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Original Investigation
March 11, 2019

Evaluation of Journal Registration Policies and Prospective Registration of Randomized Clinical Trials of Nonregulated Health Care Interventions

Author Affiliations
  • 1Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
  • 2Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
  • 3Department of Psychology, McGill University, Montreal, Quebec, Canada
  • 4Library, Concordia University, Montreal, Quebec, Canada
  • 5Studies of Translation, Ethics and Medicine, Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
  • 6Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
  • 7Department of Psychiatry, McGill University, Montreal, Quebec, Canada
  • 8Department of Medicine, McGill University, Montreal, Quebec, Canada
  • 9Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
JAMA Intern Med. 2019;179(5):624-632. doi:10.1001/jamainternmed.2018.8009
Key Points

Question  Have specialty journals, such as in the fields of nursing, rehabilitation, or surgery, that publish randomized clinical trials of health care interventions not subject to regulation by the US Food and Drug Administration implemented and enforced prospective trial registration policies?

Findings  In this study of 953 nonregulated intervention trials published in 254 journals included in the study, only 11% of journals required prospective registration. Only 34% of trials published in journals with a policy were prospectively registered compared with 18% of trials in journals without a policy.

Meaning  Nonregulated health care intervention trials published in specialty journals are often not prospectively registered, and existing registration policies are rarely enforced;


Importance  Many interventions that are important to the health care of patients are not subject to regulation by the US Food and Drug Administration (FDA) or comparable regulatory bodies in other nations.

Objective  To determine whether specialty journals that publish trials of primarily nonregulated health care interventions require prospective registration and whether the prospective registration policies are associated with the publication of prospectively registered trials, trials with adequately registered outcomes, and trials with primary outcomes consistent with the registered primary outcomes.

Design and Methods  PubMed was searched daily, from March 18, 2016, to September 17, 2016, for nonregulated intervention randomized clinical trials. The search included all journals in the Clarivate Analytics Science Citation Index Expanded categories of behavioral sciences, nursing, nutrition and dietetics, psychology, rehabilitation, and surgery. Trials of interventions not subject to FDA regulation were included. One investigator extracted journal registration policy and trial registration status. Two investigators independently extracted trial registration and publication characteristics.

Main Outcomes and Measures  For journals, the main outcome was the trial registration policy. For trials, the main outcomes were prospective registration, adequacy of outcome registration, and concordance of registered with published primary outcomes.

Results  In total, 953 nonregulated intervention trials published in 254 journals were identified. Prospective registration was required for publication by 29 (11.4%) of 254 journals, and an additional 12 journals (4.7%) had conditional date-based requirements. Only 189 (19.8%) of the 953 trials were registered prospectively, including 33 of 98 published in journals with prospective registration policies as compared with 156 of 855 in journals without policies (33.7% vs 18.2%; P = .004). Among the 17 journals that required prospective registration and had at least 2 included trials, none had a prospective registration of more than 50%. In journals with policies, only 3 of 98 trials included primary outcomes consistent with prospectively, adequately registered outcomes, as compared with 34 of 852 trials in journals without policies (3.1% vs 4.0%; P = .62).

Conclusions and Relevance  Few journals in behavioral sciences or psychology, nursing, nutrition and dietetics, rehabilitation, and surgery require prospective trial registration, and those with existing registration policies rarely enforce them; this finding suggests that strategies for encouraging prospective registration of clinical trials not subject to FDA regulation should be developed and tested.

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