Introduction
Methods
Inclusion Criteria and Search Strategy
Defining Diabetes Remission and Data Extraction
Statistical Analysis
Results
Study Characteristics
Study | Countrya
| Bariatric procedure(s) | Conventional weight-loss therapy | Study design + weight class, T2DM variables, IRB, IC, Reg. | Analysis time points (months) |
---|---|---|---|---|---|
Sjöström et al. [40] | Sweden | LAGB (19.0 %; adjustable and nonadjustable) VBG (68.0 %) RYGB (13.0 %) | Nonstandardized nonsurgical treatment ranging from lifestyle intervention and behavior modification to no treatment | nRCT (“SOS study”) w/contemporaneous subject matching | 24; 120 |
Morbidly obese patients | |||||
T2DM variables = FPG, med. use | |||||
IRB, IC | |||||
Reg. Swedish Obese Subjects (SOS) registry | |||||
O’Brien et al. [41] | Australia | LAGB in addition to lifestyle modification instruction (i.e., increased exercise + good eating practices) | Intensive weight-loss program including initial VLCD (500 to 550 kcal/day, followed by transition phase), pharmacotherapy, and lifestyle change tailored to patients individually | RCT, nonblinded | 24 |
Mildly obese patients | |||||
T2DM variables = FPG, insulin | |||||
IRB, IC | |||||
Reg. ACTRN012605000113651 | |||||
Dixon et al. [42] | Australia | LAGB in addition to conventional T2DM therapy | Conventional dietary and T2DM therapy administered by diabetologist with focus on lifestyle change | RCT, nonblinded | 24 |
Mild to morbidly obese patients | |||||
T2DM variables = FPG, HbA1C, HOMA, med. use | |||||
IRB, IC | |||||
Reg. ACTRN012605000159651 | |||||
Hofsø et al. [43] | Norway | RYGB after following low-calorie diet for 3–6 weeks | Intensive lifestyle intervention through four 1–4 week stays at rehabilitation center specializing in care of morbidly obese patients; cognitive approach to motivate increased activity and normalized eating habits | nRCT (“MOBIL trial”) | 12 |
Morbidly obese patients | |||||
T2DM variables = FPG, HbA1C, insulin, med. use | |||||
IRB, IC | |||||
Reg. NCT00273104 | |||||
Adams et al. [44] | USA | RYGB | No structured, monitored weight-loss intervention in either of 2 nonsurgical control groups (1 = nonintervened surgery-seekers; 2 = population-based subjects not seeking surgery) | nRCT | 24 |
Morbidly obese patients | |||||
T2DM variables = FPG, HbA1C, HOMA-IR, insulin, med. use | |||||
IRB, IC | |||||
Reg. NIDDK DK-55006 & NCRR M01-RR00064 | |||||
Serrot et al. [45] | USA | RYGB | Routine medical management with nutrition, weight management, and exercise counseling | Retrospective study of surgery recipients and database of matched nonsurgical controls | 12 |
Mildly obese patients | |||||
T2DM variables = HbA1C, med. use | |||||
IRB, no Reg. | |||||
Martins et al. [46] | Norway | RYGB | Option of residential intermittent program; commercial weight-loss camp; or hospital outpatient program | Prospective comparison of patients on surgery wait list given option of surgery or 1 of 3 conservative weight-loss programs | 12 |
Morbidly obese patients | |||||
T2DM variables = FPG | |||||
IRB, IC, no reg. | |||||
Iaconelli et al. [47] | Italy | BPD | Individualized medical therapy with conventional weight, exercise, and dietary support; diabetologist available for consult every 3 months | Prospective, matched, open case-controlled trial | 12–120 |
Morbidly obese patients | |||||
T2DM variables = FPG, HbA1C, T2DM remission, HOMA, insulin | |||||
IRB, IC, no Reg. study | |||||
Obese and morbidly obese patients | |||||
T2DM variables = FPG, HbA1C, T2DM remission, med. use | |||||
IRB, no Reg. | |||||
Scopinaro et al. [48] | Italy | BPD | Routine medical therapy | Prospective study of surgical patients matched with nonsurgical database controls | 12 |
Overweight and mildly obese patients | |||||
T2DM variables = FPG, HbA1C, HOMA-IR | |||||
IRB, IC, no reg. | |||||
Leonetti et al. [49] | Italy | LSG | Standard medical therapy with individual lifestyle modification programs, access to diabetologists, dietician, nurse. | Prospective study of surgical patients matched with nonsurgical controls | 3; 6; 12; 18 |
Obese and morbidly obese patients | |||||
T2DM variables = FPG, HbA1C, med. use | |||||
IRB, IC, no Reg. | |||||
Mingrone et al. [50] | Italy | RYGB (50.0 %) BPD (50.0 %) | Diet, exercise, lifestyle modification program, including medication optimization and treatment by diabetologist, dietician, nurse—1, 3, 6, 9, 12, and 24 months. | • RCT, nonblinded | 24 |
• Morbidly obese patients | |||||
• T2DM variables = FPG, HbA1C, med. use, T2DM remission | |||||
IRB, IC | |||||
Reg. NCT00888836 | |||||
Heo et al. [51] | Korea | RYGB (28.0 %) | Conventional medical therapy, including lifestyle modification, medication optimization, counseling by dietician and exercise practitioner | Retrospective multicenter database | 18 |
LAGB (27.6 %) LSG (44.4 %) | |||||
Dorman et al. [52] | USA | RYGB (60,1 %) LAGB (20.9 %) DS (18.8 %) | Conventional management by endocrinologist for medication use; lifestyle modification to promote weight loss was encouraged | Retrospective case-matched database study | 12 |
Morbidly obese patients | |||||
T2DM variables = HbA1C, med. use | |||||
IRB, no Reg. | |||||
Leslie et al. [53] | USA | RYGB | Conventional medical management | Prospective study of surgical patients matched with nonsurgical database controls | 24 |
Morbidly obese patients | |||||
T2DM variables = HbA1C, med. use | |||||
IRB, no reg. | |||||
Schauer et al. [54] | USA | RYGB (50.0 %) LSG (50.0 %) | Intensive medical therapy with lifestyle counseling by diabetes educator, weight management, encouraged to join Weight Watchers; clinic visits every 3 months | RCT, nonblinded | 12 |
Obese patients | |||||
T2DM variables = FPG, HbA1C, HOMA | |||||
IRB, IC | |||||
Reg. NCT00432809 | |||||
Ikramuddin et al. [55] | USA | RYGB + intensive medical management | Medical management including lifestyle modification (diet, exercise) for maximal weight loss and medication optimization | RCT, nonblinded, multicenter trial | 12 |
Mildly obese and obese patients | |||||
T2DM variables = FPG, HbA1C
| |||||
IRB, IC | |||||
Reg. NCT00641251 |
Preliminary Analysis of RCTs vs OSs
Patient Characteristics and Baseline Clinical Profile
Study |
N at baseline | Body mass index, kg/m2
| HbA1C, % | Fasting plasma glucose, mg/dL | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Mean (SEa) | Mean (SEa) | Mean (SEa) | |||||||||
Bari. | Conv. | Bari. | Conv. |
p valuea
| Bari. | Conv. |
p valuea
| Bari. | Conv. |
p valuea
| |
Sjöström et al. [40] | 1,845 | 1,660 | 42.3 (0.10) | 40.0 (0.11) | <0.001 | – | – | – | 97.3 (0.88) | 93.7 (0.84) | <0.01 |
O’Brien et al. [41] | 40 | 40 | 33.7 (0.29) | 33.5 (0.22) | NS (0.58) | – | – | – | 95.4 (5.41) | 90.1 (1.71) | NS (0.35) |
Dixon et al. [42] | 30 | 30 | 37.0 (0.49) | 37.2 (0.46) | NS (0.77) | 7.8 (0.22) | 7.6 (0.26) | NS (0.55) | 156.7 (7.03) | 158.6 (8.89) | NS (0.87) |
Hofsø et al. [43] | 76 | 63 | 46.7 (0.65) | 43.3 (0.63) | <0.001 | 7.1 (0.15) | 5.8 (0.15) | <0.001 | 122.5 (4.76) | 115.3 (3.86) | NS (0.25) |
Adams et al. [44] | 294 | 522 | 47.9 (0.47) | 45.0 (0.39) | <0.001 | 5.7 (0.05) | 5.6 (0.06) | NS (0.54) | 96.9 (1.15) | 96.3 (1.30) | NS (0.76) |
Serrot et al. [45]c
| 17 | 17 | 34.6 (1.38) | 34.0 (1.29) | NS (0.75) | 8.2 (0.32) | 7.0 (0.28) | <0.005 | – | – | – |
Martins et al. [46] | 50 | 129 | 45.2 (0.76) | 45.6 (0.51) | NS (0.67) | – | – | – | – | – | – |
Iaconelli et al. [47] | 22 | 28 | 50.5 (1.81) | 51.5 (1.17) | NS (0.63) | 8.0 (0.28) | 8.0 (0.22) | NS (0.99) | 156.7 (10.7) | 156.7 (7.00) | NS (0.99) |
Scopinaro et al. [48] | 30 | 38 | 30.6 (0.53) | 30.2 (0.57) | NS (0.62) | 9.3 (0.27) | 8.3 (0.13) | <0.001 | 220.0 (12.6) | 171.0 (6.16) | <0.001 |
Leonetti et al. [49] | 30 | 30 | 41.3 (1.10) | 39.0 (1.00) | NS (0.13) | 7.9 (0.38) | 8.1 (0.31) | NS (0.69) | 166.0 (12.4) | 183.0 (11.6) | NS (0.32) |
Mingrone et al. [50] | 40 | 20 | 45.0 (1.03) | 45.6 (1.39) | NS (0.73) | 8.7 (0.25) | 8.5 (0.27) | NS (0.62) | 173.4 (9.68) | 179.0 (13.8) | NS (0.74) |
Heo et al. [51] | 261 | 224 | 39.0 (0.38) | 34.3 (0.25) | <0.001 | – | – | – | – | – | – |
Dorman et al. [52] | 29 | 29 | 42.4 (0.56) | 40.2 (0.80) | <0.05 | 7.2 (0.20) | 7.2 (0.22) | NS (0.99) | – | – | – |
Leslie et al. [53] | 152 | 115 | 47.4 (0.54) | 40.7 (0.47) | <0.001 | 7.6 (0.10) | 7.2 (0.10) | <0.01 | – | – | – |
Schauer et al. [54] | 100 | 50 | 36.6 (0.36) | 36.3 (0.42) | NS (0.61) | 9.4 (0.16) | 8.9 (0.20) | NS (0.06) | 178.5 (5.27)c
| 155.0 (6.29)c
| <0.01 |
Ikramuddin et al. [55] | 60 | 60 | 34.9 (0.39) | 34.3 (0.40) | NS (0.28) | 9.6 (0.13) | 9.6 (0.16) | NS (0.99) | 222.0 (9.94) | 207.0 (7.36) | NS (0.23) |
Total | 3,076 | 3,055 | – | – | – | – | – | – | – | – | – |
IV Weighted mean | – | – | 40.9 (1.23) | 39.4 (1.10) | 8.0 (0.50) | 7.7 (0.45) | 150.3 (7.5) | 143.1 (6.77) | |||
(95 % CI) | (38.5, 43.3) | (37.3, 41.6) | (7.1, 9.0) | (6.8, 8.5) | (135.7, 164.9) | (129.8, 156.3) | |||||
Pooled SMDb
| 0.33 (0.09) | – | 0.39 (0.14) | 0.15 (0.07) | |||||||
(95 % CI) | – | – | – | (0.16, 0.51) | (0.12, 0.67) | – | (0.02, 0.28) | ||||
p value | <0.001 | <0.01 | <0.05 |
Assessment of Within-Group Change in Clinical Markers After Treatment
Study | Bariatric procedure | Conventional treatment | ||||||
---|---|---|---|---|---|---|---|---|
Pre | Post | Change (95 % CI) |
p valuea
| Pre | Post | Change (95 % CI) |
p valuea
| |
Body mass index, kg/m2 mean (SEa) | ||||||||
Sjöström et al. [40] | 42.3 (0.10) | 32.4 (0.12) | 9.9 (9.6, 10.2) | <0.001 | 40.0 (0.11) | 40.04 (0.13) | −0.04 (−0.38,0.30) | NS (0.82) |
O’Brien et al. [41] | 33.7 (0.29) | 26.4 (0.58) | 7.3 (6.0, 8.6) | <0.001 | 33.5 (0.22) | 31.5 (0.91) | 2.0 (0.36, 3.64) | <0.05 |
Dixon et al. [42] | 37.0 (0.49) | 29.5 (0.67) | 7.5 (5.9, 9.1) | <0.001 | 37.2 (0.46) | 36.6 (0.92) | 0.6 (−1.4, 2.6) | NS (0.56) |
Hofsø et al. [43] | 46.7 (0.65) | 32.7 (0.57) | 14.0 (12.3, 15.7) | <0.001 | 43.3 (0.63) | 39.6 (0.68) | 3.7 (1.9, 5.5) | <0.001 |
Adams et al. [44] | 47.9 (0.47) | 32.2 (0.47) | 15.5 (14.2,16.8) | <0.001 | 45.0 (0.39) | 44.6 (0.39) | 0.4 (−0.69, 1.5) | NS (0.47) |
Serrot et al. [45] | 34.6 (1.38) | 25.8 (1.21) | 8.8 (5.2, 12.4) | <0.001 | 34.0 (1.29) | 34.3 (1.32) | −0.3 (−3.9, 3.3) | NS (0.87) |
Martins et al. [46] | 45.2 (0.76) | 31.1 (0.71) | 14.1 (12.1, 16.1) | <0.001 | 45.6 (0.51) | 40.7 (0.48) | 4.9 (3.5, 6.3) | <0.001 |
Iaconelli et al. [47] | 50.5 (1.81) | 34.6 (1.07) | 15.9 (11.8, 20.0) | <0.001 | 51.5 (1.17) | 43.6 (1.02) | 7.9 (4.9, 10.9) | <0.001 |
Scopinaro et al. [48] | 30.6 (0.53) | 25.3 (0.42) | 5.3 (4.0, 6.6) | <0.001 | 30.2 (0.57) | 30.2 (0.58) | 0.0 (−1.6, 1.6) | NS (0.99) |
Leonetti et al. [49] | 41.3 (1.10) | 28.3 (0.99) | 13.0 (10.1, 15.9) | <0.001 | 39.0 (1.00) | 39.8 (0.91) | −0.8 (−3.5, 1.9) | NS (0.56) |
Mingrone et al. [50] | 45.0 (1.03) | 29.3 (0.62) | 15.8 (13.4, 18.1) | <0.001 | 45.6 (1.39) | 43.1 (1.51) | 2.5 (−1.5, 6.5) | NS (0.22) |
Heo et al. [51] | 39.0 (0.38) | 30.2 (0.75) | 8.8 (6.9, 10.7) | <0.001 | 34.3 (0.25) | 32.0 (0.89) | 2.3 (0.89, 3.7) | <0.05 |
Dorman et al. [52] | 42.4 (0.56) | 27.6 (0.52) | 14.8 (13.3, 16.3) | <0.001 | 40.2 (0.80) | 40.6 (0.84) | −0.4 (−2.7, 1.9) | NS (0.73) |
Leslie et al. [53] | 47.4 (0.54) | 32.4 (0.53) | 15.0 (13.5, 16.5) | <0.001 | 40.7 (0.47) | 40.8 (0.47) | −0.1 (−1.4, 1.2) | NS (0.88) |
Schauer et al. [54] | 36.6 (0.36) | 27.0 (0.37) | 9.6 (8.6, 10.6) | <0.001 | 36.3 (0.42) | 34.4 (0.79) | 1.9 (0.23, 3.57) | <0.05 |
Ikramuddin et al. [55] | 34.9 (0.39) | 25.8 (0.46) | 9.1 (7.9, 10.3) | <0.001 | 34.3 (0.40) | 31.6 (0.49) | 2.7 (1.5, 3.9) | <0.001 |
Weighted mean | 40.9 (1.23) | 29.4 (0.81) | 11.4 (0.73) WMD | 39.4 (1.10) | 37.8 (1.08) | 1.6 (0.49) WMD | ||
(95 % CI) | (38.5, 43.3) | (27.8, 30.9) | (10.0, 12.9) | <0.001a
| (37.3, 41.6) | (35.6, 39.9) | (0.7, 2.6) | <0.001a
|
HbA1C, % mean (SEa) | ||||||||
Dixon et al. [42] | 7.8 (0.22) | 6.0 (0.15) | 1.8 (1.3, 2.3) | <0.001 | 7.6 (0.26) | 7.2 (0.25) | 0.4 (−0.3, 1.1) | NS (0.28) |
Hofsø et al. [43] | 7.1 (0.15) | 6.6 (0.12) | 0.5 (0.1, 0.9) | <0.05 | 5.8 (0.15) | 6.3 (0.14) | −0.5 (−0.9, −0.1) | <0.05 |
Adams et al. [44] | 5.7 (0.05) | 5.6 (0.05) | 0.1 (−0.04, 0.24) | NS (0.16) | 5.6 (0.06) | 5.8 (0.06) | −0.2 (−0.4, −0.1) | <0.05 |
Serrot et al. [45] | 8.2 (0.32) | 6.1 (0.25) | 2.1 (1.3, 2.9) | <0.001 | 7.0 (0.28) | 7.1 (0.27) | −0.1 (−0.9, 0.7) | NS (0.80) |
Iaconelli et al. [47] | 8.0 (0.28) | 5.2 (0.22) | 2.8 (2.1, 3.5) | <0.001 | 8.0 (0.22) | 7.2 (0.21) | 0.8 (0.2, 1.4) | <0.05 |
Scopinaro et al. [48] | 9.3 (0.27) | 6.5 (0.15) | 2.8 (2.2, 3.4) | <0.001 | 8.3 (0.13) | 7.7 (0.11) | 0.6 (0.3, 0.9) | <0.005 |
Leonetti et al. [49] | 7.9 (0.38) | 6.0 (0.27) | 1.9 (1.0, 2.8) | <0.001 | 8.1 (0.31) | 7.1 (0.24) | 1.0 (0.2, 1.8) | <0.05 |
Mingrone et al. [50] | 8.7 (0.25) | 5.7 (0.16) | 3.0 (2.4, 3.6) | <0.001 | 8.5 (0.27) | 7.7 (0.14) | 0.8 (0.2, 1.4) | <0.05 |
Dorman et al. [52] | 7.2 (0.20) | 5.9 (0.19) | 1.3 (0.8, 1.8) | <0.001 | 7.2 (0.22) | 7.3 (0.26) | −0.1 (−0.8, 0.6) | NS (0.77) |
Leslie et al. [53] | 7.6 (0.10) | 6.4 (0.10) | 1.2 (0.9, 1.5) | <0.001 | 7.2 (0.10) | 7.2 (0.10) | 0.0 (−0.3, 0.3) | NS (0.99) |
Schauer et al. [54] | 9.4 (0.16) | 6.5 (0.10) | 2.9 (2.5, 3.3) | <0.001 | 8.9 (0.20) | 7.5 (0.28) | 1.4 (0.7, 2.1) | <0.001 |
Ikramuddin et al. [55] | 9.6 (0.13) | 6.3 (0.12) | 3.3 (3.0, 3.7) | <0.001 | 9.6 (0.16) | 7.8 (0.20) | 1.8 (1.3, 2.3) | <0.05 |
Weighted mean | 8.0 (0.50) | 6.1 (0.15) | 2.0 (.40) WMD | 7.7 (0.45) | 7.2 (0.27) | 0.47 (0.19) WMD | ||
(95 % CI | (7.1, 9.0) | (5.8, 6.4) | (1.2, 2.8) | <0.001a
| (6.8, 8.5) | (6.6, 7.7) | (0.1, 0.9) | <0.05a
|
Fasting plasma glucose, mg/dL mean (SEa) | ||||||||
Sjöström et al. [40] | 97.3 (0.88) | 84.1 (0.7) | 13.2 (11.0, 15.4) | <0.001 | 93.7 (0.84) | 98.5 (0.8) | −4.8 (−7.1, −2.5) | <0.001 |
O’Brien et al. [41] | 95.4 (5.4) | 88.4 (5.3) | 7.0 (−7.8, 21.8) | NS (0.35) | 90.1 (1.7) | 89.8 (7.6) | 0.3 (−13.3, 13.9) | NS (0.99) |
Dixon et al. [42] | 156.7 (7.0) | 105.6 (5.5) | 51.1 (33.6, 68.6) | <0.001 | 158.6 (8.9) | 139.6 (7.0) | 19.0 (−3.1, 41.1) | NS (0.09) |
Hofsø et al. [43] | 122.5 (4.8) | 88.3 (3.3) | 34.2 (22.8, 45.6) | <0.001 | 115.3 (3.9) | 100.9 (4.3) | 14.4 (3.1, 25.7) | <0.05 |
Adams et al. [44] | 96.9 (1.2) | 82.0 (1.2) | 14.9 (11.7, 18.0) | <0.001 | 96.3 (1.3) | 97.3 (1.3) | −1.0 (−4.6, 2.6) | NS (0.58) |
Iaconelli et al. [47] | 156.7 (10.7) | 75.7 (6.2) | 81.0 (56.8, 105.2) | <0.001 | 156.7 (7.0) | 126.1 (6.4) | 30.6 (11.9, 49.2) | <0.01 |
Scopinaro et al. [48] | 220.0 (12.6) | 149.0 (7.5) | 71.0 (42.3, 99.7) | <0.001 | 171.0 (6.2) | 151.0 (4.5) | 20.0 (5.0, 35.0) | <0.01 |
Leonetti et al. [49] | 166.0 (12.4) | 97.0 (5.3) | 69.0 (42.5, 95.5) | <0.001 | 183.0 (11.6) | 150.0 (8.8) | 33.0 (4.5, 61.5) | <0.05 |
Mingrone et al. [50] | 173.4 (9.7) | 86.3 (5.5) | 87.1 (65.0,109.2) | <0.001 | 179.0 (13.8) | 141.1 (7.1) | 37.9 (6.5, 69.3) | <0.05 |
Schauer et al. [54]b
| 178.5 (5.3) | 98.0 (3.3) | 80.5 (68.3, 92.7) | <0.001 | 155.0 (6.3) | 120.0 (6.6) | 35.0 (17.0, 53.0) | <0.001 |
Ikramuddin et al. [55] | 222.0 (9.9) | 111.0 (4.5) | 111.0 (89.2,132.8) | <0.001 | 207.0 (7.4) | 153.0 (7.8) | 54.0 (33.0, 75.0) | <0.001 |
Weighted mean | 150.3 (7.5) | 95.3 (3.1) | 53.3 (6.8) WMD | 143.1 (6.8) | 123.2 (5.1) | 17.4 (4.4) WMD | ||
(95 % CI) | (135.7, 164.9) | (89.3, 101.3) | (40.0, 66.7) | <0.001a
| (129.8, 156.3) | (113.3, 133.1) | (8.8, 26.0) | <0.001a
|
Assessment of Between-Group Differences in Clinical Markers After Treatment
Effects of Bariatric Surgery vs Conventional Therapy on %EWL and T2DM
Study | %EWLa
| T2DM remission rate | |||
---|---|---|---|---|---|
Mean | % (N) | ||||
Bariatric | Conventional | Bariatric | Conventional |
p valueb
| |
Sjöström et al. [40] | 57.2 | −0.3 | 72.0 (342) | 21.0 (248) | <0.001 |
O’Brien et al. [41] | 83.9 | 23.5 | 93.0 (15) | 46.7 (15) | <0.01 |
Dixon et al. [42] | 62.5 | 4.9 | 73.0 (30) | 13.0 (30) | <0.001 |
Hofsø et al. [43] | 64.5 | 20.2 | 79.0 (14) | 0.0 (6) | <0.005 |
Adams et al. [44] | 69.6 | 1.9 | 78.7 (61) | 2.6 (114) | <0.001 |
Serrot et al. [45] | 91.7 | 3.3 | 64.7 (17) | 0.0 (17) | <0.001 |
Martins et al. [46] | 69.8 | 23.8 | 67.0 (6) | 36.8 (38) | NS (0.17) |
Iaconelli et al. [47] | 62.4 | 29.8 | 100.0 (22) | 45.0 (28) | <0.001 |
Scopinaro et al. [48]c
| 94.6 | 0.0 | 83.0 (30) | 0.0 (38) | <0.001 |
Leonetti et al. [49] | 79.8 | −5.7 | 80.0 (30) | 0.0 (30) | <0.001 |
Mingrone et al. [50] | 79.0 | 12.1 | 85.0 (40) | 0.0 (20) | <0.001 |
Heo et al. [51] | 62.9 | 24.7 | 57.1 (84) | 9.5 (21) | <0.001 |
Dorman et al. [52] | 85.1 | −2.6 | 65.0 (29) | 3.4 (29) | <0.001 |
Leslie et al. [53] | 67.0 | −0.6 | 38.2 (152) | 17.4 (115) | <0.001 |
Schauer et al. [54]d
| 82.8 | 16.8 | 39.4 (99) | 12.0 (41) | <0.005 |
Ikramuddin et al. [55] | 91.9 | 29.0 | 49.0 (57) | 19.0 (57) | <0.001 |
Overall | 75.3 | 11.3 | 63.5 (1,028) | 15.6 (847) | <0.001 |
(Range) | (57.2–94.6) | (−5.7–29.8) | (38.2–100.0) | (0.0–46.7) |