Systematic Reviews, Meta Analysis, Critically Appraised Topics & Paper

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Systematic Reviews, Meta Analysis, Critically Appraised Topics & Paper

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effect size
unit less number we are able to calculate that estimates strength of treatment effect
– provides indication of clinical meaningfulness
Cohens d interpretation of effect sizes
> 0.8 = strong
0.5 – 0.8 = moderate
0.2 – 0.5 = small
< 0.2 = weak - can range from negative to positive - negative is just as strong as positive effect size
confidence interval
set of values for the parameter being estimated that are plausible
– level of interval = 95% (most common)
confidence interval inerpretation
– if CI includes 0 (including pos. and neg.) = non significant result, no difference b/t 2 groups
– if CI doesn’t include 0 (all pos. or all neg.) = significant result
systematic review
one paper that reviews many different previously published papers and trying to make recommendation based on result of those papers
components of systematic review
– title page
– abstract
– background
– objectives
– methods
– results
– discussion
– conclusions
– references
– tables and figures
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meta-analysis
subtype of systematic review
*All meta-analyses are systematic review, but all systematic reviews are not meta-analyses*
– Meta-analysis combines the effects from multiple studies to give a single estimation of the overall effect
what a meta analysis is not
not a simple average of magnitude of effects across all the included studies
meta analysis conti…
provides weighted average of treatment effect
what contributes to weighting
sample size
– large sample = greater weighing
variance
– incertainty
– lower variance = more certain = greater weighting
components of meta analysis
– subjects
– must have strict inclusion and exclusion criteria
– individual study characteristics must be similar for inclusion
what can meta analysis answer?
– what is direction of effect?
– what is the size of effect?
– is the effect consistent?
meta analysis advantages
– Allows for single quantitative estimate from results pooled across multiple studies
– Increases statistical power and provides a more precise estimate of the treatment effect
meta analysis limitation
must make sure that all included studies asked the same clinical question
critically appraised topics
– provide a reader friendly source of evidence for practicing clinicians to help guide their clinical decision making
– Critical review and summary of 3-4 studies, each directed at answering a specific clinical question
difference between CAT and systematic review
level of rigor
– CAT provides lower level evidence but easy to read
critically appraised paper
critical review and summary of a single study
– longer than abstract shorter than article
– usually done for high level of evidence papers

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