This is because the risk of bias may differ depending on how an outcome is measured and how the data for the outcome are analysed.

Research Synthesis Methods 2013; 4: 49–62. Cochrane Reviews seek to minimize bias.

Misclassification of intervention status is seldom a problem in randomized trials and other experimental studies, because interventions are actively assigned by the researcher and their accurate recording is a key feature of the study. JAMA 2018; 319: 408-409.

Post-baseline CD4 cell counts might influence switches between the regimens of interest. Confounding occurs when there are common causes of the choice of intervention and the outcome of interest.

The study is sound for a non-randomized study with regard to this domain but cannot be considered comparable to a well-performed randomized trial. measurements of outcomes were made at sufficiently many time points, in both the intervention and comparator groups, to permit characterization of pre-intervention trends and patterns; any extraneous events or changes in context around the time of the intervention that could have influenced the outcome were experienced equally by both intervention groups; and. Section 7.6 discusses some possible courses of action that may be preferable to retaining such studies in the synthesis.

Stratifying according to the overall risk of bias will produce multiple estimates of the intervention effect: for example, one based on all studies, one based on studies at low risk of bias, and one based on studies at high risk of bias. Quality and Safety in Health Care 2003; 12: 47–52.

pain) and therefore likely to be influenced by knowledge of the intervention received, and lower when the outcome is objectively measured (e.g. The following sections summarize some of the key evidence about bias that informs our guidance on risk-of-bias assessments in Cochrane Reviews. Several studies have found that in most cases there were no major differences between summary estimates of meta-analyses restricted to English-language studies compared with meta-analyses including studies in languages other than English (Morrison et al 2012, Dechartres et al 2018). Source of funding may be reported in a trial publication, and conflicts of interest may be reported in an accompanying declaration, for example the International Committee of Medical Journal Editors (ICMJE) declaration. BMJ 2014; 349: g6501. In the target trial, the effect of interest will be either the effect of assignment to the interventions at baseline, regardless of the extent to which the interventions were received as intended, or the effect of adhering to the interventions as specified in the study protocol (see Chapter 8, Section 8.2.2). Jørgensen L, Paludan-Muller AS, Laursen DR, Savovic J, Boutron I, Sterne JAC, Higgins JPT, Hróbjartsson A. Both practices lead to a situation similar to that when an entire study report is unavailable because of the nature of the results (also known as publication bias). it has been omitted selectively from the report or under-reported), then a risk-of-bias assessment at the level of the study result is not applicable.

Dechartres A, Boutron I, Trinquart L, Charles P, Ravaud P. Single-center trials show larger treatment effects than multicenter trials: evidence from a meta-epidemiologic study. Company stock prices before and after public announcements related to oncology drugs.

However, reliability in reaching judgements about risk of bias compared with human reviewers was slight to moderate depending on the domain assessed (Gates et al 2018). Journal of Nervous and Mental Disease 2002; 190: 583-592. Grundy Q, Dunn AG, Bourgeois FT, Coiera E, Bero L. Prevalence of Disclosed Conflicts of Interest in Biomedical Research and Associations With Journal Impact Factors and Altmetric Scores. Review authors assessing risk of bias should have either content or methodological expertise (or both), and an adequate understanding of the relevant methodological issues addressed by the risk-of-bias tool.

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