Skip to main content
Top
Published in: BMC Medical Research Methodology 1/2016

Open Access 01-12-2016 | Debate

Resuming the discussion of AMSTAR: What can (should) be made better?

Authors: Uta Wegewitz, Beate Weikert, Alba Fishta, Anja Jacobs, Dawid Pieper

Published in: BMC Medical Research Methodology | Issue 1/2016

Login to get access

Abstract

Background

Evidence syntheses, and in particular systematic reviews (SRs), have become one of the cornerstones of evidence-based health care. The Assessment of Multiple Systematic Reviews (AMSTAR) tool has become the most widely used tool for investigating the methodological quality of SRs and is currently undergoing revision. The objective of this paper is to present insights, challenges and potential solutions from the point of view of a group of assessors, while referring to earlier methodological discussions and debates with respect to AMSTAR.

Discussion

One major drawback of AMSTAR is that it relies heavily on reporting quality rather than on methodological quality. This can be found in several items. Furthermore, it should be acknowledged that there are now new methods and procedures that did not exist when AMSTAR was developed. For example, the note to item 1 should now refer to the International Prospective Register of Ongoing Systematic Reviews (PROSPERO). Furthermore, item 3 should consider the definition of hand-searching, as the process of reviewing conference proceedings using the search function (e.g. in Microsoft Word or in a PDF file) does not meet the definition set out by the Cochrane Collaboration. Moreover, methods for assessing the quality of the body of evidence have evolved since AMSTAR was developed and should be incorporated into a revised AMSTAR tool.

Summary

Potential solutions are presented for each AMSTAR item with the aim of allowing a more thorough assessment of SRs. As the AMSTAR tool is currently undergoing further development, our paper hopes to add to preceding discussions and papers regarding this tool and stimulate further discussion.
Literature
2.
go back to reference Pieper D, et al. Overviews of reviews often have limited rigor: a systematic review. J Clin Epidemiol. 2012;65(12):1267–73.CrossRefPubMed Pieper D, et al. Overviews of reviews often have limited rigor: a systematic review. J Clin Epidemiol. 2012;65(12):1267–73.CrossRefPubMed
3.
go back to reference Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol. 1991;44(11):1271–8.CrossRefPubMed Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol. 1991;44(11):1271–8.CrossRefPubMed
4.
go back to reference Oxman AD, et al. Agreement among reviewers of review articles. J Clin Epidemiol. 1991;44(1):91–8.CrossRefPubMed Oxman AD, et al. Agreement among reviewers of review articles. J Clin Epidemiol. 1991;44(1):91–8.CrossRefPubMed
5.
6.
go back to reference Pieper D, et al. Systematic review found AMSTAR, but not R(evised)-AMSTAR, to have good measurement properties. J Clin Epidemiol. 2015;68(5):574–83.CrossRefPubMed Pieper D, et al. Systematic review found AMSTAR, but not R(evised)-AMSTAR, to have good measurement properties. J Clin Epidemiol. 2015;68(5):574–83.CrossRefPubMed
7.
go back to reference Johnson BT, et al. Methodological quality of meta-analyses on the blood pressure response to exercise: a review. J Hypertens. 2014;32(4):706–23.CrossRefPubMed Johnson BT, et al. Methodological quality of meta-analyses on the blood pressure response to exercise: a review. J Hypertens. 2014;32(4):706–23.CrossRefPubMed
8.
go back to reference Huedo-Medina TB, et al. Methodologic quality of meta-analyses and systematic reviews on the Mediterranean diet and cardiovascular disease outcomes: a review. Am J Clin Nutr. 2016;103(3):841–50.CrossRefPubMed Huedo-Medina TB, et al. Methodologic quality of meta-analyses and systematic reviews on the Mediterranean diet and cardiovascular disease outcomes: a review. Am J Clin Nutr. 2016;103(3):841–50.CrossRefPubMed
9.
go back to reference Berkhof M, et al. Effective training strategies for teaching communication skills to physicians: an overview of systematic reviews. Patient Educ Couns. 2011;84(2):152–62.CrossRefPubMed Berkhof M, et al. Effective training strategies for teaching communication skills to physicians: an overview of systematic reviews. Patient Educ Couns. 2011;84(2):152–62.CrossRefPubMed
10.
go back to reference Kelley GA, Kelley KS. Effects of exercise in the treatment of overweight and obese children and adolescents: a systematic review of meta-analyses. J Obes. 2013;2013:783103.CrossRefPubMedPubMedCentral Kelley GA, Kelley KS. Effects of exercise in the treatment of overweight and obese children and adolescents: a systematic review of meta-analyses. J Obes. 2013;2013:783103.CrossRefPubMedPubMedCentral
11.
go back to reference Aziz T, et al. Methodological quality and descriptive characteristics of prosthodontic-related systematic reviews. J Oral Rehabil. 2013;40(4):263–78.CrossRefPubMed Aziz T, et al. Methodological quality and descriptive characteristics of prosthodontic-related systematic reviews. J Oral Rehabil. 2013;40(4):263–78.CrossRefPubMed
12.
go back to reference Faggion Jr CM. Critical appraisal of AMSTAR: challenges, limitations, and potential solutions from the perspective of an assessor. BMC Med Res Methodol. 2015;15:63.CrossRefPubMedPubMedCentral Faggion Jr CM. Critical appraisal of AMSTAR: challenges, limitations, and potential solutions from the perspective of an assessor. BMC Med Res Methodol. 2015;15:63.CrossRefPubMedPubMedCentral
13.
go back to reference Burda BU, Holmer HK, Norris SL. Limitations of A Measurement Tool to Assess Systematic Reviews (AMSTAR) and suggestions for improvement. Syst Rev. 2016;5(1):58.CrossRefPubMedPubMedCentral Burda BU, Holmer HK, Norris SL. Limitations of A Measurement Tool to Assess Systematic Reviews (AMSTAR) and suggestions for improvement. Syst Rev. 2016;5(1):58.CrossRefPubMedPubMedCentral
16.
18.
go back to reference Kirkham JJ, Altman DG, Williamson PR. Bias due to changes in specified outcomes during the systematic review process. PLoS One. 2010;5(3). Kirkham JJ, Altman DG, Williamson PR. Bias due to changes in specified outcomes during the systematic review process. PLoS One. 2010;5(3).
19.
go back to reference Page MJ, et al. Bias due to selective inclusion and reporting of outcomes and analyses in systematic reviews of randomised trials of healthcare interventions. Cochrane Database Syst Rev. 2014;10:MR000035. Page MJ, et al. Bias due to selective inclusion and reporting of outcomes and analyses in systematic reviews of randomised trials of healthcare interventions. Cochrane Database Syst Rev. 2014;10:MR000035.
20.
go back to reference Silagy CA, Middleton P, Hopewell S. Publishing protocols of systematic reviews: comparing what was done to what was planned. JAMA. 2002;287(21):2831–4.CrossRefPubMed Silagy CA, Middleton P, Hopewell S. Publishing protocols of systematic reviews: comparing what was done to what was planned. JAMA. 2002;287(21):2831–4.CrossRefPubMed
21.
go back to reference Booth A, et al. An international registry of systematic-review protocols. Lancet. 2011;377(9760):108–9.CrossRefPubMed Booth A, et al. An international registry of systematic-review protocols. Lancet. 2011;377(9760):108–9.CrossRefPubMed
24.
go back to reference Buscemi N, et al. Single data extraction generated more errors than double data extraction in systematic reviews. J Clin Epidemiol. 2006;59(7):697–703.CrossRefPubMed Buscemi N, et al. Single data extraction generated more errors than double data extraction in systematic reviews. J Clin Epidemiol. 2006;59(7):697–703.CrossRefPubMed
26.
go back to reference Morrison A, et al. The effect of English-language restriction on systematic review-based meta-analyses: a systematic review of empirical studies. Int J Technol Assess Health Care. 2012;28(2):138–44.CrossRefPubMed Morrison A, et al. The effect of English-language restriction on systematic review-based meta-analyses: a systematic review of empirical studies. Int J Technol Assess Health Care. 2012;28(2):138–44.CrossRefPubMed
27.
go back to reference Pham B, et al. Language of publication restrictions in systematic reviews gave different results depending on whether the intervention was conventional or complementary. J Clin Epidemiol. 2005;58(8):769–76.CrossRefPubMed Pham B, et al. Language of publication restrictions in systematic reviews gave different results depending on whether the intervention was conventional or complementary. J Clin Epidemiol. 2005;58(8):769–76.CrossRefPubMed
28.
go back to reference Xue J, et al. Significant discrepancies were found in pooled estimates of searching with Chinese indexes versus searching with English indexes. J Clin Epidemiol. 2015;70:246–53.CrossRefPubMed Xue J, et al. Significant discrepancies were found in pooled estimates of searching with Chinese indexes versus searching with English indexes. J Clin Epidemiol. 2015;70:246–53.CrossRefPubMed
29.
go back to reference Higgins, JPTD, JJ. Chapter 7: Selecting studies and collecting data, in Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, J.P.T.G. Higgins, S., Editor. 2011, The Cochrane Collaboration. Higgins, JPTD, JJ. Chapter 7: Selecting studies and collecting data, in Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, J.P.T.G. Higgins, S., Editor. 2011, The Cochrane Collaboration.
30.
go back to reference Hartling L, et al. Testing the Newcastle Ottawa Scale showed low reliability between individual reviewers. J Clin Epidemiol. 2013;66(9):982–93.CrossRefPubMed Hartling L, et al. Testing the Newcastle Ottawa Scale showed low reliability between individual reviewers. J Clin Epidemiol. 2013;66(9):982–93.CrossRefPubMed
31.
go back to reference Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.CrossRefPubMed Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.CrossRefPubMed
32.
go back to reference Schünemann HJ, et al. Interpreting Results and Drawing Conclusions, in Cochrane Handbook for Systematic Reviews of Interventions. 2008, John Wiley & Sons, Ltd. p. 359–387 Schünemann HJ, et al. Interpreting Results and Drawing Conclusions, in Cochrane Handbook for Systematic Reviews of Interventions. 2008, John Wiley & Sons, Ltd. p. 359–387
34.
go back to reference Berkman ND, et al. Grading the Strength of a Body of Evidence When Assessing Health Care Interventions for the Effective Health Care Program of the Agency for Healthcare Research and Quality: An Update. 2008 Berkman ND, et al. Grading the Strength of a Body of Evidence When Assessing Health Care Interventions for the Effective Health Care Program of the Agency for Healthcare Research and Quality: An Update. 2008
35.
go back to reference Guyatt G, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–94.CrossRefPubMed Guyatt G, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–94.CrossRefPubMed
36.
go back to reference Fu R, et al. Conducting Quantitative Synthesis When Comparing Medical Interventions: AHRQ and the Effective Health Care Program. 2008 Fu R, et al. Conducting Quantitative Synthesis When Comparing Medical Interventions: AHRQ and the Effective Health Care Program. 2008
37.
go back to reference Kemp CA. Qigong as a therapeutic intervention with older adults. J Holist Nurs. 2004;22(4):351–73.CrossRefPubMed Kemp CA. Qigong as a therapeutic intervention with older adults. J Holist Nurs. 2004;22(4):351–73.CrossRefPubMed
38.
go back to reference Ng BH, Tsang HW. Psychophysiological outcomes of health qigong for chronic conditions: a systematic review. Psychophysiology. 2009;46(2):257–69.CrossRefPubMed Ng BH, Tsang HW. Psychophysiological outcomes of health qigong for chronic conditions: a systematic review. Psychophysiology. 2009;46(2):257–69.CrossRefPubMed
39.
go back to reference Guyatt G, et al. GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. J Clin Epidemiol. 2013;66(2):151–7.CrossRefPubMed Guyatt G, et al. GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. J Clin Epidemiol. 2013;66(2):151–7.CrossRefPubMed
40.
go back to reference Guyatt GH, et al. GRADE guidelines: 5. Rating the quality of evidence--publication bias. J Clin Epidemiol. 2011;64(12):1277–82.CrossRefPubMed Guyatt GH, et al. GRADE guidelines: 5. Rating the quality of evidence--publication bias. J Clin Epidemiol. 2011;64(12):1277–82.CrossRefPubMed
41.
go back to reference Deeks JJ, Higgins JPT, Altman DG. Analysing Data and Undertaking Meta-Analyses, in Cochrane Handbook for Systematic Reviews of Interventions. 2008, John Wiley & Sons, Ltd. p. 243–296 Deeks JJ, Higgins JPT, Altman DG. Analysing Data and Undertaking Meta-Analyses, in Cochrane Handbook for Systematic Reviews of Interventions. 2008, John Wiley & Sons, Ltd. p. 243–296
42.
go back to reference Kliner M, Garner P. When trial authors write Cochrane Reviews: competing interests need to be better managed. Cochrane Database Syst Rev. 2014;9:ED000089. Kliner M, Garner P. When trial authors write Cochrane Reviews: competing interests need to be better managed. Cochrane Database Syst Rev. 2014;9:ED000089.
44.
go back to reference Moher D, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9. W64.CrossRefPubMed Moher D, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9. W64.CrossRefPubMed
Metadata
Title
Resuming the discussion of AMSTAR: What can (should) be made better?
Authors
Uta Wegewitz
Beate Weikert
Alba Fishta
Anja Jacobs
Dawid Pieper
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Medical Research Methodology / Issue 1/2016
Electronic ISSN: 1471-2288
DOI
https://doi.org/10.1186/s12874-016-0183-6

Other articles of this Issue 1/2016

BMC Medical Research Methodology 1/2016 Go to the issue