Skip to main content
Top
Published in: Trials 1/2010

Open Access 01-12-2010 | Review

Reporting on covariate adjustment in randomised controlled trials before and after revision of the 2001 CONSORT statement: a literature review

Authors: Ly-Mee Yu, An-Wen Chan, Sally Hopewell, Jonathan J Deeks, Douglas G Altman

Published in: Trials | Issue 1/2010

Login to get access

Abstract

Objectives

To evaluate the use and reporting of adjusted analysis in randomised controlled trials (RCTs) and compare the quality of reporting before and after the revision of the CONSORT Statement in 2001.

Design

Comparison of two cross sectional samples of published articles.

Data Sources

Journal articles indexed on PubMed in December 2000 and December 2006.

Study Selection

Parallel group RCTs with a full publication carried out in humans and published in English

Main outcome measures

Proportion of articles reported adjusted analysis; use of adjusted analysis; the reason for adjustment; the method of adjustment and the reporting of adjusted analysis results in the main text and abstract.

Results

In both cohorts, 25% of studies reported adjusted analysis (84/355 in 2000 vs 113/422 in 2006). Compared with articles reporting only unadjusted analyses, articles that reported adjusted analyses were more likely to specify primary outcomes, involve multiple centers, perform stratified randomization, be published in general medical journals, and recruit larger sample sizes. In both years a minority of articles explained why and how covariates were selected for adjustment (20% to 30%). Almost all articles specified the statistical methods used for adjustment (99% in 2000 vs 100% in 2006) but only 5% and 10%, respectively, reported both adjusted and unadjusted results as recommended in the CONSORT guidelines.

Conclusion

There was no evidence of change in the reporting of adjusted analysis results five years after the revision of the CONSORT Statement and only a few articles adhered fully to the CONSORT recommendations.
Appendix
Available only for authorised users
Literature
1.
go back to reference Assmann SF, Pocock SJ, Enos LE, Kasten LE: Subgroup analysis and other (mis)uses of baseline data in clinical trials. Lancet. 2000, 355: 1064-9. 10.1016/S0140-6736(00)02039-0.CrossRefPubMed Assmann SF, Pocock SJ, Enos LE, Kasten LE: Subgroup analysis and other (mis)uses of baseline data in clinical trials. Lancet. 2000, 355: 1064-9. 10.1016/S0140-6736(00)02039-0.CrossRefPubMed
2.
go back to reference Altman DG: Comparability of randomised groups. Statistician. 1985, 34: 125-36. 10.2307/2987510.CrossRef Altman DG: Comparability of randomised groups. Statistician. 1985, 34: 125-36. 10.2307/2987510.CrossRef
3.
go back to reference Hauck WW, Anderson S, Marcus SM: Should we adjust for covariates in nonlinear regression analyses of randomized trials?. Control Clin Trials. 1998, 19: 249-56. 10.1016/S0197-2456(97)00147-5.CrossRefPubMed Hauck WW, Anderson S, Marcus SM: Should we adjust for covariates in nonlinear regression analyses of randomized trials?. Control Clin Trials. 1998, 19: 249-56. 10.1016/S0197-2456(97)00147-5.CrossRefPubMed
4.
go back to reference Senn SJ: Covariate imbalance and random allocation in clinical trials. Stat Med. 1989, 8: 467-75. 10.1002/sim.4780080410.CrossRefPubMed Senn SJ: Covariate imbalance and random allocation in clinical trials. Stat Med. 1989, 8: 467-75. 10.1002/sim.4780080410.CrossRefPubMed
5.
go back to reference Pocock SJ, Assmann SE, Enos LE, Kasten LE: Subgroup analysis, covariate adjustment and baseline comparisons in clinical trial reporting: current practice and problems. Stat Med. 2002, 21: 2917-30. 10.1002/sim.1296.CrossRefPubMed Pocock SJ, Assmann SE, Enos LE, Kasten LE: Subgroup analysis, covariate adjustment and baseline comparisons in clinical trial reporting: current practice and problems. Stat Med. 2002, 21: 2917-30. 10.1002/sim.1296.CrossRefPubMed
6.
go back to reference ICH E9 Expert Working Group: Statistical principles for clinical trials: ICH harmonized tripartite guidelines. Stats Med. 1999, 18: 1905-42. ICH E9 Expert Working Group: Statistical principles for clinical trials: ICH harmonized tripartite guidelines. Stats Med. 1999, 18: 1905-42.
7.
go back to reference CPMP: Points to consider on adjustment for baseline covariates (cpmp/ewp/2863/99). 2003, Emea: London CPMP: Points to consider on adjustment for baseline covariates (cpmp/ewp/2863/99). 2003, Emea: London
8.
go back to reference Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, for the CONSORT Group: The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med. 2001, 134: 663-94.CrossRefPubMed Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, for the CONSORT Group: The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med. 2001, 134: 663-94.CrossRefPubMed
9.
go back to reference Yu LM, Alder N, Altman DG, Deeks J, Chan AW: Adjusting for covariates in randomised clinical trials: a review of published trials. Proceedings of the ISCB meeting: 15-19 August. 2004, ; Leiden Yu LM, Alder N, Altman DG, Deeks J, Chan AW: Adjusting for covariates in randomised clinical trials: a review of published trials. Proceedings of the ISCB meeting: 15-19 August. 2004, ; Leiden
10.
go back to reference Altman DG: Adjustment for covariate imbalance. Encyclopedia of biostatistics. Edited by: Armitage P, Colton T. 2005, Chichester: John Wiley, 1273-8. 2 Altman DG: Adjustment for covariate imbalance. Encyclopedia of biostatistics. Edited by: Armitage P, Colton T. 2005, Chichester: John Wiley, 1273-8. 2
11.
go back to reference Chan AW, Altman DG: Epidemiology and reporting of randomised trials published in PubMed journals. Lancet. 2005, 1365: 1159-62. 10.1016/S0140-6736(05)71879-1.CrossRef Chan AW, Altman DG: Epidemiology and reporting of randomised trials published in PubMed journals. Lancet. 2005, 1365: 1159-62. 10.1016/S0140-6736(05)71879-1.CrossRef
12.
go back to reference Chan AW, Altman DG: Identifying outcome reporting bias in randomised trials on PubMed: review of publications and survey of authors. BMJ. 2005, 333: 753-10.1136/bmj.38356.424606.8F.CrossRef Chan AW, Altman DG: Identifying outcome reporting bias in randomised trials on PubMed: review of publications and survey of authors. BMJ. 2005, 333: 753-10.1136/bmj.38356.424606.8F.CrossRef
13.
go back to reference Robinson KA, Dickersin K: Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. Int J Epidemiol. 2002, 31: 150-3. 10.1093/ije/31.1.150.CrossRefPubMed Robinson KA, Dickersin K: Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. Int J Epidemiol. 2002, 31: 150-3. 10.1093/ije/31.1.150.CrossRefPubMed
14.
go back to reference Austin PC, Manca A, Zwarenstein M, Juurlink DN, Stanbrook MB: A substantial and confusing variation exists in handling of baseline covariates in randomized controlled trials: a review of trials published in leading medical journals. J Clin Epidemiol. 2010, 63: 142-153. 10.1016/j.jclinepi.2009.06.002.CrossRefPubMed Austin PC, Manca A, Zwarenstein M, Juurlink DN, Stanbrook MB: A substantial and confusing variation exists in handling of baseline covariates in randomized controlled trials: a review of trials published in leading medical journals. J Clin Epidemiol. 2010, 63: 142-153. 10.1016/j.jclinepi.2009.06.002.CrossRefPubMed
15.
go back to reference Mullner M, Matthews H, Altman DG: Reporting on statistical methods to adjust for confounding: a cross-sectional survey. Ann Intern Med. 2002, 136: 122-26.CrossRefPubMed Mullner M, Matthews H, Altman DG: Reporting on statistical methods to adjust for confounding: a cross-sectional survey. Ann Intern Med. 2002, 136: 122-26.CrossRefPubMed
16.
go back to reference Hernández AV, Steyerberg EW, Taylor GS, Marmarou A, Habbema JD, Maas AI: Subgroup analysis and covariate adjustment in randomized clinical trials of traumatic brain injury: a systematic review. Neurosurgery. 2005, 57: 1244-53. 10.1227/01.NEU.0000186039.57548.96.CrossRefPubMed Hernández AV, Steyerberg EW, Taylor GS, Marmarou A, Habbema JD, Maas AI: Subgroup analysis and covariate adjustment in randomized clinical trials of traumatic brain injury: a systematic review. Neurosurgery. 2005, 57: 1244-53. 10.1227/01.NEU.0000186039.57548.96.CrossRefPubMed
17.
go back to reference Hernandez AV, Eijkemans MJ, Steyerberg EW: Randomized controlled trials with time-to-event outcomes: how much does pre-specified covariate adjustment increase power?. Annals of Epidemiology. 2006, 16: 41-48. 10.1016/j.annepidem.2005.09.007.CrossRefPubMed Hernandez AV, Eijkemans MJ, Steyerberg EW: Randomized controlled trials with time-to-event outcomes: how much does pre-specified covariate adjustment increase power?. Annals of Epidemiology. 2006, 16: 41-48. 10.1016/j.annepidem.2005.09.007.CrossRefPubMed
18.
go back to reference Hernandez AV, Steyerberg EW, Habbema JD: Covariate adjustment in randomized controlled trials with dichotomous outcomes increases statistical power and reduces sample size requirements. J Clin Epidemiol. 2004, 57: 454-60. 10.1016/j.jclinepi.2003.09.014.CrossRefPubMed Hernandez AV, Steyerberg EW, Habbema JD: Covariate adjustment in randomized controlled trials with dichotomous outcomes increases statistical power and reduces sample size requirements. J Clin Epidemiol. 2004, 57: 454-60. 10.1016/j.jclinepi.2003.09.014.CrossRefPubMed
19.
go back to reference Negassa A, Hanley JA: The effect of omitted covariates on confidence interval and study power in binary outcome analysis: a simulation study. Contemp Clin Trials. 2007, 28: 242-8. 10.1016/j.cct.2006.08.007.CrossRefPubMed Negassa A, Hanley JA: The effect of omitted covariates on confidence interval and study power in binary outcome analysis: a simulation study. Contemp Clin Trials. 2007, 28: 242-8. 10.1016/j.cct.2006.08.007.CrossRefPubMed
20.
go back to reference Chan AW, Hróbjartsson A, Jørgensen KJ, Gøtzsche PC, Altman DG: Discrepancies in sample size calculations and data analyses reported in randomised trials: comparison of publications with protocols. BMJ. 2008, 337: a2299-10.1136/bmj.a2299.CrossRefPubMedPubMedCentral Chan AW, Hróbjartsson A, Jørgensen KJ, Gøtzsche PC, Altman DG: Discrepancies in sample size calculations and data analyses reported in randomised trials: comparison of publications with protocols. BMJ. 2008, 337: a2299-10.1136/bmj.a2299.CrossRefPubMedPubMedCentral
21.
go back to reference Forsythe AB, Stitt FW: Randomization or minimization in the treatment assignment of patient trials: validity and power of tests. Technical Report. 1977, Health Sciences Computing Facility, University of California, Los Angeles, 28 Forsythe AB, Stitt FW: Randomization or minimization in the treatment assignment of patient trials: validity and power of tests. Technical Report. 1977, Health Sciences Computing Facility, University of California, Los Angeles, 28
22.
go back to reference Rochon J: Issues in adjusting for covariates arising postrandomization in clinical trials. Drug Inf J. 1999, 33: 1219-1228. Rochon J: Issues in adjusting for covariates arising postrandomization in clinical trials. Drug Inf J. 1999, 33: 1219-1228.
23.
go back to reference Yusuf S, Wittes J, Probstfield J, Tyroler HA: Analysis and interpretation of treatment effects in subgroups of patients in randomized clinical trials. JAMA. 1991, 266: 93-8. 10.1001/jama.266.1.93.CrossRefPubMed Yusuf S, Wittes J, Probstfield J, Tyroler HA: Analysis and interpretation of treatment effects in subgroups of patients in randomized clinical trials. JAMA. 1991, 266: 93-8. 10.1001/jama.266.1.93.CrossRefPubMed
24.
go back to reference Walraven van C, Davis D, Forster AJ, Wells GA: Time-dependent bias was common in survival analyses published in leading clinical journals. J Clin Epidemiol. 2004, 57: 672-82. 10.1016/j.jclinepi.2003.12.008.CrossRefPubMed Walraven van C, Davis D, Forster AJ, Wells GA: Time-dependent bias was common in survival analyses published in leading clinical journals. J Clin Epidemiol. 2004, 57: 672-82. 10.1016/j.jclinepi.2003.12.008.CrossRefPubMed
26.
go back to reference Moher D, Jones A, Lepage L, CONSORT Group (Consolitdated Standards for Reporting of Trials): Use of the CONSORT statement and quality of reports of randomized trials: a comparative before-and-after evaluation. JAMA. 2001, 285: 1992-5. 10.1001/jama.285.15.1992.CrossRefPubMed Moher D, Jones A, Lepage L, CONSORT Group (Consolitdated Standards for Reporting of Trials): Use of the CONSORT statement and quality of reports of randomized trials: a comparative before-and-after evaluation. JAMA. 2001, 285: 1992-5. 10.1001/jama.285.15.1992.CrossRefPubMed
27.
go back to reference Kane RL, Wang J, Garrard J: Reporting in randomized clinical trials improved after adoption of the CONSORT statement. J Clin Epidemiol. 2007, 60: 241-9. 10.1016/j.jclinepi.2006.06.016.CrossRefPubMed Kane RL, Wang J, Garrard J: Reporting in randomized clinical trials improved after adoption of the CONSORT statement. J Clin Epidemiol. 2007, 60: 241-9. 10.1016/j.jclinepi.2006.06.016.CrossRefPubMed
28.
go back to reference Nicholson A, Kuper H, Hemingway H: Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J. 2006, 27: 2763-74. 10.1093/eurheartj/ehl338.CrossRefPubMed Nicholson A, Kuper H, Hemingway H: Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J. 2006, 27: 2763-74. 10.1093/eurheartj/ehl338.CrossRefPubMed
29.
go back to reference Peters J, Mengersen K: Selective reporting of adjusted estimates in observational epidemiology studies: reasons and implications for meta-analyses. Eval Health Prof. 2008, 31: 370-89. 10.1177/0163278708324438.CrossRefPubMed Peters J, Mengersen K: Selective reporting of adjusted estimates in observational epidemiology studies: reasons and implications for meta-analyses. Eval Health Prof. 2008, 31: 370-89. 10.1177/0163278708324438.CrossRefPubMed
30.
go back to reference Pildal J, Hróbjartsson A, Jørgensen KJ, Hilden J, Altman DG, Gøtzsche PC: Impact of allocation concealment on conclusions drawn from meta-analyses of randomized trials. Int J Epidemiol. 2007, 36: 847-57. 10.1093/ije/dym087.CrossRefPubMed Pildal J, Hróbjartsson A, Jørgensen KJ, Hilden J, Altman DG, Gøtzsche PC: Impact of allocation concealment on conclusions drawn from meta-analyses of randomized trials. Int J Epidemiol. 2007, 36: 847-57. 10.1093/ije/dym087.CrossRefPubMed
Metadata
Title
Reporting on covariate adjustment in randomised controlled trials before and after revision of the 2001 CONSORT statement: a literature review
Authors
Ly-Mee Yu
An-Wen Chan
Sally Hopewell
Jonathan J Deeks
Douglas G Altman
Publication date
01-12-2010
Publisher
BioMed Central
Published in
Trials / Issue 1/2010
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-11-59

Other articles of this Issue 1/2010

Trials 1/2010 Go to the issue