Methods in Cochrane Reviews: a chose-andpick model versus

Methods in Cochrane Reviews: a chose-andpick model versus

Methods in Cochrane Reviews: a chose-andpick model versus a structured model Cochrane Methods Symposium Georgia Salanti Statistical Methods Group Comparing Multiple Interventions Methods Group Vienna, 02nd October 2015 Trusted evidence. Informed decisions. Better health.

When do difficult situations arise? Methods to debate Use of emerging methods New developments or improvements in existing approaches are needed in some areas and apply to some CRGs (e.g. metaanalysis for sparse data) Not all are suitable for CRs or

reviews at all! Debate which Use of existing methodsone is more appropriate Is MECIR enough to address these issues? Incomplete methodological guidance Under-developped methodology MECIR tells you what you are expected to do but now how you should do it!

Handbook balances between being understandable and technically sound and cannot cover all detail. Plus, recommendations in the Handbook are not binding! What to do when disagreements arise? Framework Anarchy Driving engine for innovation Encourages peoples creativity Gives a feeling of autonomy to CRGs CGRs know best whats

appropriate for their reviews When do difficult situations arise? Flexibility in CRGs Anarchy Tyranny Aristocracy Guarantees minimum methodological standards for all reviews Safeguards against a pick-andchose approach Makes the best use of resources

many Cochrane methodologists When do difficult situations arise? Flexibility in CRGs Anarchy Democratic federation Tyranny - Aristocracy Try to find a sensible business model ....Where methods in Cochrane Reviews can be picked from a pool of

Optimal methods Appropriate methods Tolerated methods Inappropriate methods List to be established by Methods Groups in collaboration with CRGs A communication model is needed to feedback between Review Groups and the Methods Groups (e.g. prompting the Methods Groups when a new method is published, or flagging out methodological gaps link with MIF) Example: Challenges in SMG

Estimators of heterogeneity and alternative RE models Discussion in SMG mailing list (couple year ago!) attracted our attention There are different estimates of heterogeneity and alternative random effects models Concerns about Cochrane Reviews using out-of-date methods to synthesize data and draw conclusions! Example: Challenges in SMG Estimators of heterogeneity An Heterogeneity and Random Effects Task Force was created with experts from the field (included non-Cochrane researchers)

We reviewed the literature, examined simulation/empirical studies and compiled expert opinion Reached consensus and summarized it in a paper We have recommendations With our own resources This was an exceptional case Example: Challenges in Methods Groups CRGs Reviewers

Method s Groups Handbook Revman Discuss with CRGs A Democratic Federation needs: Each Methods Group needs to Review the literature

Assess the available methods for suitability for CRs Come up with the list of optimal, appropriate Optimal methods Appropriate methods and tolerated methods and no-no methods! Inform MIF for important research gaps Tolerated methods methods Devise an interim policy for methodological Inappropriate gaps

Update the list of methods regularly You cant do this with volunteers! SMG has now a part-time methodologist! We need to do this now Because prevention is always preferable to cure

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