Meta-analysis as a research design – Steps demystified for novice medical researchers
Keywords:Evidence-based medicine, Meta-analysis, Research design, Systematic review
Meta-analysis is a study design that assesses previous research quantitatively and arrives at a conclusion for a research question; that outcome or conclusion is considered strong enough to be kept in an apex position in the hierarchy of evidence. Meta-analysis is found to be a hurdle for most novice researchers due to complex statistical procedures and the availability of unbiased published literature globally. The lack of accurate theoretical background also adds to the aforementioned complexity. This paper tries to portray a simple, practical outline about meta-analysis, justification for using this design, other essential aspects concerned and methods to be used. Literature relevant to the topic published within ten years in prominent journals and websites has been reviewed thoroughly while writing this paper. Keywords used for literature search were; ‘Meta-analysis’, ‘systematic review’, ‘Meta-analysis research design’ and ‘Meta-analysis framework’. The search was carried out after applying appropriate Boolean operators. Thoroughly and rigorously conducted meta-analysis is valid and has the potential of decision making in evidence-based medicine practice as it provides a more precise and cumulative estimate of the effect of a treatment/intervention, risk factor for a disease and or efficacy of drugs. The necessity to inculcate results or findings from numerous research studies makes it clear that meta-analysis as a research design is desirable in the field of medicine.
Bello A, Wiebe N, Garg A, Tonelli M. Evidence-based decision-making 2: Systematic reviews and meta-analysis. Methods Mol Biol. 2015;1281:397-416. doi: 10.1007/978-1-4939-2428-8_24. PMID: 25694324.
Burns PB, Rohrich RJ, Chung KC. The Levels of Evidence and their role in Evidence-Based Medicine. Plast Reconstr Surg. 2011 Jul;128(1):305–10.
Greco T, Zangrillo A, Biondi-Zoccai G, Landoni G. Meta-analysis: pitfalls and hints. Heart Lung Vessel. 2013; 5(4):219–25.
Haidich AB. Meta-analysis in medical research. Hippokratia. 2010 Dec; 14(Suppl 1):29–37.
Glass GV. Primary, secondary and meta-analysis of research. Educational Researcher. 1976;5:3–8.
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. 2011.
Aslam S, Emmanuel P. Formulating a researchable question: A critical step for facilitating good clinical research. Indian J Sex Transm Dis AIDS. 2010;31(1):47–50.
Methley AM, Campbell S, Chew-Graham C, McNally R, Cheraghi-Sohi S. PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Serv Res [Internet]. 2014 Nov 21 [cited 2020 Sep 12];14. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4310146/
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097.
Library THS. Research Guides: Systematic Reviews: Creating a Search Strategy [Internet]. [Cited 2020 Sep 13]. Available from: https://guides.lib.umich.edu/c.php?g=283340&p=2126706
Aromataris, Edoardo&Riitano, Dagmara. (2014). Constructing a search strategy and searching for evidence. A guide to the literature search for a systematic review. The American journal of nursing. 114. 49-56.
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomized or non-randomized studies of healthcare interventions, or both. BMJ. 2017 ;358:j4008. doi: 10.1136/bmj.j4008.
Alberani V, De Castro Pietrangeli P, Mazza AM. The use of grey literature in health sciences: a preliminary survey. Bull Med Libr Assoc. 1990 Oct;78(4):358-63.
Stegenga J. Is meta-analysis the platinum standard of evidence? Stud Hist Philos Biol Biomed Sci. 2011 Dec;42(4):497-507. doi: 10.1016/j.shpsc.2011.07.003.
Peter Jüni, Franziska Holenstein, Jonathan Sterne, Christopher Bartlett, Matthias Egger, Direction and impact of language bias in meta-analyses of controlled trials: empirical study, International Journal of Epidemiology, Volume 31, Issue 1, February 2002: 115–123.
Dubben H-H, Beck-Bornholdt H-P. Systematic review of publication bias in studies on publication bias. BMJ. 2005 Aug 20;331(7514):433–4.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997 Sep 13;315(7109):629–34.
Williamson, P. R. et al. (2005) 'Outcome selection bias in meta-analysis', Statistical Methods in Medical Research, 14(5), pp. 515–524.
Zlowodzki M, Poolman RW, Kerkhoffs GM, Tornetta P, Bhandari M; International Evidence-Based Orthopedic Surgery Working Group. How to interpret a meta-analysis and judge its value as a guide for clinical practice. Acta Orthop. 2007 Oct;78(5):598-609. doi: 10.1080/17453670710014284. PMID: 17966018.
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019).
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. 2008: The Cochrane Collaboration, Oxford.
Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol 1991; 44: 1271-8.
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials 1996;17:1-12.
Study Quality Assessment Tools | NHLBI, NIH [Internet]. [cited 2020 Sep 15]. Available from: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools.
Glynn L. A critical appraisal tool for library and information research. Cleyle S, editor. Library Hi Tech. 2006 Jul;24(3):387–99.
Sterne JAC, Hernán MA, Reeves BC, Savovi? J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomized studies of interventions. BMJ. 2016;355.
CARE Checklist [Internet]. CARE Case Report Guidelines. [cited 2020 Sep 15]. Available from: https://www.care-statement.org/checklist.
Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Medical Research Methodology. 2003 Nov 10;3(1):25.
Hayden JA, van der Windt DA, Cartwright JL, Côté P, Bombardier C. Assessing bias in studies of prognostic factors. Ann Intern Med. 2013;158(4):280-286.
Pedder H, Sarri G, Keeney E, Nunes V, Dias S. Data extraction for complex meta-analysis guide. Syst Rev [Internet]. 2016 [cited 2020 Sep 15];5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5154138/
Higgins JPT, Li T, Deeks JJ (editors). Chapter 6: Choosing effect measures and computing estimates of effect. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019.
Cannon CP, Steinberg BA, Murphy SA, Mega JL, Braunwald E. Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy. Journal of the American College of Cardiology. 2006 Aug;48(3):438–45.
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. (2009). Introduction to meta-analysis. Chichester, U.K: John Wiley & Sons.
Wallace, B.C., Schmid, C.H., Lau, J. et al. Meta-Analyst: software for meta-analysis of binary, continuous and diagnostic data. BMC Med Res Methodol9, 80 (2009).
Wang J, Leeflang M. Recommended software/packages for meta-analysis of diagnostic accuracy. J Lab Precis Med 2019;4:22.
Chalmers TC, Buyse M. Meta-analysis. In: Chalmers TC, Blum A, Buyse M, et al., editors. Data Analysis for Clinical Medicine: The Quantitative Approach to Patient Care. Rome, Italy: International University Press; 1988. pp. 75–84
Liberati Alessandro, Altman Douglas G, Tetzlaff Jennifer, Mulrow Cynthia, Gøtzsche Peter C, Ioannidis John P A et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration BMJ 2009; 339:b2700
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of Observational Studies in Epidemiology: A Proposal for Reporting. JAMA. 2000;283(15):2008–2012. doi:10.1001/jama.283.15.2008.
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