High quality (certainty) evidence changes less often than low-quality evidence, but the magnitude of effect size does not systematically differ between studies with low versus high-quality evidence.
High quality (certainty) evidence changes less often than low-quality evidence, but the magnitude of effect size does not systematically differ between studies with low versus high-quality evidence.
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DOI：
10.1111/jep.13657
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发表时间：
2022-06
影响因子：
2.4
通讯作者：
中科院分区：
文献类型：
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一般认为，来自低质量证据的证据比来自高（确定性）质量证据（CoE）的证据更容易产生关于治疗效果的不准确估计。因此，我们可以预期：（a）最初基于高卓越中心的健康干预措施影响估计值的变化频率低于低卓越中心估计值的变化频率（B）高卓越中心和低卓越中心之间的影响大小估计值不同。缺乏对循证医学这些基本原则的实证评估。我们对2016年1月至2021年5月期间的科克伦系统评价数据库进行了审查，以获得基于建议评估、开发和评价分级（GRADE）方法的对CoE评估变更的原始和更新综述。我们评估了原始综述与更新综述之间的效应量差异，作为CoE变化的函数，我们将其报告为比值比（ROR）。我们比较了在研究中生成的ROR，在这些研究中，CoE从极低/低（VL/L）变为中/高（M/H），而M/H变为VL/L。使用tau和I2统计量评估异质性和不一致性。我们还评估了效应估计值的精密度变化（通过计算标准误比）（seR）和治疗效应估计值的绝对偏差（aROR）。纳入了419对综述，其中414对（207 × 2）用于CoE评估，384对（192 × 2）用于效应量评估。我们发现，最初评估为VL/L的CoE在未来研究中发生变化的几率比M/H CoE高2.1倍[95%置信区间（CI）：1.19-4.12; p = 0.0091]。然而，与M/H → VL/L（ROR = 1.02 [95% CI：0.44-2.37]）相比，当CoE从VL/L → M/H [ROR = 1.02（95% CI：0.74-1.39）]变化时，效应量无差异（p = 1）。观察到VL/L → M/H与M/H → VL/L亚组之间aROR的相似重叠[中位数（IQR）：1.12（1.07-1.57）vs. 1.21（1.12-2.43）]。我们观察到ROR估计值之间存在较大的不一致性（I2 = 99%）。从VL/L到M/H（seR = 1.46）的处理效果不精确性大于从M/H到VL/L（seR = 0.72）的处理效果不精确性。我们发现，低质量的证据比高质量的证据更容易改变。然而，低与高CoE研究之间的效应量没有系统性差异。结果表明，低和高卓越中心之间的效果大小没有差异，这表明迫切需要完善目前的循证医学关键评估方法。
It is generally believed that evidence from low quality of evidence generate inaccurate estimates about treatment effects more often than evidence from high (certainty) quality evidence (CoE). As a result, we would expect that (a) estimates of effects of health interventions initially based on high CoE change less frequently than the effects estimated by lower CoE (b) the estimates of magnitude of effect size differ between high and low CoE. Empirical assessment of these foundational principles of evidence‐based medicine has been lacking. We reviewed the Cochrane Database of Systematic Reviews from January 2016 through May 2021 for pairs of original and updated reviews for change in CoE assessments based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. We assessed the difference in effect sizes between the original versus updated reviews as a function of change in CoE, which we report as a ratio of odds ratio (ROR). We compared ROR generated in the studies in which CoE changed from very low/low (VL/L) to moderate/high (M/H) versus M/H to VL/L. Heterogeneity and inconsistency were assessed using the tau and I 2 statistic. We also assessed the change in precision of effect estimates (by calculating the ratio of standard errors) (seR), and the absolute deviation in estimates of treatment effects (aROR). Four hundred and nineteen pairs of reviews were included of which 414 (207 × 2) informed the CoE appraisal and 384 (192 × 2) the assessment of effect size. We found that CoE originally appraised as VL/L had 2.1 [95% confidence interval (CI): 1.19–4.12; p = 0.0091] times higher odds to be changed in the future studies than M/H CoE. However, the effect size was not different (p = 1) when CoE changed from VL/L → M/H [ROR = 1.02 (95% CI: 0.74–1.39)] compared with M/H → VL/L (ROR = 1.02 [95% CI: 0.44–2.37]). Similar overlap in aROR between the VL/L → M/H versus M/H → VL/L subgroups was observed [median (IQR): 1.12 (1.07–1.57) vs. 1.21 (1.12–2.43)]. We observed large inconsistency across ROR estimates (I 2 = 99%). There was larger imprecision in treatment effects when CoE changed from VL/L → M/H (seR = 1.46) than when it changed from M/H → VL/L (seR = 0.72). We found that low‐quality evidence changes more often than high CoE. However, the effect size did not systematically differ between the studies with low versus high CoE. The finding that the effect size did not differ between low and high CoE indicate urgent need to refine current EBM critical appraisal methods.
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DOI：
10.1001/jama.1992.03490170092032
发表时间：
1992-11-04
影响因子：
120.7
作者：
GUYATT, G
通讯作者：
GUYATT, G
影响因子：
7.2
作者：
Ewald, Hannah;Klerings, Irma;Hemkens, Lars G.
通讯作者：
Hemkens, Lars G.
影响因子：
2
作者：
Higgins, JPT;Thompson, SG
通讯作者：
Thompson, SG
影响因子：
45.3
作者：
PETERS, WP;ROSS, M;HURD, D
通讯作者：
HURD, D
影响因子：
7.2
作者：
Guyatt, Gordon H.;Oxman, Andrew D.;Schuenemann, Holger J.
通讯作者：
Schuenemann, Holger J.