Skip to main content
Top
Published in: Trials 1/2008

Open Access 01-12-2008 | Research

An assessment of the quality of randomised controlled trials conducted in China

Authors: Dalu Zhang, Peng Yin, Nick Freemantle, Rachel Jordan, Nanshan Zhong, KK Cheng

Published in: Trials | Issue 1/2008

Login to get access

Abstract

Background

Despite the rapid increase in research in China, little is known about the quality of clinical trials conducted there.

Methods

A systematic review and critical appraisal of randomised controlled trials (RCTs) conducted in China and published in 2004 was undertaken to describe their characteristics, assess the quality of their reporting, and where possible, the quality of their conduct. Randomised controlled trials in all disease areas and types of interventions, which took place in China and included Chinese citizens were identified using PubMed and hand searching the Journal Series of the Chinese Medical Association. Quality was assessed against a subset of criteria adapted from the CONSORT statement.

Results

Three hundred and seven RCTs were included. One hundred and ninety-nine (64.8%) failed to report methods of randomization and 254 (82.4%) did not mention blinding of either participants or investigators. Reporting of baseline characteristics, primary outcome and length of follow-up was inadequate in a substantial proportion of studies. Fewer than 11% of RCTs mentioned ethical approval and only 18.0% adequately discussed informed consent. However, dropout rates were very favourable with nearly 44% of trials reporting a zero dropout rate.

Conclusion

Reporting of RCTs in China requires substantial improvement to meet the targets of the CONSORT statement. The conduct of Chinese RCTs cannot be directly inferred from the standard of reporting; however without good reporting the methods of the trials cannot be clearly ascertained.
Appendix
Available only for authorised users
Literature
1.
go back to reference Freidman LM, Furberg C, DeMets DL: Fundamentals of clinical trials. 1981, Boston:Wright PSG Freidman LM, Furberg C, DeMets DL: Fundamentals of clinical trials. 1981, Boston:Wright PSG
2.
go back to reference Byar DP, Simon RM, Friedewald WT, Schlesselman JJ, DeMets DL, Ellenberg JH, Gail MH, Ware JH: Randomized clinical trials. Perspectives on some recent ideas. N Engl J Med. 1976, 295: 74-80.CrossRefPubMed Byar DP, Simon RM, Friedewald WT, Schlesselman JJ, DeMets DL, Ellenberg JH, Gail MH, Ware JH: Randomized clinical trials. Perspectives on some recent ideas. N Engl J Med. 1976, 295: 74-80.CrossRefPubMed
3.
go back to reference Chalmers TC, Sacks HS, Smith H: Historical versus randomized controls for clinical trials. Control Clin Trials. 1980, 1: 177-10.1016/0197-2456(80)90057-4.CrossRef Chalmers TC, Sacks HS, Smith H: Historical versus randomized controls for clinical trials. Control Clin Trials. 1980, 1: 177-10.1016/0197-2456(80)90057-4.CrossRef
4.
go back to reference Tygstrup N, Lachin JM, Juhl E: The randomized clinical trial and therapeutic decisions. 1982, New York: Marcel Dekker Tygstrup N, Lachin JM, Juhl E: The randomized clinical trial and therapeutic decisions. 1982, New York: Marcel Dekker
5.
go back to reference Klimt CR: The conduct and principles of randomized clinical trials. Control Clin Trials. 1981, 1: 283-293. 10.1016/0197-2456(81)90031-3.CrossRefPubMed Klimt CR: The conduct and principles of randomized clinical trials. Control Clin Trials. 1981, 1: 283-293. 10.1016/0197-2456(81)90031-3.CrossRefPubMed
6.
go back to reference Ruthstein DD: The ethical design of human experiments. Daedalus. 1969, 523-541. Ruthstein DD: The ethical design of human experiments. Daedalus. 1969, 523-541.
7.
go back to reference Chalmers TC: The impact of controlled trials on the practice of medicine. Mt Sinai J Med. 1974, 41: 753-759.PubMed Chalmers TC: The impact of controlled trials on the practice of medicine. Mt Sinai J Med. 1974, 41: 753-759.PubMed
8.
go back to reference Prescott RJ, Counsell CE, Gillespie WJ, Grant AM, Russell IT, Kiauka S, Colthart IR, Ross S, Shepherd SM, Russell D: Factors that limit the quality, number and progress of randomised controlled trials. Health Technol Assess. 1999, 3: 1-143.PubMed Prescott RJ, Counsell CE, Gillespie WJ, Grant AM, Russell IT, Kiauka S, Colthart IR, Ross S, Shepherd SM, Russell D: Factors that limit the quality, number and progress of randomised controlled trials. Health Technol Assess. 1999, 3: 1-143.PubMed
9.
go back to reference Schulz KF, Chalmers I, Hayes RJ, Altman DG: Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA. 1995, 273: 408-412. 10.1001/jama.273.5.408.CrossRefPubMed Schulz KF, Chalmers I, Hayes RJ, Altman DG: Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA. 1995, 273: 408-412. 10.1001/jama.273.5.408.CrossRefPubMed
10.
go back to reference Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M, Tugwell P, Klassen TP: Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?. Lancet. 1998, 352: 609-613. 10.1016/S0140-6736(98)01085-X.CrossRefPubMed Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M, Tugwell P, Klassen TP: Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?. Lancet. 1998, 352: 609-613. 10.1016/S0140-6736(98)01085-X.CrossRefPubMed
11.
go back to reference Moher D, Schulz KF, Altman DG: The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet. 2001, 357: 1191-1194. 10.1016/S0140-6736(00)04337-3.CrossRefPubMed Moher D, Schulz KF, Altman DG: The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet. 2001, 357: 1191-1194. 10.1016/S0140-6736(00)04337-3.CrossRefPubMed
12.
go back to reference Moher D, Jones A, Lepage L: Use of the CONSORT statement and quality of reports of randomized trials: A comparative before-and-after evaluation. JAMA. 2001, 285: 1992-1995. 10.1001/jama.285.15.1992.CrossRefPubMed Moher D, Jones A, Lepage L: Use of the CONSORT statement and quality of reports of randomized trials: A comparative before-and-after evaluation. JAMA. 2001, 285: 1992-1995. 10.1001/jama.285.15.1992.CrossRefPubMed
13.
go back to reference He Q, Wang C, Lin M, Xue C: The analysis of recognition of respiratory physician on evidence based medicine. Chinese Journal of Tuberculosis and Respiratory Disease. 2004, 27: 460-462. He Q, Wang C, Lin M, Xue C: The analysis of recognition of respiratory physician on evidence based medicine. Chinese Journal of Tuberculosis and Respiratory Disease. 2004, 27: 460-462.
14.
go back to reference Chen F, Zeng Y, Wei H: Analysis of the quality of clinical trials about therapeutic research using the standard of evidence based medicine. Chinese Journal of Ophthalmology. 2004, 40: 609-613.PubMed Chen F, Zeng Y, Wei H: Analysis of the quality of clinical trials about therapeutic research using the standard of evidence based medicine. Chinese Journal of Ophthalmology. 2004, 40: 609-613.PubMed
15.
go back to reference Wang J: Conducting high quality randomized controlled clinical trials. Chinese Journal of Hepatology. 2004, 12: 451-452.PubMed Wang J: Conducting high quality randomized controlled clinical trials. Chinese Journal of Hepatology. 2004, 12: 451-452.PubMed
16.
go back to reference Liu Z, Xiong T, Meads C: Clinical effectiveness of treatment with hyperbaric oxygen for neonatal hypoxic-ischaemic encephalopathy: systematic review of Chinese literature. BMJ. 2006, 333: 334-376. 10.1136/bmj.333.7563.334.CrossRef Liu Z, Xiong T, Meads C: Clinical effectiveness of treatment with hyperbaric oxygen for neonatal hypoxic-ischaemic encephalopathy: systematic review of Chinese literature. BMJ. 2006, 333: 334-376. 10.1136/bmj.333.7563.334.CrossRef
17.
go back to reference Bian ZX, Moher D, Dagenais S, Li YP, Wu TX, Liu L, Miao JX, Song L, Zhang HM: Improving the quality of randomized controlled trials in Chinese herbal medicine, part IV: applying a revised CONSORT checklist to measure reporting quality. Journal of Chinese Integrative Medicine. 2006, 4 (3): 233-242. 10.3736/jcim20060303.CrossRefPubMed Bian ZX, Moher D, Dagenais S, Li YP, Wu TX, Liu L, Miao JX, Song L, Zhang HM: Improving the quality of randomized controlled trials in Chinese herbal medicine, part IV: applying a revised CONSORT checklist to measure reporting quality. Journal of Chinese Integrative Medicine. 2006, 4 (3): 233-242. 10.3736/jcim20060303.CrossRefPubMed
18.
go back to reference Peng X, Zhao Y, Liang X, Wu L, Cui S, Guo A, Wang W: Assessing the quality of RCTs on the effect of beta-elemene, one ingredient of a Chinese herb, against malignant tumours. Contemporary Clinical Trials. 2006, 27 (1): 70-82. 10.1016/j.cct.2005.07.002.CrossRefPubMed Peng X, Zhao Y, Liang X, Wu L, Cui S, Guo A, Wang W: Assessing the quality of RCTs on the effect of beta-elemene, one ingredient of a Chinese herb, against malignant tumours. Contemporary Clinical Trials. 2006, 27 (1): 70-82. 10.1016/j.cct.2005.07.002.CrossRefPubMed
19.
go back to reference Wang G, Mao B, Xiong Z-Y, Fan T, Chen X-D, Wang L, Liu G-J, Liu J, Guo J, Chang J, Wu T-X, Li T-Q: The quality of reporting of randomized controlled trials of traditional Chinese medicine: A survey of 13 randomly selected journals from mainland China. Clin Ther. 2007, 29 (7): 1456-1467. 10.1016/j.clinthera.2007.07.023.CrossRefPubMed Wang G, Mao B, Xiong Z-Y, Fan T, Chen X-D, Wang L, Liu G-J, Liu J, Guo J, Chang J, Wu T-X, Li T-Q: The quality of reporting of randomized controlled trials of traditional Chinese medicine: A survey of 13 randomly selected journals from mainland China. Clin Ther. 2007, 29 (7): 1456-1467. 10.1016/j.clinthera.2007.07.023.CrossRefPubMed
21.
go back to reference Juni P, Witschi A, Bloch R, Egger M: The hazards of scoring the quality of clinical trials for meta-analysis. JAMA. 1999, 282: 1054-1060. 10.1001/jama.282.11.1054.CrossRefPubMed Juni P, Witschi A, Bloch R, Egger M: The hazards of scoring the quality of clinical trials for meta-analysis. JAMA. 1999, 282: 1054-1060. 10.1001/jama.282.11.1054.CrossRefPubMed
22.
go back to reference Yousefi-Nooraie R, Shakiba B, Mortaz-Hejri S: Country development and manuscript selection bias: a review of published studies. BMC Med Res Methodol. 2006, 6: 37-10.1186/1471-2288-6-37.CrossRefPubMedPubMedCentral Yousefi-Nooraie R, Shakiba B, Mortaz-Hejri S: Country development and manuscript selection bias: a review of published studies. BMC Med Res Methodol. 2006, 6: 37-10.1186/1471-2288-6-37.CrossRefPubMedPubMedCentral
23.
go back to reference Gibson RS, Sazawal S, Peerson JM: Design and quality control issues related to dietary assessment, randomized clinical trials and meta-analysis of field-based studies in developing countries. J Nutr. 2003, 133 (5 Suppl 1): 1569S-73S.PubMed Gibson RS, Sazawal S, Peerson JM: Design and quality control issues related to dietary assessment, randomized clinical trials and meta-analysis of field-based studies in developing countries. J Nutr. 2003, 133 (5 Suppl 1): 1569S-73S.PubMed
24.
go back to reference Jadad AR, Moore A, Carrol D: Assessing the quality of reports of randomized clinical trials: Is blinding necessary?. Control Clin Trials. 1996, 17: 1-12. 10.1016/0197-2456(95)00134-4.CrossRefPubMed Jadad AR, Moore A, Carrol D: Assessing the quality of reports of randomized clinical trials: Is blinding necessary?. Control Clin Trials. 1996, 17: 1-12. 10.1016/0197-2456(95)00134-4.CrossRefPubMed
26.
go back to reference Chan A-W, Altman DG: Epidemiology and reporting of randomised trials published in PubMed journals. Lancet. 2005, 365: 1159-62. 10.1016/S0140-6736(05)71879-1.CrossRefPubMed Chan A-W, Altman DG: Epidemiology and reporting of randomised trials published in PubMed journals. Lancet. 2005, 365: 1159-62. 10.1016/S0140-6736(05)71879-1.CrossRefPubMed
27.
go back to reference Strippoli GFM, Craig JC, Francesco P: The number, quality, and coverage of randomized controlled trials in nephrology. J Am Soc Nephrol. 2004, 15 (2): 411-9. 10.1097/01.ASN.0000100125.21491.46.CrossRefPubMed Strippoli GFM, Craig JC, Francesco P: The number, quality, and coverage of randomized controlled trials in nephrology. J Am Soc Nephrol. 2004, 15 (2): 411-9. 10.1097/01.ASN.0000100125.21491.46.CrossRefPubMed
28.
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: 241-249. 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: 241-249. 10.1016/j.jclinepi.2006.06.016.CrossRefPubMed
Metadata
Title
An assessment of the quality of randomised controlled trials conducted in China
Authors
Dalu Zhang
Peng Yin
Nick Freemantle
Rachel Jordan
Nanshan Zhong
KK Cheng
Publication date
01-12-2008
Publisher
BioMed Central
Published in
Trials / Issue 1/2008
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-9-22

Other articles of this Issue 1/2008

Trials 1/2008 Go to the issue