在随机对照试验的元分析中,质量指标与治疗效果估计的相关性
Ethan M Balk1, Peter A L Bonis, Harry Moskowitz
1Evidence-based Practice Center, Division of Clinical Care Research, Tufts University School of Medicine, New England Medical Center, 750 Washington St, No. 63, Boston, MA 02111, USA.
JAMA
|June 8, 2002
概括
随机对照试验中的个体质量测量并不总是与治疗效果大小相关. 在特定的医学领域发现的关联并不能在所有临床领域进行概括.
科学领域:
- 医学研究方法学 医学研究方法学
- 临床试验质量评估 临床试验质量评估
- 进行元分析分析.
背景情况:
- 试验质量特征可能会影响随机研究中观察到的治疗效果.
- 评估试验质量在元分析中很常见,但它与治疗效果的关联在各种医学领域尚未得到充分确立.
研究的目的:
- 在随机对照试验 (RCT) 中调查特定质量测量和治疗效果大小之间的关联.
主要方法:
- 从心血管疾病,传染病,儿科和外科手术的RCT中发表的尺度评估质量指标.
- 包括至少6个RCT的元分析,二分结果和显著的异质性.
- 分析了相对概率比率 (ORs),比较了高质量与低质量的研究.
主要成果:
- 在276个RCT和26个元分析中,24个质量指标没有显示出与治疗效果的统计学意义上的关联 (相对ORs:0.83-1.26)
- 具体措施,如安慰剂控制和失明,在有限的分析中显示了相关性,但这些不一致.
- 符合质量标准的研究比例在四个医学领域有很大差异.
结论:
- 在各种研究和医疗领域中,个别质量测量缺乏与治疗效果强度的可靠关联.
- 虽然特定的质量测量在有支持证据的定义领域可能是相关的,但它们的通用性是有限的.
- 调查结果提醒人们不要在元分析中广泛地将质量测量与治疗效果的关联应用.
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