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Theoretically, Pringle and colleagues identify twelve methodological attributes of an ideal indicator: validity, communicable, effective, reliable, objective, available, contextual, attributable, interpretation, comparable, remediable and repeatable (see Table 1 for definitions) [ 7].
Key methodological attributes of the studies are outlined in Table 1.
First, it is possible that our assessment of the methodological attributes of included trials could underestimate their quality.
Fourteen trials did not have any methodological attributes with high quality; 38 trials had one; 37 had two, 38 had three; 30 had four; and 14 had five.
On average, the included set of trials had between two and three methodological attributes with high quality (average methodological quality score across the included set of trials was 2.65).
First was quality related bias, which we defined as the potential underestimation or overestimation of the true intervention effect due to flaws in the methodological attributes of randomised controlled trials.
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On each methodological attribute, we gave studies a rating of high, low, or uncertain quality.
Only 11 trials were rated as having high quality on all six methodological quality attributes.
Figure 4 shows the sensitivity of the dose comparative effects of individual statins to different trial-level methodological quality attributes.
The effect size tended to get smaller in sensitivity analyses that included only trials with high methodological quality attributes.
This paper contributes empirical evidence to the limited methodological literature on attributes and levels development for DCE, thereby providing further empirical guidance on the matter, specifically within rural communities of low- and middle-income countries.
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