Cited by 1,057Meta-analysis and systematic reviewsStatistical Methods in EpidemiologyDelphi Technique in Research

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Fixed or random effects meta-analysis? Common methodological issues in systematic reviews of effectiveness

Tufanaru, Catalin, Munn, Zachary, Stephenson, Matthew, Aromataris, Edoardo·2015·International Journal of Evidence-Based Healthcare

DOI 10.1097/xeb.0000000000000065

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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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Patel, K., & Hoover, K. W. (2017) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2016-003186 · Cited by 2
The impact of outpatient telehealth compared to standard care on emergency room visits and hospital admissions in pediatric diabetes patients: a systematic review protocol
Armstrong, K., & Moore, M. M. (2018) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2016-003328 · Cited by 2
Health-related quality of life of young people and adults with primary or recurrent episodes of genital herpes: a mixed methods systematic review protocol
Bennett, C. L., Rebafka, A., Carrier, J., Edwards, D. J., & Jones, J. (2018) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003478 · Cited by 2
“2015.(43) Where statistical pooling is not possible the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate A funnel plot will be generated to assess publication bias if there are 10 or more studies included in a meta-analysis.”
BackgroundMethodInfluential
Second trimester ultrasound detection of fetal anomalies in the obese obstetrical population: a systematic review protocol
Preen, C., Munn, Z., Raju, S. E., & Flack, N. (2018) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003505 · Cited by 2
Self-citation
Effectiveness of discharge education on outcomes in acute coronary syndrome patients: a systematic review protocol
Kourbelis, C., Franzon, J., Foote, J. W., Brown, A. D. H., Daniel, M., Coffee, N. T., Newman, P., Nicholls, S. J., & Clark, R. A. (2018) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003543 · Cited by 2
Community-based interventions to address alcohol and drug use in Indigenous populations in Australia, New Zealand and Canada: a systematic review protocol
Stewart, T., Reilly, R. E., & Ward, J. S. (2018) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003504 · Cited by 2
Effectiveness and safety of conservative management of occult pneumothorax in mechanically ventilated patients: a systematic review protocol
Smith, J. A., Secombe, P. J., & Aromataris, E. (2019) · JBI Evidence Synthesis · doi:10.11124/jbisrir-d-19-00196 · Cited by 2
Self-citation
Effectiveness of non-pharmacological interventions for managing agitation during post-traumatic amnesia following traumatic brain injury: a systematic review protocol
Carrier, S. L., Hicks, A. J., Ponsford, J. L., & McKay, A. (2020) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00216 · Cited by 2
Risk factors for hyperglycemia and hypoglycemia in adults with pharmacologically treated type 2 diabetes mellitus: a quantitative systematic review protocol
Lopes, R. O. P., Barbosa, G. D. S., Zaccaro, K. R. L., Mercês, C. A. M. F., Santana, R. F., & Brandão, M. A. G. (2020) · JBI Evidence Synthesis · doi:10.11124/jbisrir-d-19-00295 · Cited by 2
Organic food consumption and the incidence of cancer: a systematic review protocol
Jadotte, Y. T., Koos, J. A., & Lane, D. S. (2020) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00115 · Cited by 2
“Data synthesis Data from experimental and observational studies will be meta-analyzed separately.(18) The random effects model accounts for the between-study variability and is the preferred meta-analytic approach in this review.”
Method
Ultrasonography relative to Cormack-Lehane in predicting difficult laryngoscopy: a systematic review of diagnostic test accuracy
Ferszt, P., Hill, J., & Larson, S. L. (2020) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00141 · Cited by 2
Effectiveness of dietary inorganic nitrate in lowering blood pressure in hypertensive adults: a systematic review protocol
Remington, J., & Winters, K. P. (2017) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2016-003307 · Cited by 2
The effectiveness of low-dosed outpatient biopsychosocial interventions compared to active physical interventions on pain and disability in adults with nonspecific chronic low back pain: A protocol for a systematic review with meta-analysis
Hochheim, M., Ramm, P., & Amelung, V. E. (2022) · PLoS ONE · doi:10.1371/journal.pone.0273983 · Cited by 2
“This model not only accounts for the statistical heterogeneity of the included studies, but allows for generalisation beyond these studies [52,53].”
Method
Safety and effectiveness of regional anesthesia compared with anesthetic techniques not using regional anesthesia on outcomes after free tissue flap surgery: a systematic review protocol
Smith, A., Weigand, J., Greenwood, J., & Tierney, K. (2022) · JBI Evidence Synthesis · doi:10.11124/jbies-21-00476 · Cited by 2
Experiences of residents of long-term-care homes with the use of socially assistive technologies and the effectiveness of these technologies: a mixed methods systematic review protocol
Macdonald, M., Weeks, L. E., Moody, E., Martin‐Misener, R., Iduye, D., States, C., Ignaczak, M., Delahunty‐Pike, A., Caruso, J., Simm, J., et al. (2022) · JBI Evidence Synthesis · doi:10.11124/jbies-21-00409 · Cited by 2
Protocol for a systematic review of interventions targeting mental health, cognition or psychological well-being among individuals with long COVID
Hawke, L. D., Brown, E. E., Rodak, T., Rossell, S. L., Ski, C. F., Strudwick, G., Thompson, D. R., Wang, W., Xu, D., & Castle, D. J. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-063846 · Cited by 3
Nebulised magnesium sulphate as an adjuvant to the treatment of acute exacerbation of COPD: A systematic review and meta-analysis of randomised controlled trials with trial sequential analysis
Datta, P. K., Aravindan, A., Nath, S., Chowdhury, S. R., & Dutta, D. (2023) · Lung India · doi:10.4103/lungindia.lungindia_473_22 · Cited by 2
“Fixed-effect model was used to meta-analyse the data in case a number of studies was 5 or less.[7] In case studies used different pulmonary function parameters to assess expiratory flow function, such as forced expiratory volume in 1 second (FEV1) or peak expiratory flow rate (PEFR), sensitivity analysis was done for…”
Method
Anticancer Effects of Gingerol, Shogaol and Curcumin in Cervical Cancer: A Systematic Review Protocol
Rahim, U. A., Roos, N. A. C., Mustapa, M., Nurdin, A., Taridi, N. M., & Yusof, Y. A. M. (2023) · Advances in Human Biology · doi:10.4103/aihb.aihb_222_22 · Cited by 2
Does bilateral hearing aid fitting improve spatial hearing ability: a systematic review and meta-analysis
Kumar, S., Nayak, S., Kanagokar, V., & Pitchaimuthu, A. N. (2024) · Disability and Rehabilitation Assistive Technology · doi:10.1080/17483107.2024.2316293 · Cited by 2
“…the best model to estimate the overall effect is often selected based on the number of studies and the degree of heterogeneity. tufanaru et al. [41] recommended a fixed effects (Fe) model when the number of studies is less than five and the heterogeneity is low (i 2 < 30%). if the above-stated…”
Effectiveness of financial incentives for long-acting injectable antipsychotic adherence in patients with psychotic and bipolar disorders: a systematic review protocol
Dennis, R., Christian, R., & Palokas, M. J. (2019) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003926 · Cited by 2
“2015.(29) Subgroup analyses will be conducted where there is sufficient data to investigate patient diagnosis, length of time on LAI antipsychotic medications, age and sex.”
Background
Effectiveness of parenting education for expectant primiparous women in Asian countries: a quantitative systematic review protocol
Mori, E., Iwata, H., Maehara, K., Sakajo, A., Ina, K., & Harada, N. (2019) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003974 · Cited by 2
Association between restriction policies and rate of alcohol-related harm in Australian Aboriginal and Torres Strait Islander communities: a systematic review protocol
Hines, S. J., Carey, T. A., Martin, K., & Cibich, M. (2019) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-d-19-00041 · Cited by 2
Effectiveness of serial focused ultrasound of the lungs and inferior vena cava for monitoring patients with acute dyspnea: a systematic review protocol
Arvig, M. D., Laursen, C. B., Jacobsen, N., Gæde, P., & Lassen, A. T. (2019) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-d-19-00027 · Cited by 2
Effectiveness and usability of mobile health applications for medication adherence in patients with heart failure: a systematic review protocol
de Barros, K. A. A. L., Martins, M. A. P., Praxedes, M. F. D. S., & Ribeiro, A. L. P. (2021) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00399 · Cited by 2
Risk Factors for Late Linkage to Care and Delayed Antiretroviral Therapy Initiation Amongst HIV Infected Adults in Sub-saharan Africa: a Systematic Review and Meta-analysesPreprint
Fuge, T. G., Tsourtos, G., & Miller, E. R. (2022) · Research Square · doi:10.21203/rs.3.rs-840708/v1 · Cited by 2
Effects of physical exercise interventions on cognitive function in Parkinson’s disease: an updated systematic review and meta-analysis of randomized controlled trialsPreprint
Kim, R., Kang, N., Lee, T. L., Lee, H., Ko, D. K., Lee, J. H., Shin, H., Lim, D., Jun, J., Byun, K., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-3162661/v1 · Cited by 2
Experiences and effectiveness of occupational therapy interventions delivered in the acute setting: a mixed methods systematic review protocol
George, S., Barrett, M., Ionno, J. D., Fletcher, L., Choo, W. S., Rivas-Dominguez, S., Romanic, N., Lizarondo, L. M., & Stern, C. (2021) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00407 · Cited by 1
Effectiveness of osteopathic manipulative treatment in cardiovascular function: a systematic review protocol
Vanier, C. H., Johnston, K., DeArmond, M., Salloum, L., Arjmand, S., Toder, E., & Ioudina, M. (2022) · JBI Evidence Synthesis · doi:10.11124/jbies-21-00378 · Cited by 1
Impact of traditional East Asian medicine as an add-on therapy on survival and recurrence after surgery for breast cancer: A systematic review and meta-analysis
Yoon, J.-H., Kim, E. H., Park, S. B., Jin, H., & Yoon, S. W. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1125373 · Cited by 1
“In other cases, a random effects model was used (Tufanaru et al., 2015).”
Method
Autism Spectrum Disorder and Face Identity Recognition Deficit across Ages
Song, Y. (2023) · Graduate Student Journal of Psychology · doi:10.52214/gsjp.v20i1.10622 · Cited by 1
Biopsychosocial Predictors of Postpartum Depression: Protocol for Systematic Review and Meta-Analysis
Ahmad, M. A., Awar, S. A. A. R. A., Sallam, G. S., Alkaabi, M. S. N., Smetanina, D., Statsenko, Y. A., & Zaręba, K. T. (2024) · Healthcare · doi:10.3390/healthcare12060650 · Cited by 5
“Specifically, we plan to apply a random effects model, which helps to generalise findings beyond the included papers [52].”
Method
Effectiveness of Spontaneous Pushing versus Valsalva Pushing in the Second Stage of Labor on Maternal and Neonatal Outcomes: A Systematic Review and Meta-analysis
Kownaklai, J., Phanwichatkul, T., Chaichan, A., & Lee, A. J. (2024) · Pacific Rim International Journal of Nursing Research · doi:10.60099/prijnr.2024.264145 · Cited by 1
Endodontic Surgery and Post-Treatment Apical Periodontitis: A Systematic Review
Iqbal, A., Khattak, O., Almutairi, H. A., Almaktoom, I. T., Alanazi, G. R. A., Alruwaili, K. H. A., Alruwaili, A. M., Alftaikhah, S. A. A., Issrani, R., Mustafa, M., et al. (2024) · The Open Dentistry Journal · doi:10.2174/0118742106296829240513095047 · Cited by 1

Authors: Tufanaru, C., Munn, Z., Stephenson, M., & Aromataris, E.
Affiliations: The University of Adelaide (AU)
ORCID: Munn, Zachary
Stephenson, Matthew
Aromataris, Edoardo
Venue: International Journal of Evidence-Based Healthcare
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2015-09
Volume: 13
Issue: 3
Pages: 196-207
ISSN: 1744-1595 (ISSN-L)
1744-1609
DOI: 10.1097/xeb.0000000000000065
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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Fixed or random effects meta-analysis? Common methodological issues in systematic reviews of effectiveness

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