From Systematic Reviews to Clinical Recommendations for Evidence- Based Health Care: Validation of Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) for Grading of Clinical Relevance~!2009-10-24~!2009-10-03~!2010-07-16~!

Abstract

Research synthesis seeks to gather, examine and evaluate systematically research reports that converge toward answering a carefully crafted research question, which states the problem patient population, the intervention under consideration, and the clinical outcome of interest. The product of the process of systematically reviewing the research literature pertinent to the research question thusly stated is the “systematic review”.The objective and transparent approach of the systematic review aims to minimize bias. Most systematic reviews yield quantitative analyses of measurable data (e.g., acceptable sampling analysis, meta-analysis). Systematic reviews may also be qualitative, while adhering to accepted standards for gathering, evaluating, and reporting evidence. Systematic reviews provide highly rated recommendations for evidence-based health care; but, systematic reviews are not equally reliable and successful in minimizing bias.Several instruments are available to evaluate the quality of systematic reviews. The 'assessment of multiple systematic reviews' (AMSTAR) was derived from factor analysis of the most relevant items among them. AMSTAR consists of eleven items with good face and content validity for measuring the methodological quality of systematic reviews, has been widely accepted and utilized, and has gained in reliability, reproducibility. AMSTAR does not produce quantifiable assessments of systematic review quality and clinical relevance. In this study, we have revised the AMSTAR instrument, detracting nothing from its content and construct validity, and utilizing the very criteria employed in the development of the original tool, with the aim of yielding an instrument that can quantify the quality of systematic reviews. We present validation data of the revised AMSTAR (R-AMSTAR), and discuss its implications and application in evidence-based health care.

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

“…44 l Quality of evidence included within systematic review: this reflects the rigour with which the reviews assessed the quality of the studies included in each of the reviews, looking for potential bias, conflicting results across individual studies, sparse evidence or a lack of relevance to the review question. 41 We used the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) quality appraisal tool to assess the methodological quality of all included systematic reviews 45 (see Appendix 15). Assessment of Multiple Systematic Reviews (AMSTAR) has good face and content validity but is unable to produce quantifiable assessments of quality.…”

“…46,47 R-AMSTAR is a revised version of the AMSTAR instrument which can quantify the quality of systematic reviews. 45 Due to the dearth of tools to assess quality of qualitative systematic reviews, we adapted the R-AMSTAR for this purpose (see Appendix 16). The qualitative tool was assessed out of 40 and papers were judged to be high quality if scored as ≥ 30 and low quality if scored < 30.…”

Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis

“…As part of this project we also searched for other systematic reviews covering the same topic published since 1 January 2011 with a revised AMSTAR score ≥32. 11 No such reviews were identified for hydrolysed formula.…”

“…Subgroup analysis suggested a significant difference in outcome according to study design or disease risk, with a more positive outcome in the single quasi-randomised controlled trial of normal risk infants. Analysis of data from randomised controlled trials for the most commonly studied partially hydrolysed formula (Nan HA/Good Start/Nidina HA/Beba HA, Nestlé, Vevey, Switzerland) showed no significant effect on risk of eczema at age 0-4 (0.94, 0.75 [5][6][7][8][9][10][11][12][13][14]. Direct comparison of extensively versus partially hydrolysed formula, and casein versus whey dominant extensively hydrolysed formula, did not show a significant difference in risk of eczema at age 0-4 or 5-14.…”

“…Direct comparison of extensively versus partially hydrolysed formula, and casein versus whey dominant extensively hydrolysed formula, did not show a significant difference in risk of eczema at age 0-4 or 5-14. When we combined data for partially and extensively hydrolysed formula as "any hydrolysed formula" there was evidence of reduced eczema at age 0-4 (but not at age [5][6][7][8][9][10][11][12][13][14]. This analysis necessitated use of per protocol data from the GINI study, had high statistical heterogeneity, and showed evidence of publication bias (fig 8).…”