Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Canberra, ACT, Australia; SYRCLE, Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands.
National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.
J Clin Epidemiol. 2020 Jan;117:36-45. doi: 10.1016/j.jclinepi.2019.09.010. Epub 2019 Sep 18.
The quality of primary research is commonly assessed before inclusion in meta-analyses. Findings are discussed in the context of the quality appraisal by categorizing studies according to risk of bias. The impact of appraised risk of bias on study outcomes is typically judged by the reader; however, several methods have been developed to quantify this risk of bias assessment and incorporate it into the pooled results of meta-analysis, a process known as bias adjustment. The advantages, potential limitations, and applicability of these methods are not well defined.
Comparative evaluation of the applicability of the various methods and their limitations are discussed using two examples from the literature. These methods include weighting, stratification, regression, use of empirically based prior distributions, and elicitation by experts.
Use of the two examples from the literature suggest that all methods provide similar adjustment. Methods differed mainly in applicability and limitations.
Bias adjustment is a feasible process in meta-analysis with several strategies currently available. Quality effects modelling was found to be easily implementable with fewer limitations in comparison to other methods.
在纳入荟萃分析之前，通常会对初级研究的质量进行评估。通过根据偏倚风险对研究进行分类，在质量评估的背景下讨论研究结果。评估偏倚风险对研究结果的影响通常由读者判断；但是，已经开发了几种方法来量化这种偏倚风险评估，并将其纳入荟萃分析的汇总结果中，这一过程称为偏倚调整。这些方法的优点、潜在局限性和适用性尚未得到很好的定义。
使用文献中的两个示例比较评估了各种方法的适用性及其局限性。这些方法包括加权、分层、回归、使用基于经验的先验分布以及专家征询。
使用文献中的两个示例表明，所有方法都提供了类似的调整。方法的主要区别在于适用性和局限性。
荟萃分析中偏倚调整是一种可行的方法，目前有多种策略可供选择。与其他方法相比，质量效应模型的实施相对简单，局限性也较少。
