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Methodological criteria for the assessment of moderators in systematic reviews of randomised controlled trials : a consensus study

By Tamar Pincus, Clare Miles, Robert J. Froud, Martin Underwood, Dawn Carnes and Stephanie J. C. Taylor


Background: Current methodological guidelines provide advice about the assessment of sub-group analysis within\ud RCTs, but do not specify explicit criteria for assessment. Our objective was to provide researchers with a set of\ud criteria that will facilitate the grading of evidence for moderators, in systematic reviews.\ud Method: We developed a set of criteria from methodological manuscripts (n = 18) using snowballing technique,\ud and electronic database searches. Criteria were reviewed by an international Delphi panel (n = 21), comprising\ud authors who have published methodological papers in this area, and researchers who have been active in the\ud study of sub-group analysis in RCTs. We used the Research ANd Development/University of California Los Angeles\ud appropriateness method to assess consensus on the quantitative data. Free responses were coded for consensus\ud and disagreement. In a subsequent round additional criteria were extracted from the Cochrane Reviewers’\ud Handbook, and the process was repeated.\ud Results: The recommendations are that meta-analysts report both confirmatory and exploratory findings for subgroups\ud analysis. Confirmatory findings must only come from studies in which a specific theory/evidence based apriori\ud statement is made. Exploratory findings may be used to inform future/subsequent trials. However, for\ud inclusion in the meta-analysis of moderators, the following additional criteria should be applied to each study:\ud Baseline factors should be measured prior to randomisation, measurement of baseline factors should be of\ud adequate reliability and validity, and a specific test of the interaction between baseline factors and interventions\ud must be presented.\ud Conclusions: There is consensus from a group of 21 international experts that methodological criteria to assess\ud moderators within systematic reviews of RCTs is both timely and necessary. The consensus from the experts\ud resulted in five criteria divided into two groups when synthesising evidence: confirmatory findings to support\ud hypotheses about moderators and exploratory findings to inform future research. These recommendations are\ud discussed in reference to previous recommendations for evaluating and reporting moderator studies

Topics: R1
Publisher: BioMed Central Ltd.
Year: 2011
OAI identifier:

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