网络元分析如何在评估证据确定性时解决不过渡性问题:系统调查
Ying Wang1, Ruyu Xia2, Tina Poklepovic Pericic3
1Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada yingwwy@163.com.
BMJ open
|November 30, 2023
概括
三分之一使用网络元分析 (NMAs) 的系统性审查,使用推评估,开发和评估 (GRADE) 方法对证据进行了低估,原因是证据不具有传递性. 对解决不过渡性的方法的报告有限,这表明需要改进实践和更明确的指导.
科学领域:
- 卫生研究方法论 卫生研究方法论
- 证据综合 证据综合
- 进行元分析分析.
背景情况:
- 网络元分析 (NMA) 越来越多地用于合成来自多个随机对照试验的证据.
- 推评估,开发和评价 (GRADE) 方法的分级是广泛采用的框架,用于评估证据的确定性.
- 不过过渡性是违反NMA中过渡性假设的行为,可能会影响网络估计的可靠性,需要仔细评估.
研究的目的:
- 描述使用GRADE NMA方法的系统审查如何在评估证据确定性时解决不传递性问题.
- 评估下调评级的频率,证据表明不过渡性和评审人员提供的解释.
主要方法:
- 对2014年9月至2022年10月期间发表的系统评价进行了系统调查.
- 包括使用汇总数据的NMA和GRADE NMA方法进行证据评估确定性的审查.
- 数据提取的重点是审查员如何描述处理不过渡性,效果修饰器和降级决策的方法.
主要成果:
- 不到一半 (44.8%) 符合条件的系统性审查在他们的方法中提到不过渡性.
- 只有15.0%的人明确地寻找直接比较之间的差异,以解决不过渡性问题.
- 三分之一 (33.1%) 的评论低估了不传递性的间接证据,在59.6%的案件中提供了解释,经常引用效果修饰剂的差异.
结论:
- 使用GRADE NMA方法进行的大量系统性审查中,由于不传递性而降低了证据的评级.
- 关于解决不过渡性问题的方法的报告限制是相当大的,这表明评估和报告实践中的潜在缺陷.
- 需要改进报告实践和更明确的GRADE指导,以便在实践中解决不过渡性问题,以提高NMA证据的可靠性.
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