As more complex meta-analytical techniques such as network and multivariate meta-analyses become increasingly common, further pressures are placed on reviewers to extract data in a systematic and consistent manner. Failing to do this appropriately wastes time, resources and jeopardises accuracy. This guide (data extraction for complex meta-analysis (DECiMAL)) suggests a number of points to consider when collecting data, primarily aimed at systematic reviewers preparing data for meta-analysis. Network meta-analysis (NMA), multiple outcomes analysis and analysis combining different types of data are considered in a manner that can be useful across a range of data collection programmes. The guide has been shown to be both easy to learn and useful in a small pilot study.

Background: Model‐based meta‐analysis (MBMA) is increasingly used to inform drug‐development decisions by synthesising results from multiple studies to estimate treatment, dose‐response, and time‐course characteristics. Network meta‐analysis (NMA) is used in Health Technology Appraisals for simultaneously comparing effects of multiple treatments, to inform reimbursement decisions. Recently, a framework for dose‐response model‐based network meta‐analysis (MBNMA) has been proposed that combines, often nonlinear, MBMA modelling with the statistically robust properties of NMA. Here, we aim to extend this framework to time‐course models.Methods: We propose a Bayesian time‐course MBNMA modelling framework for continuous summary outcomes that allows for nonlinear modelling of multiparameter time‐course functions, accounts for residual correlation between observations, preserves randomisation by modelling relative effects, and allows for testing of inconsistency between direct and indirect evidence on the time‐course parameters. We demonstrate our modelling framework using an illustrative dataset of 23 trials investigating treatments for pain in osteoarthritis.Results: Of the time‐course functions that we explored, the E_max model gave the best fit to the data and has biological plausibility. Some simplifying assumptions were needed to identify the ET₅₀, due to few observations at early follow‐up times. Treatment estimates were robust to the inclusion of correlations in the likelihood.Conclusions: Time‐course MBNMA provides a statistically robust framework for synthesising evidence on multiple treatments at multiple time points. The use of placebo‐controlled studies in drug‐development means there is limited potential for inconsistency. The methods can inform drug‐development decisions and provide the rigour needed in the reimbursement decision‐making process.

Following a rigorous systematic review of the literature, the International Menopause Society (IMS) has produced detailed new recommendations and key messages on women's midlife health, menopause and menopause hormone therapy (MHT) to help guide healthcare professionals to optimize their management of women at this critical stage of life. The term MHT has been used to cover therapies including estrogens, progestogens and combined regimens. This guidance provides a summary of the recommendations and key messages generated from the systematic review process. The longer version, including the detailed text, key meta-analyses, references, figures and supplementary materials, will be published simultaneously online and can be accessed via the IMS website (https://www.imsociety.org/statements/ims-recommendations/). The quality of evidence and the strength of recommendations used in this guideline are based on the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) and the Appraisal of Guidelines for Research & Evaluation II (AGREE II) approaches. The new recommendations now include levels of evidence, grades of recommendations, good practice points and key messages. The recommendations were developed by a body of 38 authors and 26 support team members derived from the IMS and other organizations. Global stakeholder surveys, targeted at both healthcare providers and consumers, were initially conducted to identify the key questions. A Publication Steering Committee (PSC) provided oversight of the process through regular meetings and ensured consistency of methodology. By the end of the process, 30 completed sections were submitted by the authors to individual lead reviewers selected from the PSC to provide peer review and finally endorsed by the PSC, IMS board and stakeholders. Overall, 341 recommendations (285 supported by research data and 56 good practice points) and 38 key messages have been formulated. These span a diverse range of health topics, including lifestyle, midlife body changes, vasomotor symptoms, genitourinary syndrome of menopause, osteoporosis, cardiometabolic health, dementia, premature ovarian insufficiency and various malignancies. A new section addresses the often-overlooked topic of sarcopenia which requires urgent attention. Current controversial topics, such as the influence of the media, the role of the pharmaceutical industry and publication ethics, are also explored. The overall aim of these recommendations and guidelines is to provide the blueprint for the management of women's midlife health and menopause, given the latest available evidence. In preparing these international recommendations, experts have endeavored to consider geographical variations in medical care, prevalence of diseases/conditions, symptom severity, availability and licensing of MHT and alternatives, and country-specific attitudes of the public, medical community and health authorities toward menopause management.

Background and Objective: Contextual effects (e.g. patient expectations) may play a role in treatment effectiveness. This study aimed to estimate the magnitude of contextual effects for conservative, non‐pharmacological interventions for musculoskeletal pain conditions. A systematic review and meta‐analysis of randomized controlled trials (RCTs) that compared placebo conservative non‐pharmacological interventions to no treatment for musculoskeletal pain. The outcomes assessed included pain intensity, physical functioning, health‐related quality of life, global rating of change, depression, anxiety and sleep at immediate, short‐, medium‐ and/or long‐term follow‐up.Databases and Data Treatment: MEDLINE, EMBASE, CINAHL, Web of Science Core Collection, CENTRAL and SPORTDiscus were searched from inception to September 2021. Trial registry searches, backward and forward citation tracking and searches for prior systematic reviews were completed. The Cochrane risk of bias 2 tool was implemented.Results: The study included 64 RCTs (N = 4314) out of 8898 records. For pain intensity, a mean difference of (MD: −5.32, 95% confidence interval (CI): −7.20, −3.44, N = 57 studies with 74 outcomes, GRADE: very low) was estimated for placebo interventions. A small effect in favour of the placebo interventions for physical function was estimated (SMD: −0.22, 95% CI: −0.35, −0.09; N = 37 with 48 outcomes, GRADE: very low). Similar results were found for a broad range of patient‐reported outcomes. Meta‐regression analyses did not explain heterogeneity among analyses.Conclusion: The study found that the contextual effect of non‐pharmacological conservative interventions for musculoskeletal conditions is likely to be small. However, given the known effect sizes of recommended evidence‐based treatments for musculoskeletal conditions, it may still contribute an important component.Significance: Contextual effects of non‐pharmacological conservative interventions for musculoskeletal conditions are likely to be small for a broad range of patient‐reported outcomes (pain intensity, physical function, quality of life, global rating of change and depression). Contextual effects are unlikely, in isolation, to offer much clinical care. But these factors do have relevance in an overall treatment context as they provide almost 30% of the minimally clinically important difference.