Methodological quality and homogeneity influenced agreement between randomized trials and nonrandomized studies of the same intervention for back pain.
OBJECTIVE
To determine the influence of methodological quality and homogeneity on the agreement between pairs of randomized trials (RCTs) and nonrandomized studies (NRSs) of the same interventions for low-back problems. Homogeneity was assessed regarding settings, population, interventions, and outcomes.


METHODS
We searched Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE up to May 2005 for matching pairs of NRS and RCT. Analyses were done using correlation, linear and logistic regression.


RESULTS
Forty-eight matched pairs were included with no significant overall correlation between effect sizes (r=0.09). There was a trend showing more agreement among the 22 pairs with higher methodological quality (r=0.33). The correlation among the 20 very homogeneous pairs was 0.59, and among the 28 heterogeneous pairs was -0.09. The agreement of authors' recommendations was influenced by the pair's homogeneity (odds ratio [OR]=2.78, 95% CI=1.44-5.37) rather than by methodological quality of the NRS (OR=0.93, 95% CI=0.67-1.29) or the RCT (OR=1.03, 95% CI=0.73-1.45).


CONCLUSIONS
Pairs of low-quality studies disagreed more than pairs where at least one study was of high quality. However, pairs with similar settings, population, interventions, and outcomes showed higher agreement than pairs that were not as homogeneous.
Furlan
Andrea D
AD
Institute for Work & Health, Toronto, ON, Canada M5G 2E9. afurlan@iwh.on.ca
Tomlinson
George
G
Jadad
Alejandro Alex R
AA
Bombardier
Claire
C
D003627:Data Interpretation, Statistical; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D019370:Observation; D016032:Randomized Controlled Trials as Topic / Q000379:methods* / Q000592:standards; D012107:Research Design; D016896:Treatment Outcome