The opportunity to improve the results of clinical practice is as great from applying the results of research already conducted as it is from a new discovery or innovation. For doctors of chiropractic to apply research to practice and subsequently achieve evidence-based practice is hard work and time consuming. One of the most efficient means of achieving this is to access the findings of recent relevant systematic reviews. The Cochrane Collaboration produces high-quality systematic reviews of interventions that can assist with evidence-based clinical decisions.
The Cochrane Collaboration is an international nonprofit and independent organization that aims to help people make well-informed decisions about health care. It does this by preparing, maintaining, and promoting the accessibility of systematic reviews of the effects of health care interventions. The collaboration was established in response to Archie Cochrane's call for systematic reviews of randomized controlled trials when he said in 1972 that, “It is surely a great criticism of our profession that we have not organized a critical summary…of all relevant randomized controlled trials.”1
A Brief History of the Cochrane Collaboration
The first Cochrane center opened in 1992 in the United Kingdom, funded by the UK National Health Service. The center's function was to collaborate with others to facilitate reviews of randomized controlled trials across all areas of health care. The following year, the New York Academy of Science organized a meeting where the idea of an international collaboration working toward the goal of systematic reviews in all areas of health care was discussed. The Cochrane Collaboration was officially established in October 1993. Now, more than a decade on, the collaboration has grown exponentially. There are more than 11,500 contributors from more than 90 countries. There is worldwide support for the collaboration from hundreds of organizations, including health service providers, research funding agencies, government departments of health, and universities.
Various entities make up the Cochrane Collaboration. These entities are under the directorship of the Cochrane Collaboration Steering Group, which sets policies for the organization after input from its subgroups. There are 12 Cochrane centers spread throughout the world that coordinate local activities. There are 11 methods groups that provide advice and support to the collaboration in the development of the methods of systematic reviews. There is a consumer network to ensure that the perspectives and needs of consumers are incorporated into Cochrane systematic reviews. The collaboration has 50 review groups representing 50 clinical areas; review preparation is coordinated by these groups. For doctors of chiropractic, review groups of particular interest may include the Back Group; the Bone, Joint, and Muscle Trauma Group; the Musculoskeletal Group; and the Neuromuscular Disease Group. Finally, there are 12 fields that identify health issues of importance to specific populations and/or intervention types and that facilitate reviews across the relevant review groups.
What Are Cochrane Systematic Reviews?
A systematic review is the most efficient way to access high-quality information. No study, regardless of its type, should be interpreted in isolation. Thus, a systematic review is generally considered one of the best forms of evidence.2 Systematic reviews synthesize multiple studies, enabling increased and efficient access to evidence.
Cochrane reviews are systematic reviews undertaken by volunteer members of the Cochrane Collaboration adhering to a specific methodology.3 The target audience of Cochrane reviews includes health care clinicians, researchers, policymakers, and the general public. Completed Cochrane reviews are published in The Cochrane Library, which is available by subscription. The Cochrane Library is published 4 times a year. Each issue contains all existing Cochrane reviews plus new and updated reviews. In the third issue for 2005, The Cochrane Library contained 2435 completed reviews and 1606 protocols for reviews in progress.
Are Cochrane Reviews Relevant?
It is important that Cochrane review information are widely available and relevant. Doctors of chiropractic who wish to incorporate evidence into practice will find an abundance of relevant information available from the Cochrane Collaboration.
Cochrane reviews contain information that can contribute to important changes in many areas of health care. At the clinical practice level, decisions about health interventions can be informed by Cochrane reviews. For example, a chiropractor may provide conservative care supported by a Cochrane review to a patient with carpal tunnel syndrome.4 If the patient's symptoms become progressive, the doctor may consider referring the patient for surgery using a recent Cochrane review that examined new surgical techniques compared with traditional open surgery for the said condition.5 The results of this review can assist the doctor in informing the patient of the preferred surgical technique and in liaising with a surgeon. An exhaustive list of clinical areas that Cochrane reviews cover is included in Cochrane Collaboration websites (Fig 1).
More than 360 Cochrane reviews are relevant to musculoskeletal health care, and more than 100 of these reviews are related to complementary medicine. Because of the chiropractic profession's broad scope and interests, many reviews are directly relevant to clinical practice.
Systematic reviews are important because they summarize the overwhelming amount of research-based health care information that is available. They also overcome some of the biases associated with small single trials where results may not be robust against chance variation if the effects being investigated are small. Finally, systematic reviews may overcome the lack of generalizability inherent in studies conducted in one particular type of population by including many trials conducted in varying populations.
The Cochrane Collaboration provides high-quality evidence that can inform practitioners when making clinical decisions. In this era of evidence-based practice, all health care providers need to be up-to-date with the latest evidence; accessing The Cochrane Library is an efficient way of achieving this.
References
1. 1Cochrane AL. 1931-1971: a critical review, with particular reference to the medical profession. In: Medicines for the year 2000. London: Office of Health Economics; 1979;p. 1–11.
2. 2Glasziou P, Vanderbroucke J, Chalmers I. Assessing the quality of research. BMJ. 2004;328:39–41.
3. 3In: Higgins JPT, Green S editor. Cochrane handbook for systematic reviews of interventions 4.2.5 [updated May 2005]. The Cochrane Library, Issue 3. Chichester (UK): John Wiley & Sons, Ltd; 2005;.
4. 4O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003;[Issue 1. Art. No.: CD003219].
5. 5Scholten RJPM, Bouter LM, Gerritsen A, Uitdenhaag BM, de Vet HCW, van Geldere D. Surgical treatment options for Carpal tunnel syndrome. Cochrane Database Syst Rev. 2004;[Issue 1. Art. No.: CD003905].
aResearch Fellow, Australasian Cochrane Centre, Institute of Health Services Research, Monash University, Australia
bDirector, Australasian Cochrane Centre, Institute of Health Services Research, Monash University, Australia
The Australasian Cochrane Centre, of which both authors are employees, is funded by the Australian Department of Health and Ageing and supported by Monash University. Sally Green is a member of the Cochrane Collaboration Steering Group. The views expressed in this editorial represent those of the authors and are not necessarily the views or the official policy of The Cochrane Collaboration (unless otherwise stated and referenced).
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