Research
The COMET initiative “brings together people interested in the development and application of agreed standardised sets of outcomes” for clinical trials. This is a crucial if we are to collect valuable, informative data of effectiveness, meaningfully synthesise data from multiple clinical studies, as highlighted in Prof Buckley’s blog and compare effect sizes for different interventions. Reaching consensus amongst orthopaedic and trauma surgeons is notoriously hard – we’re often wrong but never in doubt!
Well, we attempted the impossible last month. Warwick Medical School hosted a consensus meeting of surgeons, anaesthetists, geriatricians, allied health professionals, methodologists, trialists and experts in measuring outcomes to discuss what we should measure in trials of patients with hip fracture. The clinical imperative here is clear and much research has already been carried out. However, a quick review of Martyn Parker’s work with the Cochrane Collaboration demonstrates the limitations on the interpretation of this considerable volume of data given the variety of outcomes that have been measured. ...
We found that identifying those aspects of health that are important to measure was relatively straight forward – including domains such as pain, walking and emotional functions. How best to measure these domains was much more difficult and there was considerable debate. We agreed that, as a minimum, clinical trials should report EQ-5D, mortality and walking ability.
In a sense the output is less important than a discussion amongst interested parties so that a true, broad consensus can be reached internationally. That way funders, trialists and systematic reviewers can agree on a common set of outcomes to measure and report. Hopefully, the process that we started last month can be iterative so that research in this field can achieve the greatest impact possible.
Mr Xavier Griffin, NIHR Clinical Lecturer, Warwick Orthopaedics, Warwick Medical School, UK
May 2013
