Methodological Quality and Risk of Bias of Systematic Reviews and Meta-Analyses on Stem Cells for Knee Osteoarthritis: A Cross-Sectional Survey

Abstract

Background: Clinical guidelines need high-quality studies to support clinical decision-making, in which the evidence often was collected from systematic reviews (SRs) and/or meta-analyses (MAs). At present, the methodological quality and risk of bias (RoB) of SRs/MAs on stem cell therapy for the treatment of knee osteoarthritis (KOA) has been poorly investigated. This study aims to strictly evaluate the methodological quality and RoB in SRs/MAs of stem cell therapy for KOA.Methods: Four electronic databases (PubMed, Embase, Cochrane Library, and Web of Science databases) were searched, from inception to October 5th, 2021. SRs/MAs involving RCTs or cohort studies on stem cell therapy for the treatment of KOA were included. The methodological quality and RoB were assessed using AMSTAR 2 and ROBIS tool respectively.Results: In total, 22 SRs/MAs were included. According to the results obtained by AMSTAR 2 tool, all SRs/MAs were rated as "Critically low". Main methodological weaknesses were as follows: eight items accounted for more than 50% of "No", including Items 2 Protocol registration (81.82%), Item 7 Study exclusion and justi cation (86.36%) and Item 15 Investigation and discussion of publication bias (63.64%) were critical items. ROBIS-based RoB assessment showed that all the SRs/MAs were rated as "High". Conclusions:The overall methodological quality of the SRs/MAs concerning the application of stem cell therapy in treating KOA is "Critically low", while the RoB is high. It is di cult to provide effective evidence for the formulation of guidelines for KOA treatment. We suggest that the relevant methodological quality assessment should be carried out in the future before the SRs/MAs are used as clinical evidence.

A systematic review, umbrella review, and quality assessment on clinical translation of stem cell therapy for knee osteoarthritis: Are we there yet?

“…This may be because PRISMA reporting specification merely provides researchers with a checklist of items to report while they themselves determine the actual content and level of detail of the final report. Additionally, the list of excluded studies and their reasons, and the early registration of protocols, had a substantial effect on the methodological quality of SRs/MAs [ 126 ], but few studies followed guidelines by registering protocols, establishing PICOs, and providing lists of excluded papers. According to AMSTAR 2 and PRISMA guidelines, relying solely on electronic database searches is insufficient.…”

Methodological quality of randomized controlled trials of home-based rehabilitation in knee osteoarthritis: A cross-sectional survey

“…Most of the studies we included did not report or underreported some features related to reporting methodological quality (concealed allocation, blinding, intention to treat, power analysis) according to CONSORT checklists. Articles with low methodological quality tend to exaggerate treatment effects and have a high risk of bias [28,29].…”