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- \u2018Overviews of systematic reviews\u2019 are a feature of evidence-based decision making, but are only as strong as the individual reviews they include. Evaluating potential biases and the methodological quality of systematic reviews is therefore crucial.<\/li>\n
- A recent article examines 2 recommended systematic review assessment tools, AMSTAR-2 and ROBIS. While both have value, their use requires proper training, time, and know-how.<\/li>\n<\/ul>\n
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<\/a><\/p>\nSynthesising evidence from multiple systematic reviews (also known as conducting an umbrella review<\/a> or\u00a0 \u2018overview of reviews\u2019) can form a key part of evidence-based decision making<\/a> and treatment guidelines. However, conducting effective \u2018overviews of reviews\u2019 requires careful planning to minimise bias, which can be present at either a primary study or individual review level<\/a>. In a recent BMJ Medicine<\/em><\/a> methods primer<\/a>, Carole Lunny and colleagues address the challenges of assessing and reporting bias in systematic reviews. The group offer a detailed examination of AMSTAR-2<\/a> and ROBIS<\/a>, two recommended appraisal tools<\/a>, and provide practical guidance for authors of \u2018overviews of reviews\u2019.<\/p>\n
AMSTAR-2 versus ROBIS<\/strong><\/p>\n
The group compared key features of each tool.<\/p>\n
AMSTAR-2:<\/p>\n
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- 16-item checklist<\/li>\n
- focuses on the methodological quality of systematic reviews of healthcare interventions, including risk of bias<\/li>\n
- reportedly favoured for its quick and easy-to-use format<\/li>\n
- may be preferred for broad assessment of systematic review quality.<\/li>\n<\/ul>\n
ROBIS:<\/p>\n
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- domain-based tool<\/li>\n
- 19 items, aimed at identifying biases in systematic reviews<\/li>\n
- useful for pinpointing concerns in review conduct and assessing relevance<\/li>\n
- requires \u201cmore thoughtful assessment and time\u201d<\/li>\n
- may be preferred for more nuanced assessments, or comparisons of risk of bias across multiple types of systematic reviews.<\/li>\n<\/ul>\n
Standardising \u2018overviews of reviews\u2019<\/strong><\/p>\n
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The authors call for a standardised approach to \u2018overviews of reviews\u2019 to enhance their credibility and value.<\/p>\n<\/blockquote>\n
Regardless of the appraisal tool used, the authors call for a standardised approach to \u2018overviews of reviews\u2019 to enhance their credibility and value. They outline several key recommendations:<\/p>\n
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- Report methodological quality or bias by item, domain, and overall judgement, focusing on outcomes.<\/li>\n
- Discuss risk of bias for each outcome.<\/li>\n
- Highlight any individual review methodological quality issues or potential biases as limitations of the \u2018overview of reviews\u2019.<\/li>\n
- Use ROBIS to subgroup reviews by risk of bias, identifying overemphasised findings and excluding high-risk reviews.<\/li>\n<\/ul>\n
An expanding toolkit<\/strong><\/p>\n
Previously, the launch of \u00a0PRISMA-S<\/a> provided much-needed guidance on reporting literature searches within systematic reviews, and Cochrane\u2019s Hilda Bastian<\/a> proposed solutions to ensure that systematic review protocols were robust. Now, Lunny and colleagues\u2019 primer, and the tools therein, sit alongside initiatives from the LATITUDES Network<\/a>\u00a0to form part of a drive to reduce bias in evidence synthesis.<\/p>\n
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