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Consensus-based recommendations for investigating clinical heterogeneity in systematic reviews
Joel J Gagnier1, Hal Morgenstern, Doug G Altman
1Department of Orthopaedic Surgery, University of Michigan, MedSport, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, USA. jgagnier@umich.edu.
BMC Medical Research Methodology
|September 6, 2013
Summary
Systematic reviews often lack clinical applicability due to heterogeneity. This study developed recommendations for investigating clinical heterogeneity, improving the relevance of review findings for individual patient care.
Area of Science:
- Medical research methodology
- Evidence-based medicine
- Systematic review processes
Background:
- Clinical heterogeneity, or true effect heterogeneity, is a significant challenge in systematic reviews, limiting their applicability to individual patient care.
- Existing methods for addressing statistical and methodological heterogeneity in systematic reviews are well-established, but clinical aspects remain under-investigated.
Framework:
- Developed recommendations for investigating clinical heterogeneity using a modified Delphi technique.
- Defined clinical heterogeneity as variations in treatment effects attributable to clinically relevant characteristics.
Implementation:
- A three-phase modified Delphi technique involved pre-meeting item generation, a face-to-face consensus meeting, and post-meeting feedback.
- Participants with expertise in systematic review methodology, reporting, and meta-analysis statistics were recruited.
Implications:
- The generated recommendations provide guidance for systematic reviewers to conduct robust investigations of clinical heterogeneity.
- Addressing clinical heterogeneity can enhance the validity, reliability, and clinical applicability of systematic review findings for patient management.
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