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Statistical methods used to test for agreement of medical instruments measuring continuous variables in method comparison studies: a systematic review

BACKGROUND: Accurate values are a must in medicine. An important parameter in determining the quality of a medical instrument is agreement with a gold standard. Various statistical methods have been used to test for agreement. Some of these methods have been shown to be inappropriate. This can resu...

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Main Authors: Zaki, R., Bulgiba, A., Ismail, R., Ismail, N.A.
Format: Article
Language:English
Published: Public Library of Science 2012
Subjects:
R Medicine
Online Access:http://eprints.um.edu.my/3378/1/11.pdf
http://eprints.um.edu.my/3378/
http://www.ncbi.nlm.nih.gov/pubmed/22662248
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spelling my.um.eprints.33782017-07-04T07:42:23Z http://eprints.um.edu.my/3378/ Statistical methods used to test for agreement of medical instruments measuring continuous variables in method comparison studies: a systematic review Zaki, R. Bulgiba, A. Ismail, R. Ismail, N.A. R Medicine BACKGROUND: Accurate values are a must in medicine. An important parameter in determining the quality of a medical instrument is agreement with a gold standard. Various statistical methods have been used to test for agreement. Some of these methods have been shown to be inappropriate. This can result in misleading conclusions about the validity of an instrument. The Bland-Altman method is the most popular method judging by the many citations of the article proposing this method. However, the number of citations does not necessarily mean that this method has been applied in agreement research. No previous study has been conducted to look into this. This is the first systematic review to identify statistical methods used to test for agreement of medical instruments. The proportion of various statistical methods found in this review will also reflect the proportion of medical instruments that have been validated using those particular methods in current clinical practice. METHODOLOGY/FINDINGS: Five electronic databases were searched between 2007 and 2009 to look for agreement studies. A total of 3,260 titles were initially identified. Only 412 titles were potentially related, and finally 210 fitted the inclusion criteria. The Bland-Altman method is the most popular method with 178 (85%) studies having used this method, followed by the correlation coefficient (27%) and means comparison (18%). Some of the inappropriate methods highlighted by Altman and Bland since the 1980s are still in use. CONCLUSIONS: This study finds that the Bland-Altman method is the most popular method used in agreement research. There are still inappropriate applications of statistical methods in some studies. It is important for a clinician or medical researcher to be aware of this issue because misleading conclusions from inappropriate analyses will jeopardize the quality of the evidence, which in turn will influence quality of care given to patients in the future. Public Library of Science 2012 Article PeerReviewed application/pdf en http://eprints.um.edu.my/3378/1/11.pdf Zaki, R. and Bulgiba, A. and Ismail, R. and Ismail, N.A. (2012) Statistical methods used to test for agreement of medical instruments measuring continuous variables in method comparison studies: a systematic review. PLoS ONE, 7 (5). ISSN 1932-6203 http://www.ncbi.nlm.nih.gov/pubmed/22662248 PMID: 22662248
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
language English
topic R Medicine
spellingShingle R Medicine
Zaki, R.
Bulgiba, A.
Ismail, R.
Ismail, N.A.
Statistical methods used to test for agreement of medical instruments measuring continuous variables in method comparison studies: a systematic review
description BACKGROUND: Accurate values are a must in medicine. An important parameter in determining the quality of a medical instrument is agreement with a gold standard. Various statistical methods have been used to test for agreement. Some of these methods have been shown to be inappropriate. This can result in misleading conclusions about the validity of an instrument. The Bland-Altman method is the most popular method judging by the many citations of the article proposing this method. However, the number of citations does not necessarily mean that this method has been applied in agreement research. No previous study has been conducted to look into this. This is the first systematic review to identify statistical methods used to test for agreement of medical instruments. The proportion of various statistical methods found in this review will also reflect the proportion of medical instruments that have been validated using those particular methods in current clinical practice. METHODOLOGY/FINDINGS: Five electronic databases were searched between 2007 and 2009 to look for agreement studies. A total of 3,260 titles were initially identified. Only 412 titles were potentially related, and finally 210 fitted the inclusion criteria. The Bland-Altman method is the most popular method with 178 (85%) studies having used this method, followed by the correlation coefficient (27%) and means comparison (18%). Some of the inappropriate methods highlighted by Altman and Bland since the 1980s are still in use. CONCLUSIONS: This study finds that the Bland-Altman method is the most popular method used in agreement research. There are still inappropriate applications of statistical methods in some studies. It is important for a clinician or medical researcher to be aware of this issue because misleading conclusions from inappropriate analyses will jeopardize the quality of the evidence, which in turn will influence quality of care given to patients in the future.
format Article
author Zaki, R.
Bulgiba, A.
Ismail, R.
Ismail, N.A.
author_facet Zaki, R.
Bulgiba, A.
Ismail, R.
Ismail, N.A.
author_sort Zaki, R.
title Statistical methods used to test for agreement of medical instruments measuring continuous variables in method comparison studies: a systematic review
title_short Statistical methods used to test for agreement of medical instruments measuring continuous variables in method comparison studies: a systematic review
title_full Statistical methods used to test for agreement of medical instruments measuring continuous variables in method comparison studies: a systematic review
title_fullStr Statistical methods used to test for agreement of medical instruments measuring continuous variables in method comparison studies: a systematic review
title_full_unstemmed Statistical methods used to test for agreement of medical instruments measuring continuous variables in method comparison studies: a systematic review
title_sort statistical methods used to test for agreement of medical instruments measuring continuous variables in method comparison studies: a systematic review
publisher Public Library of Science
publishDate 2012
url http://eprints.um.edu.my/3378/1/11.pdf
http://eprints.um.edu.my/3378/
http://www.ncbi.nlm.nih.gov/pubmed/22662248
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score 13.211869

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