CHORUS aims to bring together people interested in the development and application of agreed standards in different areas of clinical and research practice including standardised sets of outcomes, known as ‘core outcome sets’ (COS), guidelines, and minimum practice standards.
Patient centred high-quality care should be based on the best available research evidence. However, research quality and outcomes are highly variable. It has been estimated that 85% of research funding is wasted in the design and reporting of clinical trials as well as other types of research. Waste is evident in all stages of production and reporting and is related to the inclusion of low priority outcomes, inappropriate study design that may lack consideration of existing evidence, selective reporting, publication bias and concealment of planned study outcomes. Although this mainly refers to clinical trials, such issues are expected to feature in other types of research as well.
The NIHR’s Health Technology Assessment Programme aims to tackle such limitations and among other recommendations considers the conduct of systematic reviews as a prerequisite before funding primary studies. Journal editors require new studies to be set in the context of systematic assessments of previous research evidence.
Studies in female pelvic floor disorders including urinary incontinence (1 in 10 to 1 in 2 women), pelvic organ prolapse (1 in 10 women), childbirth perineal trauma (8 in 10 women who deliver vaginally) and pelvic pain syndromes (1 in 7 women) have reported many different outcomes resulting in significant outcome reporting bias and an inability to synthesise results across studies.
A substantial variation in the recommendations and methodological quality of national and international guidelines has been demonstrated in different areas of gynaecological practice. Guidelines should be developed with reference to high quality methods, in consultation with key stakeholders, including patients, ensuring their scope can truly inform clinical practice and eliminate unjustified variations in clinical practice.