Evidence map›Paper›PMID 37684502›Full record

SynthesisSports medicine (Auckland, N.Z.)2024

The Perils of Misinterpreting and Misusing "Publication Bias" in Meta-analyses: An Education Review on Funnel Plot-Based Methods.

José Afonso, Rodrigo Ramirez-Campillo, Filipe Manuel Clemente, Fionn Cléirigh Büttner, Renato Andrade

Abstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Sports medicine (Auckland, N.Z.), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 91 papers, 56 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
91citing papers in PubMed, 56 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

91 citing papers in PubMed, 56 syntheses or guidelines pooled it.

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  18. Effect of patient education in improving quality of life, fatigue and anxiety in people diagnosed with lung cancer: systematic review.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
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31 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.

José AfonsoFaculty of Sport, Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), University of Porto, Porto, Portugal. jneves@fade.up.pt.ORCID 0000-0002-2038-393X
Rodrigo Ramirez-CampilloExercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, School of Physical Therapy, Universidad Andres Bello, Santiago, Chile.ORCID 0000-0003-2035-3279
Filipe Manuel ClementeEscola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial Comercial de Nun'Álvares, 4900-347, Viana do Castelo, Portugal.ORCID 0000-0001-9813-2842
Fionn Cléirigh BüttnerPragmatic Clinical Trials Unit, Centre for Evaluation and Methods, Wolfson Centre of Population Health, Queen Mary University of London, London, UK.ORCID 0000-0002-5987-3063
Renato AndradePorto Biomechanics Laboratory (LABIOMEP), University of Porto, Porto, Portugal.ORCID 0000-0002-7636-7816

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Publication bias refers to a systematic deviation from the truth in the results of a meta-analysis due to the higher likelihood for published studies to be included in meta-analyses than unpublished studies. Publication bias can lead to misleading recommendations for decision and policy making. In this education review, we introduce, explain, and provide solutions to the pervasive misuses and misinterpretations of publication bias that afflict evidence syntheses in sport and exercise medicine, with a focus on the commonly used funnel-plot based methods. Publication bias is more routinely assessed by visually inspecting funnel plot asymmetry, although it has been consistently deemed unreliable, leading to the development of statistical tests to assess publication bias. However, most statistical tests of publication bias (i) cannot rule out alternative explanations for funnel plot asymmetry (e.g., between-study heterogeneity, choice of metric, chance) and (ii) are grossly underpowered, even when using an arbitrary minimum threshold of ten or more studies. We performed a cross-sectional meta-research investigation of how publication bias was assessed in systematic reviews with meta-analyses published in the top two sport and exercise medicine journals throughout 2021. This analysis highlights that publication bias is frequently misused and misinterpreted, even in top tier journals. Because of conceptual and methodological problems when assessing and interpreting publication bias, preventive strategies (e.g., pre-registration, registered reports, disclosing protocol deviations, and reporting all study findings regardless of direction or magnitude) offer the best and most efficient solution to mitigate the misuse and misinterpretation of publication bias. Because true publication bias is very difficult to determine, we recommend that future publications use the term "risk of publication bias".

Indexed as

Publication BiasBiasCross-Sectional StudiesHumansSystematic Reviews as Topic

Identifiers

PMID37684502
PMCPMC10933152

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.