A systematic review of 12 randomized controlled trials shows heterogeneity (I² = 75%). The most appropriate method of analysis in this scenario is:

• A Fixed-effects model meta-analysis
• B Cumulative meta-analysis
• C Narrative synthesis only
• D Random-effects model meta-analysis ✓

Explanation

When I² is greater than 50%, there is significant heterogeneity among studies, meaning they do not all share the same true effect size. In this situation, the random-effects model is preferred as it accounts for both within-study and between-study variation. The fixed-effects model is appropriate only when heterogeneity is low (I² < 25–30%).

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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