The quality of Cochrane systematic reviews of acupuncture: an overview

Abstract Background Many systematic reviews of clinical trials on acupuncture were performed within the Cochrane Collaboration, the evidence-based medicine (EBM) most recognized organization. Objective of the article was to systematically collect and identify systematic reviews of acupuncture published in the Cochrane Library and assess their quality from a methodological perspective. Methods A comprehensive literature search was performed in the Cochrane Database of Systematic Reviews to identify the reviews of acupuncture conducted until June 2019. The methodological quality of the included reviews was assessed using the AMSTAR 2 checklist, an evaluation tool for systematic reviews. Results Out of a total of 126 eligible reviews, 50 systematic reviews were included. According to the AMSTAR 2, 52% of Cochrane Systematic Reviews (CSRs) were of low quality, due to the presence of one or more weaknesses in at least one of the domains defined as critical for the methodological quality assessment. The less satisfied critical domain was inadequate investigation and discussion of publication bias. Declaration of potential sources of conflict of interest, and funding of the authors of the review and of the included studies were other important weaknesses. Conclusions The main methodological flaws in the included CSRs were related to topics of relatively new concern in the conduction of systematic reviews of the literature. However, both, lack of attention about retrieval of negative studies, and statements about conflict of interests are crucial point for the evaluation of therapeutic interventions according to EBM methodology.

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Appraisal of systematic reviews on interventions for postpartum depression: systematic review

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03496-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ryan Chow ◽

Eileen Huang ◽

Allen Li ◽

Sophie Li ◽

Sarah Y. Fu ◽

...

Keyword(s):

Systematic Review ◽

Postpartum Depression ◽

Systematic Reviews ◽

Methodological Quality ◽

A Priori ◽

Behavioural Therapy ◽

Therapeutic Interventions ◽

Current Evidence ◽

Cochrane Library ◽

Measurement Tool

Abstract Background Postpartum depression (PPD) is a highly prevalent mental health problem that affects parental health with implications for child health in infancy, childhood, adolescence and beyond. The primary aim of this study was to critically appraise available systematic reviews describing interventions for PPD. The secondary aim was to evaluate the methodological quality of the included systematic reviews and their conclusions. Methods An electronic database search of MEDLINE, Embase, and the Cochrane Library from 2000 to 2020 was conducted to identify systematic reviews that examined an intervention for PPD. A Measurement Tool to Assess Systematic Reviews was utilized to independently score each included systematic review which was then critically appraised to better define the most effective therapeutic options for PPD. Results Of the 842 studies identified, 83 met the a priori criteria for inclusion. Based on the systematic reviews with the highest methodological quality, we found that use of antidepressants and telemedicine were the most effective treatments for PPD. Symptoms of PPD were also improved by traditional herbal medicine and aromatherapy. Current evidence for physical exercise and cognitive behavioural therapy in treating PPD remains equivocal. A significant, but weak relationship between AMSTAR score and journal impact factor was observed (p = 0.03, r = 0.24; 95% CI, 0.02 to 0.43) whilst no relationship was found between the number of total citations (p = 0.27, r = 0.12; 95% CI, − 0.09 to 0.34), or source of funding (p = 0.19). Conclusion Overall the systematic reviews on interventions for PPD are of low-moderate quality and are not improving over time. Antidepressants and telemedicine were the most effective therapeutic interventions for PPD treatment.

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Evidence-Based Podiatric Medicine

Journal of the American Podiatric Medical Association ◽

10.7547/0980260 ◽

2009 ◽

Vol 99 (3) ◽

pp. 260-266 ◽

Cited By ~ 3

Author(s):

Fiona Hawke ◽

Joshua Burns ◽

Karl B. Landorf

Keyword(s):

Systematic Reviews ◽

Medical Literature ◽

Cochrane Collaboration ◽

The United States ◽

Evidence Base ◽

Cochrane Library ◽

Free Access ◽

Evidence Based ◽

User Friendliness ◽

The Cochrane Library

Due to the exponential increase in the quantity and quality of podiatric medicine–related research during the past decade, podiatric physicians are inundated with an insurmountable volume of research relevant to clinical practice. Systematic reviews can refine this literature by using explicit, rigorous, and reproducible methods to identify, critically appraise, and synthesize the best evidence from all clinical trials to answer clearly defined clinical questions. The Cochrane Collaboration is an international not-for-profit organization created to improve the user-friendliness and accessibility of medical literature mainly through preparing and maintaining systematic reviews of health-care interventions. The Cochrane Library currently contains more than 50 podiatric medicine–relevant systematic reviews summarizing and synthesizing evidence from many hundreds of randomized controlled trials evaluating interventions for foot problems. Although more than 60 countries worldwide have open online access to The Cochrane Library, in the United States, only the state of Wyoming has free access to full-text reviews. In an era demanding an evidence-based approach for every clinical intervention, high-quality systematic reviews streamline podiatric medical literature by reducing the time, cost, and training necessary to establish a solid evidence base for practice. (J Am Podiatr Med Assoc 99(3): 260–266, 2009)

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Outcomes of digital biomarker-based interventions: protocol for a systematic review of systematic reviews (Preprint)

10.2196/preprints.28204 ◽

2021 ◽

Author(s):

Hossein Motahari-Nezhad ◽

Márta Péntek ◽

László Gulácsi ◽

Zsombor Zrubka

Keyword(s):

Clinical Outcomes ◽

Systematic Reviews ◽

Meta Analysis ◽

Cochrane Library ◽

Level Of Evidence ◽

Clinical Benefits ◽

The Cochrane Library ◽

The Impact ◽

Digital Biomarkers

BACKGROUND Digital biomarkers are defined as objective, quantifiable physiological and behavioral data that are collected and measured by means of digital devices such as portables, wearables, implantables or digestibles. For their widespread adoption in publicly financed healthcare systems, it is important to understand how their benefits translate into improved patient outcomes, which is essential for demonstrating their value. OBJECTIVE To assess the quality and strength of evidence of the impact of digital biomarkers on clinical outcomes compared to interventions without digital biomarkers, reported in systematic reviews. METHODS A comprehensive search for 2019-2020 will be conducted in the PubMed and the Cochrane Library using keywords related to digital biomarkers and a filter for systematic reviews. Original full-text English publications of systematic reviews comparing clinical outcomes of interventions with and without digital biomarkers via meta-analysis will be included. The AMSTAR-2 tool will be used to assess the methodological quality of reviews. To assess the quality of evidence, we will evaluate systematic reviews using the GRADE tool. To detect the possible presence of reporting bias, we will record whether the protocol of the systematic reviews was published before the start of the study. A qualitative summary of results by digital biomarker technology and outcome will be provided. RESULTS This protocol was submitted before data collection. The next steps in this review will be initiated after the protocol is accepted for publication. CONCLUSIONS Our study will provide a comprehensive summary of the highest level of evidence available on digital biomarker interventions. Our results will help identify clinical areas where the use of digital biomarkers leads to favorable clinical outcomes. In addition, our findings will highlight areas of evidence gaps where the clinical benefits of digital biomarkers have not yet been demonstrated.

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Telemonitoring Interventions in COPD Patients: Overview of Systematic Reviews

BioMed Research International ◽

10.1155/2020/5040521 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Xuanlin Li ◽

Yang Xie ◽

Hulei Zhao ◽

Hailong Zhang ◽

Xueqing Yu ◽

...

Keyword(s):

Quality Of Life ◽

Exercise Capacity ◽

Systematic Reviews ◽

Methodological Quality ◽

Grade System ◽

Cochrane Library ◽

Exacerbation Rate ◽

Copd Patients

Objective. The role of telemonitoring interventions (TIs) for chronic obstructive pulmonary disease (COPD) has been studied in many systematic reviews (SRs) and meta-analyses (MAs), but robust conclusions have not been reached due to wide variations in scopes, qualities, and outcomes. The aim of this overview was to determine the effectiveness of TIs on COPD patients. Methods. PubMed, EMBASE, Web of Science, and Cochrane Library were searched for all reviews on the topic of TI in treating COPD from inception to July 8, 2019, without restrictions on language. According to the inclusion and exclusion criteria, the retrieved literature studies were screened to select SRs and MAs of randomized control trials (RCTs) that evaluated the effects of TIs in COPD patients. The methodological quality of SRs and MAs was assessed with the AMSTAR-2 tool, and the strength of evidence was assessed with the grades of recommendations, assessment, development, and evaluation (GRADE) system for concerned outcomes in terms of mortality, quality of life (SGRQ total scores), exercise capacity (6MWD), and exacerbation-related outcomes (hospitalizations, exacerbation rate, and emergency room visits). Results. Our overview included eight SRs and MAs published in 2011 to 2019, from 95 RCTs involving 10632 participants. After strict evaluation by the AMSTAR-2 tool, 75% of the SRs and MAs in this overview had either low or critically low methodological quality. The effects of TIs for COPD on mortality, quality of life, exercise capacity, and exacerbation-related outcomes are limited, and all of these outcomes scored either low or very low quality of evidence on the GRADE system. Conclusions. There might be insufficient evidence to support the effectiveness of TIs for COPD currently, but the results of this overview should be interpreted dialectically and prudently, and the role of TIs in COPD needs further exploration.

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Systematic Reviews and Meta-Analysis in Spine Surgery—How Good Are They in Methodological Quality? A Systematic Review

Global Spine Journal ◽

10.1177/2192568220906810 ◽

2020 ◽

pp. 219256822090681 ◽

Cited By ~ 2

Author(s):

Muthu Sathish ◽

Ramakrishnan Eswar

Keyword(s):

Systematic Review ◽

Spine Surgery ◽

Systematic Reviews ◽

Methodological Quality ◽

Meta Analysis ◽

Eligibility Criteria ◽

Cochrane Database ◽

Critical Flaw ◽

Meta Analyses

Study Design: Systematic review. Objectives: To assess the methodological quality of systematic reviews and meta-analyses in spine surgery over the past 2 decades. Materials and Methods: We conducted independent and in duplicate systematic review of the published systematic reviews and meta-analyses between 2000 and 2019 from PubMed Central and Cochrane Database pertaining to spine surgery involving surgical intervention. We searched bibliographies to identify additional relevant studies. Methodological quality was evaluated with AMSTAR score and graded with AMSTAR 2 criteria. Results: A total of 96 reviews met the eligibility criteria, with mean AMSTAR score of 7.51 (SD = 1.98). Based on AMSTAR 2 criteria, 13.5% (n = 13) and 18.7% (n = 18) of the studies had high and moderate level of confidence of results, respectively, without any critical flaws. A total of 29.1% (n = 28) of the studies had at least 1 critical flaw and 38.5% (n = 37) of the studies had more than 1 critical flaw, so that their results have low and critically low confidence, respectively. Failure to analyze the conflict of interest of authors of primary studies included in review and lack of list of excluded studies with justification were the most common critical flaw. Regression analysis demonstrated that studies with funding and studies published in recent years were significantly associated with higher methodological quality. Conclusion: Despite improvement in methodological quality of systematic reviews and meta-analyses in spine surgery in current decade, a substantial proportion continue to show critical flaws. With increasing number of review articles in spine surgery, stringent measures must be taken to adhere to methodological quality by following PRISMA and AMSTAR guidelines to attain higher standards of evidence in published literature.

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Assessing the methodological quality of systematic reviews using the AMSTAR tool

Colombian Journal of Anesthesiology ◽

10.5554/22562087.e913 ◽

2020 ◽

Author(s):

Ana Beatriz Pizarro ◽

Sebastián Carvajal ◽

Adriana Buitrago-López

Keyword(s):

Systematic Reviews ◽

Health Professionals ◽

Methodological Quality ◽

Critical Appraisal ◽

Internal Validity ◽

Critical Assessment ◽

Cochrane Library ◽

Publication Date ◽

Review Of Literature

Introduction: Making decisions based on evidence has been a challenge for health professionals, given the need to have the tools and skills to carry out a critical appraisal of the evidence and assess the validity of the results. Systematic reviews of the literature (SRL) have been used widely to answer questions in the clinical field. Tools have been developed that support the appraisal of the quality of the studies. AMSTAR is one of these, validated and supported by reproducible evidence, which guides the methodological quality of the SRL. Objectives: To show a historical, theoretical and practical guide for critical assessment of systematic reviews using AMSTAR to guide the argumental bases for their use according to the components of this methodological structure in health research, and to provide practical examples of how to apply this checklist. Methods: We conducted a non-exhaustive review of literature in Pubmed and Cochrane Library using “AMSTAR” and “Systematic Reviews” as free terms without language or publication date limit; we also collected information from experts in the evaluation of the quality of the evidence. Conclusions: AMSTAR is an instrument used, validated and supported by reproducible evidence for the evaluation of the internal validity of systematic reviews of the literature. It consists of 16 items that assess the overall methodological quality of an SRL. It is currently used indiscriminately and favorably, but it is not exempt from limitations and future updates based on new reproducibility and validation studies.

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Effectiveness of feeding supplementation in preterm infants: an overview of systematic reviews

BMC Pediatrics ◽

10.1186/s12887-021-03052-w ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Keqin Liu ◽

Jiaxin Tao ◽

Jixin Yang ◽

Yufeng Li ◽

Yanwei Su ◽

...

Keyword(s):

Health Outcomes ◽

Preterm Infants ◽

Systematic Reviews ◽

Methodological Quality ◽

Data Extraction ◽

Cochrane Library ◽

Qualitative Synthesis ◽

Term Infants ◽

Online Library

Abstract Background Preterm infants have higher nutrition needs than term infants. The effectiveness of various feeding supplementation was assessed by the improvement of health outcomes in single specific systematic reviews (SRs). The aim of this review was to comprehensively describe the effectiveness of feeding supplementation in promoting health outcomes of preterm infants. Methods A literature search was conducted in the PUBMED, EMBASE, Science Direct, Cochrane library, Web of Science, and Wiley online library. SRs selection followed clear inclusion and exclusion criteria. Pairs of reviewers independently applied the criteria to both titles/abstracts and full texts. Screening and data extraction were performed by using the advanced tables. The methodological quality of SRs and the quality of the evidence were carried out according to the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool and the Grades of Recommendation, Assessment, Development, and Evaluation guidelines (GRADE) respectively. A qualitative synthesis of evidence is presented. Results Seventeen SRs were included in the review. Fifteen kinds of feeding supplementation were reported in the SRs. In preterm infants, the effectiveness of feeding supplementation in addition to regular breast-feeding was mainly shown in six aspects: physical health, neurodevelopment, biochemical outcomes, other health outcomes, morbidity and all-cause mortality. And the effectiveness of the interventions on health outcomes in preterm infants was found by most systematic reviews. The methodological quality of all the included SRs was high, and most of the evidences was of low or very low quality. Conclusions Our results will allow a better understanding of the feeding supplementation in preterm infants. Although the feeling supplements may improve the health outcomes of in preterm infants, the existing evidence is uncertain. Therefore, the clinical use of these supplements should be considered cautiously and more well-designed RCTs are still needed to further address the unsolved problems of the included SRs.

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Reasons and factors associated with inconclusiveness of systematic reviews about interventions for neuropathic pain

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2020-0165 ◽

2020 ◽

Author(s):

Svjetlana Dosenovic ◽

Andria Dujmic ◽

Danijela Nujic ◽

Ivana Vuka ◽

Goran Tintor ◽

...

Keyword(s):

Neuropathic Pain ◽

Systematic Reviews ◽

Methodological Quality ◽

Meta Analysis ◽

Measurement Tool ◽

Efficacy And Safety ◽

Factors Associated ◽

Explicit Statement ◽

Cochrane Database

Aim: Systematic reviews (SRs) are frequently inconclusive. The aim of this study was to analyze factors associated with conclusiveness of SRs about efficacy and safety of interventions for neuropathic pain (NeuP). Materials & methods: The study protocol was registered in the PROSPERO database (No. CRD42015025831). Five electronic databases (Medical Literature Analysis and Retrieval System Online, Cochrane Database of Systematic Reviews, Cumulative Index for Nursing and Allied Health Literature, Database of Abstracts of Reviews of Effects and Psychological Information Database) were searched until July 2018 for SRs about NeuP management. Conclusion statements for efficacy and safety, and characteristics of SRs were analyzed. Conclusiveness was defined as explicit statement by the SR authors that one intervention is better/similar to the other in terms of efficacy and safety. Methodological quality of SRs was assessed with the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) tool. Results: Of 160 SRs, 37 (23%) were conclusive for efficacy and/or safety. In the SRs, conclusions about safety were missing in half of the analyzed abstracts, and a third of the full texts. Conclusive SRs included significantly more trials and participants, searched more databases, had more authors, conducted meta-analysis, analyzed quality of evidence, and had lower methodological quality than inconclusive SRs. The most common reasons for the lack of conclusiveness indicated by the SR authors were the small number of participants and trials, and the high heterogeneity of included studies. Conclusion: Most SRs about NeuP treatment were inconclusive. Sources of inconclusiveness of NeuP reviews need to be further studied, and SR authors need to provide conclusions about both safety and efficacy of interventions.

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Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews

BMC Public Health ◽

10.1186/s12889-020-09855-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Pawel Posadzki ◽

Dawid Pieper ◽

Ram Bajpai ◽

Hubert Makaruk ◽

Nadja Könsgen ◽

...

Keyword(s):

Physical Activity ◽

Health Outcomes ◽

Systematic Reviews ◽

Effect Size ◽

Methodological Quality ◽

Prediction Interval ◽

Mortality Rates ◽

Noncommunicable Diseases ◽

Cochrane Library

Abstract Background Sedentary lifestyle is a major risk factor for noncommunicable diseases such as cardiovascular diseases, cancer and diabetes. It has been estimated that approximately 3.2 million deaths each year are attributable to insufficient levels of physical activity. We evaluated the available evidence from Cochrane systematic reviews (CSRs) on the effectiveness of exercise/physical activity for various health outcomes. Methods Overview and meta-analysis. The Cochrane Library was searched from 01.01.2000 to issue 1, 2019. No language restrictions were imposed. Only CSRs of randomised controlled trials (RCTs) were included. Both healthy individuals, those at risk of a disease, and medically compromised patients of any age and gender were eligible. We evaluated any type of exercise or physical activity interventions; against any types of controls; and measuring any type of health-related outcome measures. The AMSTAR-2 tool for assessing the methodological quality of the included studies was utilised. Results Hundred and fifty CSRs met the inclusion criteria. There were 54 different conditions. Majority of CSRs were of high methodological quality. Hundred and thirty CSRs employed meta-analytic techniques and 20 did not. Limitations for studies were the most common reasons for downgrading the quality of the evidence. Based on 10 CSRs and 187 RCTs with 27,671 participants, there was a 13% reduction in mortality rates risk ratio (RR) 0.87 [95% confidence intervals (CI) 0.78 to 0.96]; I2 = 26.6%, [prediction interval (PI) 0.70, 1.07], median effect size (MES) = 0.93 [interquartile range (IQR) 0.81, 1.00]. Data from 15 CSRs and 408 RCTs with 32,984 participants showed a small improvement in quality of life (QOL) standardised mean difference (SMD) 0.18 [95% CI 0.08, 0.28]; I2 = 74.3%; PI -0.18, 0.53], MES = 0.20 [IQR 0.07, 0.39]. Subgroup analyses by the type of condition showed that the magnitude of effect size was the largest among patients with mental health conditions. Conclusion There is a plethora of CSRs evaluating the effectiveness of physical activity/exercise. The evidence suggests that physical activity/exercise reduces mortality rates and improves QOL with minimal or no safety concerns. Trial registration Registered in PROSPERO (CRD42019120295) on 10th January 2019.

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