A systematic review finds core outcome set uptake varies widely across different areas of health

The aim of our review was to bring together studies that had assessed the uptake of core outcome sets (COS) to explore the level of uptake across different COS and areas of health.

Study Design and Setting
We examined the citations of 337 COS reports to identify studies that had assessed the uptake of a particular COS in randomised controlled trials (RCTs) or systematic reviews (SRs).

We identified 24 studies that had assessed uptake in RCTs and two studies that has assessed uptake in SRs. The studies covered a total of 17/337 (5%) COS. Uptake rates reported for RCTs varied from 0% of RCTs (gout) to 82% RCTs (rheumatoid arthritis) measuring the full COS. Studies that assessed uptake of individual core outcomes showed wide variation in uptake between the outcomes. Suggested barriers to uptake included lack of validated measures, lack of patient and other key stakeholder involvement in COS development and lack of awareness of the COS.

Few studies have been undertaken to assess the uptake of COS in RCTs and SRs. Further studies are needed to assess whether COS have been implemented across a wider range of disease categories and to explore the barriers and facilitators to COS uptake.


1. To systematically identify all studies that have evaluated the uptake of a COS.
2. To explore the level of COS uptake across different areas of health.
3. To review the methods used to assess uptake of COS.


Karen Hughes PhD Student (1)
Paula Williamson Primary PhD Supervisor (1)
Mike Clarke Co-supervisor (2)


1 MRC North West Hub for Trials Methodology Research, Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom
2 Centre for Public Health, Institute of Clinical Sciences, Queen’s University Belfast, Royal Victoria Hospital, Belfast, United Kingdom


Journal: Journal of Clinical Epidemiology
Pages: -
Year: 2020
DOI: 10.1016/j.jclinepi.2020.09.029

Further Study Information

Current Stage: Completed
Date: July 2018 - July 2020
Funding source(s): This work was supported by the MRC Network of Hubs for Trials Methodology Research (MR/L004933/1- Q30) and the MRC North West Hub for Trials Methodology Research (MR/K025635/1).

Health Area

Disease Category: Other

Disease Name: N/A

Target Population

Age Range: 0 - 120

Sex: Either

Nature of Intervention: Any

Stakeholders Involved

- None

Study Type

- Systematic review of COS uptake studies


- Systematic review

Information sources: Citation reports will be obtained via Scopus for all COS reports published between 1981 (year of the first COS report identified) and up to two years prior to the start of the search. The COS reports will be identified via systematic reviews published by the COMET Initiative. Weekly Scopus alerts will be set to identify studies of COS uptake that were published after the search cut-off date. No language restrictions will be applied to the search.
Inclusion criteria: Studies that have assessed uptake of the outcomes recommended by a particular COS developed for any condition, population or intervention. Studies will be included if they have assessed uptake of the COS outcomes, either individually or as a full set, by RCTs or SRs.
Study selection: The titles of articles that have cited a COS report will be searched for keywords relating to COS and uptake. Titles containing a keyword will be screened, followed by abstract screening. The full texts of potentially eligible studies will be assessed.
Data extraction: A data collection form will record:
• Disease category
• Disease name
• Scope of the uptake study
• Period covered by the assessment
• Number of RCTs/SRs assessed
• % RCTs/SRs that measured the full COS and/or % RCTs/SRs that measured each individual outcome in the COS
• Method used to assess uptake.

The results of the review will be presented descriptively using text and tables.

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