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- Title
Subgroup effects despite homogeneousheterogeneity test results.
- Authors
Groenwold, Rolf H. H.; Rovers, Maroeska M.; Lubsen, Jacobus; van der Heijden, Geert J. M. G.
- Abstract
Background: Statistical tests of heterogeneity are very popular in meta-analyses, as heterogeneity might indicate subgroup effects. Lack of demonstrable statistical heterogeneity, however, might obscure clinical heterogeneity, meaning clinically relevant subgroup effects. Methods: A qualitative, visual method to explore the potential for subgroup effects was provided by a modification of the forest plot, i.e., adding a vertical axis indicating the proportion of a subgroup variable in the individual trials. Such a plot was used to assess the potential for clinically relevant subgroup effects and was illustrated by a clinical example on the effects of antibiotics in children with acute otitis media. Results: Statistical tests did not indicate heterogeneity in the meta-analysis on the effects of amoxicillin on acute otitis media (Q = 3.29, p = 0.51; I2 = 0%; T2 = 0). Nevertheless, in a modified forest plot, in which the individual trials were ordered by the proportion of children with bilateral otitis, a clear relation between bilaterality and treatment effects was observed (which was also found in an individual patient data meta-analysis of the included trials: p-value for interaction 0.021). Conclusions: A modification of the forest plot, by including an additional (vertical) axis indicating the proportion of a certain subgroup variable, is a qualitative, visual, and easy-to-interpret method to explore potential subgroup effects in studies included in meta-analyses.
- Subjects
QUANTITATIVE research; HETEROGENEITY; META-analysis; DRUG efficacy; ACUTE otitis media
- Publication
BMC Medical Research Methodology, 2010, Vol 10, p43
- ISSN
1471-2288
- Publication type
Article
- DOI
10.1186/1471-2288-10-43