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

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.

Overview of Methodological Quality of Systematic Reviews about Gastric Cancer Risk and Protective Factors

“…And 9.09% to 92.73% studies did not conduct any contents of item 2 to item 11, especially for item 2, 4, 7, 8, which were not conducted in more than half of studies. Of 52 small items which were operationalized from the R-AMSTAR (Kung et al, 2010), seven small items were not conducted in all included studies , twenty-seven small items were conducted in less than half of all included studies (eleven small items were conducted in less than 25% of all included studies). Even though, meta-analyses/ SRs of observational studies about the etiology have been developed for about twenty years, their methodological quality were still low.…”

“…So the validities of the results of these SRs/meta-analyses were questionable, as some serious methodological flaws might lead to a high risk of bias (Lundh and Knijnenburg, 2009). In the future, checklists about assessing the methodological qualities and reporting SRs/meta-analyses were needed to follow (Stroup et al, 2000;Kung et al, 2010 ).…”

“…The methodological qualities of included SRs were evaluated using assessment of multiple systematic reviews (AMSTAR), because it has good content validity, wide acceptance, recognized reliability and reproducibility Shea et al, 2009;Kung et al, 2010). Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) was chosen in our study, as it could produce quantifiable assessments of SR quality (Kung et al, 2010).…”

“…Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) was chosen in our study, as it could produce quantifiable assessments of SR quality (Kung et al, 2010).…”

“…Of 52 small items from the R-AMSTAR (Kung et al, 2010), seven small items were not conducted in all included studies, seventeen small items were conducted in more than half of all included studies (five small items were conducted in more than 75% of all included studies), twenty-seven small items were conducted in less than half of all included studies (eleven small items were conducted in less than 25% of all included studies).…”