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Evidence · Trials

How to read a forest plot, properly, from scratch

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Solved by t.karlsen in post #8
Absolute numbers, not just relative: a 30% relative reduction tells you the ratio but not the practical magnitude. The event rate in each arm and the difference between them tells you how many people benefit. On balance I think that is right, and I would not bet much on it.

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SC
s.cardosoTL224 Jun 2025#1

The question in the title: How to read a forest plot, properly, from scratch I will give what I have already checked below so nobody repeats it.

Reading STEP 4 (JAMA, 2021) for the population rather than the effect, which I have not done properly before.

The baseline table is more restrictive than the way the trial gets discussed here. Several of the questions in this category come from people who would not have been enrolled.

What is the honest way to describe what the trial says to somebody outside its population?

0 likes 13mo
PD
p.dialloTL21 Jul 2025#2

Risk of bias: structured appraisal of internal validity. Key things to assess: randomisation method (was it truly random or could someone predict the next assignment), concealment (could randomisation be subverted), blinding (who was blinded and why or why not), completeness of outcome reporting.

23 likes 13mo
BJ
b.jankowiakTL3Regular5 Jul 2025#3
p.diallo, post #2: Risk of bias: structured appraisal of internal validity. Key things to assess: randomisation method (was it truly random or could someone predict the next assignment), concealment (could randomisation be subverted), blinding (who was blinded and why or why not), completeness of outcome reporting. Go to post

The opening post put the caveat in the right place and I want to underline it.

Absolute numbers, not just relative: a 30% relative reduction tells you the ratio but not the practical magnitude. The event rate in each arm and the difference between them tells you how many people benefit.

10 likes in reply to #2 13mo
RM
r.mensahTL29 Jul 2025#4

Building on post #3 rather than restating it.

Absolute and relative effects answer different questions. Write down the event rate in each arm and the difference between them; everything quotable is derived from those two numbers.

Noting that the question and the thing people usually mean by it are different.

3 likes 13mo
YM
y.mensahTL3Wiki editor13 Jul 2025#5

A treatment-policy estimand asks what happens to people assigned to a strategy, including those who abandon it. A hypothetical estimand asks what would have happened had everyone continued. Both are legitimate and they give different numbers.

0 likes 13mo
CC
c.castellanosTL217 Jul 2025 · edited#6
s.cardoso, post #1: The question in the title: How to read a forest plot, properly, from scratch I will give what I have already checked below so nobody repeats it. Reading STEP 4 ( JAMA , 2021) for the population rather than the effect, which I have not done properly before. The baseline table is more restrictive than the way the trial gets discussed… Go to post

Post #3 answers the question as asked. The question underneath it is different.

Risk of bias: structured appraisal of internal validity. Key things to assess: randomisation method (was it truly random or could someone predict the next assignment), concealment (could randomisation be subverted), blinding (who was blinded and why or why not), completeness of outcome reporting.

1 like in reply to #1 12mo
NE
n.ekstromTL2Regular20 Jul 2025#7

Noted, and I have changed what I was going to do on the strength of it.

0 likes 12mo
TK
t.karlsenTL2 Solution23 Jul 2025#8

Absolute numbers, not just relative: a 30% relative reduction tells you the ratio but not the practical magnitude. The event rate in each arm and the difference between them tells you how many people benefit.

On balance I think that is right, and I would not bet much on it.

22 likes 12mo
CC
c.correiaTL226 Jul 2025#9
p.diallo, post #2: Risk of bias: structured appraisal of internal validity. Key things to assess: randomisation method (was it truly random or could someone predict the next assignment), concealment (could randomisation be subverted), blinding (who was blinded and why or why not), completeness of outcome reporting. Go to post

Post #8 describes the usual case. This is about the unusual one.

A treatment-policy estimand asks what happens to people assigned to a strategy, including those who abandon it. A hypothetical estimand asks what would have happened had everyone continued. Both are legitimate and they give different numbers.

10 likes in reply to #2 12mo
AA
a.almeidaTL230 Jul 2025#10
c.correia, post #9: Post #8 describes the usual case. This is about the unusual one. A treatment-policy estimand asks what happens to people assigned to a strategy, including those who abandon it. A hypothetical estimand asks what would have happened had everyone continued. Both are legitimate and they give different numbers. Go to post

Discontinuation handling is the methodological detail that most changes a result and gets the least attention. Read how missing data was imputed before reading the effect size.

None of the above is medical advice and I am not qualified to give any.

3 likes in reply to #9 12mo
DO
dr_okonkwoTL4 Moderator2 Aug 2025#11
b.jankowiak, post #3: The opening post put the caveat in the right place and I want to underline it. Absolute numbers, not just relative: a 30% relative reduction tells you the ratio but not the practical magnitude. The event rate in each arm and the difference between them tells you how many people benefit. Go to post

Absolute and relative effects answer different questions. Write down the event rate in each arm and the difference between them; everything quotable is derived from those two numbers.

4 likes in reply to #3 12mo
MP
m.perrinTL25 Aug 2025#12

No notes. Posting so the count is not one.

13 likes 12mo
DF
d.fontaineTL27 Aug 2025#13

Risk of bias: structured appraisal of internal validity. Key things to assess: randomisation method (was it truly random or could someone predict the next assignment), concealment (could randomisation be subverted), blinding (who was blinded and why or why not), completeness of outcome reporting.

27 likes 12mo
IB
i.bakkenTL210 Aug 2025#14

Coming back to post #10, because the follow-up matters more than the original answer.

Composite endpoints should be read component by component. A composite driven entirely by its softest component is a different finding from one where the components move together.

This has been discussed before and I could not find the thread, so, again.

0 likes 12mo
VS
v.szaboTL3Analytical chemist13 Aug 2025 · edited#15
p.diallo, post #2: Risk of bias: structured appraisal of internal validity. Key things to assess: randomisation method (was it truly random or could someone predict the next assignment), concealment (could randomisation be subverted), blinding (who was blinded and why or why not), completeness of outcome reporting. Go to post

Adding the measurement that post #13 says would settle it.

Absolute and relative effects answer different questions. Write down the event rate in each arm and the difference between them; everything quotable is derived from those two numbers.

Scoping that to what I have actually seen rather than what I have read.

8 likes in reply to #2 11mo
VK
v.kirchnerTL216 Aug 2025#16

Absolute numbers, not just relative: a 30% relative reduction tells you the ratio but not the practical magnitude. The event rate in each arm and the difference between them tells you how many people benefit.

Second-hand, so weight it accordingly.

19 likes 11mo
SK
s.karlsen_rphTL319 Aug 2025#17
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o.vukovicTL221 Aug 2025#18
v.kirchner, post #16: Absolute numbers, not just relative: a 30% relative reduction tells you the ratio but not the practical magnitude. The event rate in each arm and the difference between them tells you how many people benefit. Second-hand, so weight it accordingly. Go to post

A treatment-policy estimand asks what happens to people assigned to a strategy, including those who abandon it. A hypothetical estimand asks what would have happened had everyone continued. Both are legitimate and they give different numbers.

0 likes in reply to #16 11mo
CL
customs_ledgerTL3Regular24 Aug 2025#19

The arithmetic in post #16 is right; the assumption feeding it is the part to check.

Absolute and relative effects answer different questions. Write down the event rate in each arm and the difference between them; everything quotable is derived from those two numbers.

Adding a source would improve this post and I do not have one to hand.

13 likes 11mo
PO
p.ostergaardTL227 Aug 2025#20
y.mensah, post #5: A treatment-policy estimand asks what happens to people assigned to a strategy, including those who abandon it. A hypothetical estimand asks what would have happened had everyone continued. Both are legitimate and they give different numbers. Go to post

Answering the question post #18 raises rather than the one it answers.

Absolute numbers, not just relative: a 30% relative reduction tells you the ratio but not the practical magnitude. The event rate in each arm and the difference between them tells you how many people benefit.

Not the answer, but possibly the question that gets there.

26 likes in reply to #5 11mo
CH
c.haddadTL229 Aug 2025 · edited#21
r.mensah, post #4: Building on post #3 rather than restating it. Absolute and relative effects answer different questions. Write down the event rate in each arm and the difference between them; everything quotable is derived from those two numbers. Noting that the question and the thing people usually mean by it are different. Go to post

Risk of bias: structured appraisal of internal validity. Key things to assess: randomisation method (was it truly random or could someone predict the next assignment), concealment (could randomisation be subverted), blinding (who was blinded and why or why not), completeness of outcome reporting.

For what it is worth, the same held on the two occasions I checked.

1 like in reply to #4 11mo
PN
plateau_notesTL2Regular1 Sep 2025#22
p.ostergaard, post #20: Answering the question post #18 raises rather than the one it answers. Absolute numbers, not just relative: a 30% relative reduction tells you the ratio but not the practical magnitude. The event rate in each arm and the difference between them tells you how many people benefit. Not the answer, but possibly the question that gets there. Go to post

Sensible. I would want the same detail before I acted on it either.

0 likes in reply to #20 11mo
NV
n.vukovicTL23 Sep 2025#23

Everything in post #19 holds. The case it does not cover is the one I have.

A treatment-policy estimand asks what happens to people assigned to a strategy, including those who abandon it. A hypothetical estimand asks what would have happened had everyone continued. Both are legitimate and they give different numbers.

15 likes 11mo
AD
appeals_deskTL3Regular6 Sep 2025#24

The arithmetic in post #23 is right; the assumption feeding it is the part to check.

Absolute and relative effects answer different questions. Write down the event rate in each arm and the difference between them; everything quotable is derived from those two numbers.

5 likes 11mo
YR
y.rahimiTL28 Sep 2025 · edited#25
p.diallo, post #2: Risk of bias: structured appraisal of internal validity. Key things to assess: randomisation method (was it truly random or could someone predict the next assignment), concealment (could randomisation be subverted), blinding (who was blinded and why or why not), completeness of outcome reporting. Go to post

Post #23 and I disagree about the size of the effect, not about the direction.

Absolute numbers, not just relative: a 30% relative reduction tells you the ratio but not the practical magnitude. The event rate in each arm and the difference between them tells you how many people benefit.

0 likes in reply to #2 11mo
P
preregisteredTL3Research methods11 Sep 2025#26

Absolute and relative effects answer different questions. Write down the event rate in each arm and the difference between them; everything quotable is derived from those two numbers.

A guess, clearly labelled as one.

30 likes 11mo
RP
r.petrovTL213 Sep 2025#27

A treatment-policy estimand asks what happens to people assigned to a strategy, including those who abandon it. A hypothetical estimand asks what would have happened had everyone continued. Both are legitimate and they give different numbers.

I would hold that lightly until someone with a larger sample weighs in.

10 likes 10mo
PE
ppm_errorTL3Analytical chemist15 Sep 2025#28

Narrowing post #27, because the general version has more than one answer.

Risk of bias: structured appraisal of internal validity. Key things to assess: randomisation method (was it truly random or could someone predict the next assignment), concealment (could randomisation be subverted), blinding (who was blinded and why or why not), completeness of outcome reporting.

3 likes 10mo
BV
b.vanheckeTL218 Sep 2025#29
dr_okonkwo, post #11: Absolute and relative effects answer different questions. Write down the event rate in each arm and the difference between them; everything quotable is derived from those two numbers. Go to post

Clear enough that I do not think I have a follow-up, which is unusual.

5 likes in reply to #11 10mo
C
chromatogramTL4Analytical chemist20 Sep 2025#30

Post #27 is the version of this I will quote in future. One addition.

Discontinuation handling is the methodological detail that most changes a result and gets the least attention. Read how missing data was imputed before reading the effect size.

0 likes 10mo