Evaluation of spinal stability
Uitgangsvraag
Key question
How can the stability of the affected vertebrae in patients with spinal metastases be determined with a view to mobilization?
Aanbeveling
Recommendations
Assessing the Risk of Spinal Instability
- Consider using a validated spinal stability scoring system, such as the Spinal Instability Neoplastic Score (SINS), to assess the risk of spinal instability. See also module Selection of treatment modalities and the SINS-appendix of this guideline.
- Use a scoring system only as part of a comprehensive clinical assessment (including general health, pain increasing with verticalization and/or maximal bending, and imaging information). Always consult an specialized center in case of doubt.
Mobilisation
- Mobilize based on pain symptoms:
-
- Only confirmed (painful) spinal instability may justify limiting mobilization and using supportive devices.
- When mobilizing a bedridden patient, pay attention to increases in pain and worsening of neurological symptoms.
Overwegingen
Considerations
Balance between desired and undesired effects
There is no scoring system that can be used independently as an absolute predictor of instability. When using the SINS, clinical assessment is essential and at least equally important.
The following aspects should be considered in the clinical assessment:
- Ability to mobilize in relation to pain.
- Use of pain medication or assistive devices to enable mobilization.
- Pay attention to neurological deficits.
The SINS appears to be a suitable scoring system for assessing stability. SINS enables the clinician to consider various aspects of the tumor and requires the physician to examine the patient, and at a minimum, to perform a CT and MRI of the affected spine. Moreover, SINS is easy to interpret and, in most centers, can be reliably calculated using MRI and CT in combination with a clinical consultation. A potential risk is that clinicians may start to use it as a decision tool, which it is not. It is up to an expert center to determine the appropriate course of action, which means the patient should be evaluated by that center.
With regard to mobilization, the benefit lies in maintaining mobility and preventing complications of immobility (such as pressure ulcers, pneumonia, and urinary tract infections).
A disadvantage, in the case of true instability, is an increased risk of pain, which is not problematic in itself. The potential risk of deformity and/or neurological deficits is a highly undesirable effect of mobilization, but this risk is generally low.
Quality of Evidence
The overall quality of evidence is low (based on the GRADE assessment from the NICE guideline). This means there is uncertainty regarding the estimated effect on crucial outcomes. The evidence was downgraded due to serious risk of bias, as determined by the ROBIS and PROBAST tools.
Values and Preferences of Patients (and, if applicable, Their Relatives/Caregivers)
Discuss with patients/relatives the possibility of mobilization in relation to pain complaints and the potential use of assistive devices. Also, discuss warning symptoms indicative of instability or neurological deficits.
Cost Considerations
Cost aspects do not play a role in these recommendations.
Equity (Health Equity/Equitable)
Equity considerations do not play a role in these recommendations.
Acceptability and Sustainability
The working group does not consider it ethical to unjustly immobilize a patient. Other ethical or sustainability aspects are not relevant to this key question.
Feasibility
The diagnostics appear feasible. Diagnostics and mobilization are generally already standard care in practice. When there is doubt about the assessment of spinal stability or the treatment plan, it is advised to consult an expert center.
Onderbouwing
Background
In patient with spinal metastases, usually, the stability of the spine is assessed clinically and based on the available radiological imaging. To come up with a comprehensive tool to get a better idea of the stability of the spine and aid clinicians to discuss cases with referral centers for patients with spinal metastases the Spinal Instability Neoplastic Score (SINS) was developed (Fisher, 2010). The most recent NICE guideline 'Spinal metastases and metastatic spinal cord compression' was published in 2023, which also includes a section on determining the stability of the spine. For this purpose, a systematic search of the literature was also carried out, focusing on validated scoring systems. The search strategy from the NICE guideline (2021) served as the basis, which we updated and expanded to also cover 'clinical evaluation'.
Summary of Findings
|
Outcome |
Study results and measurements |
Effect estimates SINS (cutoff 7) |
Certainty of the Evidence (Quality of evidence) |
Conclusions |
|
|
Sensitivity (crucial) |
Based on data from 903 participants in 8 studies |
Range TP: 8 – 44
Range FP: 9 – 168
Range FN: 1 – 20
Range TN: 17 – 185 |
Range: 0.64 to 0.95 (95%CI NA) |
Low1 |
The evidence suggests that predicting VCF with the SINS (at cutoff 7) results in a range between 0.64 and 0.95 in sensitivity. |
|
Specificity (important) |
Based on data from 903 participants in 8 studies |
Range: 0.42 to 0.82 (95%CI NA) |
Low1 |
The evidence suggests that predicting VCF with the SINS (at cutoff 7) results in a range between 0.42 and 0.82 in specificity. |
|
|
- |
- |
- |
- |
- |
No evidence was found regarding the prognostic value of clinical evaluation. |
Abbreviations: SINS=Spinal Instability Neoplastic Score; TP=true positive; FP=false positive; FN=false negative; TN=true negative;
1. Adapted from the NICE guideline
Description of studies
A total of two studies were included in the analysis of the literature. Important study characteristics and results are summarized in table 1. The assessment of the risk of bias and the GRADE assessment is adapted from the NICE guideline.
Ehresman (2020) performed a retrospective cohort study to 1) create a simple MRI scoring system for evaluating trabecular vertebral bone quality (VBQ), and 2) to evaluate the effectiveness of this new scoring method, along with other risk factors, in predicting the occurrence of new vertebral compression fractures (VCFs) in patients with spinal metastases. Patients of at least 18 years old, with a diagnosis of spinal metastasis who had undergone T1-weighted non-contrast-enhanced MRI of the lumbar spine without prior lumbar instrumentation and presented to Johns Hopkins Hospital with no more than one previous VCF and had attended follow-up visits for at least 6 months after the diagnosis of spinal metastasis were included. In total, 105 patients were included (mean age 61.2 years). The Spinal Instability Neoplastic Score (SINS) (at threshold of 7) was used as predictor.
Kim (2021) performed a systematic review of retrospective cohort studies to evaluate the diagnostic value of the SINS in predicting radiotherapy-induced VCF and to propose recommendations for enhancing its diagnostic accuracy. The databases PubMed, Embase, Web of Science and the Cochrane Database were searched from inception to January 1st, 2020. Besides, references of included papers were screened to find additional studies. No language restrictions were applied and in case of overlapping study populations only the largest study was included. Studies were included if they 1) used the SINS to predict VCFs in patients with spinal metastases, 2) reported the number of patients for 2 or 3 SINS categories and the number of VCFs and 3) used data with sufficient information to assess true-positive (TP; fracture in the unstable group), true-negative (TN; no fracture in the stable group), false-positive (FP; fracture in the stable group) and false negative (FN; no fracture in the unstable group) cases. Seven retrospective studies were included that reported the accuracy of the SINS (Cunha, 2012; Sahgal, 2013; Thibault, 2014; Thibault, 2015; Aiba, 2016; Shi, 2018 and Lee, 2018). The Spinal Instability Neoplastic Score (SINS) (at threshold of 7) was used as predictor.
Table 2. Characteristics of included studies
|
Study |
Participants |
Predictors |
Follow-up |
Outcomes |
Comments |
Risk of bias (per outcome measure)* |
|
Included in systematic review Kim, 2021 |
||||||
|
Aiba, 2016 |
N=47
Mean age (SD): 67 years
Primary cancer (major organs): Non-small cell lung cancer |
SINS (at threshold of 7) |
10.2 (SD=13.7) months |
Accuracy, sensitivity and specificity to predict vertebral compression fractures |
Source of funding and conflicts of interest not reported. Study performed in Japan |
Serious. Details, please see risk of bias assessment in NICE guideline |
|
Cunha, 2012 |
N=90
Mean age (SD): 57.0 (18.4) years
Primary cancer (major organs): multiple (kidney, breast, lung) |
SINS (at threshold of 7)
|
7.4 (SD=9.4) months |
Accuracy, sensitivity and specificity to predict vertebral compression fractures |
Source of funding and conflicts of interest not reported. Study performed in Canada |
Serious. Details, please see risk of bias assessment in NICE guideline |
|
Lee, 2018 |
N=53
Mean age (SD): 61.0 (10.7) years
Primary cancer (major organs): Colorectal Cancer |
SINS (at threshold of 7)
|
10 (SD=24.50 months |
Accuracy, sensitivity and specificity to predict vertebral compression fractures |
Source of funding and conflicts of interest not reported. Study performed in Korea |
Serious. Details, please see risk of bias assessment in NICE guideline |
|
Sahgal, 2013 |
N=252
Mean age (SD): 57.6 (18.4) years
Primary cancer (major organs): multiple (kidney, breast, lung) |
SINS (at threshold of 7)
|
11.5 (SD=28.8) months |
Accuracy, sensitivity and specificity to predict vertebral compression fractures |
Source of funding and conflicts of interest not reported. Study performed in the US |
Serious. Details, please see risk of bias assessment in NICE guideline |
|
Shi, 2018 |
N=203
Mean age (SD): 60.0 (18.9) years
Primary cancer (major organs): multiple (breast, lung) |
SINS (at threshold of 7)
|
5.9 months |
Accuracy, sensitivity and specificity to predict vertebral compression fractures |
Source of funding and conflicts of interest not reported. Study performed in the US |
Serious. Details, please see risk of bias assessment in NICE guideline |
|
Thibault, 2014 |
N=37
Mean age (SD): 63.0 (12.5) years
Primary cancer (major organs): renal cell cancer |
SINS (at threshold of 7)
|
12.3 (SD=13.8) months |
Accuracy, sensitivity and specificity to predict vertebral compression fractures |
Source of funding and conflicts of interest not reported. Study performed Canada |
Serious. Details, please see risk of bias assessment in NICE guideline |
|
Thibault, 2015 |
N=116
Mean age (SD): 60.2 (13.9) years
Primary cancer (major organs): renal cell cancer |
SINS (at threshold of 7)
|
8.0 (SD=19.4) months |
Accuracy, sensitivity and specificity to predict vertebral compression fractures |
Source of funding and conflicts of interest not reported. Study performed the US and Canada |
Serious. Details, please see risk of bias assessment in NICE guideline |
|
Individual studies |
||||||
|
Ehresman, 2020 |
N=105
Sex 57 males / 48 females
Age: 61.2 years (SD not reported)
|
SINS (at threshold of 7)
|
Median 26 months for those with VCF and 34 months for those without VCF |
Sensitivity and specificity to predict vertebral compression fractures |
Source of funding not reported. Non-commercial conflicts of interest. |
Serious. Details, please see risk of bias assessment in NICE guideline |
*For further details, see risk of bias table in the appendix
Results
The sensitivity and specificity for predicting VCF with the SINS is shown in table 3.
Table 3. Overview of sensitivity, specificity and other diagnostic accuracy measures for the SINS at cut-off of 7 (adapted from Ehresman, 2020; Kim, 2021 and the NICE guideline)
|
Study |
Sensitivity (crucial) |
Specificity (important) |
TP |
FP |
FN |
TN |
AUC |
|
Aiba, 2016 |
0.80 (95%CI 0.52 to 0.96) |
0.53 (95%CI 0.35 to 0.71) |
12 |
15 |
3 |
17 |
NR |
|
Cunha, 2012 |
0.74 (95%CI 0.49 to 0.91) |
0.61 (95%CI 0.52 to 0.69) |
14 |
58 |
5 |
90 |
NR |
|
Ehresman, 2020 |
0.64 (95%CI NR) |
0.82 (95%CI NR) |
36 |
9 |
20 |
40 |
0.73 |
|
Lee, 2018 |
0.95 (95%CI 0.77 to 1.00) |
0.66 (95%CI 0.57 to 0.75) |
21 |
42 |
1 |
83 |
NR |
|
Sahgal, 2013 |
0.77 (95%CI 0.64 to 0.87) |
0.52 (95%CI 0.47 to 0.58) |
44 |
168 |
13 |
185 |
NR |
|
Shi, 2018 |
0.72 (95%CI 0.58 to 0.84) |
0.42 (95%CI 0.35 to 0.49) |
36 |
116 |
14 |
83 |
NR |
|
Thibault, 2014 |
0.80 (95%CI 0.44 to 0.97) |
0.69 (95%CI 0.54 to 0.81) |
8 |
16 |
2 |
35 |
NR |
|
Thibault, 2015 |
0.85 (95%CI 0.69 to 0.95) |
0.42 (95%CI 0.34 to 0.50) |
29 |
89 |
5 |
64 |
NR |
Abbreviations: AUC=area under the receiver operating characteristic curve; TP=true positive; FP=false positive; FN=false negative; TN=true negative; NR=not reported
Search and select
A systematic review of the literature was performed to answer the following question(s):
What is the prognostic value of validated scoring systems and clinical evaluation in evaluating spinal instability in people with spinal metastases or direct malignant infiltration of the spine, with or without spinal cord compression?
Table 1. PICO(TS)
| Patients | Patients with spinal metastases |
| Intervention |
Clinical evaluation and/or multivariable prognostic tools such to predict fractures, for example: 1. model in which Spine Instability Neoplastic Score (SINS) is used as a factor for predicting the event after (x) weeks/months 2. model in which MM (multiple myeloma) spinal stability scoring system is used as a factor for predicting the event after (x) weeks/months |
| Control | No model/coincidence |
| Outcomes | Sensitivity, specificity, negative predictive value, positive predictive value |
| Timing | Primary diagnoses spinal metastases |
| Setting | At the hospital |
| Other selection criteria | Study design: systematic reviews, randomized controlled trials (about the effect of prediction models), other literature about development and validation of prediction models |
Relevant outcome measures
The guideline panel considered sensitivity and negative predictive value as a critical outcome measure for decision making; and specificity and positive predictive value as an important outcome measure for decision making.
Er bestaat geen scoresysteem die als losstaand onderdeel kan gebruiken als absolute voorspeller voor instabiliteit. Bij het gebruik van de SINS als tool voor overleg gaat de voorkeur uit naar een sens/spec van >0.90. Hierin is klinische beoordeling minstens zo belangrijk als een scoresysteem.
Search and select (Methods)
A systematic literature search was performed by a literature specialists using the following bibliographic databases: Embase.com and Ovid/Medline. Both databases were searched from from January 1st, 2014 until the 2nd of July, 2024 for systematic reviews, RCTs and observational studies. Systematic searches were completed using a combination of controlled vocabulary/subject headings (e.g., Emtree-terms, MeSH) wherever they were available and natural language keywords. The overall search strategy was derived from three primary search concepts: (1) spinal metastases; (2) spinal (in)stability; (3) prognostic/diagnostic filter/clinical evaluation. Duplicates were removed using EndNote software. After deduplication a total of 333 records were imported for title/abstract screening. Initially, seven studies were selected based on title and abstract screening. After reading the full text, five studies were excluded (see the exclusion table under the tab ‘Evidence tabellen’), and two studies were included (Ehresman, 2020; Kim, 2021). These two studies were included in the NICE guideline. Therefore, NICE guideline is used for the development of this module.
- 1 - Ehresman J, Schilling A, Pennington Z, Gui C, Chen X, Lubelski D, Ahmed AK, Cottrill E, Khan M, Redmond KJ, Sciubba DM. A novel MRI-based score assessing trabecular bone quality to predict vertebral compression fractures in patients with spinal metastasis. J Neurosurg Spine. 2019 Dec 20;32(4):499-506. doi: 10.3171/2019.9.SPINE19954. PMID: 31860825.
- 2 - Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, Harrop JS, Fehlings MG, Boriani S, Chou D, Schmidt MH. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine. 2010 Oct 15;35(22):E1221-9.
- 3 - Kim YR, Lee CH, Yang SH, Hyun SJ, Kim CH, Park SB, Kim KJ, Chung CK. Accuracy and precision of the spinal instability neoplastic score (SINS) for predicting vertebral compression fractures after radiotherapy in spinal metastases: a meta-analysis. Sci Rep. 2021 Mar 10;11(1):5553. doi: 10.1038/s41598-021-84975-3. PMID: 33692442; PMCID: PMC7947012.
- 4 - NICE, Spinal metastases and metastatic spinal cord compression: evidence reviews for Prognostic tools – spinal instability FINAL (September 2023) https://www.nice.org.uk/guidance/ng234/evidence/k-prognostic-tools-spinal-instability-pdf-472849134229, assessed 4 nov 2025.
Evidence tables
Risk of Bias tables
See NICE guideline.
Table of excludes studies
|
Reference |
Reason for exclusion |
|
Bostel T, Akbaba S, Wollschläger D, Klodt T, Oebel L, Mayer A, Drabke S, Sprave T, Debus J, Förster R, Rief H, Rühle A, Grosu AL, Schmidberger H, Nicolay NH. Comparative Analyses of Two Established Scores to Assess the Stability of Spinal Bone Metastases Before and After Palliative Radiotherapy. Front Oncol. 2021 Oct 19;11:753768. doi: 10.3389/fonc.2021.753768. PMID: 34737961; PMCID: PMC8562722. |
Wrong outcomes: no sensitivity or specificity reported |
|
Gui C, Chen X, Sheikh K, Mathews L, Lo SL, Lee J, Khan MA, Sciubba DM, Redmond KJ. Radiomic modeling to predict risk of vertebral compression fracture after stereotactic body radiation therapy for spinal metastases. J Neurosurg Spine. 2021 Sep 24;36(2):294-302. doi: 10.3171/2021.3.SPINE201534. PMID: 34560656. |
Not matchting with PICO: after radiotherapy (no untreated spine with metastasis) |
|
Nakanishi K, Hijikata Y, Uchino K, Sugimoto Y, Iba H, Watanabe S, Mitani S. Predicting Skeletal-related Events Using SINS. Spine (Phila Pa 1976). 2024 Nov 15;49(22):E367-E371. doi: 10.1097/BRS.0000000000004983. Epub 2024 Mar 13. PMID: 38475677. |
Wrong outcomes: no sensitivity or specificity reported |
|
Pennington Z, Mikula AL, Lakomkin N, Martini M, Clarke MJ, Sebastian AS, Freedman BA, Rose PS, Karim SM, Nassr A, Bydon M, Kowalchuk RO, Merrell KW, Krauss WE, Fogelson JL, Elder BD. Comparison of Hounsfield units and vertebral bone quality score for the prediction of time to pathologic fracture in mobile spine metastases treated with radiotherapy. J Neurosurg Spine. 2023 Oct 13;40(1):19-27. doi: 10.3171/2023.8.SPINE23420. PMID: 37856377. |
Not matching with PICO: predictive value of CT/MRI to determine the risk of fracture after radiotherapy |
|
Vargas E, Lockney DT, Mummaneni PV, Haddad AF, Rivera J, Tan X, Jamieson A, Mahmoudieh Y, Berven S, Braunstein SE, Chou D. An analysis of tumor-related potential spinal column instability (Spine Instability Neoplastic Scores 7-12) eventually requiring surgery with a 1-year follow-up. Neurosurg Focus. 2021 May;50(5):E6. doi: 10.3171/2021.2.FOCUS201098. PMID: 33932936. |
Wrong outcomes: no sensitivity or specificity reported |
Beoordelingsdatum en geldigheid
Publicatiedatum : 05-06-2026
Beoordeeld op geldigheid : 05-06-2026
Algemene gegevens
De ontwikkeling/herziening van deze richtlijnmodule werd ondersteund door het Kennisinstituut van de Federatie Medisch Specialisten (www.demedischspecialist.nl/kennisinstituut) en werd gefinancierd door de Stichting Kwaliteitsgelden Medisch Specialisten (SKMS). De financier heeft geen enkele invloed gehad op de inhoud van de richtlijnmodule.
Samenstelling werkgroep
Voor het ontwikkelen van de richtlijnmodule is in 2023 een multidisciplinaire werkgroep ingesteld, bestaande uit vertegenwoordigers van alle relevante specialismen (zie hiervoor de Samenstelling van de werkgroep) die betrokken zijn bij de zorg voor patiënten met wervelmetastasen.
Werkgroep
- dr. W. (Walter) Taal (voorzitter), neuroloog Erasmuc MC, Nederlandse Vereniging voor Neurologie
- drs. L. (Lena) van Iterson, AIOS-neuroloog Elisabeth-TweeSteden Ziekenhuis, Nederlandse Vereniging voor Neurologie
- drs. R.P.B. (Robin) Boltjes, neuroloog Antoni van Leeuwenhoek Ziekenhuis, Nederlandse Vereniging voor Neurologie
- Prof. dr. JJ. (Jorrit-Jan) Verlaan, Orthopedisch chirurg UMC Utrecht, Nederlandse Orthopaedische Vereniging
- dr. J. (Jasper) van Tiel, Orthopedisch chirurg UMC Utrecht, Nederlandse Orthopaedische Vereniging
- dr. V. (Vivian) Bongers, Nucleaire geneeskunde Diakonessenhuis Utretch, Nederlandse Vereniging voor Nucleaire Geneeskunde
- Prof. dr. R. (Ronald) Bartels, Neurochirurg Radboudumc, Nederlandse Vereniging voor Neurochirurgie
- dr. S.O. (Selma) Algra, Radioloog UMC Utrecht, Nederlandse Vereniging voor Radiologie
- drs. M.G.A. (Maaike) Schippers, radiotherapeut Instituut Verbeeten, Nederlandse Vereniging voor Radiotherapie en Oncologie
- dr. J.M. (Joanne) van der Velden, radiotherapeut UMC Utrecht, Nederlandse Vereniging voor Radiotherapie en Oncologie
- dr. M.S. (Marthe) Paats, longarts Erasmus MC, Nederlandse Vereniging voor Artsen voor Longziekten en TBC
- dr. P.F. (Paula) Ypma, Internist hematoloog Haga Ziekenhuis, Nederlandse Internisten Vereniging
- dr. F.Y.F.L. (Filip) de Vos, internist-oncoloog en kaderarts palliatieve zorg UMC Utrecht, Nederlandse Internisten Vereniging
- dr. M. (Marije) Vos- van der Hulst, revalidatiearts Sint Maartenskliniek, Nederlandse Vereniging van Revalidatieartsen (vanaf oktober 2025)
- Mevr. S (Silvie) Dronkers†, patiëntvertegenwoordiger, Stichting Darmkanker (tot oktober 2025)
- dr. T.A.R. (Tebbe) Sluis†, Revalidatiearts Rijndam, Nederlandse Vereniging van Revalidatieartsen (tot mei 2025)
Klankbordgroep
- Mevr. Manon Immerzeel, Verpleegkundig specialist Reinier de Graaf ziekenhuis, Verpleegkundigen en Verzorgenden Nederland
- drs. A. (Anita) Ophof, anesthesioloog Antoni van Leeuwenhoek Ziekenhuis, Nederlandse Vereniging voor Anesthesiologie
Met dank aan
- dr. J.H. (Jurgen) Runge, interventieradioloog, UMC Groningen, Nederlandse Vereniging voor Radiologie
Met ondersteuning van
- dr. J. (Josefien) Buddeke, senior adviseur, Kennisinstituut van de Federatie Medisch Specialisten (vanaf juli 2024)
- dr. L. (Linda) Oostendorp, senior adviseur, Kennisinstituut van de Federatie Medisch Specialisten (tot juli 2024)
- drs. B. (Beatrix) Vogelaar, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- dr. J. (Jing) de Haan-Du, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- drs. D. (Danique) Middelhuis, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- drs. A. (Alies) Oost, informatiespecialist, Kennisinstituut van de Federatie Medisch Specialisten
Belangenverklaringen
Een overzicht van de belangen van werkgroepleden en het oordeel over het omgaan met eventuele belangen vindt u in onderstaande tabel. De ondertekende belangenverklaringen zijn op te vragen bij het secretariaat van het Kennisinstituut van de Federatie Medisch Specialisten via secretariaat@kennisinstituut.nl.
Gemelde (neven)functies en belangen werkgroep
|
Naam WERKGROEP |
Hoofdfunctie |
Nevenwerkzaamheden |
Persoonlijke Financiele_Belangen |
Persoonlijke Relaties |
Extern Gefinancierd Onderzoek |
Intellectuele Belangen Reputatie |
Overige Belangen |
Datum |
Acties |
|
Jasper van Tiel |
Orthopedisch chirurg UMC Utrecht en Acibadem IMC |
geen |
geen |
geen |
geen |
geen |
geen |
22-11-2023 |
Geen restrictie |
|
Joanne van der Velden |
Radiotherapeut bij het UMC Utrecht, betaald |
Bestuurslid bij het Landelijk Platform Palliatieve Radiotherapie (NVRO), onbetaald |
Geen |
Geen |
Deelname aan 2 extern gefinancierde onderzoeken, zie onder |
Verwerven van erkenning speelt mee aan mijn deelname aan de werkgroep richtlijn Wervelmetastasen |
Geen overige belangen |
28-12-2023 |
Geen restrictie |
|
Jorrit-Jan Verlaan |
Orthopedisch chirurg, UMC Utrecht (0.4 Fte) |
Lid steering committee AO Spine Knowledge Forum Tumor (onbetaald maar met onkosten vergoeding). |
Hoe de richtlijn wordt vormgegeven staat los van mijn persoonlijke financiële belangen. Er zijn ook geen belangen voor SentryX hoe de richtlijn wordt vormgegeven. |
geen |
Ja. |
Ik heb nationale/internationale expertise/reputatie en een leerstoel op het gebied van de behandeling van wervelmetastasen. Een goed uitgevoerde richtlijn kan helpen deze expertise/reputatie meer exposure te geven maar de impact en eventuele belangenverstrengeling zijn mij onduidelijk. |
geen |
22-11-2023 |
Geen restrictie. Geen penvoerder bij module 'Inschatten overleving'. |
|
Filip de Vos |
Internist-oncoloog en kaderarts palliatieve zorg |
geen |
geen |
geen |
ja |
geen |
BMS Advisory Board; Faculty member ESMO CNS tumors; Quality of Care commission Dutch Society of Medical Oncology; |
20-12-2023 |
Geen restrictie. (In de richtlijn worden geen systemische therapien aanbevolen.) |
|
Maaike Schippers |
Radiotherapeut |
geen |
geen |
geen |
geen |
geen |
geen |
3-12-2023 |
Geen restrictie |
|
Marthe Paats |
Longarts Erasmus MC |
geen |
Geen relevant voor huidige richtlijn. |
geen |
industrie gesponsorde studies lopend in het Erasmus MC waarbij ik lokale PI ben. |
geen |
geen |
26-02-2024 |
Geen restrictie. In de richtlijn worden geen systemische therapien aanbevolen. |
|
Robin Boltjes |
Neuroloog in Antoni van Leeuwenhoek/NKI |
geen |
geen |
nee |
geen |
geen |
nee |
22-11-2023 |
Geen restrictie |
|
Ronald Bartels |
Neurochirurg |
Medisch Adviseur |
geen |
nee |
geen |
net |
geen |
03-04-2024 |
Restrictie ten aanzien van besluitvorming betreffende 'Inschatten overleving'. Vanuit expertise wel meegediscussierd over inhoud van de module, niet betrokken bij het formuleren van de aanbevelingen. |
|
Tebbe Sluis |
revalidatiearts |
geen |
geen |
geen |
geen |
geen |
geen |
11-12-2023 |
Geen restrictie |
|
Vivian Bongers |
MSB Domstad, medisch specialist |
Uitgeverij Prelum, Redacteur tijdschrift IMAGO |
Geen |
Geen |
Geen |
Geen |
Geen |
23-11-2023 |
Geen restrictie |
|
Ypma |
internist hematoloog Hagaziekenhuis den Haag |
geen |
geen |
geen |
Alphabet trial |
geen |
nvt |
04-05-2024 |
Geen restrictie |
|
Van Iterson |
AIOS neurologie |
geen |
geen |
geen |
geen |
geen |
geen |
25-04-2024 |
Geen restrictie |
|
Selma Algra |
Radioloog,St Jansdal Ziekenhuis |
geen |
geen |
geen |
geen |
geen |
geen |
03-09-2024 |
Geen resctrictie |
|
Silvie Dronkers |
Stichting Darmkanker |
geen |
geen |
geen |
geen |
geen |
geen |
06-02-2025 |
Geen restrictie |
|
Walter Taal (voorzitter) |
Neuroloog, Erasmus MC, Rotterdam |
Geen |
Geen |
Geen |
Ja. Alleen op het gebied van neurofibromatose type 1 |
Geen |
Geen |
07-06-2023 |
Geen restrictie |
|
Marije Vos-van der Hulst |
Revalidatie arts, Sint Maartenskliniek Nijmegen |
Voorzitter werkgroep revalidatie artsen dwarslaesie (Nederlands Vlaams dwarslaesie genootschap= werkgroep van de vereniging revalidatieartsen nederland (VRA)) |
geen |
geen |
geen |
geen |
geen |
13-10-2025 |
Geen restrictie |
|
Naam KLANKBORDGROEP |
Hoofdfunctie |
Nevenwerkzaamheden |
Persoonlijke Financiele_Belangen |
Persoonlijke Relaties |
Extern Gefinancierd Onderzoek |
Intellectuele Belangen Reputatie |
Overige Belangen |
Datum |
Acties |
|
Manon Immerzeel |
Deelnemer clusterstuurgroep |
Geen |
Geen |
Geen |
Geen |
Voorzitter in het bestuur van V&VN pijnverpleegkundigen |
Neen |
22-03-2022 |
Geen restrictie |
|
Anita Ophof |
Antoni van Leeuwenhoek Ziekenhuis |
Geen |
Geen |
Geen |
Geen |
Geen |
Geen |
01-05-2025 |
Geen restrictie |
Inbreng patiëntenperspectief
Kwalitatieve raming van mogelijke financiële gevolgen in het kader van de Wkkgz
Bij de richtlijnmodule voerde de werkgroep conform de Wet kwaliteit, klachten en geschillen zorg (Wkkgz) een kwalitatieve raming uit om te beoordelen of de aanbevelingen mogelijk leiden tot substantiële financiële gevolgen. Bij het uitvoeren van deze beoordeling is de richtlijnmodule op verschillende domeinen getoetst (zie het stroomschema bij Werkwijze).
De kwalitatieve raming is toegevoegd aan het einde van elke herziene module.
| Module | Uitkomst raming | Toelichting |
| Evaluation of spinal stability | Geen substantiële financiële gevolgen | Hoewel uit de toetsing volgt dat de aanbevelingen breed toepasbaar zijn (5.000-40.000 patiënten), volgt ook uit de toetsing dat het geen nieuwe manier van zorgverlening of andere organisatie van zorgverlening betreft. Er worden daarom geen substantiële financiële gevolgen verwacht. |
Werkwijze
Voor meer details over de gebruikte richtlijnmethodologie verwijzen wij u naar de Werkwijze. Relevante informatie voor de ontwikkeling/herziening van deze richtlijnmodule is hieronder weergegeven.
Zoekverantwoording
Algemene informatie
|
Cluster/richtlijn: NVN Wervelmetastasen |
|
|
Uitgangsvraag/modules: UV9 Hoe kan bij patiënten met wervelmetastasen de stabiliteit van de betrokken wervels bepaald worden met het oog op een eventuele stabiliserende operatie? |
|
|
Database(s): Embase.com, Ovid/Medline |
Datum: 2 juli 2024 |
|
Periode: vanaf 2014 |
Talen: geen restrictie |
|
Literatuurspecialist: Alies Oost |
Rayyan review: https://rayyan.ai/reviews/1082004 |
|
BMI-zoekblokken: voor verschillende opdrachten wordt (deels) gebruik gemaakt van de zoekblokken van BMI-Online https://blocks.bmi-online.nl/ Deduplication: voor het ontdubbelen is gebruik gemaakt van http://dedupendnote.nl/ |
|
|
Toelichting: Voor deze vraag is gezocht op de elementen:
De sleutelartikelen worden gevonden met deze search |
|
|
Te gebruiken voor richtlijntekst: In de databases Embase.com en Ovid/Medline is op 2 juli 2024 systematisch gezocht naar studies vanaf 2014 over het bepalen van de (in)stabiliteit van de wervelkolom bij patiënten met wervelmetastasen. De literatuurzoekactie leverde 333 unieke treffers op. |
|
Zoekopbrengst
|
|
EMBASE |
OVID/MEDLINE |
Ontdubbeld |
|
SR |
18 |
16 |
23 |
|
RCT |
34 |
30 |
50 |
|
Observationele studies |
165 |
144 |
194 |
|
Overig |
55 |
38 |
66 |
|
Totaal |
272 |
228 |
333* |
*in Rayyan
Zoekstrategie
Embase.com
|
No. |
Query |
Results |
|
#1 |
'spine metastasis'/exp OR 'spinal cord metastasis'/exp OR 'cervical lymph node metastasis'/exp OR (('spinal cord tumor'/exp OR 'spine tumor'/exp OR 'spinal cord compression'/exp OR (((spine* OR spinal* OR medulla*) NEAR/3 (compress* OR impingement OR pinch*)):ti,ab,kw)) AND ('metastasis'/de OR 'bone metastasis'/de OR metasta*:ti,ab,kw OR oligometasta*:ti,ab,kw OR micrometasta*:ti,ab,kw OR (((neoplas* OR carcinoma OR cancer* OR malignan* OR tumor* OR tumour*) NEAR/4 (dissemination OR disseminated OR spread* OR secondary OR migrat* OR seed*)):ti,ab,kw))) OR (((spine* OR spinal* OR intraspinal OR vertebr* OR 'cauda equina' OR cervicothoracic OR cord* OR coccyx OR duralsac* OR 'dural sac*' OR epidural OR extradural OR 'extra dural' OR intervertebr* OR lumbar OR lumbosac* OR 'lumbo sac*' OR orthothoracic OR sacral OR sacrum OR 'thecal sac*' OR thoracolumbar OR odontoid OR 'anterior horn' OR 'posterior horn' OR 'extrapyramidal tract*' OR 'pyramidal tract*' OR 'substantia gelatinosa' OR 'spinothalamic tract*') NEAR/4 (metast* OR oligometast* OR micrometast*)):ti,ab,kw) OR ((cervical*:ti,ab,kw OR medulla*:ti,ab,kw OR intramedulla*:ti,ab,kw OR thoracic:ti,ab,kw) AND (spine*:ti,ab,kw OR spinal*:ti,ab,kw OR intraspinal:ti,ab,kw OR vertebr*:ti,ab,kw OR intervertebr*:ti,ab,kw OR lumbar:ti,ab,kw) AND (metast*:ti,ab,kw OR oligometast*:ti,ab,kw OR micrometast*:ti,ab,kw)) OR mescc:ti,ab,kw OR mscc:ti,ab,kw |
29256 |
|
#2 |
'spine instability'/exp OR 'spine stabilization'/exp OR (((spine* OR spinal) NEAR/3 (stabili* OR instabili* OR unstable OR stable)):ti,ab,kw) OR sins:ti,ab,kw |
20902 |
|
#3 |
'area under the curve'/exp OR 'brier score'/exp OR 'computer prediction'/exp OR 'c statistic'/exp OR 'c statistics'/exp OR 'integrated discrimination improvement'/exp OR 'net reclassification improvement'/exp OR 'net reclassification index'/exp OR 'prediction'/exp OR 'predictive model'/exp OR 'predictive modeling'/exp OR 'predictive validity'/exp OR 'regression analysis'/exp OR 'statistical model'/exp OR 'area under the curve':ti,ab,kw OR 'brier score*':ti,ab,kw OR 'c statistic*' OR 'computer prediction':ti,ab,kw OR 'decision curve anal*':ti,ab,kw OR (('net reclassification' NEAR/2 (improvement OR index)):ti,ab,kw) OR (((predict* OR statistical*) NEAR/3 (model* OR validity OR value)):ti,ab,kw) OR 'proportional hazards model*':ti,ab,kw OR 'r square*':ti,ab,kw OR regression:ti,ab,kw OR predict*:ti OR multivariate:ti,ab,kw OR multivariab*:ti,ab,kw OR 'sensitivity and specificity'/de OR sensitivity:ab,ti OR specificity:ab,ti OR predict*:ab,ti OR 'roc curve':ab,ti OR 'receiver operator':ab,ti OR 'receiver operators':ab,ti OR likelihood:ab,ti OR 'diagnostic error'/exp OR 'diagnostic accuracy'/exp OR 'diagnostic test accuracy study'/exp OR 'inter observer':ab,ti OR 'intra observer':ab,ti OR interobserver:ab,ti OR intraobserver:ab,ti OR validity:ab,ti OR kappa:ab,ti OR reliability:ab,ti OR reproducibility:ab,ti OR ((test NEAR/2 're-test'):ab,ti) OR ((test NEAR/2 'retest'):ab,ti) OR 'reproducibility'/exp OR accuracy:ab,ti OR 'differential diagnosis'/exp OR 'validation study'/de OR 'measurement precision'/exp OR 'diagnostic value'/exp OR 'reliability'/exp OR 'predictive value'/exp OR ppv:ti,ab,kw OR npv:ti,ab,kw OR (((false OR true) NEAR/3 (negative OR positive)):ti,ab) |
7968353 |
|
#4 |
'clinical evaluation'/exp OR 'physical examination'/exp OR 'anamnesis'/exp OR (((clinical* OR physical*) NEAR/3 (evaluat* OR examin* OR diagnos* OR consult*)):ti,ab,kw) OR anamnes*:ti,ab,kw OR 'history taking':ti,ab,kw OR 'medical interview*':ti,ab,kw |
1502821 |
|
#5 |
#1 AND #2 AND (#3 OR #4) NOT ('conference abstract'/it OR 'editorial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp) NOT (('adolescent'/exp OR 'child'/exp OR adolescent*:ti,ab,kw OR child*:ti,ab,kw OR schoolchild*:ti,ab,kw OR infant*:ti,ab,kw OR girl*:ti,ab,kw OR boy*:ti,ab,kw OR teen:ti,ab,kw OR teens:ti,ab,kw OR teenager*:ti,ab,kw OR youth*:ti,ab,kw OR pediatr*:ti,ab,kw OR paediatr*:ti,ab,kw OR puber*:ti,ab,kw) NOT ('adult'/exp OR 'aged'/exp OR 'middle aged'/exp OR adult*:ti,ab,kw OR man:ti,ab,kw OR men:ti,ab,kw OR woman:ti,ab,kw OR women:ti,ab,kw)) AND [2014-2024]/py |
272 |
|
#6 |
'meta analysis'/exp OR 'meta analysis (topic)'/exp OR metaanaly*:ti,ab OR 'meta analy*':ti,ab OR metanaly*:ti,ab OR 'systematic review'/de OR 'cochrane database of systematic reviews'/jt OR prisma:ti,ab OR prospero:ti,ab OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab) OR ((systemic* NEAR/1 review*):ti,ab) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab) OR (((literature NEAR/3 review*):ti,ab) AND (search*:ti,ab OR database*:ti,ab OR 'data base*':ti,ab)) OR (('data extraction':ti,ab OR 'data source*':ti,ab) AND 'study selection':ti,ab) OR ('search strategy':ti,ab AND 'selection criteria':ti,ab) OR ('data source*':ti,ab AND 'data synthesis':ti,ab) OR medline:ab OR pubmed:ab OR embase:ab OR cochrane:ab OR (((critical OR rapid) NEAR/2 (review* OR overview* OR synthes*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synthes*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynthes*:ti,ab OR 'meta synthes*':ti,ab |
1041707 |
|
#7 |
'clinical trial'/exp OR 'randomization'/exp OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'crossover procedure'/exp OR 'placebo'/exp OR 'prospective study'/exp OR rct:ab,ti OR random*:ab,ti OR 'single blind':ab,ti OR 'randomised controlled trial':ab,ti OR 'randomized controlled trial'/exp OR placebo*:ab,ti |
4061567 |
|
#8 |
'major clinical study'/de OR 'clinical study'/de OR 'case control study'/de OR 'family study'/de OR 'longitudinal study'/de OR 'retrospective study'/de OR 'prospective study'/de OR 'comparative study'/de OR 'cohort analysis'/de OR ((cohort NEAR/1 (study OR studies)):ab,ti) OR (('case control' NEAR/1 (study OR studies)):ab,ti) OR (('follow up' NEAR/1 (study OR studies)):ab,ti) OR (observational NEAR/1 (study OR studies)) OR ((epidemiologic NEAR/1 (study OR studies)):ab,ti) OR (('cross sectional' NEAR/1 (study OR studies)):ab,ti) |
8299631 |
|
#9 |
'case control study'/de OR 'comparative study'/exp OR 'control group'/de OR 'controlled study'/de OR 'controlled clinical trial'/de OR 'crossover procedure'/de OR 'double blind procedure'/de OR 'phase 2 clinical trial'/de OR 'phase 3 clinical trial'/de OR 'phase 4 clinical trial'/de OR 'pretest posttest design'/de OR 'pretest posttest control group design'/de OR 'quasi experimental study'/de OR 'single blind procedure'/de OR 'triple blind procedure'/de OR (((control OR controlled) NEAR/6 trial):ti,ab,kw) OR (((control OR controlled) NEAR/6 (study OR studies)):ti,ab,kw) OR (((control OR controlled) NEAR/1 active):ti,ab,kw) OR 'open label*':ti,ab,kw OR (((double OR two OR three OR multi OR trial) NEAR/1 (arm OR arms)):ti,ab,kw) OR ((allocat* NEAR/10 (arm OR arms)):ti,ab,kw) OR placebo*:ti,ab,kw OR 'sham-control*':ti,ab,kw OR (((single OR double OR triple OR assessor) NEAR/1 (blind* OR masked)):ti,ab,kw) OR nonrandom*:ti,ab,kw OR 'non-random*':ti,ab,kw OR 'quasi-experiment*':ti,ab,kw OR crossover:ti,ab,kw OR 'cross over':ti,ab,kw OR 'parallel group*':ti,ab,kw OR 'factorial trial':ti,ab,kw OR ((phase NEAR/5 (study OR trial)):ti,ab,kw) OR ((case* NEAR/6 (matched OR control*)):ti,ab,kw) OR ((match* NEAR/6 (pair OR pairs OR cohort* OR control* OR group* OR healthy OR age OR sex OR gender OR patient* OR subject* OR participant*)):ti,ab,kw) OR ((propensity NEAR/6 (scor* OR match*)):ti,ab,kw) OR versus:ti OR vs:ti OR compar*:ti OR ((compar* NEAR/1 study):ti,ab,kw) OR (('major clinical study'/de OR 'clinical study'/de OR 'cohort analysis'/de OR 'observational study'/de OR 'cross-sectional study'/de OR 'multicenter study'/de OR 'correlational study'/de OR 'follow up'/de OR cohort*:ti,ab,kw OR 'follow up':ti,ab,kw OR followup:ti,ab,kw OR longitudinal*:ti,ab,kw OR prospective*:ti,ab,kw OR retrospective*:ti,ab,kw OR observational*:ti,ab,kw OR 'cross sectional*':ti,ab,kw OR cross?ectional*:ti,ab,kw OR multicent*:ti,ab,kw OR 'multi-cent*':ti,ab,kw OR consecutive*:ti,ab,kw) AND (group:ti,ab,kw OR groups:ti,ab,kw OR subgroup*:ti,ab,kw OR versus:ti,ab,kw OR vs:ti,ab,kw OR compar*:ti,ab,kw OR 'odds ratio*':ab OR 'relative odds':ab OR 'risk ratio*':ab OR 'relative risk*':ab OR 'rate ratio':ab OR aor:ab OR arr:ab OR rrr:ab OR ((('or' OR 'rr') NEAR/6 ci):ab))) |
15207176 |
|
#10 |
#5 AND #6 - SR |
18 |
|
#11 |
#5 AND #7 NOT #10 - RCT |
34 |
|
#12 |
#5 AND (#8 OR #9) NOT (#10 OR #11) - observationeel |
165 |
|
#13 |
#5 NOT (#10 OR #11 OR #12) - overig |
55 |
Ovid/Medline
|
# |
Searches |
Results |
|
1 |
((exp Spinal Neoplasms/ or exp Spinal Cord Neoplasms/ or exp Spinal Cord Compression/ or ((spine* or spinal* or medulla*) adj3 (compress* or impingement or pinch*)).ti,ab,kf.) and (exp Neoplasm Metastasis/ or metasta*.ti,ab,kf. or oligometasta*.ti,ab,kf. or micrometasta*.ti,ab,kf. or ((neoplas* or carcinoma or cancer* or malignan* or tumor* or tumour*) adj4 (dissemination or disseminated or spread* or secondary or migrat* or seed*)).ti,ab,kf.)) or ((spine* or spinal* or intraspinal or vertebr* or 'cauda equina' or cervicothoracic or cord* or coccyx or duralsac* or 'dural sac*' or epidural or extradural or 'extra dural' or intervertebr* or lumbar or lumbosac* or 'lumbo sac*' or orthothoracic or sacral or sacrum or 'thecal sac*' or thoracolumbar or odontoid or "Anterior Horn" or "Posterior Horn" or "Extrapyramidal Tract*" or "Pyramidal Tract*" or "Substantia Gelatinosa" or "Spinothalamic Tract*") adj4 (metast* or oligometast* or micrometast*)).ti,ab,kf. or ((cervical* or medulla* or intramedulla* or thoracic) and (spine* or spinal* or intraspinal or vertebr* or intervertebr* or lumbar) and (metast* or oligometast* or micrometast*)).ti,ab,kf. or mescc.ti,ab,kf. or mscc.ti,ab,kf. |
15151 |
|
2 |
exp Joint Instability/ or ((spine* or spinal) adj3 (stabili* or instabili* or unstable or stable)).ti,ab,kf. or sins.ti,ab,kf. |
32923 |
|
3 |
Area Under Curve/ or exp Forecasting/ or "Predictive Value of Tests"/ or exp Multivariate Analysis/ or exp Regression Analysis/ or exp Models, Statistical/ or area under the curve.ti,ab,kf. or brier score*.ti,ab,kf. or c statistic*.ti,ab,kf. or computer prediction.ti,ab,kf. or decision curve anal*.ti,ab,kf. or (net reclassification adj2 (improvement or index)).ti,ab,kf. or ((predict* or statistical*) adj3 (model* or validity or value)).ti,ab,kf. or proportional hazards model*.ti,ab,kf. or r square*.ti,ab,kf. or regression.ti,ab,kf. or predict*.ti. or multivaria*.ti,ab,kf. or exp "Sensitivity and Specificity"/ or (sensitivity or specificity).ti,ab. or (predict* or ROC-curve or receiver-operator*).ti,ab. or (likelihood or LR*).ti,ab. or exp Diagnostic Errors/ or (inter-observer or intra-observer or interobserver or intraobserver or validity or kappa or reliability).ti,ab. or reproducibility.ti,ab. or (test adj2 (re-test or retest)).ti,ab. or "Reproducibility of Results"/ or accuracy.ti,ab. or Diagnosis, Differential/ or Validation Study/ or ((false or true) adj3 (negative or positive)).ti,ab. |
6314712 |
|
4 |
exp "Signs and Symptoms"/ or exp Physical Examination/ or exp Medical History Taking/ or ((clinical* or physical*) adj3 (evaluat* or examin* or diagnos* or consult*)).ti,ab,kf. or anamnes*.ti,ab,kf. or 'history taking'.ti,ab,kf. or 'medical interview*'.ti,ab,kf. |
3791778 |
|
5 |
(1 and 2 and (3 or 4)) not (comment/ or editorial/ or letter/) not ((exp animals/ or exp models, animal/) not humans/) not ((Adolescent/ or Child/ or Infant/ or adolescen*.ti,ab,kf. or child*.ti,ab,kf. or schoolchild*.ti,ab,kf. or infant*.ti,ab,kf. or girl*.ti,ab,kf. or boy*.ti,ab,kf. or teen.ti,ab,kf. or teens.ti,ab,kf. or teenager*.ti,ab,kf. or youth*.ti,ab,kf. or pediatr*.ti,ab,kf. or paediatr*.ti,ab,kf. or puber*.ti,ab,kf.) not (Adult/ or adult*.ti,ab,kf. or man.ti,ab,kf. or men.ti,ab,kf. or woman.ti,ab,kf. or women.ti,ab,kf.)) |
331 |
|
6 |
limit 5 to yr="2014 -Current" |
228 |
|
7 |
meta-analysis/ or meta-analysis as topic/ or (metaanaly* or meta-analy* or metanaly*).ti,ab,kf. or systematic review/ or cochrane.jw. or (prisma or prospero).ti,ab,kf. or ((systemati* or scoping or umbrella or "structured literature") adj3 (review* or overview*)).ti,ab,kf. or (systemic* adj1 review*).ti,ab,kf. or ((systemati* or literature or database* or data-base*) adj10 search*).ti,ab,kf. or ((structured or comprehensive* or systemic*) adj3 search*).ti,ab,kf. or ((literature adj3 review*) and (search* or database* or data-base*)).ti,ab,kf. or (("data extraction" or "data source*") and "study selection").ti,ab,kf. or ("search strategy" and "selection criteria").ti,ab,kf. or ("data source*" and "data synthesis").ti,ab,kf. or (medline or pubmed or embase or cochrane).ab. or ((critical or rapid) adj2 (review* or overview* or synthes*)).ti. or (((critical* or rapid*) adj3 (review* or overview* or synthes*)) and (search* or database* or data-base*)).ab. or (metasynthes* or meta-synthes*).ti,ab,kf. |
757521 |
|
8 |
exp clinical trial/ or randomized controlled trial/ or exp clinical trials as topic/ or randomized controlled trials as topic/ or Random Allocation/ or Double-Blind Method/ or Single-Blind Method/ or (clinical trial, phase i or clinical trial, phase ii or clinical trial, phase iii or clinical trial, phase iv or controlled clinical trial or randomized controlled trial or multicenter study or clinical trial).pt. or random*.ti,ab. or (clinic* adj trial*).tw. or ((singl* or doubl* or treb* or tripl*) adj (blind$3 or mask$3)).tw. or Placebos/ or placebo*.tw. |
2745782 |
|
9 |
Epidemiologic studies/ or case control studies/ or exp cohort studies/ or Controlled Before-After Studies/ or Case control.tw. or cohort.tw. or Cohort analy$.tw. or (Follow up adj (study or studies)).tw. or (observational adj (study or studies)).tw. or Longitudinal.tw. or Retrospective*.tw. or prospective*.tw. or consecutive*.tw. or Cross sectional.tw. or Cross-sectional studies/ or historically controlled study/ or interrupted time series analysis/ [Onder exp cohort studies vallen ook longitudinale, prospectieve en retrospectieve studies] |
4765974 |
|
10 |
Case-control Studies/ or clinical trial, phase ii/ or clinical trial, phase iii/ or clinical trial, phase iv/ or comparative study/ or control groups/ or controlled before-after studies/ or controlled clinical trial/ or double-blind method/ or historically controlled study/ or matched-pair analysis/ or single-blind method/ or (((control or controlled) adj6 (study or studies or trial)) or (compar* adj (study or studies)) or ((control or controlled) adj1 active) or "open label*" or ((double or two or three or multi or trial) adj (arm or arms)) or (allocat* adj10 (arm or arms)) or placebo* or "sham-control*" or ((single or double or triple or assessor) adj1 (blind* or masked)) or nonrandom* or "non-random*" or "quasi-experiment*" or "parallel group*" or "factorial trial" or "pretest posttest" or (phase adj5 (study or trial)) or (case* adj6 (matched or control*)) or (match* adj6 (pair or pairs or cohort* or control* or group* or healthy or age or sex or gender or patient* or subject* or participant*)) or (propensity adj6 (scor* or match*))).ti,ab,kf. or (confounding adj6 adjust*).ti,ab. or (versus or vs or compar*).ti. or ((exp cohort studies/ or epidemiologic studies/ or multicenter study/ or observational study/ or seroepidemiologic studies/ or (cohort* or 'follow up' or followup or longitudinal* or prospective* or retrospective* or observational* or multicent* or 'multi-cent*' or consecutive*).ti,ab,kf.) and ((group or groups or subgroup* or versus or vs or compar*).ti,ab,kf. or ('odds ratio*' or 'relative odds' or 'risk ratio*' or 'relative risk*' or aor or arr or rrr).ab. or (("OR" or "RR") adj6 CI).ab.)) |
5727424 |
|
11 |
6 and 7 - SR |
16 |
|
12 |
(6 and 8) not 11 - RCT |
30 |
|
13 |
(6 and (9 or 10)) not (11 or 12) - observationeel |
144 |
|
14 |
6 not (11 or 12 or 13) - overig |
38 |