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Statistical Methods Used to Test for Agreement of Medical Instruments Measuring Continuous Variables in Method Comparison Studies: A Systematic Review

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  • Rafdzah Zaki
  • Awang Bulgiba
  • Roshidi Ismail
  • Noor Azina Ismail

Abstract

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.

Suggested Citation

  • Rafdzah Zaki & Awang Bulgiba & Roshidi Ismail & Noor Azina Ismail, 2012. "Statistical Methods Used to Test for Agreement of Medical Instruments Measuring Continuous Variables in Method Comparison Studies: A Systematic Review," PLOS ONE, Public Library of Science, vol. 7(5), pages 1-7, May.
    • Handle: RePEc:plo:pone00:0037908
    DOI: 10.1371/journal.pone.0037908
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    Cited by:

    1. Hubert Krysztofiak & Marcel Młyńczak & Łukasz A Małek & Andrzej Folga & Wojciech Braksator, 2019. "Left ventricular mass normalization for body size in children based on an allometrically adjusted ratio is as accurate as normalization based on the centile curves method," PLOS ONE, Public Library of Science, vol. 14(11), pages 1-16, November.
    2. Carlos D. Gómez-Carmona & José Pino-Ortega & Braulio Sánchez-Ureña & Sergio J. Ibáñez & Daniel Rojas-Valverde, 2019. "Accelerometry-Based External Load Indicators in Sport: Too Many Options, Same Practical Outcome?," IJERPH, MDPI, vol. 16(24), pages 1-13, December.
    3. Ivan Simko & Ryan J Hayes, 2018. "Accuracy, reliability, and timing of visual evaluations of decay in fresh-cut lettuce," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-18, April.
    4. Chinyereugo M Umemneku Chikere & Kevin Wilson & Sara Graziadio & Luke Vale & A Joy Allen, 2019. "Diagnostic test evaluation methodology: A systematic review of methods employed to evaluate diagnostic tests in the absence of gold standard – An update," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-25, October.
    5. Kate A Timmins & Kimberley L Edwards, 2016. "Validation of Spatial Microsimulation Models: a Proposal to Adopt the Bland-Altman Method," International Journal of Microsimulation, International Microsimulation Association, vol. 9(2), pages 106-122.

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