York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, North Yorkshire, UK.
York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, North Yorkshire, UK.
J Clin Epidemiol. 2015 Feb;68(2):175-81. doi: 10.1016/j.jclinepi.2014.09.023. Epub 2014 Nov 12.
OBJECTIVES: An unknown number of randomized controlled trials (RCTs) have their treatment allocation subverted. If such trials are included in systematic reviews, biased results may be used to change policy. To assess whether a systematic review contains subverted trials, a meta-analysis of group differences regarding a baseline variable can be undertaken. In this article, the performance of age with another prognostic variable in detecting selection bias within systematic reviews is compared. STUDY DESIGN AND SETTING: Two Cochrane systematic reviews, one of low back pain and one of hip protectors for fracture prevention, were identified. The component RCT texts were obtained, and data were extracted on age, baseline back pain score (low back pain review), and baseline body mass (hip protector review). In this exemplar, we tested for baseline heterogeneity with a fixed-effects meta-analysis. RESULTS: Heterogeneity in age between the intervention and control groups was found. The observed heterogeneity increased with baseline back pain and body mass relative to age in each review. CONCLUSION: We found that covariates predictive of outcome demonstrate greater heterogeneity than age. However, there were fewer missing data relating to age. Reviewers should consider using age and another prognostic covariate in baseline meta-analyses to check the validity of their results.
目的:许多随机对照试验(RCT)的治疗分组发生了偏移。如果这些试验被纳入系统评价,有偏倚的结果可能会被用来改变政策。为了评估一个系统评价是否包含偏移试验,可以对基线变量的组间差异进行 meta 分析。在本文中,比较了年龄与另一个预后变量在检测系统评价中选择偏倚的表现。
研究设计和环境:确定了两个 Cochrane 系统评价,一个是腰痛,一个是髋保护器预防骨折。获取了其中的 RCT 文本,并提取了年龄、基线腰痛评分(腰痛评价)和基线体重(髋保护器评价)的数据。在这个示例中,我们使用固定效应 meta 分析测试了基线异质性。
结果:干预组和对照组之间的年龄存在异质性。在每个评价中,观察到的异质性随着基线腰痛和体重相对于年龄的增加而增加。
结论:我们发现,预测结果的协变量比年龄表现出更大的异质性。然而,与年龄相关的缺失数据较少。评审员应该考虑在基线 meta 分析中使用年龄和另一个预后协变量来检查其结果的有效性。
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