A new tool to assess Clinical Diversity In Meta-analyses (CDIM) of interventions

Marija Barbateskovic, Thijs M Koster, Ruben J Eck, Mathias Maagaard, Arash Afshari, Maria Cronhjort, Maria L Fabritius, Josh Feinberg, Craig French, Barzi Gareb, Anja Geisler, Anders Granholm, Bart Hiemstra, Ruixue Hu, Georgina Imberger, Bente T Jensen, Andreas B Jonsson, Oliver Karam, De Zhao Kong, Steven K KorangGeert Koster, Baoyong Lai, Ning Liang, Lars H Lundstrøm, Søren Marker, Tine S Meyhoff, Emil E Nielsen, Anders K Nørskov, Marie W Munch, Emilie C Risom, Sofie L Rygård, Sanam Safi, Naqash Sethi, Fredrik Sjövall, Susanne V Lauridsen, Nico van Bakelen, Meint Volbeda, Iwan C C van der Horst, Christian Gluud, Anders Perner, Morten H Møller, Eric Keus, Jørn Wetterslev, Willem Dieperink, Fredrike Blokzijl

Research output: Contribution to journalArticleAcademicpeer-review


OBJECTIVE: To develop and validate Clinical Diversity In Meta-analyses (CDIM), a new tool for assessing clinical diversity between trials in meta-analyses of interventions.

STUDY DESIGN AND SETTING: The development of CDIM was based on consensus work informed by empirical literature and expertise. We drafted the CDIM tool, refined it, and validated CDIM for interrater scale reliability and agreement in three groups.

RESULTS: CDIM measures clinical diversity on a scale that includes four domains with 11 items overall: setting (time of conduct/country development status/units type); population (age, sex, patient inclusion criteria/baseline disease severity, comorbidities); interventions (intervention intensity/strength/duration of intervention, timing, control intervention, cointerventions); and outcome (definition of outcome, timing of outcome assessment). The CDIM is completed in two steps: first two authors independently assess clinical diversity in the four domains. Second, after agreeing upon scores of individual items a consensus score is achieved. Interrater scale reliability and agreement ranged from moderate to almost perfect depending on the type of raters.

CONCLUSION: CDIM is the first tool developed for assessing clinical diversity in meta-analyses of interventions. We found CDIM to be a reliable tool for assessing clinical diversity among trials in meta-analysis.

Original languageEnglish
Pages (from-to)29-41
Number of pages13
JournalJournal of Clinical Epidemiology
Early online date6 Feb 2021
Publication statusPublished - 1 Jul 2021
Externally publishedYes


  • diversity
  • heterogeneity
  • tools
  • meta-analysis
  • evidence
  • quality
  • systematic review


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