BMJ Open 4:e004720 doi:10.1136/bmjopen-2013-004720
  • Evidence based practice
    • Research

Failure to address potential bias in non-randomised controlled clinical trials may cause lack of evidence on patient-reported outcomes: a method study

  1. Michael Pinkawa4
  1. 1Children's Hospital, University of Cologne, Cologne, Germany
  2. 2Outcomes Research Center, University of Illinois, Peoria, Illinois, USA
  3. 3FOM University of Applied Science for Economics & Management, Essen, Germany
  4. 4Department of Radiotherapy, University Hospital, Aachen, Germany
  1. Correspondence to Frank Peinemann; pubmedprjournal{at}
  • Received 19 December 2013
  • Revised 28 April 2014
  • Accepted 13 May 2014
  • Published 4 June 2014


Objectives We conducted a workup of a previously published systematic review and aimed to analyse why most of the identified non-randomised controlled clinical trials with patient-reported outcomes did not match a set of basic quality criteria.

Setting There were no limits on the level of care and the geographical location.

Participants The review evaluated permanent interstitial low-dose rate brachytherapy in patients with localised prostate cancer and compared that intervention with alternative procedures such as external beam radiotherapy, radical prostatectomy and no primary therapy.

Primary outcome measure Fulfilment of basic inclusion criteria according to a Participants, Interventions, Comparisons, Outcomes (PICO) framework and accomplishment of requirements to contain superimposed risk of bias.

Results We found that 21 of 50 excluded non-randomised controlled trials did not meet the PICO inclusion criteria. The remaining 29 studies showed a lack in the quality of reporting. The resulting flaws included attrition bias due to loss of follow-up, lack of reporting baseline data, potential confounding due to unadjusted data and lack of statistical comparison between groups.

Conclusions With respect to the reporting of patient-reported outcomes, active efforts are required to improve the quality of reporting in non-randomised controlled trials concerning permanent interstitial low-dose rate brachytherapy in patients with localised prostate cancer.

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