Development of an instrument to rate the credibility of a sub-group analysis

Article type
Authors
Guyatt G1, Sun X1, Johnston B1, Briel M2, Busse J1, Vandvik P3
1Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
2Basel Institute for Clinical Epidemiology, Basel, Switzerland
3Norwegian Knowledge Centre for the Health Services, Oslo, Norway
Abstract
Background: Apparent sub-group effects often arise in systematic reviews of RCTs, suggesting the need for a formal instrument for rating their credibility. Objectives: To develop an instrument for evaluating reports of both primary RCTs and systematic reviews resulting in a rating of sub-group effects credibility from extremely implausible to extremely likely. Methods: To generate an item pool, we reviewed methods articles addressing the issue of sub-group analysis credibility and consulted with a group of 18 methodologically trained individuals participating in a review of sub-group analysis in RCTs. The steering group of the study decided on item wording and response options. We plan to ask 5 external senior methodologists to evaluate the draft instrument for clarity, completeness, and redundancy. We will apply the instrument to a sample of primary studies and meta-analyses that make claims regarding sub-group effects. Two raters will independently evaluate each article; results will allow estimation of reliability and conduct of a factor analysis that will guide possible item reduction. Exploration of construct validity will include 1) examining the relation between application of the instrument to particular sub-group analyses versus authors’ claims in those same analyses 2) in situations in which conclusions regarding sub-group effects are definitive, examining the extent to which application of the instrument at an earlier time – when fewer studies were available – predicts the ultimate outcome. Results: Item generation yielded 17 items including issues of power and statistical significance, a priori hypothesis generation, within or between study comparison, and the methodological quality of the original studies (Table). We have decided on a four-point scale for response options (e.g., definitely not to definitely yes). We anticipate data from subsequent stages of the project will be available at the time of the Colloquium. Conclusion: Our instrument should prove helpful to Cochrane reviewers evaluating possible sub-group effects.