Methodological Considerations Regarding Heterogeneity and Statistical Modeling in "Effects on Exercise Tolerance and Functional Outcomes of Eccentric versus Concentric Aerobic Exercise in People with COPD" [Letter].

Additionally, we noted the frequent use of the term “improvements” when describing outcomes that did not reach statistical significance (eg, quadriceps strength, p = 0.43, or 6MWT, p = 0.12).

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Applying a fixed-effect model under these conditions leads to “false precision,” where a result appears highly significant despite substantial inconsistency across studies. 3 To illustrate the potential impact of model choice, we contrasted the fixed-effect estimates reported by the authors with pooled effects re-estimated under random-effects assumptions (DerSimonian and Laird inverse-variance method) for each outcome using Review Manager (version 5.4, Cochrane Collaboration) software.

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