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. 2022 Apr;66(1):7-20.

Risk of bias in chiropractic mixed methods research: a secondary analysis of a meta-epidemiological review

Peter C Emary  1   2   3 , Kent J Stuber  4 , Lawrence Mbuagbaw  1   5   6   7 , Mark Oremus  1   8 , Paul S Nolet  4   9 , Jennifer V Nash  10 , Craig A Bauman  11   12 , Carla Ciraco  2 , Rachel J Couban  13 , Jason W Busse  1   10   13   14
Affiliations

Risk of bias in chiropractic mixed methods research: a secondary analysis of a meta-epidemiological review

Peter C Emary et al. J Can Chiropr Assoc. 2022 Apr.

Abstract
in English, French

Objective: To examine the risk of bias in chiropractic mixed methods research.

Methods: We performed a secondary analysis of a meta-epidemiological review of chiropractic mixed methods studies. We assessed risk of bias with the Mixed Methods Appraisal Tool (MMAT) and used generalized estimating equations to explore factors associated with risk of bias.

Results: Among 55 eligible studies, a mean of 62% (6.8 [2.3]/11) of MMAT items were fulfilled. In our adjusted analysis, studies published since 2010 versus pre-2010 (adjusted odds ratio [aOR] = 2.26; 95% confidence interval [CI], 1.39 to 3.68) and those published in journals with an impact factor versus no impact factor (aOR = 2.21; 95% CI, 1.33 to 3.68) were associated with lower risk of bias.

Conclusion: Our findings suggest opportunities for improvement in the quality of conduct among published chiropractic mixed methods studies. Author compliance with the MMAT criteria may reduce methodological bias in future mixed methods research.

Objectif: examiner le risque de biais dans la recherche sur les méthodes mixtes chiropratiques.

Méthodologie: nous avons effectué une analyse secondaire d’un examen méta-épidémiologique d’études de méthodes mixtes chiropratiques. Nous avons examiné le risque de biais avec The Mixed Methods Appraisal Tool, MMAT (l’outil d’évaluation des méthodes mixtes), et utilisé des équations d’estimation généralisées pour explorer les facteurs associés au risque de biais.

Résultats: parmi 55 études admissibles, une moyenne de 62 % (6,8 [2,3]/11) des items du MMAT ont été remplis. Dans notre analyse ajustée, les études publiées depuis 2010 versus celles d’avant 2010 (rapport de cotes [aOR] ajusté = 2,26; intervalle de confiance [IC] à 95 %, 1,39 à 3,68), et celles publiées dans des revues avec un indice de citations versus aucun indice de citations (aOR = 2,21; IC à 95 %, 1,33 à 3,68) étaient associées à un risque de biais plus faible.

Conclusion: nos résultats suggèrent des opportunités d’amélioration de la qualité de la conduite parmi les études publiées sur les méthodes mixtes chiropratiques. La conformité des auteurs aux critères MMAT peut réduire les biais méthodologiques dans les futures recherches sur les méthodes mixtes.

Keywords: chiropractic; methodological review; mixed methods research; risk of bias.

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Conflict of interest statement

The authors have no disclaimers, competing interests, or sources of support or funding to report in the preparation of this manuscript. Dr. Emary is supported by research grants from McMaster University, the NCMIC Foundation, and the Canadian Chiropractic Research Foundation outside of the submitted work. Dr. Busse is funded, in part, by a Canada Research Chair in the prevention and management of chronic pain from the Canadian Institutes of Health Research Fellowship Award.

Figures

Figure 1
Figure 1
Frequency of “mixed methods” articles published over the last 20 years in PubMed.
Figure 2
Figure 2
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.
Figure 3
Figure 3
Summary of risk of bias assessments of the 55 eligible studies according to the Mixed Methods Appraisal Tool (MMAT), version 2011. Overall judgements are based on methods by Pluye et al. (Risk-of-bias plot was created using: McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Syn Meth. 2020; 1–7.)
See this image and copyright information in PMC

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