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Health and Quality of Life Outcomes

, 11:211

First Online: 21 December 2013Received: 11 February 2013Accepted: 17 December 2013


Systematic reviews and meta-analyses of randomized trials that include patient-reported outcomes PROs often provide crucial information for patients, clinicians and policy-makers facing challenging health care decisions. Based on emerging methods, guidance on improving the interpretability of meta-analysis of patient-reported outcomes, typically continuous in nature, is likely to enhance decision-making. The objective of this paper is to summarize approaches to enhancing the interpretability of pooled estimates of PROs in meta-analyses. When differences in PROs between groups are statistically significant, decision-makers must be able to interpret the magnitude of effect. This is challenging when, as is often the case, clinical trial investigators use different measurement instruments for the same construct within and between individual randomized trials. For such cases, in addition to pooling results as a standardized mean difference, we recommend that systematic review authors use other methods to present results such as relative relative risk, odds ratio or absolute risk difference dichotomized treatment effects, complimented by presentation in either: natural units e.g. overall depression reduced by 2.4 points when measured on a 50-point Hamilton Rating Scale for Depression; minimal important difference units e.g. where 1.0 unit represents the smallest difference in depression that patients, on average, perceive as important the depression score was 0.38 95% CI 0.30 to 0.47 units less than the control group; or a ratio of means e.g. where the mean in the treatment group is divided by the mean in the control group, the ratio of means is 1.27, representing a 27% relative reduction in the mean depression score.

AbbreviationsCRQChronic respiratory questionnaire

HRSDHamilton rating scale for depression

HRQoLHealth-related quality of life

MIDMinimal important difference

MADRSMontgomery Asberg depression rating scale

SMDStandardized mean difference.

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Autor: Bradley C Johnston - Donald L Patrick - Kristian Thorlund - Jason W Busse - Bruno R da Costa - Holger J Schünemann - G


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