General Category of Recommendation | Specific Recommendation | Number of Resources1 | Citations |
---|---|---|---|
When to identify covariates in the review process | A priori (e.g., in protocol) | 17 | 76, 92,93,95, 100, 98, 18, 26, 39, 40, 30, 59, 29, 31, 46, 94, 114 |
How to find important clinical covariates from trial information | Looking at forest plots (variation in point estimates/CI overlap/ adding a vertical line for levels of some clinical variable) | 6 | 92, 98, 93, 97, 98, 94 |
 | Proceed regardless of formal testing of statistical heterogeneity | 5 | 35, 92, 97, 98, 29 |
 | Looking at L’Abbe plots | 4 | 98, 45, 93, 98 |
 | Influence plot | 3 | 98, 54, 85 |
 | Looking at summary tables | 2 | 92, 24 |
 | Looking at funnel plots | 2 | 49, 98 |
 | Use conceptual frameworks to facilitate choice of covariates (i.e., using taxonomies for active ingredients) | 2 | 98, 112 |
 | I2 (look at the change in statistical heterogeneity by adding subgroups) | 2 | 87, 100 |
 | Plot of effect size against individual covariates | 1 | 48 |
 | Using an adaptation of multidimensional scaling (CoPlot) | 1 | 55 |
 | Plot of normalized z-scores | 1 | 93 |
 | Radial/Galbraith plot | 1 | 93 |
 | Frequency distributions | 1 | 98 |
 | Dose-response graph | 1 | 3? |
 | Use P.I.C.O. model to guide choice of characteristics | 1 | 115 |
 | Use causal mediating processes | 1 | 113 |
 | Treat strata within trials as separate studies; these subgroups if similar across studies can be combined | 1 | 46 |
Rationale for choice of covariate | Scientific (e.g., pathophysiological, pharmacologic argument) | 10 | 7,76,92,93, 100, 18, 26, 59, 31, 115 |
 | Previous research (e.g., large RCT) | 3 | 76, 68, 100 |
 | Clinical grounds | 2 | 96, 100 |
 | Indirect evidence | 1 | 59 |
Personnel | Use of clinical experts | 2 | 21, 115 |
 | Blind to results of trials | 1 | 35 |
Number of covariates/trials needed | Small number of covariates | 7 | 92, 95, 100, 18, 26, 31, 94 |
 | Each covariate investigation should be based on an adequate number of studies (e.g., 10 for every moderator) | 6 | 100, 59, 50, 94, 115 |
 | Investigators must report actual number of covariates investigated for reader to determine the potential for false-positives | 1 | 115 |
Number of outcomes to investigate | Restrict investigations to small number of outcomes (e.g., primary) | 1 | 26 |
 | Limit to central question in the analysis | 1 | 94 |
Interpretation of results of investigations | Use caution (4 resources note especially with post hoc testing) | 12 | 100, 18, 29, 31, 85, 16, 20, 23, 25, 61, 32, 35 |
 | Observational only | 6 | 59, 23, 94, 98, 100, 114 |
 | Exploratory or hypothesis generating only | 4 | 32, 100, 40, 94 |
 | Consider confounding between covariates | 4 | 100, 50, 115, 59 |
 | Consider artifactual causes of between-study variation | 2 | 6, 98 |
 | Consider biases (e.g., misclassification, dilution, selection) | 2 | 93, 115 |
 | Look at magnitude of the effect and the 95% CI; not just effect and p-value; consider precision of the subgroup effects (e.g., sample sizes in the studies dictate precision of the subgroup effects) | 2 | 100, 115 |
 | Seek evidence to justify claims of subgroup findings | 1 | 26 |
 | Identify knowledge gaps in the investigations | 1 | 24 |
 | Consider effect of variability within studies | 1 | 19 |
 | Consider if the magnitude is clinically important (i.e., differences in effect between subgroups) | 1 | 100 |
 | Think through causal relationships, especially directionality | 1 | 113 |
 | Use caution with variables grouped after randomization | 1 | 23 |
 | Consider parabolic relationships (i.e., beyond linear regression) | 1 | 115 |
 | Be cautious not to say there is a consistency of effect if no subgroup effects are found | 1 | 115 |
Descriptive methods | Perform a narrative synthesis of these investigations | 4 | 115, 98, 27, 100 |
 | Other: 1. idea webbing, 2. qualitative case descriptions, 3. investigator/methodological/conceptual triangulation | 1 | 98 |
Use of types of data | Aggregate patient data for trial level covariates | 4 | 23, 25, 118, 46 |
 | Only group characteristics derived prior to randomization (e.g., stratifying) | 2 | 23, 46 |
 | Individual patient data for participant level covariates | 1 | 59 |
 | Individual patient data only for all covariates where possible | 1 | 59 |