To meta-analyze or not to meta-analyze? A combined meta-analysis of N-of-1 trial data with RCT data on amphetamines and methylphenidate for pediatric ADHD

Punja, Salima, Schmid, Christopher H., Hartling, Lisa, Urichuk, Liana, Nikles, Catherine Jane and Vohra, Sunita (2016) To meta-analyze or not to meta-analyze? A combined meta-analysis of N-of-1 trial data with RCT data on amphetamines and methylphenidate for pediatric ADHD. Journal of Clinical Epidemiology, 76 76-81. doi:10.1016/j.jclinepi.2016.03.021


Author Punja, Salima
Schmid, Christopher H.
Hartling, Lisa
Urichuk, Liana
Nikles, Catherine Jane
Vohra, Sunita
Title To meta-analyze or not to meta-analyze? A combined meta-analysis of N-of-1 trial data with RCT data on amphetamines and methylphenidate for pediatric ADHD
Journal name Journal of Clinical Epidemiology   Check publisher's open access policy
ISSN 1878-5921
0895-4356
Publication date 2016
Sub-type Article (original research)
DOI 10.1016/j.jclinepi.2016.03.021
Open Access Status Not Open Access
Volume 76
Start page 76
End page 81
Total pages 6
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Collection year 2017
Language eng
Subject 2713 Epidemiology
Formatted 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.
Keyword ADHD
Amphetamine
Meta-analysis
Methylphenidate
N-of-1
Systematic review
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
HERDC Pre-Audit
School of Nursing, Midwifery and Social Work Publications
 
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