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158Review Method of incorporating Results of quality investigationquality into synthesisGriffiths, 1997 225 Qualitative Studies were categorised by level of evidence. The quality of positive European studies is superior to thenegative US studies, so that 13 recommendations could be givenGrimes, 1997 383 Qualitative Studies classified by level of evidence and grade of recommendation. Methodological limitations were notdiscussed in detailGrullon, 1997 382 Qualitative Studies were discussed according to level of evidence provided. Insufficient evidence was found either to supportor to condemn the safety of early postpartum dischargeGyorkos, 1994 269 Quantitative For adult influenza vaccination strong/moderate quality comparisons demonstrated a lower rate difference (RDSubgroup analysis according to internal 17.9%, 95% CI: 16.7 to 19.0%) compared with weak quality comparisons (RD 20.0%, 95% CI: 18.4 tovalidity rating (strong/moderate/weak) 21.6%). For adult pneumococcal immunisation programmes, the average increase in coverage in studies rated‘strong’ (two RCTs and one NRS) was 34.6% (95% CI: –0.6 to 69.8%). Three RCTs and one cohort study ofmoderate internal validity had an average effect of 78% (95% CI: 72.3 to 83.8%). The five ‘weak’ studies(including three RCTs) had a pooled effect of 18.5% (95% CI: 17.7 to 19.3%). The authors made no furthercomment on these results and did not suggest any alternative explanations for these resultsHancock, Qualitative Methodological discussion of included studies – mainly relatively poor. The few methodologically adequate1990–95 272 studies show little evidence of large benefitsHayes, 1992 204 Qualitative Methodological issues were discussed, most studies received low scores. A trend towards effectiveness wasindicated but the authors conclude that this is not clinically significantHearn, 1998 395 Not consideredHelfenstein, 1994 278 Quantitative The only significant explanatory variable was study duration (coefficient of determination r 2 = 0.71, p = 0.002)Correlation analysis between quality itemsand outcome (including study duration,professional cleaning, fluoride rinsing only incontrol group, randomisation, blinded outcomeassessment, double-blinding, attrition)Heneghan, 1996 279 Qualitative Only acceptable studies were included in the review. Methodological assessment used to describe limitations ofthe included studies, rather than to interpret results of the reviewHeyland, 1993 350 Not consideredHoag, 1997 282 Quantitative Experimenter preference for the intervention (identified from introductory section of papers) producedCorrelation analysis used to examine ES and significantly higher ES (0.72 vs 0.30, p = 0.05). Neither the content nor source of outcome measure wereclient, treatment and methodological significantly related to improvement in group treatmentdomainsHoffman, 1993 283 Qualitative Studies examined according to Sackett’s levels of evidence. Both high- and low-quality trials showed positiveeffects from standard discectomy on reoperation rates. Methodological flaws limit the ability to estimate rates ofsuccessful outcomesAppendix 7continued
© Queen’s Printer and Controller of HMSO 2003. All rights reserved.Review Method of incorporating Results of quality investigationquality into synthesisHowell, 1997 284 Quantitative No association with outcome was foundRegression analysis to investigate designcharacteristics such as internal validity (high,medium or low), subject location, type ofdiet and the average of multiple observationsJabbour, 1996 285 Qualitative Only studies scoring 3/7 or higher were analysed in detail. Methodological flaws were discussed and in somecases the impact on the interpretation of results was discussed, e.g. quality did not appear to affect the impact onknowledge scoresJohnston, 1994 289 Qualitative Only seven studies scored highly in terms of quality; however, the authors concluded that several sound studiesprovided evidence for at least some of the outcomes evaluatedKasiske, 1995 291 Quantitative A multiple linear regression model was used: few differences were found whether regression was weighted byQuality weightingstudy variance, quality weight or sample size or was unweighted (data not shown). Authors conclude that withrespect to the regression weighting, the results appeared to be robustKasiske, 1998 292 Not consideredKasiske, 1993 293 Quantitative No significant effect was found (results not reported)Subgroup analysis for each of the nine qualityassessment criteria (including randomisation,drop-out rate, selection bias, discontinuationof treatment)Kay, 1996 186 Qualitative Score 12 or more required for inclusion in review, 15 or more for inclusion in meta-analysis. Some discussion ofmethodological problems provided. Narrative review indicated positive effect on knowledge/attitudes. Onlyseven RCTs of high-enough quality to be included in meta-analysisKingery, 1997 297 Not consideredKinney, 1996 298 Quantitative Quality score was associated with ES: higher quality = larger effects. Larger effects also produced by smallerSubgroup analysis according to quality score sample size and convenience sampling. Data not presentedKlassen, 1995 299 Qualitative Studies discussed in terms of methodological flaws; most scored poor to moderate. There is no empiricalevidence available on which to base a treatment plan for depression in patients with Parkinson’s diseaseKleijnen, 1994 300 Qualitative Methodological limitations and implications for study results were discussed. Most trials had shortcomings on fiveor more quality criteria, indicating a serious chance that the results are biased. The results of two ‘highest’ qualitytrials were discussed; however, several shortcomings made it difficult to draw conclusionsKleijnen, 1995 301 Qualitative Results based on highest quality studies; eight higher quality trials indicated that hyperbaric oxygen is notefficacious in the treatment of multiple sclerosiscontinuedHealth Technology Assessment 2003; Vol. 7: No. 27159
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