Basic concepts in meta-analysis: a primer for clinicians

KHOSHDEL, A.; ATTIA, J.; CARNEY, S. L.

doi:10.1111/j.1742-1241.2006.01078.x

Cited by 55Meta-analysis and systematic reviewsStatistical Methods in EpidemiologyDelphi Technique in Research

Basic concepts in meta-analysis: a primer for clinicians

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KHOSHDEL, A., ATTIA, J., CARNEY, S. L.·2006·International Journal of Clinical Practice

DOI 10.1111/j.1742-1241.2006.01078.x

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Abstract

With the expanding volume of medical literature, meta-analysis, a form of systematic review, has become indispensable for clinicians for evidence-based decision making. While the number of meta-analyses has substantially increased during recent years, there are still controversial issues regarding their methodology, interpretation and clinical application. In this review, the basic concepts of meta-analysis have been discussed from a clinician's perspective in order to facilitate its understanding, appraising and applicability in clinical practice. Although randomised controlled trials are the usual source for meta-analysis, observational studies are also being increasingly considered for meta-analysis. Like every other research design, meta-analysis starts with formulating a question, followed by searching for related data, based on predefined criteria and strategies. Inclusion of studies must be carried out with careful consideration of their quality and assessment of homogeneity using graphical means as well as statistical tools such as Q statistics, I(2) statistics and meta-regression. The pooled effect size is commonly calculated using either a 'fixed effect model' or 'random effect model'. Publication bias and other source of bias should be investigated and the impact of potential confounders should be eliminated as required. Given the above-mentioned considerations, meta-analysis can provide a more precise estimate of an effect size to be used in clinical decision making.

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Sixteen articles (17%) provided recommendations on the key item "protocol development", with publication dates between 1994 and 2015 (median year 2009).
“Sixteen articles (17%) provided recommendations on the key item “protocol development” (Table 3), [29–44] with publication dates between 1994 and 2015 (median year of publication 2009).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [30]
Twenty articles (22%) gave recommendations on the key item "research question", with publication dates between 1997 and 2015 (median year 2009).
“Twenty articles (22%) gave recommendations on the key item “research question” [29, 30, 35, 36, 38–43, 45–54], with publication dates between 1997 and 2015 (median year of publication 2009).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [30]
Many articles recommended that the eligibility criteria need to be pre-specified and that the rationale for defining the eligibility criteria should be explicitly justified, unambiguous, and derived from the review question.
“Many recommended that the eligibility criteria need to be pre-specified [30, 33, 38, 39, 47, 55, 65] and that the rationale for defining the eligibility criteria should be explicitly justified [38, 39, 65], unambiguous [65], and derived from the review question [47].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [30]
Thirty-three articles (35%) made recommendations about the key item "search strategy", with publication dates between 1995 and 2016 (median year 2007).
“Thirty-three articles (35%) made recommendations about the key item “search strategy” [12, 29, 30, 33–36, 38, 39, 43, 46–51, 53–69], 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 [30]
Twenty-two articles (24%) provided recommendations on the key item "study eligibility", with publication dates between 1995 and 2016 (median year 2009).
“Twenty-two articles (24%) provided recommendations on the key item “study eligibility”, [12, 29, 30, 33, 34, 37–39, 41–43, 46–48, 54, 55, 61, 65, 70–73] with publication dates between 1995 and 2016 (median year of publication 2009).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [30]

Five articles gave recommendations about how to assess eligibility: it should be blind, independent, and performed by two reviewers.
“Five articles gave recommendations about how to assess eligibility: it should be blind [29, 30, 46], independent [29, 33, 46, 48], and performed by two reviewers [29, 30, 33, 48].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [30]
The majority of articles advised against the use of scales but 12 articles recommended their use.
“The majority of articles advised against the use of scales but 12 articles recommended their use [29, 30, 48–50, 52, 53, 56, 66, 77, 86, 91].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [30]
Thirty-nine articles (42%) made recommendations on the assessment of quality and risk of bias of individual studies, with publication dates between 1994 and 2016 (median year 2009).
“Thirty-nine articles (42%) made recommendations on the assessment of quality and risk of bias of individual studies, [12, 16, 29, 30, 32–35, 37, 38, 43, 47–50, 52–54, 56, 64–66, 70, 71, 73, 75, 77, 82, 84–94] with publication dates between 1994 and 2016 (median year of publication 2009).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [30]
Thirty-nine articles (42%) provided recommendations on heterogeneity and its assessment, with publication dates between 1994 and 2016 (median year 2006).
“Thirty-nine articles (42%) provided recommendations on heterogeneity and its assessment, [8, 12, 16, 29, 30, 33, 34, 36, 38, 39, 41–44, 47, 49–52, 54–56, 61, 66, 70, 72, 77, 82, 85, 87, 98, 100–107] with publication dates between 1994 and 2016 (median year of publication 2006).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [30]
Fifty-two articles (56%) provided recommendations on the statistical analysis in the context of meta-analysis of observational studies, with publication dates between 1994 and 2016 (median year 2006).
“Fifty-two articles (56%), provided recommendations on the statistical analysis in the context of meta-analysis of observational studies [8, 12, 16, 29–31, 33–36, 38, 41–44, 47, 48, 52, 54–56, 61, 66, 70, 72, 73, 77, 79–83, 85, 87, 96, 100, 101, 103–105, 107–118], with publication dates between 1994 and 2016 (median year of publication 2006).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [30]

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Authors: KHOSHDEL, A., ATTIA, J., & CARNEY, S. L.
Affiliations: John Hunter Hospital (AU)
University of Newcastle Australia (AU)
Corresponding author: KHOSHDEL, A.
ORCID: KHOSHDEL, A.
ATTIA, J.
Venue: International Journal of Clinical Practice
Publisher: Hindawi Limited
Published: 2006-09-08
Volume: 60
Issue: 10
Pages: 1287-1294
ISSN: 1368-5031 (ISSN-L)
DOI: 10.1111/j.1742-1241.2006.01078.x
OpenAlex: W1525151941
Cited by: 55
References: 29
Citations by year: 2026: 2 · 2025: 5 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 1 · 2018: 3 · 2017: 1 · 2016: 3 · 2015: 1 · 2014: 3 · 2013: 3 · 2012: 1
FWCI: 1.39
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 3280 d)
Locations: International Journal of Clinical Practice (publishedVersion)
PubMed (publishedVersion)
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: meta-analysis, systematic reviews, evidence-based medicine, randomized controlled trials, observational studies, study quality assessment, heterogeneity, publication bias, confounding, fixed effects model, random effects models, pooled effect size, meta-regression, clinical decision-making
MeSH terms: Data Collection, Regression Analysis, Meta-Analysis as Topic, Bias, Randomized Controlled Trials as Topic

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