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(Stroke. 2006;37:1367.)
© 2006 American Heart Association, Inc.

Letters to the Editor

Response to Letter by Chen et al

Maree L. Hackett, MA (Hons) Craig S. Anderson, PhD, FRACP, FAFPHM

Neurological and Mental Health Division, The George Institute For International Health, Royal Prince Alfred Hospital and The University of Sydney Australia

Allan O. House, DM, MRCP, MRCPsych

Institute of Health Sciences and Public Health Research, Academic Unit of Psychiatry and Behavioural Sciences, School of Medicine, University of Leeds, United Kingdom

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Response:

Chen and Guo reviewed our recently published systematic review of pharmacological strategies for the management of depression after stroke¹ and performed a meta-analysis of the continuous end points in this review. We had refrained from pooling these end points because of the considerable heterogeneity and methodological shortcomings in the studies reviewed, including small sample sizes and multiple methods used to assess depression both within and across studies. Moreover, Chen and Guo added data from a crossover study² and excluded data from a study where mean and standard deviation data were extracted from a published figure.³

We conducted our systematic review and meta-analysis to Cochrane standards,⁴ in line with our peer-reviewed Cochrane protocol. Cochrane guidelines do not allow post hoc decisions about whether to include or exclude a trial in a systematic review in order to avoid selection bias. We maintain that the data in our systematic review should not be pooled for the following reasons:

1. Data should not be pooled if the trials under consideration are clinically or statistically heterogeneous.

2. Randomization only deals with bias and confounding if a trial is large enough for the randomization to overcome the play of chance. Because small trials were included in our review, there is a real possibility that groups had unbalanced characteristics at baseline, with the exception of exposure to treatment, so that between-group differences in outcomes may be misleading without appropriate adjustments being made for baseline differences.

3. There are several issues to consider when including crossover trial . . . [Full Text of this Article]

Related Article:

Meta-Analysis of Antidepressant Treatment for Patients With Poststroke Depression

Yan Chen and Jeff J. Guo
Stroke 2006 37: 1365-1366. [Extract] [Full Text] [PDF]