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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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“Statistical heterogeneity was assessed using both the I 2 and chi-square tests [26].”
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“33 Sensitivity analysis was performed to explore the source of heterogeneity.”
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“Statistical analyses will be performed using the random effects model.(26) Methodological heterogeneity will be managed using subgroup analyses according to study design and/or focus of program (eg, de-escalation or behavior recognition), program delivery (eg, online or face-to-face) and/or participant type (eg, docto…”
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“Analytical examinations will be done using a fixed-effect model if there are less than five studies included and a random-effects model if there are five or more studies included.(39) A funnel plot will be created in STATA v.”
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“Only studies having a minimum score of 7 or above for cross-sectional studies and a score of 9 or higher for cohort studies were included after each study was evaluated against these criteria [ 15 ] .”
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“1), a random-effects model was applied; otherwise, a fixed-effects model was used (31).”
MethodRinse-free hand wash for reducing absenteeism among school- and preschool-aged children
Munn, Z., Tufănaru, C., Lockwood, C. S., & Stern, C. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012566 · Cited by 3
Self-citationGoreth, M. B., & Palokas, M. J. (2018) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003447 · Cited by 3
Lyndon, H., Underwood, F., Latour, J. M., Marsden, J. F., Brown, A., & Kent, B. (2019) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-d-19-00082 · Cited by 3
“Statistical analyses will be performed using a random effects model as it is highly unlikely that normality of distribution will be found.(23) Subgroup analyses will be conducted where there is sufficient data to investigate.”
MethodKebede, H. K., Gesesew, H. A., Mwanri, L., & Ward, P. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18083917 · Cited by 3
“However, we will only consider fixed effect model irrespective of the level of heterogeneity if the number of studies that reported the intervention and UNAIDS target will be small (n < 5) [45,46].”
BackgroundMethodPutnikovic, M., Ward, M., & Jordan, Z. (2021) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00473 · Cited by 3
Transtheoretical model for lifestyle changes in older persons: a systematic review protocol
da Rosa, M. C., Rosa, C. B., Boff, R. D. M., Oliveira, M. D. S., & Schwanke, C. H. A. (2021) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.14714 · Cited by 3
Naruse, T., Kynoch, K., Sumikawa, Y., Ramis, M., & Tuckett, A. G. (2022) · JBI Evidence Synthesis · doi:10.11124/jbies-21-00231 · Cited by 3
Cardiovascular meta-analyses: fool’s gold or gold for fools?
Biondi‐Zoccai, G., Windecker, S., Jüni, P., & Bhatt, D. L. (2022) · European Heart Journal · doi:10.1093/eurheartj/ehac312 · Cited by 3
Telemedicine and medical education: a mixed methods systematic review protocol
Hoffman, B., Braund, H., McKeown, S., Dalgarno, N., Godfrey, C. M., & Appireddy, R. (2022) · JBI Evidence Synthesis · doi:10.11124/jbies-21-00481 · Cited by 4
Chaparro, C. J., Maluf, V. A. B., Moullet, C., Kiszio, B., Pugliese, M., Ramelet, A., Morice, C., Valla, F. V., & Tume, L. N. (2023) · JBI Evidence Synthesis · doi:10.11124/jbies-22-00133 · Cited by 3
Tegg, N. L., Myburgh, C., Kennedy, M., & Norris, C. M. (2023) · JBI Evidence Synthesis · doi:10.11124/jbies-23-00047 · Cited by 3
Effectiveness of school-based sleep promotion programs for adolescents: a systematic review protocol
Duque, F. M., Santos, D., Pinto, D. L., Rêgo, A. D. S., Vidinha, T., Cardoso, D., Cardoso, A. F., Veríssimo, C., & Rodrigues, R. (2023) · JBI Evidence Synthesis · doi:10.11124/jbies-23-00053 · Cited by 3
Nouira, M., Souayeh, N., Arfa, S., Maatouk, M., Hasnaoui, A., Bouchahda, H., & Ennigrou, S. (2023) · F1000Research · doi:10.12688/f1000research.141114.1 · Cited by 2
Matsunaka, E., Ooshige, N., Ueki, S., & Morokuma, S. (2024) · JBI Evidence Synthesis · doi:10.11124/jbies-23-00274 · Cited by 3
Farantos, G. I., & Dounias, G. (2024) · Academic journal of business, administration, law and social sciences · doi:10.2478/ajbals-2024-0001 · Cited by 3
White, J. W., Pfledderer, C. D., Kinard, P., Beets, M. W., von Klinggraeff, L., Armstrong, B., Adams, E. L., Welk, G. J., Burkart, S. A., & Weaver, R. G. (2023) · International journal of exercise science · doi:10.70252/vnkn6618 · Cited by 3
Varughese, A., Janakiram, C., Karuveettil, V., & James, A. (2024) · JBI Evidence Synthesis · doi:10.11124/jbies-23-00376 · Cited by 4
Wu, Z., Zhang, H., Li, J., Diao, Y., Huang, M.-J., Gao, D.-Y., Liang, C., & Luo, Z. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1337179 · Cited by 3
Woldegerima, E., Aemiro, M., Fetene, G., & Birhanie, N. (2024) · Parasitology International · doi:10.1016/j.parint.2024.102922 · Cited by 4
Yeo, B. S. Y., Koh, J. H., Shi, B. Y., Chan, J. H., Ng, A. C. W., Loh, S. R. H., Leow, L. C., Ong, T. H., Gooley, J. J., & Toh, S. T. (2024) · Sleep And Breathing · doi:10.1007/s11325-024-03092-3 · Cited by 5
“Evidence suggests that the random effects model provides a more comprehensive outcome measure than the fixed effects model [20].”
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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