Journal Information
Vol. 9. Issue 49.
Pages 265-272 (July - August 1995)
Vol. 9. Issue 49.
Pages 265-272 (July - August 1995)
Open Access
Inclusión de la calidad de una investigación en, el metanálisis*
Inclusion of Investigation Quality in Meta-Analysis
Visits
4497
Miguel Delgado-Rodríguez1,**, María Sillero Arenas2
1 Cátedra de Medicina Preventiva y Salud Pública. Facultad de Medicina, Universidad de Cantabria
2 Delegación Provincial de la Salud, Jaén
This item has received

Under a Creative Commons license
Article information
Resumen

El objetivo de la presente revisión es la forma de considerar la calidad de un estudio en la síntesis de información procedente de varias investigaciones. Se ha criticado al metanálisis el que no valora de manera adecuada la calidad de una investigación, lo que puede resultar en que los estudios pobres desplacen a los buenos por el peso de los números. La inclusión de la calidad de una investigación en el metanálisis cuantitativo es un aspecto debatido en la actualidad. Está claro que es necesario determinar la calidad de un estudio. Sin embargo, y aunque existe un cierto grado de consenso en lo que es un buen estudio y cuáles son las características que debe reunir, no hay un protocolo de evaluación unánimemente aceptado. Otros problemas añadidos son la falta de validaciín de los cuestionarios existentes y la no comprobación de la reproducibilidad de sus resultados. Existen varios procedimientos para incorporar la calidad en el metanálisis: a) es aceptado de manera general que un estudio haya de reunir una calidad mínimay esté libre de sesgos importantes; b) se tiende a rechazar la incorporación de la calidad como criterio de ponderación; c) existen dudas acerca de los analisis gráficos o de regresión en los que se relacione la magnitud del efecto con la calidad global. Puede ser superfluo o erróneo.

Palabras clave:
Metanálisis
Calidad
Summary

The objective of this review is how study quality is taken into account in the synthesis of information from several studies. Meta-analysis has been criticized for failing into account differential quality of evidence in primary studies, allowing poor studies to drive out good science by weight of numbers. Notwithstanding there is presently no agreement on the inclusion of atudy quality score in quantitative meta-analysis; on the other hand, agreementdoes existon knowing study quality. However, and although there is a certain level of consensus about what a good study is and on what characteristics it should have, no evaluation protocol on study quality is uniformly accepted. Furthermore, there are no data on the reliability and validity of quality questionnaires. There are several procedures to include study quality in meta-analysis: a) it is generally accepted that bias-free studies should be pooled only; b) most researches reject to include quality scores in the weight; and c) no agreement is reached on the use the quality scores as acovariate in graphical methods and regression analysis. It may be superfluous or misleading.

Key words:
Meta-analysis
Quality
Full text is only aviable in PDF
Bibliografía
[1.]
K.W. Wachter.
Disturbed by meta-analysis?.
Science, 241 (1988), pp. 1407-1408
[2.]
S. Greenland.
Invited commentary: a critical look at some popular meta-analytical methods.
Am J Epidemiol, 140 (1994), pp. 290-296
[3.]
I. Olkin.
Invited commentary: Re: “A critical look at some popular meta-analytical methods”.
Am J Epidemiol, 140 (1994), pp. 297-300
[4.]
S. Greenland.
Quality scores are useless and potentially misleading. Reply to “Re: “A critical look at some popular metaanalytical methods.
Am J Epidemiol, 140 (1994), pp. 300-301
[5.]
S. Shapiro.
Meta-analysis/Shmeta-analysis.
Am J Epidemiol, 140 (1994), pp. 771-778
[6.]
W.O. Spitzer.
The challenge of meta-analysis.
J Clin Epidemiol, 48 (1995), pp. 1-4
[7.]
A.S. Detsky, C.D. Naylor, K. O’Rourke, A.J. McGeer, K.A. L’Abbé.
Incorporating variations in the quality of individual randomized trials into meta-analysis.
J Clin Epidemiol, 45 (1992), pp. 255-265
[8.]
US Preventive Services Task Force.
Guide to Clinical Preventive Services. An Assessment of the Effectiveness of 169 Interventions.
Williams & Wilkins, (1989),
[9.]
M. Maclure.
Taxonomic axes of epidemiologic study designs: a refutationist perspective.
J Clin Epidemiol, 44 (1991), pp. 1045-1053
[10.]
H. Austin, H.A. Hill, W.D. Flanders, R.S. Greenberg.
Limitations in the application of case-control methodology.
Epidemiol Rev, 16 (1994), pp. 65-76
[11.]
M. Sillero-Arenas, M. Delgado-Rodríguez, R. Rodigues-Canteras, A. Bueno-Cavanillas, R. Gálvez-Vargas.
Menopausal hormone replacement therapy and breast cancer. A metaanalysis.
Obstet Gynecol, 79 (1992), pp. 286-294
[12.]
C.J. Bulpitt.
Meta-analysis.
Lancet, ii (1988), pp. 93-94
[13.]
T.C. Chalmers, H. Levin, H.S. Sacks, D. Reitman, J. Berrier, R. Nagalingam.
Meta-analysis of clinical trials as a scientific discipline. I: Control bias and comparison with large co-operative trials.
Stat Med, 6 (1987), pp. 315-326
[14.]
H.S. Sacks, J. Berrier, D. Reitman, V.A. Arcona-Berk, T.C. Chalmers.
Meta-analyses of randomized controlled trials.
N Engl J Med, 316 (1987), pp. 150-155
[15.]
J.J. Schlesselman.
Case-control studies. Design, conduct, analysis.
Oxford University Press, (1982),
[16.]
O.S. Miettinen.
Estimability and estimation in case-referent studies.
Am J Epidemiol, 103 (1976), pp. 226-235
[17.]
O.S. Miettinen.
Theoretical Epidemiology. Principles of Ocurrence Research in Medicine.
Wiley, (1985),
[18.]
O.S. Miettinen.
The “case-control” study: valid selection of subjects.
J Chron Dis, 38 (1985), pp. 543-548
[19.]
S. Wacholder, J.K. McLaughlin, D.T. Silverman, J.S. Mandel.
Selection of controls in case-controls studies. I. Principles.
Am J Epidemiol, 135 (1992), pp. 1019-1028
[20.]
T. Lasky, P.D. Stolley.
Selection of cases and controles.
Epidemiol Rev, 16 (1994), pp. 6-17
[21.]
M. Delgado-Rodríguez, M. Sillero-Arenas, J.M. Martín-Moreno, R. Gálvez-Vargas.
Oral contraceptives and cancer of the cervix uteri. A meta-analysis.
Acta Obstet Gynecol Scand, 71 (1992), pp. 368-376
[22.]
L.C. Mayes, R.I. Horwitz, A.R. Feinstein.
A collection of 56 topics with contradictory results in case-control research.
Int J Epidemiol, 17 (1988), pp. 680-685
[23.]
M. Delgado Rodríguez, M. Sillero Arenas, R. Gálvez Vargas.
Metaanálisis en epidemiología. I. Características generates.
Gac Sanit, 5 (1991), pp. 265-272
[24.]
D.B. Pettiti.
Meta-analysis. Decision analysis and costeffectiveness analysis.
Oxford University Press, (1994),
[25.]
D.T. Felson.
Bias in meta-analytic research.
J Clin Epidemiol, 45 (1992), pp. 885-892
[26.]
T.C. Chalmers.
Problems induced by meta-analyses.
Stat Med, 10 (1991), pp. 971-980
[27.]
A. Trilla.
Por qué y cómo se aceptan o rechazan artículos para su publicación en las revistas biomédicas.
Med Clin (Barc), 95 (1990), pp. 732-734
[28.]
D.G. Altman.
Practical statistics for medical research.
pp. 477-504
[29.]
T.C. Chalmers, H. Smith Jr., B. Blackburn, B. Silverman, B. Schroeder, D. Reitman, A. Ambroz.
A method for assessing the quality of a randomized control trial.
Control Clin Trials, 2 (1981), pp. 31-49
[30.]
J.M. Elwood.
Causal relationships in medicine: a practical appraisal.
Oxford University Press, (1988),
[31.]
J.P. Realini, J.W. Goldzieher.
Oral contraceptives and cardiovascular disease: a critique of the epidemiologic studies.
Am J Obstet Gynecol, 152 (1985), pp. 729-798
[32.]
M.P. Longnecker, J.A. Berlin, M.J. Orza, T.C. Chalmers.
A metaanalysis of alcohol consumption in relation to risk of breast cancer.
JAMA, 260 (1988), pp. 652-656
[33.]
C.M. Friedenreich, R.F. Brandt, E. Riboli.
Influence of methodologic factors in a pooled analysis of 13 case-control studies of colorectal cancer and dietary fiber.
Epidemiology, 5 (1994), pp. 66-79
[34.]
C.M. Friedenreich.
Methods for pooled analyses of epidemiologic studies.
Epidemiology, 4 (1993), pp. 295-302
[35.]
M. Sillero Arenas.
Metaanálisis de la relación entre los contraceptivos orales y los cánceres de mama y cuello uterino.
Universidad de Granada, (1989),
[36.]
M. Delgado Rodríguez, M. Sillero Arenas, R. Rodríguez, A. Bueno Cavanillas, J.M. Martín Moreno, R. Gálvez Vargas.
Anticonceptivos orales y cáncer de mama: análisis de la potencia estadística de asociación.
Gac Sanit, 5 (1991), pp. 59-67
[37.]
A.R. Feinstein.
Clinimetrics.
Yale University Press, (1987),
[38.]
R.E. Slavin.
Best evidence synthesis: an intelligentaltemative to meta-analysis.
J Clin Epidemiol, 48 (1995), pp. 9-18
[39.]
W.O. Spitzer.
Meta-meta-analysis: unanswered questions about aggregating data.
J Clin Epidemiol, 44 (1991), pp. 103-107
[40.]
J.L. Fleiss, A.J. Gross.
Meta-analysis in epidemiology, with special reference to studies of the association between exposure to environmental tobacco smoke anc lung cancer: a critique.
J Clin Epidemiol, 44 (1991), pp. 127-139
[41.]
M. Sillero-Arenas, R. Rodríguez, M. Delgado Rodríguez, A. Bueno Cavanillas, R. Gálvez Vargas.
Patterns of reserach. Oral contraceptives and cancer of the cervix uteri.
Acta Obstet Gynecol Scand, 70 (1991), pp. 143-148
[42.]
M. Delgado-Rodríguez, M. Sillero-Arenas, R. Rodríguez, R. López, R. Gálvez-Vargas.
Oral contracepties and breast cancer. A meta-analysis.
Rev Epidém Santé Publ, 39 (1991), pp. 165-181
[43.]
P.J. Easterbrook, J.A. Berlin, R. Gooalan, D.R. Matthews.
Publication bias in clinical research.
Lancet, 337 (1991), pp. 867-872
[44.]
P.J. Goodwin, N.F. Boyd.
Mammographic parenchymal pattern and breast cancer risk: a critica appraisal of the evidence.
Am J Epidemiol, 127 (1988), pp. 1097-1108
[45.]
M. Delgado Rodríguez, R. Rodríguez, M. Sillero Arenas, P. Lardelli Claret, A. Bueno Cavanillas, R. Gálvez Vargas.
Contraceptivos orales y cánceres de mama y cuello uterino. Metaanálisis cualitativo.
Toko-Gin Práct, 46 (1990), pp. 336-344
[46.]
M. Delgado Rodríguez, M. Sillero Arenas, R. Rodríguez, R. Gálvez Vargas.
Pertinencia y normas para la realización de un estudio sobre anticonceptivos orales y cáncer de mama en España.
Toko-Gin Prácf, 47 (1991), pp. 19-24
[47.]
W.W. Willett.
Nutritional Epidemiology.
Oxford University Press, (1990),
[48.]
J.A. Berlin, G.A. Colditz.
A meta-analysis of physical activity in the prevention of coronary heart disease.
Am J Epidemiol, 132 (1990), pp. 612-628
[49.]
N.F. Boyd, L.J. Martin, M. Noffel, G.A. Lockwood, D.L. Tritchler.
A meta-analysis of studies of dietary fat and breast cancer risk.
BrJ Cancer, 68 (1993), pp. 627-636
[50.]
J. Lau, C.H. Schmid, T.C. Chalmers.
Cumulative meta-analysis of clinical trials builds evidence for exemplary medical care.
J Clin Epidemiol, 48 (1995), pp. 45-57

Presentado en parte a la XII Reunión Anual de la Sociedad Espanola de Epidemiología, Alicante, 1994.

Copyright © 1995. Sociedad Española de Salud Pública y Administración Sanitaria
Download PDF
Idiomas
Gaceta Sanitaria
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?