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      Erfassung der Primärstudienqualität in psychologischen Meta-Analysen : Eine systematische Übersichtsarbeit

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          Abstract

          Zusammenfassung. Meta-Analysen haben sich als Methodik zur Zusammenfassung von Studienergebnissen etabliert und sind ein wichtiges Instrument für Wissenschaftler, aber auch für politische und soziale Entscheidungsträger. Jedoch können die Schätzungen einer Meta-Analyse verzerrt sein, wenn nicht für die methodische Qualität der eingehenden Primärstudien kontrolliert wird. Die Erfassung der Primärstudienqualität und die Bereitstellung entsprechender Instrumente sollte dementsprechend essentieller Bestandteil jeder wissenschaftlichen Disziplin sein, die sich auf Meta-Analysen zur quantitativen Integration von Studienergebnissen stützt. Die vorliegende Übersichtsarbeit bietet daher einen Überblick ob und welche Qualitätskriterien in der Psychologie herangezogen werden. Insgesamt 225 Meta-Analysen, die in den letzten 10 Jahren im Psychological Bulletin veröffentlicht wurden, gingen in die Analyse ein. Nur etwa 18 % dieser Studien berücksichtigen explizit die Qualität der eingehenden Primärstudien. Zudem weisen die Strategie der Qualitätsberücksichtigung, wie auch die verwendeten Instrumente, bzw. die entwickelten Items eine ausgeprägte Heterogenität zwischen den Studien auf. Diese Unterschiede, die Vor- und Nachteile der spezifischen Vorgehensweisen als auch die praktischen Implikationen, die sich daraus ergeben werden anschließend diskutiert.

          Assessment of Study Quality in Psychological Meta-Analyses: A Systematic Review

          Abstract. Meta-analyses have developed into a preferred method for aggregating effect sizes reported in primary studies and are a viable tool for both researchers as well as political and social decision-makers. However, the meta-analytic estimates may be biased because of differences in the methodological rigor between primary studies. Accordingly, the assessment of primary study quality as well as the provision of appropriate quality appraisal tools should be an essential part of any scientific discipline that uses meta-analyses for the quantitative integration of study results. The present review provides an overview of whether and which quality criteria are used in psychological meta-analyses. A total of 225 meta-analyses published in Psychological Bulletin over the last 10 years were included in the analysis. Only about 18 % of these studies explicitly consider the quality of the primary studies. Additionally, the specific approach as well as the instruments or items used show a high degree of heterogeneity between the studies. These differences, the advantages and disadvantages of the specific procedures as well as the practical implications arising from them are thoroughly discussed.

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          Most cited references28

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

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            Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials.

            To determine if inadequate approaches to randomized controlled trial design and execution are associated with evidence of bias in estimating treatment effects. An observational study in which we assessed the methodological quality of 250 controlled trials from 33 meta-analyses and then analyzed, using multiple logistic regression models, the associations between those assessments and estimated treatment effects. Meta-analyses from the Cochrane Pregnancy and Childbirth Database. The associations between estimates of treatment effects and inadequate allocation concealment, exclusions after randomization, and lack of double-blinding. Compared with trials in which authors reported adequately concealed treatment allocation, trials in which concealment was either inadequate or unclear (did not report or incompletely reported a concealment approach) yielded larger estimates of treatment effects (P < .001). Odds ratios were exaggerated by 41% for inadequately concealed trials and by 30% for unclearly concealed trials (adjusted for other aspects of quality). Trials in which participants had been excluded after randomization did not yield larger estimates of effects, but that lack of association may be due to incomplete reporting. Trials that were not double-blind also yielded larger estimates of effects (P = .01), with odds ratios being exaggerated by 17%. This study provides empirical evidence that inadequate methodological approaches in controlled trials, particularly those representing poor allocation concealment, are associated with bias. Readers of trial reports should be wary of these pitfalls, and investigators must improve their design, execution, and reporting of trials.
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              The hazards of scoring the quality of clinical trials for meta-analysis.

              Although it is widely recommended that clinical trials undergo some type of quality review, the number and variety of quality assessment scales that exist make it unclear how to achieve the best assessment. To determine whether the type of quality assessment scale used affects the conclusions of meta-analytic studies. Meta-analysis of 17 trials comparing low-molecular-weight heparin (LMWH) with standard heparin for prevention of postoperative thrombosis using 25 different scales to identify high-quality trials. The association between treatment effect and summary scores and the association with 3 key domains (concealment of treatment allocation, blinding of outcome assessment, and handling of withdrawals) were examined in regression models. Pooled relative risks of deep vein thrombosis with LMWH vs standard heparin in high-quality vs low-quality trials as determined by 25 quality scales. Pooled relative risks from high-quality trials ranged from 0.63 (95% confidence interval [CI], 0.44-0.90) to 0.90 (95% CI, 0.67-1.21) vs 0.52 (95% CI, 0.24-1.09) to 1.13 (95% CI, 0.70-1.82) for low-quality trials. For 6 scales, relative risks of high-quality trials were close to unity, indicating that LMWH was not significantly superior to standard heparin, whereas low-quality trials showed better protection with LMWH (P<.05). Seven scales showed the opposite: high quality trials showed an effect whereas low quality trials did not. For the remaining 12 scales, effect estimates were similar in the 2 quality strata. In regression analysis, summary quality scores were not significantly associated with treatment effects. There was no significant association of treatment effects with allocation concealment and handling of withdrawals. Open outcome assessment, however, influenced effect size with the effect of LMWH, on average, being exaggerated by 35% (95% CI, 1%-57%; P= .046). Our data indicate that the use of summary scores to identify trials of high quality is problematic. Relevant methodological aspects should be assessed individually and their influence on effect sizes explored.
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                Author and article information

                Contributors
                Journal
                pru
                Psychologische Rundschau
                Hogrefe Verlag, Göttingen
                0033-3042
                2190-6238
                2020
                : 71
                : 2
                : 119-126
                Affiliations
                [ 1 ]Universität Trier, Trier
                [ 2 ]Leibniz Zentrum für psychologische Information und Dokumentation (ZPID), Trier
                Author notes
                Dr. Nadine Wedderhoff, Psychologie, Universität Trier, Universitätsring 15, 54296 Trier, wedderhoff@ 123456uni-trier.de
                Article
                pru_71_2_119
                10.1026/0033-3042/a000484
                84425876-205c-4b2f-a30c-36d49e4ec8e2
                Veröffentlicht unter der Hogrefe OpenMind Lizenz (https://doi.org/10.1026/a000002)
                History
                Categories
                Originalarbeit

                Psychology
                Risk-of-Bias,Garbage In – Garbage Out,Qualitätserfassung,Meta-Analyse,garbage in – garbage out,quality assessment,risk-of-bias,meta-analysis

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