Evidence map›Paper›PMID 22846171›Full record

ReviewBMC medical research methodology2012

Investigating clinical heterogeneity in systematic reviews: a methodologic review of guidance in the literature.

Joel J Gagnier, David Moher, Heather Boon, Joseph Beyene, Claire Bombardier

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in BMC medical research methodology, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 97 papers, 51 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
97citing papers in PubMed, 51 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

97 citing papers in PubMed, 51 syntheses or guidelines pooled it.

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  7. Rash associated with antibiotic administration in patients with infectious mononucleosis: a systematic review and meta-analysis.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2025
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  18. Rates of compliance and adherence to high-intensity interval training: a systematic review and Meta-analyses.The international journal of behavioral nutrition and physical activity · 2023
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37 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Joel J GagnierDepartments of Orthopaedic Surgery and Epidemiology, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI, USA. jgagnier@umich.edu
David Moher
Heather Boon
Joseph Beyene
Claire Bombardier

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWhile there is some consensus on methods for investigating statistical and methodological heterogeneity, little attention has been paid to clinical aspects of heterogeneity. The objective of this study is to summarize and collate suggested methods for investigating clinical heterogeneity in systematic reviews.

methodsWe searched databases (Medline, EMBASE, CINAHL, Cochrane Library, and CONSORT, to December 2010) and reference lists and contacted experts to identify resources providing suggestions for investigating clinical heterogeneity between controlled clinical trials included in systematic reviews. We extracted recommendations, assessed resources for risk of bias, and collated the recommendations.

resultsOne hundred and one resources were collected, including narrative reviews, methodological reviews, statistical methods papers, and textbooks. These resources generally had a low risk of bias, but there was minimal consensus among them. Resources suggested that planned investigations of clinical heterogeneity should be made explicit in the protocol of the review; clinical experts should be included on the review team; a set of clinical covariates should be chosen considering variables from the participant level, intervention level, outcome level, research setting, or others unique to the research question; covariates should have a clear scientific rationale; there should be a sufficient number of trials per covariate; and results of any such investigations should be interpreted with caution.

conclusionsThough the consensus was minimal, there were many recommendations in the literature for investigating clinical heterogeneity in systematic reviews. Formal recommendations for investigating clinical heterogeneity in systematic reviews of controlled trials are required.

Indexed as

BiasControlled Clinical Trials as TopicData Interpretation, StatisticalEpidemiologic Research DesignSystematic Reviews as TopicBayes TheoremClinical Trials as TopicDatabases, BibliographicEvidence-Based MedicineHumansMeta-Analysis as Topic

Identifiers

PMID22846171
PMCPMC3564789

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.