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GRADE guidelines: 7. Rating the quality of evidence--inconsistency

Guyatt, Gordon H. and Oxman, Andrew D. and Kunz, Regina and Woodcock, James and Brozek, Jan and Helfand, Mark and Alonso-Coello, Pablo and Glasziou, Paul and Jaeschke, Roman and Akl, Elie A. and Norris, Susan and Vist, Gunn and Dahm, Philipp and Shukla, Vijay K. and Higgins, Julian and Falck-Ytter, Yngve and Schünemann, Holger J. and Grade Working Group, . (2011) GRADE guidelines: 7. Rating the quality of evidence--inconsistency. Journal of clinical epidemiology, Vol. 64, H. 12. pp. 1294-1302.

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Official URL: http://edoc.unibas.ch/dok/A6007056

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Abstract

This article deals with inconsistency of relative (rather than absolute) treatment effects in binary/dichotomous outcomes. A body of evidence is not rated up in quality if studies yield consistent results, but may be rated down in quality if inconsistent. Criteria for evaluating consistency include similarity of point estimates, extent of overlap of confidence intervals, and statistical criteria including tests of heterogeneity and I(2). To explore heterogeneity, systematic review authors should generate and test a small number of a priori hypotheses related to patients, interventions, outcomes, and methodology. When inconsistency is large and unexplained, rating down quality for inconsistency is appropriate, particularly if some studies suggest substantial benefit, and others no effect or harm (rather than only large vs. small effects). Apparent subgroup effects may be spurious. Credibility is increased if subgroup effects are based on a small number of a priori hypotheses with a specified direction; subgroup comparisons come from within rather than between studies; tests of interaction generate low P-values; and have a biological rationale.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Versicherungsmedizin > Versicherungsmedizin (Kunz)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Versicherungsmedizin > Versicherungsmedizin (Kunz)
UniBasel Contributors:Kunz, Regina
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Pergamon Press
ISSN:0895-4356
Note:Publication type according to Uni Basel Research Database: Journal article
Last Modified:06 Dec 2013 09:36
Deposited On:06 Dec 2013 09:36

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