Avoiding Definitive Conclusions in Meta-analysis of Heterogeneous Studies With Small Sample Sizes

Zhou, Shouhao; Shen, Chan

doi:10.1001/jamaoto.2022.2847

Cited by 19 publications

(8 citation statements)

References 11 publications

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“…Ryan and Cochrane Consumers and Communication Review Group 38 reported that 2 studies are sufficient for meta-analytic purposes, provided the 2 trials can be meaningfully pooled and their results are sufficiently similar. Zhou and Shen 39 commented that sample sizes for a study to be included in a meta-analysis would be ideally greater than 30 per group or the number of studies to be included should be more than 5. Except for the meta-analysis on the effect of MI using the TUG that included 7 studies, none of the meta-analyses in this systematic review fulfilled the recommendation.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Motor Imagery in the Rehabilitation of People With Parkinson’s Disease: A Systematic Review and Meta-Analysis

Singer,

Fahey,

Liu

2024

Neurorehabil Neural Repair

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Background and Objective With more research completed using Motor imagery (MI) in people with Parkinson’s disease, this study gathered and synthesized evidence on the use of MI for Parkinson’s disease in improving rehabilitation outcomes. Methods Medical Literature Analysis and Retrieval System Online, Embase, Web of Science, The Cochrane Library, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched from inception to May 2023. We included randomized controlled trials that examine the effects of MI on individuals with Parkinson’s disease. Two reviewers selected articles and extracted study characteristics and results independently. The Physiotherapy Evidence Database scale was used to assess the methodological quality. Mean differences and 95% confidence intervals were calculated. Heterogeneity was assessed using the I2 statistic. Results Thirteen articles with 12 studies were included, involving 320 individuals with Parkinson’s disease, with moderate to high methodological quality (mean = 6.62/10). Compared with the control group, 3 articles reported significant greater improvements in cognitive function, 7 reported significant greater improvement in motor function, 1 article reported significant greater improvement in quality of life, and 1 reported significant greater confidence in daily task performance. No statistically significant effects were found in the meta-analyses. Conclusion. Results of individual articles were in favor of the MI intervention. No statistically significant results were found in the meta-analyses. This might be due to the small number of studies and the heterogeneity of interventions and outcome measures used. MI may be effective in improving some rehabilitation outcomes, but meta-analytic evidence is lacking. More research with larger sample size and less heterogeneous samples, interventions, and outcome measures, is warranted. Systematic Review Registration PROSPERO registration number CRD42021230556.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Motor Imagery in the Rehabilitation of People With Parkinson’s Disease: A Systematic Review and Meta-Analysis

Singer,

Fahey,

Liu

2024

Neurorehabil Neural Repair

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“…Having uniform methods for characterizing outcomes and high-quality studies that account for confounders, would facilitate more robust systematic reviews and meta-analyses and allow research groups to better determine optimal interventions for ALHL. [52][53][54][55] The selection of a global standard would be a worthwhile goal and could be addressed through collaborative action by international professional organizations of otolaryngologists and audiologists. In addition to the methodological challenges encountered in the literature, there were additional limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, studies must have clear criteria for distinguishing recurrence from fluctuation of HL. Having uniform methods for characterizing outcomes and high‐quality studies that account for confounders, would facilitate more robust systematic reviews and meta‐analyses and allow research groups to better determine optimal interventions for ALHL 52–55 . The selection of a global standard would be a worthwhile goal and could be addressed through collaborative action by international professional organizations of otolaryngologists and audiologists.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of Acute Low‐Tone Hearing Loss Without Vertigo: A Scoping Review

et al. 2023

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ObjectiveDespite its relatively high prevalence, our understanding of the natural clinical course of acute low‐tone hearing loss (ALHL) without vertigo remains incomplete. The purpose of this study is to summarize the findings of studies that evaluated recovery from hearing loss (HL), recurrence and/or fluctuation of HL, and progression to Meniere's Disease (MD) of patients presenting with ALHL without vertigo.MethodsA scoping review of the English literature was performed. On May 14, 2020 and July 6, 2022, MEDLINE, Embase, and Scopus were searched to identify articles related to the prognosis of ALHL. To be included, articles had to present outcomes that were clearly distinguishable for patients with ALHL without vertigo. Two reviewers evaluated articles for inclusion and extracted data. Disagreements were adjudicated by a third reviewer.ResultsForty‐one studies were included. There was extensive heterogeneity between studies in regard to defining ALHL, treatment methods, and time of follow‐up. Most of the cohorts (39 out of 40) reported partial or complete recovery of hearing in the majority (>50%) of patients, although reports of recurrence were relatively common. Progression to MD was infrequently reported. Shorter time from onset of symptoms to treatment predicted better hearing outcomes in 6 of 8 studies.ConclusionThe literature suggests that although the majority of patients with ALHL experience hearing improvement, recurrence and/or fluctuation are common, and progression to MD occurs in a minority of patients. Additional trials utilizing standardized inclusion and outcome criteria are needed to determine the ideal treatment for ALHL.Level of EvidenceNA Laryngoscope, 133:2457–2469, 2023

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“…We also acknowledge the limited number of trials in our subgroup meta-analyses. If the number of trials included in a meta-analysis is small (e.g., ≤ five trials (Zhou and Shen, 2022)), the result of that analysis must be cautiously interpreted. Further studies will be required to validate which subtype of attentional performance is more benefitted by NFT, which NFT protocol can most effectively improve attentional performance, and whether NFT is beneficial compared to sham-NFT or general training.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of neurofeedback training for improving attentional performance in healthy adults: A systematic review and meta-analysis

Kimura

Noyama

Onagawa³

et al. 2023

Preprint

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This systematic review and meta-analysis examined the effects of neurofeedback training (NFT) on attentional performance in healthy adults. Six databases (PubMed, Scopus, Web of Science, PsycInfo, JDream&#8546, and Ichu-shi) were searched up to June 2022 for randomized controlled trials (RCTs) comparing attentional performance following NFT to a control group. Risk of bias was determined using the Cochrane Collaboration's tool. We identified 41 RCTs for qualitative synthesis and 15 RCTs without high risk of bias (including 569 participants) for meta-analysis using a random-effects model. The overall effect of NFT on attentional performance was significant (standardized mean difference = 0.27, 95% confidence interval = 0.10–0.44). However, approximately half of the studies did not compare its effects with sham-NFT, and no significant pooled effect of NFT was found in the studies compared to a sham-NFT group. Furthermore, subgroup analyses revealed variable effects on individual attentional performance subsets (executive function, spatial orientation, and arousal). Future large-scale sham-controlled RCTs are needed to confirm the efficacy of NFT for improving attentional performance.

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Avoiding Definitive Conclusions in Meta-analysis of Heterogeneous Studies With Small Sample Sizes

Abstract: This Viewpoint argues for caution when interpreting the findings of meta-analyses of heterogenous studies with small samples.

Cited by 19 publications

References 11 publications

Effectiveness of Motor Imagery in the Rehabilitation of People With Parkinson’s Disease: A Systematic Review and Meta-Analysis

Effectiveness of Motor Imagery in the Rehabilitation of People With Parkinson’s Disease: A Systematic Review and Meta-Analysis

Prognosis of Acute Low‐Tone Hearing Loss Without Vertigo: A Scoping Review

Efficacy of neurofeedback training for improving attentional performance in healthy adults: A systematic review and meta-analysis

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