Objectives To describe how the methodological quality of primary studies is assessed in systematic reviews and whether the quality assessment is taken into account in the interpretation of results. Data sources Cochrane systematic reviews and systematic reviews in paper based journals. Study selection 965 systematic reviews (809 Cochrane reviews and 156 paper based reviews) published between 1995 and 2002. Data synthesis The methodological quality of primary studies was assessed in 854 of the 965 systematic reviews (88.5%). This occurred more often in Cochrane reviews than in paper based reviews (93.9% v 60.3%, P < 0.0001). Overall, only 496 (51.4%) used the quality assessment in the analysis and interpretation of the results or in their discussion, with no significant differences between Cochrane reviews and paper based reviews (52% v 49%, P = 0.58). The tools and methods used for quality assessment varied widely. Conclusions Cochrane reviews fared better than systematic reviews published in paper based journals in terms of assessment of methodological quality of primary studies, although they both largely failed to take it into account in the interpretation of results. Methods for assessment of methodological quality by systematic reviews are still in their infancy and there is substantial room for improvement.

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This systematic review indicates that there is no reliable evidence to support the effectiveness of multisensory stimulation programmes in patients in coma or the vegetative state.

BackgroundComa and vegetative state follow traumatic brain injury in about one out of eight patients, and in patients with non traumatic injury the prognosis is worse. The use of sensory stimulation for coma and vegetative state has gained popularity during the 1980's but beliefs and opinions about its e ectiveness vary substantially among health professionals. ObjectivesTo assess the e ectiveness of sensory stimulation programmes in patients in coma or vegetative state. Search methodsWe searched the Injuries Group specialised register, the Cochrane Controlled trials register, EMBASE, MEDLINE, CINAHL and PSYCHLIT from 1966 to January 2002, without language restriction. Reference lists of articles were scanned and we contacted experts in the area to find other relevant studies. Selection criteriaRandomised or controlled trials that compared sensory stimulation programmes with standard rehabilitation in patients in coma or vegetative state. Data collection and analysisAbstracts and papers found were screened by one reviewer. Three reviewers independently identified relevant studies, extracted data and assessed study quality resolving disagreement by consensus. Main resultsThree studies were identified with 68 patients in total. The overall methodological quality was poor and studies di ered widely in terms of outcomes measures, study design and conduct. We therefore did not carry out any quantitative synthesis but reviewed results of available studies qualitatively.Sensory stimulation for brain injured individuals in coma or vegetative state (Review)