EQUATOR Network: Resources for enhancing the quality and transparency of health research reporting
What is it?
Fewer than half of the randomised trials published in 2000 included an adequate description of the primary outcomes measured (1). This is especially problematic for busy clinicians. A shift in culture prompted healthcare professionals to move from deciding on the most appropriate treatment for their patients by relying on their experience and training (sometimes outdated) to that of continuously evolving evidence-based medicine.
Evidence-based medicine uses the scientific method to organise and apply current data to improve healthcare decisions (2). Physicians’ need to keep up-to-date with the latest advancements in policy and health research stumbles upon the overwhelming number of new manuscripts published each year; without straightforward communication of each intervention’s benefits and challenges, clinical decisions become exceedingly difficult (3).
Moreover, research reproducibility and usefulness depend upon achieving accurate, complete, and transparent reporting of all research studies. Thus, the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network was born to minimise avoidable waste of financial and human investments in health research projects. This is done by tackling common issues, such as omission or inadequate description of random sequence generation, allocation concealment, and handling of attrition — essential to assess the validity of trial findings (1), incomplete or selective reporting — cherry picking (3), as well as the tendency to favour positive instead of negative results — publication bias (4).
What is it for?
The EQUATOR programme is the first coordinated attempt to tackle the problems of inadequate reporting systematically and on a global scale. Inadequate reporting can have significant consequences for evidence-based practice, such as distorting the evidence base, harming patient care, reducing replicability, and eroding public trust. Notably, if the scientific literature is perceived as unreliable and biased, this can undermine confidence in policy decisions (5).
The EQUATOR Network’s head office, at the Oxford’s Centre for Evidence-based Medicine, ranked clinical evidence according to the strength of the results of a study (6). This hierarchy of levels of evidence can be impacted by a variety of factors (7), such as the study design, outcomes, and bias, as well as the results themselves (Table 1).
Table 1: Rating system for the hierarchy of evidence to guide clinical interventions.
What does it do?
In 2006, the EQUATOR programme set out to map the current status of all activities aimed at preparing and disseminating guidelines on reporting health research studies. Several national programmes joined efforts to research and intervene into the planning, posting, reporting (through journals), and data sharing of biomedical research worldwide (8).
As published scholarly output, all reporting guidelines are peer reviewed, and should be accompanied by an explanation of how they were developed. For example, a manuscript containing the full guideline (including the checklist), is accompanied by an explanation (9, 10). The aggregated set of all the relevant references pertaining to this guideline is in one location (11), and contains the link to an interactive checklist generator (12).
How does it work?
The EQUATOR Network website aggregates a collection of guidelines, as well as policy documents related to health research reporting. According to this website, a reporting guideline is “A checklist, flow diagram, or structured text to guide authors in reporting a specific type of research, developed using explicit methodology” (9).
Reporting guidelines and checklists have been developed for a wide variety of research types and study designs (see, for instance, ref 13). Some of the most commonly adopted guidelines are ARRIVE — for reporting any area of bioscience research using laboratory animals, PRISMA —for reporting systematic reviews and meta-analyses, CONSORT — for reporting of parallel group randomised trials, and STROBE — for observational studies in epidemiology (cohort, case-control studies, or cross-sectional studies).
Deciding on the correct guideline for your study type is not always easy, so the flow diagram below was created in 2016.
Challenges
❖ The applicability of a guideline to a novel study design may not immediately be apparent. As such, new extensions to the most commonly used guidelines are always being published, focusing on specialised uses (see, for instance, ref 14).
❖ There are many (over 600) guidelines to choose from, so figuring out the correct one for a specific study design may require some additional thinking! To help researchers with this, an AI tool was developed (15).
❖Nevertheless, reporting guidelines do not ensure that a manuscript describes novel, ethical, approved, or generalisable research. Adherence to a guideline in itself does not ensure that a manuscript clears peer review.
Some authors may view using the guidelines as merely an administrative task. Completion of a reporting checklist is not the important step. However, if used constructively, guidelines shape the construction of an article. Importantly, they can aid researchers and clinicians to consider all aspects of study design and foresee mechanisms to tackle potential issues (such as controlling for confounders).
Benefits
❖Most of the widely adopted guidelines are available in different languages (see, for instance, ref 16), which increases their accessibility and promotes their adoption. They contribute to standardised research reporting worldwide, enhancing citations and readership.
❖Guidelines ensure transparency and completeness of research by visibly linking the individual elements of the whole research process: study registration, availability of protocols, journal publication, and public availability of findings (see, for instance, ref 17).
❖Guidelines are continuously being developed and adapted to evolving clinical practice (see, for instance, ref 18). By promoting accuracy and completeness in reporting of study design, the guidelines contribute to increased replicability.
❖Guidelines ensure a speedier and streamlined peer review and publication process for authors, reviewers, and journal editors (see, for instance, ref 19). Guidelines are a useful resource that can prompt reviewers to evaluate a manuscript more critically.
Key take-aways
EQUATOR reporting guidelines ensure that a manuscript can be:
➢ Clear (understood by a reader),
➢ Reproducible (replicated by a researcher),
➢ Actionable (used by a doctor to assist in a clinical decision),
➢ Comparable to similar studies in the field (more widely cited and/or included in a systematic review), and
➢ Enable funding bodies to have a detailed account of the outcomes of their investments.
Complying with guidelines is beneficial for all involved. Sadly, researchers and healthcare providers still experience a lack of awareness in guideline use and ethical publication practices (20). This highlights the need for including training in guideline use for early career researchers and in the medical school curricula.
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