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Fixed or random effects meta-analysis? Common methodological issues in systematic reviews of effectiveness
Abstract
Systematic review aims to systematically identify, critically appraise, and summarize all relevant studies that match predefined criteria and answer predefined questions. The most common type of systematic review is that assessing the effectiveness of an intervention or therapy. In this article, we discuss some of the common methodological issues that arise when conducting systematic reviews and meta-analyses of effectiveness data, including issues related to study designs, meta-analysis, and the use and interpretation of effect sizes.
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“Additionally, it was recommended that the protocol should define the methods to be used for risk of bias assessment, meta-analysis and exploration of heterogeneity [41, 42, 44].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [44]
In the citing paper
“The articles recommended that the protocol should state the objectives, hypotheses to be tested and the rationale of the review, [29] and that it should describe eligibility criteria [29, 33, 35, 36, 38, 39, 41], define the type of studies to be included [35, 37, 42, 44], and give the reason when including observational studies in the review [35, 37, 40].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [44]
In the citing paper
“Twenty-five (27%) articles gave recommendations on item “considering different study designs” [8, 29, 34, 35, 37–39, 42, 44, 49, 51, 56, 61, 65, 70, 73, 75, 76, 77–83], with publication dates between 1995 and 2016 (median year of publication 2007).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [44]
In the citing paper
“A variation of this recommendation was to exclude studies that are at high risk of bias [42, 44, 54, 73, 82].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [44]
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Self-citationLee, G. S. J., Tay, H. S. E., Teo, V. X. Y., Goh, R. S. J., Chong, B., Chan, S. P., Tay, E. L. W., Lim, Y., Yip, J., Chew, N., et al. (2022) · Angiology · doi:10.1177/00033197221121616 · Cited by 6
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A systematic review on Autologous Matrix Induced Chondrogenesis (AMIC) for chondral knee defects
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“30 Heterogeneity will be evaluated statistically using the standard χ 2 and I 2 tests.”
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“The choice of model (random or fixed effects) and method for meta-analysis were based on the guidance by Tufanaru et al. 29 To facilitate meta-analysis, interquartile ranges were converted to standard deviations where needed and possible.”
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“We employed the random-effects model in all analyses because there is evidence that it can provide more robust outcome measures compared to the fixed-effects model (Tufanaru et al. 2015).”
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Self-citationPhysiotherapy in Patients with Stress Urinary Incontinence: A Systematic Review and Meta-analysis
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Ho, L. Y. W., Lai, C. K. Y., & Ng, S. S. M. (2024) · Topics in Stroke Rehabilitation · doi:10.1080/10749357.2024.2304966 · Cited by 5
“32,33 When required data were not directly available, the group mean was calculated using q 1 þ m þ q 3 3 , 34 and the standard deviation was calculated using q 3 (cid:0) q 1 2 (cid:0) 1 0 : 75 n (cid:0) 0 : 125 n þ 0 : 25 ð 35 ; otherwise, the Fail-Safe N analysis was used to identify the number…”
MethodWang, C., Zhang, Q., Zhang, L., Zhao, D., Xu, Y., Liu, Z., Wu, C., Wu, S., Yong, M., & Wu, L. (2024) · Frontiers in Neuroscience · doi:10.3389/fnins.2024.1352212 · Cited by 5
Risk factors for tibial infections following osteosynthesis – a systematic review and meta-analysis
Niebuhr, D., Mattson, T., Jensen, N. M., Viberg, B., & Jensen, S. S. (2024) · Journal of Clinical Orthopaedics and Trauma · doi:10.1016/j.jcot.2024.102376 · Cited by 5
Webster‐Clark, M., Filion, K. B., & Platt, R. W. (2024) · American Journal of Epidemiology · doi:10.1093/aje/kwae015 · Cited by 5
“16 Further, varying the target population across the sites of a multisite study or distributed network can help one examine effects at sites relevant to the stakeholders participating in the network, akin to analyzing a variety of target populations for randomized controlled trials.”
BackgroundEndometriosis risk is associated with shorter anogenital distance by meta-analysis
Crespi, B. J. (2024) · Journal of Endometriosis and Uterine Disorders · doi:10.1016/j.jeud.2024.100083 · Cited by 5
Carter, N., Nalbant, G., Chahal, P., & Chattopadhyay, K. (2024) · JBI Evidence Synthesis · doi:10.11124/jbies-23-00273 · Cited by 12
Gebremichael, B., Lassi, Z. S., Begum, M., & Zhou, S. J. (2024) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2024.06.029 · Cited by 5
Taylor, B., Ellis, J. P., Ponty, S., Patrick, L., Scott, T. E., & Chockalingam, N. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-086727 · Cited by 5
“29 A narrative description will be performed where insufficient continuous or dichotomous data exist for a volatile agent and outcome.”
Gatheru, P. M., Wao, H., Alamdo, A. G., Kwarteng, P. G., Kwashie, M. D., Kabiru, C. W., Alangea, D. O., Torpey, K., & Manu, A. (2024) · Reproductive Health · doi:10.1186/s12978-024-01912-z · Cited by 5
“Further rationale for using the random effects model to meta-synthesize is based on the multicriteria perspectives proposed by Tufanaru et al. [28].”
FitzGerald, H., Anderson, E., Anderson, L. R., Tracy, A., & Thomson, J. S. (2019) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2018-004040 · Cited by 5
Hang, J., Francis‐Coad, J., Naseri, C., Waldron, N., & Hill, A. (2020) · JBI Evidence Synthesis · doi:10.11124/jbisrir-d-19-00240 · Cited by 5
Evans, J. R., Canuto, K. J., Kelly, R., Caperchione, C. M., & Macniven, R. (2020) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00060 · Cited by 5
Munhoz, O. L., Morais, B. X., dos Santos, W. M., de Paula, C. C., & Magnago, T. S. B. D. S. (2022) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.6219.3709 · Cited by 5
Kunze, K. N., Kay, J., Pareek, A., Dahmen, J., Nwachukwu, B. U., Williams, R. J., KARLSSON, J. L., & de SA, D. L. (2023) · Knee Surgery Sports Traumatology Arthroscopy · doi:10.1007/s00167-023-07328-9 · Cited by 6
“In choosing this method, the following assumptions should be satisfied: (1) the sole source of variation occurs within each study; (2) all study populations do not differ in meaningful ways; (3) study selection criteria does not differ and (4) treatments do not differ across studies [5, 23, 29].”
MethodWang, M. K., Heo, R., Meyre, P. B., Blum, S., Park, L., Birchenough, L., Vuong, K., McIntyre, W. F., Healey, J. S., Devereaux, P. J., et al. (2023) · Swiss Medical Weekly · doi:10.57187/smw.2023.40056 · Cited by 5
Ting, D. S. J., Henein, C., Said, D. G., & Dua, H. S. (2020) · JBI Evidence Synthesis · doi:10.11124/jbisrir-d-19-00367 · Cited by 5
Palomaa, A.-K., Tuomikoski, A., Huhtala, S., & Pölkki, T. (2021) · JBI Evidence Synthesis · doi:10.11124/jbies-21-00010 · Cited by 5
Rieger, K. L., Lobchuk, M., Duff, M. A., Chernomas, W. M., Campbell‐Enns, H. J., Demczuk, L., Nicolas, S., & West, C. (2018) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003446 · Cited by 5
Kourbelis, C., Franzon, J., Foote, J. W., Brown, A. D. H., Daniel, M., Coffee, N. T., Newman, P. K., Ganesan, A. N., Nicholls, S. J., & Clark, R. A. (2018) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003584 · Cited by 5
Mulugeta, H., Sinclair, P. M., & Wilson, A. (2023) · medRxiv · doi:10.1101/2023.01.20.23284815 · Cited by 5
“A random-effects model with DerSimonian and Laird model will estimate the pooled effect size of the outcomes, as recommended by Tufanaru et al (35).”
MethodWang, Z., Li, Y., Wang, Q., & Su, Y. (2025) · Journal of Medical Internet Research · doi:10.2196/74347 · Cited by 7
“Researchers in 12 studies reported feasibility, which was assessed by retention rate (n=8), wearing time (n=2), whether steps per day improved or not (n=1), and adherence to interventions (n=1) [39-41,”
Metadata
- Authors
- Tufanaru, C., Munn, Z., Stephenson, M., & Aromataris, E.
- Affiliations
- The University of Adelaide (AU)
- Venue
- International Journal of Evidence-Based Healthcare
- Published
- 2015-09
- Volume
- 13
- Issue
- 3
- Pages
- 196-207
- ISSN
- 1744-1595 (ISSN-L)
- 1744-1609
- OpenAlex
- W2180006680
- Cited by
- 1,057
- References
- 62
- Citations by year
- 2026: 77 · 2025: 151 · 2024: 204 · 2023: 167 · 2022: 157 · 2021: 101 · 2020: 65 · 2019: 57 · 2018: 48 · 2017: 22 · 2016: 8
- FWCI
- 4.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Evidence-Based Healthcare (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Social Sciences › Sociology and Political Science › Delphi Technique in Research
- Keywords
- fixed-effects meta-analysis, random-effects meta-analysis, systematic review methodology, intervention effectiveness, effect size, research design
- MeSH terms
- Humans, Research Design, Review Literature as Topic, Meta-Analysis as Topic, Odds Ratio, Guidelines as Topic, Cross-Over Studies, Evidence-Based Medicine, Observational Studies as Topic
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