The Arthritis NewsletterSummer 2011
Cochrane Collaboration & LibraryBy Marilyn Walsh, Volunteer Local Contact, Ontario Spondylitis Association, Canada Volunteer Consumer Reviewer, Cochrane Musculoskeletal Review Group
Have you ever been to the doctor and been confronted with a treatment you knew nothing about and an explanation that left you just as confused? How do you decide which treatment is best for you? What are a treatment’s harms, benefits, and objectives? Making informed health-related decisions can be difficult. The abundance of health-related information these days, whether it is from the internet or medical, scientific or health-related journals, can be overwhelming for consumers (patients), healthcare providers and policy-makers alike.
Some patients assume all doctors, who have many years of education and training in their fields, must be experts in all things medical. But the reality is that due to personal time restraints and ongoing world-wide research, it is a challenge for any healthcare provider to stay constantly up-to-date. New scientific studies are published daily in a myriad of sources. To compound the problem, the results of one study may be different from or even contradictory to the results of another making it difficult to draw accurate conclusions. Another problem is that the research findings can be published in a language different from that of the person doing the searching. This is where the work of the Cochrane Collaboration can be of great help to both healthcare provider and consumer.
What is the Cochrane Collaboration?
The Canadian Cochrane Centre is one of 14 independent not-for-profit Cochrane Centres worldwide. Collectively, these centres are known as the Cochrane Collaboration which is based in the United Kingdom. The main objective of the Cochrane Collaboration is to help people make well-informed healthcare decisions by producing, maintaining and promoting systematic reviews which provide up-to-date information about healthcare interventions. To fulfill its purpose, the Cochrane Collaboration is made up of groups that are based on a particular disease or health problem (such as the Musculoskeletal Group which encompasses many types of arthritis and soft tissue disorders). Most people involved in contributing to the reviews, whether they be healthcare provider, researcher or consumer, do so voluntarily because they are committed to the outcome.
What is a Systematic Review?
A systematic review begins by addressing a clearly formulated question (such as, “Is methotrexate effective in eliminating the symptoms of rheumatoid arthritis?”). The results of many studies or trials are then rigorously assessed using scientific guidelines set out by the Cochrane Collaboration in the Cochrane Handbook. A systematic review is a detailed summary of these results and provides the answer to the initial question. Is the intervention helpful, harmful or is the result inconclusive indicating that more high-quality research is necessary? Cochrane systematic reviews take the guess-work out of making well-informed decisions about healthcare by providing people with a reliable source of evidence about an intervention. Because Cochrane systematic reviews use such high scientific standards to determine which health therapies work and which ones don’t, they are less biased and more comprehensive than traditional reviews. They are, in fact, the “gold standard” in Evidence-Based health care.
What is the Cochrane Library?
The Cochrane Library is a collection of evidence-based medical databases. The one which would probably interest consumers the most is the Cochrane Database of Systematic Reviews which is a collection of over 4,500 health treatment reviews which are published on the internet and updated at least quarterly to ensure they contain the most current data. The Library covers hundreds of medical conditions as well as a variety of topics such as injury prevention and alternative remedies.
If someone is trying to obtain information regarding a treatment for a type of arthritis, for example, the easiest way to access the Cochrane Library would be to:
- Go to https://www.cochranelibrary.com/
- Browse the “Cochrane Database of Systematic Reviews” to the left side of the page
- Click expand option
- Click on Rheumatology
- Click on the type of arthritis
- Click on chosen review topic
If you don’t find the topic you’re looking for immediately, do an advanced search using keywords or by all means browse other rheumatology topics. For example, some treatment options for the spondyloarthropathies, such as the biologics, may be covered under rheumatoid arthritis. And of course, don’t forget to check out associated disorders like psoriasis or inflammatory bowel disease if they are relevant.
The Cochrane Musculoskeletal Review Group also offers a series of “Decision Aids” which may be of benefit to anyone who needs extra guidance reaching a decision as to whether or not to try a particular treatment. Decision aids are evidence-based tools designed to complement health practitioner counselling and encourage patient involvement in decision making. There are currently decision aids available on osteoarthritis, osteoporosis and rheumatoid arthritis. Watch out for one about ankylosing spondylitis coming up soon. These decision aids may be accessed at www.musculoskeletal.cochrane.org/decision-aids.
For more details about the Cochrane Library and the Cochrane Collaboration, please move your cursor over “learn” at the top of the website homepage. You can access an excellent PowerPoint presentation and download a PDF brochure about the library and its benefits and features from the “How to use the Cochrane Library” option.
Unfortunately, not everyone will have free access to full Cochrane reviews in Canada. They are unavailable in most Canadian provinces without a subscription. However, consumers can access the full library free of charge at most good medical libraries and it may also be available in some public libraries so ask your local librarian.
The good news is that EVERYONE can download FREE abstracts and plain language summaries of reviews. Abstracts are shortened versions of reviews which still contain a certain amount of medical terminology and technical information on how the review was conducted. Plain language summaries, on the other hand, are exactly what you would expect. The review is briefly summarized in easily comprehensible language which includes the findings on benefits and harms of the intervention in question as well as any limitations of the review and studies it includes. The plain language summary is perfect for the layman and generally follows the abstract in a review.
If we’re honest, many of us are intimidated by physicians and are hesitant to question treatments. Perhaps there have even been times when you consented to a treatment you silently questioned because you didn’t feel you had other options. How many times have you realized shortly after leaving a doctor’s office that you had many questions that should have been asked but weren’t either because you were too nervous, overwhelmed or there simply wasn’t time? By broadening your knowledge base with the evidence-based information Cochrane systematic reviews can provide, you might feel better prepared to face that next doctor’s appointment and have the confidence to ask questions and work with your doctor in shared decision making. Who knows? You might even be able to mention treatment options not thought of previously. Remember that knowledge is power and you have a right to have a voice in your own health care.
The Cochrane collaboration is always interested in the opinions and involvement of consumers. If you are interested in becoming involved, please contact the Cochrane Consumer Network at http://consumers.cochrane.org/ for details regarding all the ways that consumers can contribute. You can also contact them directly here. Being involved with the Cochrane Collaboration is a satisfying way of contributing to potential improvements in the quality of health care.
The information for this article is adapted from links found at:
as well as from promotional material distributed through Cochrane Canada.