Furlan Andrea D, Tomlinson George, Jadad Alejandro Alex R, Bombardier Claire
Institute for Work & Health, Toronto, ON, Canada M5G 2E9.
J Clin Epidemiol. 2008 Mar;61(3):209-31. doi: 10.1016/j.jclinepi.2007.04.019. Epub 2008 Jan 14.
To determine the influence of methodological quality and homogeneity on the agreement between pairs of randomized trials (RCTs) and nonrandomized studies (NRSs) of the same interventions for low-back problems. Homogeneity was assessed regarding settings, population, interventions, and outcomes.
We searched Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE up to May 2005 for matching pairs of NRS and RCT. Analyses were done using correlation, linear and logistic regression.
Forty-eight matched pairs were included with no significant overall correlation between effect sizes (r=0.09). There was a trend showing more agreement among the 22 pairs with higher methodological quality (r=0.33). The correlation among the 20 very homogeneous pairs was 0.59, and among the 28 heterogeneous pairs was -0.09. The agreement of authors' recommendations was influenced by the pair's homogeneity (odds ratio [OR]=2.78, 95% CI=1.44-5.37) rather than by methodological quality of the NRS (OR=0.93, 95% CI=0.67-1.29) or the RCT (OR=1.03, 95% CI=0.73-1.45).
Pairs of low-quality studies disagreed more than pairs where at least one study was of high quality. However, pairs with similar settings, population, interventions, and outcomes showed higher agreement than pairs that were not as homogeneous.
确定方法学质量和同质性对针对下背部问题的相同干预措施的随机试验（RCT）和非随机研究（NRS）对之间一致性的影响。从研究背景、人群、干预措施和结果方面评估同质性。
我们检索了截至2005年5月的Cochrane对照试验中央注册库、MEDLINE和EMBASE，以寻找NRS和RCT的匹配对。使用相关性分析、线性回归和逻辑回归进行分析。
纳入了48对匹配对，效应量之间无显著总体相关性（r = 0.09）。在22对方法学质量较高的配对中存在一种趋势，显示出更高的一致性（r = 0.33）。20对非常同质的配对之间的相关性为0.59，28对异质配对之间的相关性为-0.09。作者建议的一致性受配对的同质性影响（优势比[OR]=2.78，95%置信区间=1.44 - 5.37），而非受NRS的方法学质量（OR = 0.93，95%置信区间=0.67 - 1.29）或RCT的方法学质量（OR = 1.03，95%置信区间=0.73 - 1.45）影响。
低质量研究对之间的分歧比至少有一项研究为高质量的配对更多。然而，在研究背景、人群、干预措施和结果相似的配对中，其一致性高于那些同质性较差的配对。
