systematic reviews: meta-analysis and meta-synthesis
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research integration and synthesis
The systematic and rigorous integration and synthesis of evidence is a cornerstone of EBP.
Impossible to develop “best practice” guidelines, protocols, and procedures without organizing and evaluating research evidence through a systematic review
is a review that methodically integrates research evidence about specific research question using careful sampling and data collection procedures that are spelled out in advance in a protocol
forms of systematic reviews
statistical integration of results used to compute common effect size. effect sixes are averaged across studies, yielding not only information about the existence of a relationship between variable in many studies but also an estimate of its magnitude across studies
it is the pinnacle of traditional evidence hierarchies
theoretical integration and interpretation of qualitative findings
are products that are more than the sum of the parts - they offer new insights and interpretation of findings
Objectivity—statistical integration eliminates bias in drawing conclusions when results in different studies are at odds.
Increased power—reduces the risk of a type II error compared to a single study
criteria for meta-analysis in systematic review
Research question or hypothesis should be essentially identical across studies.–The “fruit” problem—don’t combine apples and oranges!
Must be a sufficient knowledge base—must be enough studies of acceptable quality
Results can be varied but not totally at odds.
Steps in a Meta-Analysis
Problem formulation: Delineate research question or hypothesis to be tested.
Design of meta-analysis: Identify sampling criteria for studies to be included.
Search for evidence in literature: Develop and implement a search strategy.
Evaluation of study quality: Locate and screen sample of studies meeting the criteria.
Extract and encode data for analysis.
Evaluating Study Quality
Meta-analysts must make decisions about
handling study quality
approaches to evaluating study quality
–Omit low-quality studies (e.g., in
intervention studies, non-RCTs).
–Give more weight to high-quality studies.
–Analyze low- and high-quality studies to
see if effects differ (sensitivity
Metasynthesis:Some Ongoing Debates
Whether to exclude low-quality studies
Whether to integrate studies based in multiple qualitative traditions
Various typologies and approaches; differing terminology