1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 27 Systematic Reviews of Research Evidence: Meta-Analysis, Metasynthesis, and Mixed Studies Review

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: Evidence-based practice relies on rigorous integration of research evidence on a topic through systematic reviews.

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Evidence-based practice relies on rigorous integration of research evidence on a topic through systematic reviews. A systematic review methodically integrates research evidence about a specific research question using carefully developed sampling and data collection procedures that are spelled out in advanced in a protocol.

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Systematic Review Integrates research evidence about research question Carefully developed: –Sampling –Data collection procedures Spelled out in advance in a protocol

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: Systematic reviews of qualitative studies often involve statistical integration of findings through meta-analysis.

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Systematic reviews of quantitative studies often involve statistical integration of findings through meta-analysis, a procedure whose advantages include objectivity, enhanced power, and precision; meta-analysis is not appropriate, however, for broad questions or when there is substantial inconsistency of findings.

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Meta-Analysis Objectivity Enhanced power Precision Not appropriate: –Broad questions –Substantial inconsistency of findings

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Criteria for Using Meta-Analytic Techniques in a Systematic Review The research question being addressed or the hypothesis being tested across studies should be very similar, if not identical Concern regarding whether there is a sufficient base of knowledge for statistical integration Consistency of evidence

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps in a Meta-Analysis Formulating the problem Designing the meta-analysis study Searching the literature for data Evaluating study quality Extracting and encoding data for analysis Calculating effects Analyzing the data Writing a meta-analytic report

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: The steps in both quantitative and qualitative integration are similar.

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True The steps in both quantitative and qualitative integration are similar and involve: formulating the problem, designing the study searching the literature for a sample of primary studies, evaluating study quality, extracting and encoding data for analysis, analyzing the data, and reporting the findings.

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Quantitative and Qualitative Research Formulating the problem Designing the study Searching the literature for a sample of primary studies Evaluating study quality Extracting and encoding data for analysis Analyzing the data Reporting the findings

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: There is consensus on systematic reviews should include the grey literature.

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False There is no consensus on whether systematic reviews should include the grey literature—that is, unpublished reports.

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Concerns No consensus on whether systematic reviews should include the grey literature Quantitative studies: –Bias against the null hypothesis –Publication bias: Examined with funnel plot

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Meta Analysis Effect size index: quantifies the magnitude and direction of relationship between variables Two common effect size in nursing: –Standardized mean difference –Odds ratio Pooled to yield an estimate of the population effect size: –Weighted average –Inverse variance

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Statistical Heterogeneity Fixed effects model: assumes a single true effect size Random effects model: assumes a distribution of effects Forect plot

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonrandom Heterogeneity Subgroup analyses Meta regression Purpose: identify clinical or methodologic features systematically related to variation in effects

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Quality Assessments Exclude weak studies from reviews Differentially weight studies or sensitivity analyses: test whether including or excluding weaker studies changes conclusions

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: Metasyntheses are more than just summaries of prior quantitative findings, they involve a discovery of essential features of a body of findings and, typically, a transformation that yields new insights and interpretations.

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Metasyntheses are more than just summaries of prior qualitative findings, they involve a discovery of essential features of a body of findings and, typically, a transformation that yields new insights and interpretations.

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Undertaking Metasynthesis “A family of methodological approaches to developing new knowledge based on rigorous analysis of existing qualitative research findings”

23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Approaches Metaethnography Metastudy Metasummary Critical interpretive synthesis (CIS) Grounded formal theory Thematic synthesis

24. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Metasynthesis Analysis Analyzing and interpreting data: -Noblit and Hare Approach -Patterson and colleagues approach -Sandelowski and Barroso Approach

25. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Paterson and Colleagues Metadata analysis: the study of results in a specific substantive area through analysis of the processed data Metamethod: the study of the studies’ methodologic rigor Metatheory: the analysis of the theoretical underpinnings on which the studies are grounded

26. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Sandelowski and Barrosos Summaries: Descriptive synopses Syntheses: Interpretative explanations of the data

27. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Metasummary Developing a list if abstracted findings from the primary studies Manifest effect sizes Frequency effect size Intensity effect size

28. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Mixed Methods Research Systematic mixed studies reviews: –Systematic reviews –Disciplined –Auditable –Integrate and synthesize findings

29. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reporting Guidelines PRISMA: (Preferred Reporting Items for Systematic reviews and Meta-Analyses) is useful for writing up a systematic review of RCTs MOOSE: (Meta-analysis of Observational Studies in Epidemiology) guides reporting of meta-analyses of observational studies