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Restrictions on inclusion by study design and quality assessment excluded many weaker studies.
A significant association was found with methodologically weaker studies reporting higher treatment success percentages.
However a systematic review of older, smaller or weaker studies, or demonstrating significant heterogeneity, may be inferior to a large well conducted and generisable RCT.
Given that Khan et al's cohort constituted 19% of the total meta-analysis cohort, 1 the weaker studies might have considerably affected our results.
Retaining them in the analysis did not appear to compromise the synthesis since the weaker studies merely contributed to fewer themes rather than changing the themes.
Therefore, some of the summary results may have been based upon the findings of methodological weaker studies, which, in turn, increased the risk of bias.
Similar(51)
Because of a lack of a control group, a case-series study is considered one of the weaker study designs from which to obtain evidence on treatment effectiveness.
In summary, the two stronger studies and one methodologically weaker study found no group differences on impulsivity measures assessing ability to delay gratification.
The weaker study designs associated with population-targeted interventions increase the risk of being unable to reproduce health outcomes when implementing interventions on a broader scale.
Furthermore, our study focuses on controlled trials, rather than on evaluations with a weaker study designs, because we were interested to learn which quality improvement strategies had been evaluated most rigorously.
An additional literature search was performed to identify promising strategies that were not included in the systematic review (e.g., evaluated with a weaker study design than RCTs) or not evaluated yet (e.g., local initiatives).
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com