"Flogging dead horses": evaluating when have clinical trials achieved sufficiency and stability? A case study in cardiac rehabilitation

Most systematic reviews conclude that another clinical trial is needed. Measures of sufficiency and stability may indicate whether this is true. To show how evidence accumulated on centre-based versus home-based cardiac rehabilitation, including estimates of sufficiency and stability Systematic revi...

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Published in:	Current controlled trials in cardiovascular medicine 2011-03, Vol.12 (1), p.83-83, Article 83
Main Authors:	Dent, Louise, Taylor, Rod, Jolly, Kate, Raftery, James
Format:	Article
Language:	eng
Subjects:	Cardiovascular disease Clinical trials Clinical Trials as Topic - statistics & numerical data Community Health Services - statistics & numerical data Data Interpretation, Statistical Evidence-Based Medicine - statistics & numerical data Exercise Health aspects Heart attacks Heart Diseases - rehabilitation Heart failure Home Care Services - statistics & numerical data Hospitals Humans Intervention Meta-analysis Outpatient Clinics, Hospital - statistics & numerical data Patients Public health Rehabilitation Research Design Treatment Outcome
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Summary:	Most systematic reviews conclude that another clinical trial is needed. Measures of sufficiency and stability may indicate whether this is true. To show how evidence accumulated on centre-based versus home-based cardiac rehabilitation, including estimates of sufficiency and stability Systematic reviews of clinical trials of home versus centre-based cardiac rehabilitation were used to develop a cumulative meta-analysis over time. We calculated the standardised mean difference (SMD) in effect, confidence intervals and indicators of sufficiency and stability. Sufficiency refers to whether the meta-analytic database adequately demonstrates that an intervention works - is statistically superior to another. It does this by assessing the number of studies with null results that would be required to make the meta-analytic effect non-statistically significant. Stability refers to whether the direction and size of the effect is stable as new studies are added to the meta-analysis. The standardised mean effect difference reduced over fourteen comparisons from a non-significant difference favouring home-based cardiac rehabilitation to a very small difference favouring hospital (SMD -0.10, 95% CI -0.32 to 0.13). This difference did not reach the sufficiency threshold (failsafe ratio 0.039
ISSN:	1745-6215 1745-6215 1468-6694