It’s all in the details, and this summary of nonsurgical treatments for knee osteoarthritis left them out

New research ranks the effectiveness of nonsurgical treatments for knee osteoarthritis

Our Review Summary

knee osteoarthritisThis news release clearly describes the key findings of a comparison study of several nonsurgical treatments for knee osteoarthritis in a way that is likely to be useful to patients. However, the brevity of the release and the methods of the underlying meta-analysis mean that readers are not given specifics about the absolute clinical benefits of the treatments, only their relative rankings. There is only a brief, general mention of potential harms of some of the drugs included in the analysis. The release says that almost half of Americans are at risk of developing knee osteoarthritis. This eye-catching number comes straight from the journal article, but it is far higher than other estimates and is based on a study of only the older residents of single rural county in North Carolina.

 

Why This Matters

Sophisticated statistical methods for combining the results of multiple clinical trials, such as the network meta-analysis used in this case, are powerful tools for discerning larger, more useful, conclusions from the results of many smaller research efforts. However, the very power of these methods imposes a substantial responsibility on the researchers to perform the work capably and carefully… and then a subsequent responsibility on journalists reporting the story to seek out independent sources who are qualified to comment on the work.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

Although the news release does refer to the low-cost of naproxen (brand names including Aleve and Naprosyn), it does not discuss the costs of other treatments that were ranked highly by this meta-analysis. Injections of corticosteroids may cost about $100, not including associated clinic and provider charges. All of the treatments need to be repeated, so the cumulative cost should be considered.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The news release does not provide any specifics about the benefits of the treatments, referring only to their relative rankings. It should be noted that the researchers also did not address absolute clinical benefits in their journal article. The conclusions as stated may still be useful to patients who may have personal experience with at least some of the treatments. However, to satisfy this criterion the release should have provided some description of the absolute clinical benefit to patients.

We note that the news release highlights the conclusion of the researcher’s analysis that the results of hyaluronic acid injections were not significantly different than placebo injections. The attention to a lack of benefit is important news for patients.

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

The news release does refer to some potential harms of nonsteroidal anti-inflammatory drugs, including naproxen and ibuprofen. However, it does not quantify these risks and it does not address any of the potential harms of the other treatments in the analysis.

Does the news release seem to grasp the quality of the evidence?

Satisfactory

The news release includes key attributes of the methods the authors used to compare the results of clinical trials. These methods are what make this report potentially newsworthy.

The sort of network meta-analysis the researchers used is a powerful method for combining the results of many individual trials. However, the sophistication and complexity of the method also mean that the conclusions depend on the skill, discipline and effort of the researchers. Indeed, the authors criticize an earlier network meta-analysis for including lower-quality studies. Journalists reporting on this study should seek out qualified independent sources in order to get informed perspectives about how well this meta-analysis was performed.

Does the news release commit disease-mongering?

Not Satisfactory

The news release leads off with the statement that an “estimated 45 percent of people are at risk of developing knee osteoarthritis (OA) in their lifetime.” The journal article also leads with this statistic. However, the “45 percent” figure comes from a study of people living in one county in rural North Carolina. Another recent study estimates a far lower lifetime risk of about 14 percent. The authors of the latter report addressed the discrepancy, writing that the North Carolina study looked at an older population with different sex, race and weight distributions than the US population as a whole… and it noted that people without knee problems might have been less likely to stay in touch with researchers, which could lead to a higher estimate of lifetime risk.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

The news release identifies only where the authors work. It does not include the disclosures listed in the journal article. These disclosures should have been included in the news release.

Does the news release compare the new approach with existing alternatives?

Satisfactory

A comparison of existing alternatives is the point of the journal article. The news release highlights the comparisons in clear language.

Does the news release establish the availability of the treatment/test/product/procedure?

Satisfactory

It is clear that all the treatments noted in the release are generally available.

Does the news release establish the true novelty of the approach?

Satisfactory

The release includes a quote from an author that, “This is the first comprehensive mixed-comparison analysis comparing best-evidence scientific research and excluding lower quality studies that can bias the outcomes.” A search of PubMed.gov did not find any other similar meta-analyses, except for one that the authors discussed in their journal article. They criticized that earlier meta-analysis for including lower quality studies that they said muddled the results.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Satisfactory

This news release clearly summarizes the main conclusions of the researchers’ journal article. Other than repeating the questionable estimate of lifetime risk of knee osteoarthritis noted above, the language of the release is moderate and useful.

Total Score: 5 of 10 Satisfactory

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