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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“The heterogeneity of sample sizes of included studies is another criterion that is taken into consideration when deciding to employ a fixed- or random-effects model [4].”
BackgroundMethod
Effectiveness of protection strategies for reducing radiation exposure in proceduralists during cardiac catheterization procedures: a systematic review protocol
Fernandez, R. S., Ellwood, L., Barrett, D., & Weaver, J. C. (2019) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003834 · Cited by 1
Effectiveness of transoral incisionless fundoplication compared to Toupet fundoplication for chronic or refractory gastroesophageal reflux disease: a systematic review protocol
Joseph, S. J., Ebstein, A. M. M., & Sapp, A. (2019) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003893 · Cited by 1
The association between anti-thyroid antibodies and quality of life in patients with thyroid disorders: a systematic review protocol
Patti, M., & Christian, R. (2017) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2016-003315 · Cited by 1
Effectiveness of operative interventions for hemi or total hip arthroplasty patients who sustain a Vancouver B2 peri-prosthetic femoral fracture: a systematic review protocol
Ianunzio, J. R., Munn, Z., Mandziak, D. G., Stephenson, M., & Cain, M. (2017) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2016-002941 · Cited by 1
Self-citation
Effects of transcranial direct current stimulation on heart rate variability: a systematic review protocol
Dias, I. A., Hazime, F. A., Lopes, D. A., Silva, C. S. D., Baptista, A. F., & Silva, B. A. K. D. (2019) · JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-d-19-00134 · Cited by 1
Effectiveness of strategies for reducing risky alcohol consumption among youth living in rural or remote areas
Cibich, M., Hines, S. J., & Carey, T. A. (2019) · JBI Evidence Synthesis · doi:10.11124/jbisrir-d-19-00098 · Cited by 1
Effect of telemonitoring on self-care behaviors among community-dwelling adults with heart failure
Nick, J. M., Petersen, A. B., & Roberts, L. R. (2019) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-d-18-00016 · Cited by 1
Effectiveness of administering tranexamic acid to high-risk hip and knee arthroplasty patients: a systematic review protocol
Yapa, S., Lockwood, C. S., & Kuster, M. S. (2020) · JBI Evidence Synthesis · doi:10.11124/jbisrir-d-19-00145 · Cited by 1
Effects of whole globe enucleation versus in situ corneoscleral excision on donor cornea tissue quality: a systematic review protocol
Ting, D. S. J., Chen, Y., & Figueiredo, F. C. (2020) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00117 · Cited by 1
Impacto psicológico da pandemia da covid-19 na população geral
Figueiredo, C., Cunha, M., Sousa, L., & Santos, E. J. F. (2020) · Scientific Repository of Open Access of Portugal (RCAAP) · doi:10.29352/mill0207e.01.00360 · Cited by 1
Can We Safely Stop Administering Anti-D Immune Globulin to First Trimester Rh-Negative Mothers Undergoing Abortion? A Systematic Review and Meta-Analysis
Tolu, L. B., Tufa, T. H., Abubeker, F. A., Feyssa, M. D., & Sarah, P. (2021) · Annals of Gynecology and Obstetrics · doi:10.36959/468/477 · Cited by 1
Biological sex disparity in survival outcomes following treatment for renal cell carcinoma: a systematic review protocol
Nkemjika, S., Tokede, O., Jadotte, Y. T., Olatunji, E., Bosah, J. N., Pigott, T., & Okosun, I. S. (2021) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00277 · Cited by 1
Exploring incidence and risk factors for persistent postoperative opioid use in adult surgical patients: a systematic review protocol
Griffiths, H., Kent, B., & Martín, D. (2023) · JBI Evidence Synthesis · doi:10.11124/jbies-22-00106 · Cited by 1
Minibonds and IntangiblesPreprint
Beccari, G., Marchionne, F., & Pisicoli, B. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4120643 · Cited by 1
Biological Peripartum Predictors of Postpartum Depression: Protocol for Systematic Review and Meta-AnalysisPreprint
Ahmad, M. A., Awar, S. A. A. R. A., Sallma, G. S., Alkaabi, M. S. N., Smetanina, D., Statsenko, Y. A., & Zaręba, K. T. (2024) · Preprints.org · doi:10.20944/preprints202402.0030.v1 · Cited by 1
Decodificando a síntese da evidência: conceitos
Apóstolo, J., & de Lima, D. V. M. (2016) · Online Brazilian Journal of Nursing · doi:10.17665/1676-4285.20165169
Impact of male partner involvement on modern contraceptive use among married or partnered women in developing countries: a protocol for systematic review
Gebrie, S. A., Gebreyohannes, Y., Ararso, D., Deribe, F. M., Tefera, M. H., & Sudhakar, M. N. (2017) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2016-003106
Effectiveness of four-factor prothrombin complex concentrates versus plasma on vitamin K antagonist associated plasma international normalized ratio reversal: a systematic review protocol
McPhail, A. T., & Jokel, D. (2018) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003470
Effectiveness of sugammadex versus neostigmine on restoration of neuromuscular function in surgical patients with myasthenia gravis undergoing rocuronium-induced neuromuscular blockade: a systematic review protocol
Yellott, E., Badeaux, J. E., Martin, J. B., & Schiavo, J. H. (2018) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003624
Association between ethnicity and changes in weight, blood pressure, blood glucose and lipid levels after bariatric surgery: a systematic review protocol
Kelly, P., & Hoover, K. W. (2018) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003685
Glycemic control outcomes of manual and computerized insulin titration protocols: a systematic review protocol
Majeste, A. C., Tatum, E., Christian, R., & Palokas, M. J. (2019) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003866
Sugammadex versus neostigmine for postoperative nausea and vomiting in adult patients undergoing laparoscopic surgery paralyzed with rocuronium bromide: a systematic review protocol
Freundlich, A., Badeaux, J. E., & Adorno, M. (2019) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003997
Hernioplasty using low-cost mesh compared to surgical mesh in low- and middle-income countries: a systematic review protocol
Vaska, A., Munn, Z., Nagra, S., & Barker, T. H. (2019) · JBI Evidence Synthesis · doi:10.11124/jbisrir-d-19-00186
Self-citation
Effectiveness of the Baska mask versus the i-gel device in adult patients under general anesthesia: a systematic review protocol
Han, Q., Sun, L., Liang, H., & Feng, Y. (2020) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00045
Effectiveness of thoracic epidural anesthesia in reducing morbidity and mortality in adults with acute pancreatitis: a systematic review protocol and meta-analysis
Ede, C., Ortiz, R., & Anderson, L. R. (2020) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00119
“Statistical analyses will be performed via the fixed effect model.(21) Sensitivity analyses will be conducted to test decisions made regarding the inclusion or exclusion of studies during the review process.”
Method
Effect of preoperative nutritional supplementation on postoperative outcomes for patients undergoing pancreaticoduodenectomy for cancer: a systematic review protocol
Dangen, J., Porritt, K. A., & Abbas, S. M. (2020) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00227
Effects of shockwave therapy on pain and disability in individuals with rotator cuff tendinopathy: a systematic review protocol
Tang, Z. Y., Wee, J. J. Y., & Lim, H. H. R. (2021) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00169
“Fixed effects or random effects will be used as appropriate where possible.(29) Where there is sufficient data, subgroup analyses will be performed to stratify and group the comparator form of intervention against shockwave therapy depending on the degree and complexity of the intervention used in the control arm.”
Method
Postoperative oral drug regimen to control the inflammatory complications in mandibular third molar surgery: protocol for a systematic review and network meta-analysis
de Souza, G. M., Magesty, R. A., Fernandes, I. A., Sales, K. N. A., Galvão, E. L., & Falci, S. G. M. (2021) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00368
“Search conducted December 2020 Search Query Records retrieved #1 ‘‘analgesic s’’[All Fields] OR ‘‘analgesically’’[All Fields] OR ‘‘analgesics’’[Pharmacological Action] OR ‘‘analgesics’’[MeSH Terms] OR ‘‘analgesics’’[All Fields] OR ‘‘analgesic’’[All Fields] OR (‘‘analgesics’’[Pharmacological Action] OR ‘‘analgesics’’[M…”
MethodInfluential
The Effect of Periodontal Disease on Metabolic Control in Patients With Diabetes Mellitus in South Africa: Protocol for a Systematic Review
Jeftha, A., Roberts, T., & Kimmie‐Dhansay, F. (2021) · JMIR Research Protocols · doi:10.2196/27471
“The choice of the model (fixed or random) and the method for meta-analysis will be based on the guidance by Tufanaru et al [18] and Moola et al [19].”
Method
Intraoperative Parathyroid Hormone in Minimally Invasive Parathyroidectomy—Reply
Quinn, A. J., Ryan, É. J., & Lowery, A. (2021) · JAMA Otolaryngology–Head & Neck Surgery · doi:10.1001/jamaoto.2021.2252
Treating Umbilical Granuloma with Topical Corticosteroid: A Systematic Review and Meta-analysis
Sandinirwan, I., Leo, H., Kahuna, H., & Karina, P. P. (2021) · Journal of Research in Clinical Medicine · doi:10.34172/jrcm.2021.031
Effectiveness of School-based Interventions for Preventing Tobacco Smoking Initiation Among Young People in Low-and-middle-income Countries: a Systematic Review Protocol.Preprint
Logo, D. D., Enuameh, Y., Adjei, G., Singh, A., Nakua, E. K., Dassah, E. T., Oppong, F. B., & Owusu‐Dabo, E. (2021) · Research Square · doi:10.21203/rs.3.rs-697306/v1
Invited Response on: Letter to the Editor—Complications of Body Contouring Surgery in Postbariatric Patients: A Systematic Review and Meta-Analysis
Marouf, A., & Mortada, H. H. (2021) · Aesthetic Plastic Surgery · doi:10.1007/s00266-021-02654-0
“The use of a random effect model does not carry this assumption and its results can be, to some extent, generalized [5, 6].”
Background
Does patellar denervation prevent anterior knee pain and improve patient-reported outcomes in patients undergoing non-resurfaced total knee arthroplasty? an updated meta-analysis of randomized controlled trials.Preprint
Liu, H., Liu, Z., Zhang, Q., & Guo, W. (2020) · doi:10.21203/rs.3.rs-26676/v1
“The decision to use random-effects or fixed-effects models was based on I2 quantification of heterogeneity, as well as variability in the clinical and methodological aspects of the studies, number of studies available for pooling, and study sample sizes [16, 17].”
Method

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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