Abstract

•Designers and systematic reviewers of trials are advised to consider characteristics that may minimize risk of bias in trial results. •To date, trial characteristics recommended for consideration have been selected on the basis of empirical evidence (eg, meta-epidemiological studies) and theoretical considerations. •Herbert raises legitimate concerns about risk of bias due to confounding in the meta-epidemiological evidence underpinning these recommendations. •However, additional limitations in the evidence base also deserve attention, including misclassification of trial characteristics, nonreporting biases affecting the pool of trials available for analysis, and the generalizability of the meta-analyses sampled.

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