Roberts and colleagues used meta-analysis to assess the effectiveness of postnatal home visitation in reducing the rates of childhood injury, which is of substantial clinical importance. They used rigorous criteria that only allowed the inclusion of studies that met acceptable design standards. A problem with most meta-analyses, however, is that the outcomes and interventions that are examined can vary considerably among studies, even when they appear to reflect similar constructs. Admissions with trauma occur far less frequently than do nonhospitalised injuries, with corresponding differences in the clinical significance. Maternal reports of nonhospitalised injury may, in some cases, be a healthy sign that the mother is monitoring the child's well being.
Similar problems cloud the interpretation of the intervention itself.
The analysis by Roberts and colleagues did not contain a sufficient number of home-based interventions to estimate the relative efficacy of different home visitation models. The authors acknowledge this problem but argue that there was little discernible variation in the relative efficacy of the programs for reducing injury. David Olds, PhD University of Colorado Health Sciences Center Denver, Colorado, USA References 1. National Center for Health Statistics. Advance report of final mortality statistics 1991.