How to Read a Systematic Review and Meta-analysis and Apply the Results to Patient Care

Abstract

Clinical decisions should be based on the totality of the best evidence and not the results of individual studies. When clinicians apply the results of a systematic review or meta-analysis to patient care, they should start by evaluating the credibility of the methods of the systematic review, ie, the extent to which these methods have likely protected against misleading results. Credibility depends on whether the review addressed a sensible clinical question; included an exhaustive literature search; demonstrated reproducibility of the selection and assessment of studies; and presented results in a useful manner. For reviews that are sufficiently credible, clinicians must decide on the degree of confidence in the estimates that the evidence warrants (quality of evidence). Confidence depends on the risk of bias in the body of evidence; the precision and consistency of the results; whether the results directly apply to the patient of interest; and the likelihood of reporting bias. Shared decision making requires understanding of the estimates of magnitude of beneficial and harmful effects, and confidence in those estimates.

Potential analysis of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain / Potentialanalyse der multidisziplinären biopsychosozialen Rehabilitation für Patienten/-innen mit chronischen Rückenschmerzen

“…Die Ergebnisse dieser Studien werden nicht berichtet. Dies soll Fehlinterpretationen vermeiden, die auftreten können, wenn Ergebnisse ohne Prüfung der Evidenzqualität, Heterogenität und Gewichtung rein narrativ dargestellt werden (Murad et al, 2014 …”

Cochrane in CORR ®: Platelet-rich Therapies for Musculoskeletal Soft Tissue Injuries (Review)

“…High-quality metaanalysis should present and evaluate the ways in which results differ between studies. The reader can then judge and explore the reasons for variance in the results and the degree to which the difference influences his or her ability to use the conclusions derived from data pooling [5]. Such exploration and direction of anticipated effect should be specified a priori to reduce the risk of potentially arriving at spurious correlations [10].…”

Midodrine Efficacy in Orthostatic Hypotension

“…Even with some heterogeneity, a pooled estimate is still needed for decision making. 1 This meta-analysis tells us that an increase in standing blood pressure of 21.5 mmHg is the best estimate we have and we should expect it to occur on average, across heterogeneous populations and settings. Lastly, we do not claim that orthostatic changes are the main effect of midodrine; we simply analyzed this outcome; which was reported in the included studies, along with the change in standing blood pressure (the outcome considered most relevant by Singer et al).…”