Systematic reviews (SR) and meta-analysis (MA) of randomised controlled trials
(RCT) are the trustworthy sources of evidence. However, most systematic
reviews focus on pair-wise comparisons. Network-meta-analysis (NMA) offers
quantitative methods of integrating data from all the available comparisons of
many different treatments for each outcome. In a systematic review of
interventions, Summary of Findings (SoF) tables present the main findings of a
review in a transparent and simple form. However, it is unknown how to present
NMA findings in a tabular format. Moreover, systematic reviews and meta-analysis
of interventions can summarize bodies of evidence from randomized and
non-randomized studies (NRS). Integrating both sources of evidence in a single
study can be challenging particularly in the context of assessing the certainty of
the evidence, as well as presenting findings of both RCTs and NRS sources of
evidence.
In our study, we described how 276 NMA were conducted and how authors
reported their main findings. We also conducted 32 interviews with users of
NMAs and we designed two final NMA-SoF tables. Furthermore, we conducted
two systematic reviews that included RCTs and NRS to address methodological
challenges. Based on our results, we developed two NMA-SoF table formats to report the
main findings of NMAs. The final format was appealing for users and allowed
them to better understand NMA findings. Assessment of quality of individual NRS
remains challenging and further research is needed to increase its
appropriateness in systematic reviews of NRS. We determined that quality
assessment of individual NRS was particularly challenging to implement due to
the complexity of NRS evaluation tools. Our evaluation revealed that effect
estimates of RCTs and NRS were better presented separately. / Thesis / Doctor of Philosophy (PhD) / Systematic reviews (SR) are a summary of studies that address a particular
clinical question. Frequently, SRs are complemented with a statistical aggregation
of results of individual studies to produce a single estimate. Summary of findings
(SoF) tables are designed to present the most relevant information of systematic
reviews and meta-analysis. However, it is unknown how to present network meta-analysis
(NMA) findings in SoF tables. Another challenge relates to the
integration of randomized controlled trials (RCTs) and non-randomized (NRS)
studies. Methodological challenges in systematic reviews need to be addressed
through careful research.
In our study, we appraised how NMA were conducted, and how they presented
their main findings. We designed two versions of SoF tables to present NMA
findings. Moreover, we conducted two systematic reviews that included RCTs
and NRS to address potential challenges in analyzing and presenting their
findings.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/24013 |
| Date | January 2019 |
| Creators | Yepes-Nuñez, Juan J |
| Contributors | Schunemann, Holger, Clinical Epidemiology/Clinical Epidemiology & Biostatistics |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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