Dear Spinal Cord reader,

In recent years Spinal Cord has published increasingly more systematic reviews that evaluate the effectiveness of interventions for people with spinal cord injuries. Many methodological issues need to be considered when conducting systematic reviews: to identify all relevant trials, not just those with favourable outcomes; to carefully define the scope; and to appropriately rate trials for bias. The most important findings of systematic reviews are the estimates of treatment effectiveness. For continuous data, this is reflected in between-group differences and corresponding 95% confidence intervals (CI).1 If the 95% CI spans the minimally worthwhile treatment effect, the results are inconclusive. If the entire 95% CI is larger than the minimally worthwhile treatment effect, the treatment is clearly effective (again on average when applied to the target population); if the entire 95% CI is smaller than the minimally worthwhile treatment, the treatment is clearly ineffective. This all assumes that a favourable outcome is reflected by a positive number and a detrimental outcome is reflected by a negative number. This is not always the case, so data need to be carefully examined.

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