Enhancing the reporting and transparency of rheumatology research: a guide to reporting guidelines

Manuscripts and abstracts from biomedical journals frequently do not contain proper information for meeting required standards and serving the multiple needs of their end users. Reporting guidelines and checklists help researchers to meet those standards by providing rules or principles for specific research areas. Rheumatology research includes a broad range of heterogeneous research areas, each with its own requirements, producing several distinct categories of articles. Our objectives with this article are to raise awareness of the existence and importance of reporting guidelines, to present a structured overview of reporting guidelines that rheumatology journals could apply, and to encourage their use by journal authors, editors, and reviewers, including those of Arthritis Research & Therapy. Internationally recognized reporting guidelines exist for a diversity of research areas. We encourage colleagues to consult the 'Enhancing the QUAlity and Transparency Of health Research' (EQUATOR) network when writing scientific papers. EQUATOR is an international initiative that seeks to improve the reliability and value of biomedical research literature by promoting transparent and accurate reporting of studies. We propose specific reporting guidelines for a number of study designs: animal research, randomized trials, reliability and agreement studies, systematic reviews with and without meta-analyses, diagnostic test accuracy studies, and also observational research including cross-sectional, cohort, and case-control studies. We encourage authors, editors, and reviewers to adhere to and enforce the use of the appropriate guidelines when writing, reading, and reviewing scientific papers.


Introduction
Quite often, research reports and abstracts do not contain proper information for meeting required standards and serving the multiple needs of their end users [1], be they researchers or health care providers. Poor metho dology and reporting are widespread [2]. As a result, published studies often cannot be replicated by researchers, translated into clinical practice, or used to inform public health policy. Guidelines and checklists help researchers meet certain standards by providing sets of rules or principles for implementing best practices in a particular area [3].
Most trialists and many research managers know the advantages associated with using the CONSORT (CONsolidated Standards Of Reporting Trials) statement when writing a scientifi c paper. CONSORT is a statement intended to assess the validity of results from randomized controlled trials (RCTs) and to improve their reporting, enabling readers to understand a trial's design, conduct, analysis, and interpretations [4]. However, many do not know about the umbrella organization that CONSORT is part of, the 'Enhancing the QUAlity and Transparency Of health Research' (EQUATOR) network [5]. Th e EQUATOR network is an international initiative that seeks to improve the reliability and value of biomedical research literature by publishing a variety of diff erent reporting guidelines that promote the transparent and accurate reporting of research studies [5].
Th e objectives of this commentary are to raise aware ness of the existence and importance of reporting guidelines within the various areas of research and to present them in a structured overview so that journal authors, editors, and reviewers -including those of Arthritis Research & Th erapy -might more easily apply them.

Applying reporting guidelines
Reporting guidelines are statements that provide advice on how to report methods and fi ndings of research [5].
Usually in the form of a checklist, fl ow diagram or explicit text examples, they specify a minimum set of items required for a clear and transparent account of what was done and what was found in a study. Rheumatology and related research includes a broad range of heterogeneous research areas, each generating a category of articles with separate requirements. All reporting categories of articles should conform to the 'Uniform Requirements for Manuscripts Submitted to Biomedical Journals' , developed by the International Committee of Medical Journal Editors [6]. Nevertheless, guidelines can still be specifi cally tailored to diff erent study types while conforming to these requirements, providing more focused guidance to writers and researchers -information that is valuable even at the protocol stage [7]. It is not uncommon that scientists set up a research project in a manner that will inevitably lead to unsatisfactory reporting; that is, either the data are not there or are there in the wrong way.
Th e EQUATOR network library currently provides reporting guidelines for a number of study types, such as 'experimental studies' , 'observational studies' , 'diagnostic accuracy studies' , 'biospecimen reporting' , 'reliability and agreement studies' , 'systematic reviews' , 'qualitative research' , 'mixed methods studies' , 'economic evaluations' , and 'quality improvement studies' [8]. Table 1 presents a structured overview of research designs that could appear in a journal like Arthritis Research & Th erapy. Th e guidelines illustrated in Table 1 are already widely endorsed by other journals; thus, authors who submit papers to the EQUATOR-endorsing journals would be expected to follow the pertinent reporting statement. Th e goals associated with the EQUATOR initiative are many, but the overarching goalat least, as we see it -is to prevent authors from omitting crucial information in the description of research methods and interventions, in order to avoid disappoint ing results in primary or secondary (post hoc) analyses. Th erefore, we recommend that all reporting researchers search the EQUATOR network for its many helpful guidelines for diff erent study types. Table 1 refl ects what we currently see as the most impor tant statements that could apply for a journal like Arthritis Research & Th erapy. Th e CONSORT statement will probably be perceived as the most obvious [4], and we are confi dent that most of our publishing research colleagues are aware of this statement already. We hope they agree that the use of the CONSORT statement checklist is helpful even for purposes such as structuring an article outline and for supervising junior colleagues and students preparing their fi rst randomized controlled trial paper. Th e STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement describes what is important to report when writing an epidemiological paper [9]. Th e STROBE statement consists of a checklist of 22 items relating to the title, abstract, introduction, methods, results, and discussion sections of articles [9]. Of those 22 items, 18 are common to cohort studies, case-control studies, and crosssectional studies, and 4 are specifi c to each of the 3 study designs. Th e STROBE statement intends to improve the reporting of all three study designs, thereby facilitating critical appraisal and interpretation of fi ndings by reviewers, journal editors, and readers. Th e PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement is an evolution of the original QUOROM (Quality of Reporting of Meta-analyses) guideline on how to report systematic reviews and metaanalyses [10]. Th e PRISMA statement focuses mainly on meta-analysis of randomized controlled trials but is also relevant for meta-analyses of observational studies; the PRISMA statement does not replace the MOOSE (Metaanalysis Of Observational Studies in Epidemiology) statement [11]. Th e PRISMA statement consists of a 27-item checklist and a 4-phase fl ow diagram as a guide to authors.

Recommended statements
Guidelines can also improve diagnostic test accuracy studies, which are often submitted to medical journals. Th e STARD (Standards for Reporting of Diagnostic Accuracy) statement aims to improve the quality of reporting of studies concerning diagnostic accuracy [12]. STARD introduces a checklist of 25 items and suggests a fl ow diagram that authors can use to ensure that all relevant information is present. STARD contains a clarification of the meaning, rationale, and optimal use of each item on the checklist, as well as a short summary of the available evidence on bias and applicability [12].
An essential requirement of all outcome measures in biomedical research is that they be valid and repro ducible. Overall reproducibility concerns the degree to which repeated measurements provide the same results. Reproducibility covers both agreement and reliabilityconcepts that are not easily distinguished from each other. Reliability may be defi ned as the ratio of variability between subjects (for example, patients) or objects (for example, ultrasound assessments) to the total variability of all measurements in the sample; reliability can be defi ned as the ability of a measurement to diff erentiate between subjects or objects [13]. On the other hand, agree ment is the degree to which scores or ratings are identical. Both concepts are important, because they provide information about the quality of measurements. Reliability is highly dependent on the heterogeneity of the study sample, while the agreement, based on measurement error, is more a pure characteristic of the measurement instrument [14]. Partly overlapping the STARD statement, GRRAS (Guidelines for Reporting Reliability and Agreement Studies) includes a checklist with 15 issues that should be addressed when reliability and agreement are reported [13].
Finally, the ARRIVE (Animals in Research: Reporting In Vivo Experiments) guidelines [15] address previous inadequacies of biomedical journals that provided little or no guidance on what information to report when describing animal research. Th e ARRIVE guidelines consist of a checklist of 20 items describing the minimum information that all scientifi c publications reporting research using animals should include [15].
We anticipate some researchers would be looking for a general statement on 'Bench research' (that is, research exclusively conducted in laboratory settings), which unfortunately is not available yet -perhaps due to the multitude of diff erent research methods that are diffi cult to standardize across disciplines. However, the REporting recommendations for tumour MARKer prognostic studies (REMARK) would be recommended in oncology [16] -principles that may also be applicable in rheumatology. Research in human biospecimens should follow the recommen dations from BRISQ (Biospecimen Reporting for Improved Study Quality), which aims at improving the quality of research that uses human tissues subjected to collection, processing, and storage; it is crucial that information on the handling of biospecimens be reported in a thorough, accurate, and standardized manner [17].

Discussion
Th e aim of medical research is to advance scientifi c knowledge and thereby lead to more rational decision making and improvements in treating and preventing disease [2]. Despite the eff ort of resear chers, editors, and peer reviewers, the quality of health-research reporting in journal articles has room for improvement [5]. We present six statements and guidelines that rheumatology journals like Arthritis Research & Th erapy would benefi t from endorsing in the future. Th ese six statements and guidelines, presented in Table 1, cover broad areas, such as how to report fi ndings from randomized trials, obser vational studies, systematic reviews and meta-analyses, diagnostic tests, reliability and agreement studies, and animal studies. Th e statements specify a minimum set of items for reporting and can improve the accuracy and transparency of publications, thus facilitating easier and more reliable appraisal of quality and relevance [5].
Diff erent researchers have diff erent opinions about the role of publication guidelines [18]. In our experience, which is shared by many others, adherence to guidelines, even at the protocol stage, adds important details to the creative process, as it helps researchers consider what they will write in their fi nal paper of the research project they propose, for instance in the 'Methods section' [7]. Following CONSORT, many other guidelines were developed; currently, there are probably 100 available for reporting diff erent types of health research. Reporting guidelines may be regarded as a help for authors, editors and reviewers, and in particular, less-experienced younger colleagues.
A conventional view sees guidelines as a means of helping researchers to publish results as clearly as possible, in a way that facilitates interpretation and comparison with results from similar studies, and most guidelines are easy to employ [18]. Whatever the view on guidelines, clear reporting eases replication of studies, which is a fundamental principle in developing and applying scientifi c knowledge. Professor Doug Altman published in 2002 a thought-provoking article in JAMA titled 'Poor-Quality Medical Research -What Can Journals Do' [2], in which he encouraged researchers and journal editors to remember that a study should not mislead; otherwise it could adversely aff ect clinical practice and future research [2].
We believe that the ability to self-correct is a prudent feature of science. Self-correction is often impeded by destruction of evidence, production of faulty evidence, and/or distortion of evidence [19]. Proper and accurate reporting of scientifi c data, results, and interpretations is key to ensuring that these impediments are addressed. Th erefore, we encourage research colleagues (whether acting as authors or reviewers) and journal editors to endorse the use of guidelines and checklists as a critical fi lter when planning, performing, presenting, and publish ing research data. One way of self-correction is to consider how the results should be reported properly and accurately as early as in the conception of a research project [7]. By integrating the recommendations early in the life cycle of the study, many methodological mistakes can be avoided that inevitably lead to unsatisfactory reporting, and will ultimately result in higher value of the study. We strongly believe that using these mechanisms from project conception to publication creates win-win situations for all end users: researchers, clinicians, and patients.

Conclusion
Th e abundance of available biomedical scientifi c literature and the increasing number of published articles -in rheumatology as in other fi elds -create a need for consistency in reporting in order to enhance evidence synthesis, ease clinical decision making, and inform healthcare policy makers. Internationally recognized reporting guidelines exist for a diversity of research areas, and we encourage authors, editors, and reviewers to adhere to and enforce the use of the appropriate guidelines when writing, reading, and reviewing scientifi c papers.