Meta-Analysis: An

Introduction

George A. Kelley, DA, FACSM
School of Medicine,
Dept. of Community Medicine,
West Virginia University,
Morgantown, WV
Bio Funding Publications

Interest and Excitement for
Meta-Analysis
Proliferation of information on
health-related disease
Need to try and make sense out
of nonsense
Enjoyment for combining and
analyzing data
Learning Objectives

Identify what meta-analysis is
Identify the advantages and
different types of meta-analyses
Identify the steps for conducting a
meta-analysis of summary data


Performance Objectives
Define meta-analysis
List and describe the advantages
and types of meta-analyses
List and describe the steps
necessary for conducting a
meta-analysis of summary data
Major Topics Covered
I. Overview of Meta-Analysis
II. Steps for Conducting A Meta-
Analysis
I. Overview of Meta-Analysis
A. Meta-Analysis Defined
B. Advantages of Meta-
Analysis
C. Types of Meta-Analyses
A. Meta-Analysis
Combining the results
from many studies dealing
with the same topic.

B. Advantages of Meta-Analysis
1. Study question specific &
narrow
2. Data collection
comprehensive & specific
3. Study selection based on
uniformly applied criteria
4. Data synthesis quantitative

C. Types of Meta-Analyses
1. Summary Data
2. Individual Patient Data
II. Steps for Conducting A
Meta-Analysis

A. Data Sources
B. Study Selection
C. Data Abstraction
D. Statistical Analysis

A. Data Sources
1. Computer searches
2. Cross-referencing
3. Hand-searching
4. Expert(s) to review list
Data Sources-Example
- Computer searches (Medline,
Embase, Sport Discus, Current
Contents, Dissertation Abstracts)
- Cross-referencing from review
and original articles
- Experts to review list (Drs. James
Hagberg & Doug Seals)
B. Study Selection
1. Study designs
2. Subjects
3. Publication types
4. Languages
5. Interventions
6. Time Frame
Study Selection-Example

- RCTs or CTs with a nonexercise
control group
- Progressive resistance training
as the only mode of training
- Females > 18 years of age
- Journal articles, dissertations, &
masters theses published in
English
Study Selection (cont.)
Studies published & indexed
between January 1966 and
December 1998
Bone mineral density assessed
at femur, spine, and/or radius
Training studies > 16 weeks
C. Data Abstraction
1. Number of items coded
2. Inter-coder bias
3. Items coded
Data Abstraction Example

242 possible items coded
Data independently abstracted
by first two authors
Every data point reviewed for
accuracy and consistency
Major characteristics coded
study, physical, exercise,
primary & secondary outcomes
D. Statistical Analysis
1. Choice of metric
2. Choice of model/
heterogeneity
3. Publication bias
4. Study quality
5. Moderator analysis
1. Choice of Metric
a. Original
b. Standardized mean
difference (Mean/Standard
Deviation)


2. Choice of Model/
Heterogeneity

a. Fixed Effects
b. Random Effects
Metric, Model, &
Heterogeneity - Example
Study N

TE + SD

95% CI
1 68 -2 + 4 -3 to 1
2 92 -1 + 4 -2 to 0
3 78 -4 + 3 -5 to -3
3. Publication Bias
a. Graphical methods
b. Quantitative methods

Funnel Plot - Example
0
20
40
60
80
100
120
-25 -20 -15 -10 -5 0 5 10 15 20 25
Systolic ES (mmHg)
S
a
m
p
l
e

S
i
z
e

r = 0.50, p = 0.007
4. Study Quality
a. Difficult to assess
b. Interpret with caution
c. Numerous scales and
checklists available

5. Moderator Analysis
a. Categorical Analysis
b. Regression Analysis
Categorical Analysis - Example
Group N

+ SD
95% CI Q
b
(p)
USA
Other
17
11
-1 + 3
-4 + 4
-3 to -1
-6 to -2
4.00(0.04)*

RCT
CT
7
21
-2 + 3
-2 + 4
-3 to -1
-5 to 1
0.08(0.77)

Note: RCT, randomized controlled trials, CT, controlled trials; N,
number of effect sizes; * means significantly different at P<0.05
Regression - Example
Variables N r r
2
r
2
adj
SE p
IBMI, ISBP 18 0.75 0.57 0.51 3.47 0.002

Notes: IBMI means initial body mass index (kg/m
2
);
ISBP means initial systolic blood pressure (mmHg); N
means number of effect sizes.
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