing the reliability of the PEDro scale for rating quality of randomized controlled trials has been published in Physical Therapy 83(8):713-21, 2003 August. Abstract can be viewed at http://www.ptjournal.org/cgi/content/abstract/83/8/713. The PEDro scale has also been recommended as a particularly suitable scale for assessing the quality of clinical trials of physical interventions. This is published in the Journal of Clinical Epidemiology 58(7):668-673. Abstract can be viewed at Journal of Clinical Epidemiology.

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6. What can I do if I disagree with the quality rating of a particular trial?

Please let us know if you disagree with the rating of a particular trial. Email us at PEDro@george.org.au telling us the author, title and source of the trial in question, and letting us know why you think the trial has been incorrectly rated. If there is a particular piece of information in the trial report that causes you to dispute a rating, please let us know where in the trial report (page number, column number, paragraph number, line number) that information can be found. We will assess all disputed ratings. While we are grateful for information about disputed ratings we will not be able to reply individually to people disputing trial ratings.

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7. What can I do if I find an error in the indexing of a particular record?

There may be errors in the indexing of a particular record (for example, there may be spelling errors, the source may be incorrect, or the record may be categorised incorrectly). If you find an error, please email us at PEDro@george.org.au. Cut and paste the complete record from the "Detailed Search Results" page into the email message, and indicate what indexing error has been made. While we are grateful for information about indexing errors, we will not be able to reply individually to people who notify us of indexing errors.

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