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Network meta-analyses (NMA) compare multiple treatments using direct and indirect evidence. This guide helps surgeons assess NMA credibility and interpret results for clinical decision-making.

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Area of Science:

  • Medical research methodology
  • Evidence synthesis
  • Comparative effectiveness research

Background:

  • Traditional meta-analyses compare only two interventions using direct evidence.
  • Multiple treatment options exist for many conditions, but direct comparisons are often lacking.
  • Network meta-analyses (NMA) integrate direct and indirect evidence to compare three or more interventions.

Purpose of the Study:

  • To provide surgeons with criteria for evaluating the methodological quality and credibility of NMAs.
  • To guide surgeons in assessing the trustworthiness of NMA results for clinical application.
  • To introduce a framework for judging the certainty of treatment effect sizes and directions from NMAs.

Main Methods:

  • The study focuses on evaluating the credibility of NMA methodology.
  • It introduces criteria for assessing the quality of evidence and the validity of indirect comparisons.
  • An example from clinical orthopaedics illustrates the application of these evaluation criteria.

Main Results:

  • The guide establishes a two-part framework for trusting NMA results: assessing methodology and determining certainty in effect estimates.
  • It emphasizes the importance of understanding NMA complexities for accurate interpretation.
  • Part I demonstrates how to evaluate the credibility of NMA methodology.

Conclusions:

  • Surgeons need to critically appraise NMA methodology to trust their findings.
  • Understanding NMA evaluation criteria enhances the reliable application of synthesized evidence in practice.
  • This guide empowers surgeons to make informed decisions based on robust NMA interpretation.