Salima Punja1, Christopher H Schmid2, Lisa Hartling3, Liana Urichuk4, Catherine Jane Nikles5, Sunita Vohra6. 1. Department of Medicine, University of Alberta, 1702 College Plaza, 8215 - 112 Street NW, Edmonton, AB, Canada, T6G 2C8. 2. Department of Biostatistics and Center for Evidence Based Medicine, Brown University School of Public Health, 121 South Main St., Box G-S121-8, Providence, Rhode Island 02912, USA. 3. Department of Pediatrics, University of Alberta, 11405-87 Avenue NW, Edmonton, Alberta, Canada, T6G 1C9. 4. Alberta Health Services, 9942 108 Street NW, Unit 642, Edmonton, Alberta, Canada, T5K 2J5. 5. University of Queensland, Building 71/918 RBWH Herston, Brisbane, Queensland, Australia, 4029. 6. Complementary and Alternative Research and Education Program (CARE), Department of Pediatrics, University of Alberta, 1702 College Plaza, 8215 - 112 Street NW, Edmonton, AB, Canada, T6G 2C8. Electronic address: svohra@ualberta.ca.
Abstract
OBJECTIVES: To assess how the inclusion of N-of-1 trial data into randomized controlled trial (RCT) meta-analyses impacts the magnitude and precision of yielded treatment effects, using amphetamines and methylphenidate for pediatric attention deficit hyperactivity disorder as a model. STUDY DESIGN AND SETTING: We combined the N-of-1 and RCT data generated from previously conducted systematic reviews using parent and teacher ratings of hyperactivity and/or impulsivity as the outcome. Data were combined using standardized mean differences assuming a random effects model. The amphetamine and methylphenidate evidence were synthesized separately. RESULTS: We found that the inclusion of N-of-1 trial data in the meta-analysis impacted both magnitude and precision. The addition of the N-of-1 trial data narrowed the confidence intervals in three of the four comparisons as compared to the treatment effect yielded by RCT-only data. Furthermore, the addition of N-of-1 trials changed the overall treatment effects yielded by the RCT-only meta-analyses from statistically nonsignificant to statistically significant in one of the four outcomes. CONCLUSIONS: If the overall goal of a meta-analysis is to synthesize all available evidence on a given topic, then N-of-1 trials should be included. This study shows it is possible to combine N-of-1 trial data with RCT data and the potential merits of this approach.
OBJECTIVES: To assess how the inclusion of N-of-1 trial data into randomized controlled trial (RCT) meta-analyses impacts the magnitude and precision of yielded treatment effects, using amphetamines and methylphenidate for pediatric attention deficit hyperactivity disorder as a model. STUDY DESIGN AND SETTING: We combined the N-of-1 and RCT data generated from previously conducted systematic reviews using parent and teacher ratings of hyperactivity and/or impulsivity as the outcome. Data were combined using standardized mean differences assuming a random effects model. The amphetamine and methylphenidate evidence were synthesized separately. RESULTS: We found that the inclusion of N-of-1 trial data in the meta-analysis impacted both magnitude and precision. The addition of the N-of-1 trial data narrowed the confidence intervals in three of the four comparisons as compared to the treatment effect yielded by RCT-only data. Furthermore, the addition of N-of-1 trials changed the overall treatment effects yielded by the RCT-only meta-analyses from statistically nonsignificant to statistically significant in one of the four outcomes. CONCLUSIONS: If the overall goal of a meta-analysis is to synthesize all available evidence on a given topic, then N-of-1 trials should be included. This study shows it is possible to combine N-of-1 trial data with RCT data and the potential merits of this approach.
Authors: Sarah C O S Padilha; Suzane Virtuoso; Fernanda S Tonin; Helena H L Borba; Roberto Pontarolo Journal: Eur Child Adolesc Psychiatry Date: 2018-02-19 Impact factor: 4.785
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Authors: Heather C Kaplan; Lisa Opipari-Arrigan; Christopher H Schmid; Christine L Schuler; Shehzad Saeed; Kimberly L Braly; Jennifer C Burgis; Kaylie Nguyen; Sheri Pilley; Julie Stone; Gisele Woodward; David L Suskind Journal: Healthcare (Basel) Date: 2019-11-01