RT Journal
A1 Simunovic, Nicole
A1 Sprague, Sheila
A1 Bhandari, Mohit
T1 Methodological Issues in Systematic Reviews and Meta-Analyses of Observational Studies in Orthopaedic Research
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2009
FD May 1
VO 91
IS Supplement_3
SP 87
OP 94
DO 10.2106/JBJS.H.01576
UL http://dx.doi.org/10.2106/JBJS.H.01576
AB The validity and applicability of a systematic review depends on the quality of the primary studies that are included and the quality of the methods used to conduct the review itself. Sometimes, observational studies represent the best available evidence. Subject to selection, information, and confounding biases, observational studies are thought to overestimate treatment or exposure effects. A systematic review of observational data must therefore attempt to minimize or prevent these sources of bias by developing explicit but also broad inclusion and exclusion criteria focused on extracting the best available evidence relevant to the review question. Systematic reviews must also make use of an expansive search strategy, with use of multiple resources, to demonstrate the reproducibility of selection and quality-assessment criteria, to perform a quantitative analysis and adjustment for confounding where appropriate, and to explore possible reasons for differences between the results of the primary studies. In this paper, we address the advantages and limitations of systematic reviews and meta-analyses of observational studies and suggest solutions at the design phase of protocol development.