When continuous outcomes are measured using different scales: guide for meta-analysis and interpretation

Murad, M. Hassan; Wang, Zhen; Chu, Haitao; Lin, Lifeng

doi:10.1136/bmj.k4817

Cited by 154 publications

(134 citation statements)

References 23 publications

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“…Pooled OR and 95%CI estimates were calculated using Stata/SE 12.0 to address the relationship between BMI-defined obesity and the risk of defined outcomes among patients with COVID-19. For continuous outcome variables, SMD is a measure of distance between two group means in terms of one or more variables and used as a summary statistic when outcome from each study is measured using several different scales [16]. Since all defined-indicators of quantification of VAT among studies were accepted in our meta-analysis, SMD was used as a summary statistic for included studies to evaluate VAT difference between severe COVID-19 and non-severe COVID-19 groups.…”

Section: Discussionmentioning

confidence: 99%

Obesity in patients with COVID-19: a systematic review and meta-analysis

et al. 2020

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Background: Obesity is common in patients with coronavirus disease 2019 (COVID-19). The effects of obesity on clinical outcomes of COVID-19 warrant systematical investigation. Objective: This study explores the effects of obesity with the risk of severe disease among patients with COVID-19. Methods: Body mass index (BMI) and degree of visceral adipose tissue (VAT) accumulation were used as indicators for obesity status. Publication databases including preprints were searched up to August 10, 2020. Clinical outcomes of severe COVID-19 included hospitalization, a requirement for treatment in an intensive care unit (ICU), invasive mechanical ventilation (IMV), and mortality. Risks for severe COVID-19 outcomes are presented as odds ratios (OR) and 95% confidence interval (95%CI) for cohort studies with BMI-defined obesity, and standardized mean difference (SMD) and 95%CI for controlled studies with VAT-defined excessive adiposity. Results: A total of 45, 650 participants from 30 studies with BMI-defined obesity and 3 controlled studies with VAT-defined adiposity were included for assessing the risk of severe COVID-19. Univariate analyses showed significantly higher ORs of severe COVID

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Section: Discussionmentioning

confidence: 99%

Obesity in patients with COVID-19: a systematic review and meta-analysis

et al. 2020

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“…For the assessment of care effectiveness, the ratio of mean effectiveness scores associated with the intervention and control group was calculated. The use of a ratio helps account for disparities in the measures used to assess effectiveness of care in individual studies, facilitating the pooling and comparison of their data [34]. In the case of a lower effect score translating to a better clinical outcome, the effect ratio was inverted to reflect the appropriate change in outcome.…”

Section: Meta-analysis and Statistical Approachesmentioning

confidence: 99%

Cost and effects of integrated care: a systematic literature review and meta-analysis

et al. 2020

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Background Health and care services are becoming increasingly strained and healthcare authorities worldwide are investing in integrated care in the hope of delivering higher-quality services while containing costs. The cost-effectiveness of integrated care, however, remains unclear. This systematic review and meta-analysis aims to appraise current economic evaluations of integrated care and assesses the impact on outcomes and costs. Methods CINAHL, DARE, EMBASE, Medline/PubMed, NHS EED, OECD Library, Scopus, Web of Science, and WHOLIS databases from inception to 31 December 2019 were searched to identify studies assessing the cost-effectiveness of integrated care. Study quality was assessed using an adapted CHEERS checklist and used as weight in a random-effects meta-analysis to estimate mean cost and mean outcomes of integrated care. Results Selected studies achieved a relatively low average quality score of 65.0% (± 18.7%). Overall meta-analyses from 34 studies showed a significant decrease in costs (0.94; CI 0.90–0.99) and a statistically significant improvement in outcomes (1.06; CI 1.05–1.08) associated with integrated care compared to the control. There is substantial heterogeneity in both costs and outcomes across subgroups. Results were significant in studies lasting over 12 months (12 studies), with both a decrease in cost (0.87; CI 0.80–0.94) and improvement in outcomes (1.15; 95% CI 1.11–1.18) for integrated care interventions; whereas, these associations were not significant in studies with follow-up less than a year. Conclusion Our findings suggest that integrated care is likely to reduce cost and improve outcome. However, existing evidence varies largely and is of moderate quality. Future economic evaluation should target methodological issues to aid policy decisions with more robust evidence on the cost-effectiveness of integrated care.

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“…Interpreting effect estimates for pain intensity is challenging as this outcome can be assessed using different scales (eg, Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), SF-36 bodily pain scale or other scales). To address this issue, we will follow specific guidelines to standardise this outcome into a standard metric 81–83. We chose the 10 cm pain intensity VAS (score range 0 to 10 cm; lower score represents less pain) as this is the pain intensity scale most commonly used in acute pain trials 84–86.…”

Section: Methods and Analysismentioning

confidence: 99%

“…When assessing pain intensity data, to further optimise the interpretation of meta-analyses results, we will also calculate the proportion of patients who reported adequate pain control (no more than mild pain, as determined by a pain score <3/10 cm VAS) 88 89. By assuming a normal distribution of postoperative pain scores in both groups, differences in risk of reporting adequate pain control will be derived with its associated 95% CIs 81–83…”

Section: Methods and Analysismentioning

confidence: 99%

“…If we identify more than one trial measuring the exploratory outcomes of interest in this knowledge synthesis (eg, patient satisfaction, self-reported postoperative health status, readmissions), data will be meta-analysed and reported as WMDs (continuous measures) or RRs (dichotomous measures), as appropriate. Where relevant, outcome data using different metrics will be converted into a standard metric according to guideline recommendations 81–83. Focussed literature searches will be conducted to identify anchor-based MIDs 87…”

Section: Methods and Analysismentioning

confidence: 99%

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Opioid versus opioid-free analgesia after surgical discharge: protocol for a systematic review and meta-analysis

et al. 2020

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IntroductionExcessive prescribing after surgery has contributed to a public health crisis of opioid addiction and overdose in North America. However, the value of prescribing opioids to manage postoperative pain after surgical discharge remains unclear. We propose a systematic review and meta-analysis to assess the extent to which opioid analgesia impact postoperative pain intensity and adverse events in comparison to opioid-free analgesia in patients discharged after surgery.Methods and analysisMajor electronic databases (MEDLINE, Embase, Cochrane Library, Scopus, AMED, BIOSIS, CINAHL and PsycINFO) will be searched for multi-dose randomised-trials examining the comparative effectiveness of opioid versus opioid-free analgesia after surgical discharge. Studies published from January 1990 to July 2019 will be targeted, with no language restrictions. The search will be re-run before manuscript submission to include most recent literature. We will consider studies involving patients undergoing minor and major surgery. Teams of reviewers will, independently and in duplicate, assess eligibility, extract data and evaluate risk of bias. Our main outcomes of interest are pain intensity and postoperative vomiting. Study results will be pooled using random effects models. When trials report outcomes for a common domain (eg, pain intensity) using different scales, we will convert effect sizes to a common standard metric (eg, Visual Analogue Scale). Minimally important clinical differences reported in previous literature will be considered when interpreting results. Subgroup analyses defined a priori will be conducted to explore heterogeneity. Risk of bias will be assessed according to the Cochrane Collaboration's Risk of Bias Tool 2.0. The quality of evidence for all outcomes will be evaluated using the GRADE rating system.Ethics and disseminationEthical approval is not required since this is a systematic review of published studies. Our results will be published in a peer-reviewed journal and presented at relevant conferences. Further knowledge dissemination will be sought via public and patient organisations focussed on pain and opioid-related harms.

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When continuous outcomes are measured using different scales: guide for meta-analysis and interpretation

Cited by 154 publications

References 23 publications

Obesity in patients with COVID-19: a systematic review and meta-analysis

Obesity in patients with COVID-19: a systematic review and meta-analysis

Cost and effects of integrated care: a systematic literature review and meta-analysis

Opioid versus opioid-free analgesia after surgical discharge: protocol for a systematic review and meta-analysis

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