Jamilla A. Hussain
Missing data in randomized controlled trials testing palliative interventions pose a significant risk of bias and loss of power: a systematic review and meta-analyses
Hussain, Jamilla A.; White, Ian R.; Langan, Dean; Johnson, Miriam J.; Currow, David C.; Torgerson, David J.; Bland, Martin
Ian R. White
Professor Miriam Johnson Miriam.Johnson@hull.ac.uk
David C. Currow
David J. Torgerson
Objectives To assess the risk posed by missing data (MD) to the power and validity of trials evaluating palliative interventions. Study Design and Setting A systematic review of MD in published randomized controlled trials (RCTs) of palliative interventions in participants with life-limiting illnesses was conducted, and random-effects meta-analyses and metaregression were performed. CENTRAL, MEDLINE, and EMBASE (2009-2014) were searched with no language restrictions. Results One hundred and eight RCTs representing 15,560 patients were included. The weighted estimate for MD at the primary endpoint was 23.1% (95% confidence interval [CI] 19.3, 27.4). Larger MD proportions were associated with increasing numbers of questions/tests requested (odds ratio [OR] , 1.19; 95% CI 1.05, 1.35) and with longer study duration (OR, 1.09; 95% CI 1.02, 1.17). Meta-analysis found evidence of differential rates of MD between trial arms, which varied in direction (OR, 1.04; 95% CI 0.90, 1.20; I 2 35.9, P = 0.001). Despite randomization, MD in the intervention arms (vs. control) were more likely to be attributed to disease progression unrelated to the intervention (OR, 1.31; 95% CI 1.02, 1.69). This was not the case for MD due to death (OR, 0.92; 95% CI 0.78, 1.08). Conclusion The overall proportion and differential rates and reasons for MD reduce the power and potentially introduce bias to palliative care trials.
|Journal||Journal of clinical epidemiology|
|Peer Reviewed||Peer Reviewed|
|APA6 Citation||Hussain, J. A., White, I. R., Langan, D., Johnson, M. J., Currow, D. C., Torgerson, D. J., & Bland, M. (2016). Missing data in randomized controlled trials testing palliative interventions pose a significant risk of bias and loss of power: a systematic review and meta-analyses. Journal of clinical epidemiology, 74, 57-65 . https://doi.org/10.1016/j.jclinepi.2015.12.003|
|Keywords||Systematic review, Meta-analysis, Palliative care, Randomized controlled trials, Missing data, Differential mortality|
|Additional Information||This article is maintained by: Elsevier; Article Title: Missing data in randomized controlled trials testing palliative interventions pose a significant risk of bias and loss of power: a systematic review and meta-analyses; Journal Title: Journal of Clinical Epidemiology; CrossRef DOI link to publisher maintained version: http://dx.doi.org/10.1016/j.jclinepi.2015.12.003; Content Type: article; Copyright: © 2016 The Authors. Published by Elsevier Inc.|
2016-01-21 Hussain OA-JLE.pdf
You might also like
One evidence base; three stories: do opioids relieve chronic breathlessness?