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If there is evidence of moderate statistical heterogeneity (I statistic 30%to50%0%), we will use a random-effects model for meta-analysis.
However, there was moderate statistical heterogeneity between trials (I statistic = 68%; P = 0.01), with two trials finding benefits which reached standard levels of statistical significance (Kamolratanakul 1999 THA; Hsieh 2008 TWN).
Excluding the two most heterogeneous studies [ 22, 36] yielded a pooled OR of 0.53 with a pooled 95% CI of 0.40 to 0.70 in a combined sample of 3,946 patients (P < 0.00001; statistical power 99%) and moderate statistical heterogeneity and inconsistency (Q statistic P = 0.05; I2 = 34%).
There was moderate statistical heterogeneity between trials (I² = 48%), however it was not statistically significant (Chi² P value = 0.16) and the direction of the effect estimates was consistent.
The pooled analysis including those studies suggested an increased risk of having migraine in obese compared with normal weight subjects (PAEE 1.14; 95% CI, 1.02-1.27; P = 0.017), with moderate statistical heterogeneity (I2 = 63.3%; P for Q test = 0.002).
The pooled analysis including that study confirmed the increased risk of having migraine in underweight compared with normal weight subjects (PAEE 1.21; 95% CI, 1.08-1.37; P = 0.017), with moderate statistical heterogeneity (I2 = 63.3%; P for Q test = 0.002).
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Although moderate to high statistical heterogeneity was seen, the direction of effect was the same in all trials: no trial was found that lithium is inferior to placebo (Figure 2). Figure 2 Prevention of any episode in bipolar disorders patients in RCTs comparing lithium with placebo.
Five of 14 meta-analyses had moderate or high statistical heterogeneity.
Values of 25, 50 and 75% for the I2 test were regarded as indicative of low, moderate and high statistical heterogeneity, respectively.
Meta-analyses of any cardiotoxicity (clinical and subclinical) showed moderate to high statistical heterogeneity for four of five pooled analyses; criteria for any cardiotoxic event differed between studies.
Except for BMI, all outcomes showed moderate to high statistical heterogeneity, from 57% for SBP to 98% for HbA1c, suggesting that the effects of the diabetes disease management interventions on these outcomes were inconsistent across care groups.
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