Poor Adherence to the Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) Guidelines for...

Lumbar disc pathologies, some of the leading causes of lower back pain, have spurred interest in platelet-rich plasma (PRP) treatments; however, for these discopathies, there are multiple factors that can influence treatment efficacy. The Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines were published in 2017 as a framework to improve data reporting. Adherence to these guidelines would help eliminate inadequate reporting on important findings, such as the benefits and harm associated with this treatment.

In this systematic review, we therefore asked: How well do studies reporting on the outcomes of PRP injections for lumbar discopathies adhere to MIBO guidelines?

A systematic review of the PubMed, Embase, and Cochrane Library databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Clinical studies that assessed the outcomes of PRP injections for lumbar disc pathologies published in English in peer-reviewed journals from January 2016 to June 2024 were included. Included studies were those that reported outcomes after PRP for the treatment of lumbar disc pathologies, had at least 3 months of follow-up, had a minimum of 5 patients per cohort, were written in English, and were published in the PubMed, Embase, or Cochrane databases. The following were excluded: systematic reviews, cadaveric studies, biomechanical studies, and in vivo studies. Adherence to MIBO guidelines was evaluated by determining the total percentage of items reported out of a checklist of 46 items modified from the original MIBO items. In total, 15 studies (583 patients) were included in this systematic review, with a median (range) age of 44 years (20 to 56) and a median follow-up time of 18 months (6 to 78). There is a possibility for publication bias with these studies, which was evaluated as part of the Risk of Bias in Non-randomized studies - of Interventions (ROBINS I) and Risk of Bias 2 (RoB2) criteria.

The mean adherence percentage across all studies was 39% ± 9% of items reported. Only 1 of 15 studies had an adherence percentage greater than 50%, 5 of 15 studies had an adherence percentage between 40% and 49.9%, and 9 of 15 studies had an adherence rate less than 40%. Only 1 of 12 MIBO categories had an adherence percentage ≥ 80%. There was no qualitative difference in adherence percentages of the studies before publication of the MIBO guidelines in May 2017 (38% ± 7%) and after publication (40% ± 10%).

Considering these discoveries, stricter reporting and adherence to these guidelines are needed to attain greater transparency and reproducibility of studies evaluating the treatment of lumbar disc pathologies with PRP injections. Furthermore, not adhering to these guidelines may introduce bias, potentially leading to inaccurate reporting of the efficacy or harm in PRP use for lumbar disc pathologies. Given the relative novelty of biologics such as PRP, studies should abide more closely to these guidelines to provide accurate insight in their effect.

Level III, therapeutic study.