Multiple systematic reviews: methods for assessing discordances of results

Moja, Lorenzo; Rio, M. Pilar Fernandez del; Banzi, Rita; Cusi, Cristina; D’Amico, Roberto; Liberati, Alessandro; Lodi, Giovanni; Lucenteforte, Ersilia; Minozzi, Silvia; Pecoraro, Valentina; Virgili, Gianni; Parmelli, Elena

doi:10.1007/s11739-012-0846-1

Cited by 25 publications

(27 citation statements)

References 21 publications

(21 reference statements)

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“…To summarize the evidence on the effectiveness of HT interventions, we designed a 3-step process [ 30 , 31 ]. First, as a means of evaluating the comparability of the included systematic reviews and the extent to which reviews overlapped in terms of included studies, we carried out a bibliographic analysis that cross-linked individual systematic reviews with cited HT studies ( Multimedia Appendix 3 ).…”

Section: Methodsmentioning

confidence: 99%

Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews

Kitsiou¹,

Paré²,

Jaana³

2015

J Med Internet Res

255

232

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BackgroundGrowing interest on the effects of home telemonitoring on patients with chronic heart failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar research questions with a concomitant increase in discordant findings. Differences in the scope, methods of analysis, and methodological quality of systematic reviews can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist.ObjectiveThis overview aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to inform policy makers, practitioners, and researchers.MethodsA comprehensive literature search was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-reviewed systematic reviews published between January 1996 and December 2013. Reviews were searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to extract data and the methodological quality of included reviews was appraised using the AMSTAR (assessing methodological quality of systematic reviews) instrument. Summary of findings tables were constructed for all primary outcomes of interest, and quality of evidence was graded by outcome using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system. Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various types of home telemonitoring technologies included in the systematic reviews and the impact of these technologies on clinical outcomes.ResultsA total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively, home telemonitoring interventions reduce the relative risk of all-cause mortality (0.60 to 0.85) and heart failure-related hospitalizations (0.64 to 0.86) compared with usual care. Absolute risk reductions ranged from 1.4%-6.5% and 3.7%-8.2%, respectively. Improvements in HF-related hospitalizations appeared to be more pronounced in patients with stable HF: hazard ratio (HR) 0.70 (95% credible interval [Crl] 0.34-1.5]). Risk reductions in mortality and all-cause hospitalizations appeared to be greater in patients who had been recently discharged (≤28 days) from an acute care setting after a recent HF exacerbation: HR 0.62 (95% CrI 0.42-0.89) and HR 0.67 (95% CrI 0.42-0.97), respectively. However, quality of evidence for these outcomes ranged from moderate to low suggesting that further research is very likely to have an important impact on our confidence in the observed estimates of effect and may change these estimates. The post-hoc analysis identified five main types of non-invasive telemonitoring technologies included in the systematic reviews: (1) video-co...

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Section: Methodsmentioning

confidence: 99%

Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews

Kitsiou¹,

Paré²,

Jaana³

2015

J Med Internet Res

255

232

View full text Add to dashboard Cite

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“…We have described the rationale, design, and methods in detail in a previous publication [10]. Briefly, the eligibility of studies was assessed, independently, by two reviewers across all phrases in accordance to standard rules and implementing ad hoc forms.…”

Section: Methodsmentioning

confidence: 99%

“…Phase 1. We carried out a systematic search process starting from Clinical Evidence search strategy process, as described elsewhere [10]. Clinical Evidence is the BMJ Group medical textbook synthesizing biomedical evidence on a wide range of globally important clinical conditions [11].…”

Section: Methodsmentioning

confidence: 99%

Discordances originated by multiple meta-analyses on interventions for myocardial infarction: a systematic review

Lucenteforte

Moja

Pecoraro

et al. 2015

Journal of Clinical Epidemiology

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To clarify the impact of multiple (covering the same population,intervention, control, and outcomes) systematic reviews (SRs) on interventions for myocardial infarction (MI). STUDY DESIGN AND SETTING: Clinical Evidence (BMJ Group) sections and related search strategies regarding MI were used to identify multiple SRs published between 1997 and 2007. Multiple SRs were classified as discordant if they featured conflicting results or interpretation of them.RESULTS: Thirty-six SRs (23.5% of 153 on the treatment or prevention of MI) were classified as multiple and grouped in 16 clusters [ie, at least two SRs with the same PICO (population, condition/disease, intervention, control) and at least one common outcome] exploring angioplasty, angiotensin-converting enzyme inhibitors,anticoagulants, antiplatelets, beta-blockers, and stents. Complete agreement on statistically significant differences between interventions was found in 7 of 10 clusters with a shared composite outcome. Agreement was reduced when single outcomes were considered. Despite substantial variation and limited agreement in reporting of major outcomes, SRs agreed in their conclusions on the superiority of either the intervention or control in 14 of 16 clusters. Sources of minor discrepancies were found in terms of study and outcome selection, subgroup analyses, and interpretation of findings. CONCLUSION: Multiple SRs agreed in their qualitative conclusions but not on reporting and on analyses of hard outcomes. Discordance on significance of treatment effects was due to a combination of variation in design with inclusion of different studies and lack of precision for single hard outcomes compared with a composite outcome. Such inconsistencies among SRs could potentially slow the translation of SRs' results to clinical and public health decision making and suggest the need for a broader methodological and clinical agreement on their design

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“…Different scopes of search or different criteria of inclusion and exclusion will result in discordance among the conclusions. (14,15) A review of reviews about stroke rehabilitation therapy was performed to assess the methodological issues of systematic reviews. The methodological flaws of the reviews, in particular non-Cochrane reviews, were identified.…”

Section: Introductionmentioning

confidence: 99%

Methological quality of systematic reviews and meta-analyses on acupuncture for stroke: A review of review

Chen

et al. 2017

Chin. J. Integr. Med.

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-T. (2017) Methological quality of systematic reviews and meta-analyses on acupuncture for stroke: a review of review. Chinese Journal of Integrative Medicine, 23(11), pp. 871-877.(doi:10.1007Medicine, 23(11), pp. 871-877.(doi:10. /s11655-017-2764 This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/148733/ Database to identify systematic reviews and meta-analyses about acupuncture for stroke published from the inception to December 2016. Review characteristics and the criteria for assessing the primary studies within reviews were extracted. The methodological quality of the reviews was assessed using adapted Oxman and Guyatt Scale. The methodological quality of primary studies was also assessed.Results: Thirty-two eligible reviews were identified, 15 in English and 17 in Chinese.The English reviews were scored higher than the Chinese reviews (P=0.025), especially in criteria for avoiding bias and the scope of search. All reviews used the quality criteria to evaluate the methodological quality of primary studies, but some criteria were not comprehensive. The primary studies, in particular the Chinese reviews, had problems with randomization, allocation concealment, blinding, dropouts and withdrawals, intent to treat analysis and adverse events.Conclusions: Important methodological flaws were found in Chinese systematic reviews and primary studies. It was necessary to improve the methodological quality and reporting quality of both the systematic reviews published in China and primary studies on acupuncture for stroke. KEYWORDSsystematic review, meta-analyses, stroke, acupuncture, review of review, methodological quality 3

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Multiple systematic reviews: methods for assessing discordances of results

Cited by 25 publications

References 21 publications

Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews

Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews

Discordances originated by multiple meta-analyses on interventions for myocardial infarction: a systematic review

Methological quality of systematic reviews and meta-analyses on acupuncture for stroke: A review of review

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