AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both

Shea, Beverley; Reeves, Barnaby C; Wells, George A.; Thuku, Micere; Hamel, Candyce; Moran, Julian; Moher, David; Tugwell, Peter; Welch, Vivian; Kristjansson, Elizabeth; Henry, David

doi:10.1136/bmj.j4008

Cited by 6,218 publications

(6,110 citation statements)

References 56 publications

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“…AMSTAR was published in 2007,24 and has been widely used for assessing methodological quality of systematic reviews25–27 of both Cochrane and non-Cochrane overviews of healthcare interventions 28. AMSTAR was recently updated to AMSTAR 2, and now consists of a 16-item online tool for evaluating systematic reviews as high, moderate, low or critically low of methodological quality 24.…”

Section: Methodsmentioning

confidence: 99%

Medication adherence interventions and outcomes: an overview of systematic reviews

Wilhelmsen

Eriksson

2018

Eur J Hosp Pharm

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ObjectiveTo present evidence for healthcare-provided medication adherence interventions on clinical, economic and humanistic outcomes among patients.MethodsLiterature search of systematic reviews in Medline, Embase and CINAHL (2007–2017), validation of quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses questionnaires and, finally, extraction, combination and tabulation of results for included studies.ResultsFrom eight systematic reviews with medium to high AMSTAR 2 score, 37 randomised controlled studies involving 28 600 participants were extracted. Patient education and counselling showed some positive effects on medication adherence. Patient education also showed some positive effects on morbidity, healthcare utilities and patient satisfaction. Counselling had some benefit on mortality and healthcare utilisation. Simplifying doses was shown to have some benefit on morbidity and patient satisfaction. Interventions delivered by pharmacists and nurses showed a better result in improving adherence and outcomes than interventions delivered by general practitioners.ConclusionsSome interventions were found to have positive effect on adherence and outcomes, but no single strategy showed improvement in all settings. For future research patients should be screened for non-adherence to reveal both if they are non-adherent and type of non-adherence, as well as bigger sample sizes and longer duration of follow-up.

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Section: Methodsmentioning

confidence: 99%

Medication adherence interventions and outcomes: an overview of systematic reviews

Wilhelmsen

Eriksson

2018

Eur J Hosp Pharm

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“…(14) Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (15) If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review? (16) study may be cited only in one bibliographic database, the literature search must comprise multiple databases [3,10].…”

Section: Discussionmentioning

confidence: 99%

“…The methodological quality was assessed using the instrument "A MeaSurement Tool to Assess systematic Reviews" 2 [15]. The instrument consists of 16 domains assessing the risk of bias that may have arisen through poor conduct of the systematic reviews of both randomized controlled clinical trials and non-randomized studies [15].…”

Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

Methodologic Assessment of the Systematic Reviews of Ophthalmic Adverse Drug Reactions Published in Ophthalmology Journals: A Systematic Review

Penedones

Marques

2018

Ophthalmic Res

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Purpose: This systematic review aims to characterize and review the methodology of the systematic reviews reporting ophthalmic adverse drug reactions. Methods: This systematic review followed the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-analyses guide. MEDLINE and EMBASE databases were searched, by all Ophthalmology journals. All systematic reviews reporting ophthalmic adverse drug reactions in the last decade were included. Data on methodology were extracted. Methodological quality was assessed through A MeaSurement Tool to Assess systematic Reviews 2 scale. Descriptive analysis was performed. Results: Twenty-one systematic reviews were identified. Almost 60% of the systematic reviews reported non-ophthalmic drugs. Nine (43%) systematic reviews did not follow any recommendation. A search filter was not applied in 48% systematic reviews. Observational data was the source of information most included. The methodological quality was assessed in 57% systematic reviews. A meta-analysis was performed in 57% systematic reviews. The protocol’s elaboration, the explanation of the sources of information and the list of excluded articles were the domains less performed in the systematic reviews. Conclusion: The systematic reviews reporting ophthalmic adverse drug reactions diverged in some methodological aspects. Such an issue deserves further investigation, since discrepancies may lead to biased conclusions and, consequently, impact clinical and/or regulatory decisions.

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“…Recently, an update of the AMSTAR has been published (AMSTAR 2). This update is based on sixteen items and has an overall rating based on weaknesses in critical domains (54) . A new tool for assessing the risk of bias in systematic reviews (the ROBIS tool) mainly covers research questions relating to effectiveness, aetiology, diagnosis and prognosis (55) .…”

Section: Credibility Of the Evidence Within Meta-analysesmentioning

confidence: 99%

Generating the evidence for risk reduction: a contribution to the future of food-based dietary guidelines

et al. 2018

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A major advantage of analyses on the food group level is that the results are better interpretable compared with nutrients or complex dietary patterns. Such results are also easier to transfer into recommendations on primary prevention of non-communicable diseases. As a consequence, food-based dietary guidelines (FBDG) are now the preferred approach to guide the population regarding their dietary habits. However, such guidelines should be based on a high grade of evidence as requested in many other areas of public health practice. The most straightforward approach to generate evidence is meta-analysing published data based on a careful definition of the research question. Explicit definitions of study questions should include participants, interventions/exposure, comparisons, outcomes and study design. Such type of meta-analyses should not only focus on categorical comparisons, but also on linear and non-linear dose-response associations. Risk of bias of the individual studies of the meta-analysis should be assessed, rated and the overall credibility of the results scored (e.g. using NutriGrade). Tools such as a measurement tool to assess systematic reviews or ROBIS are available to evaluate the methodological quality/risk of bias of meta-analyses. To further evaluate the complete picture of evidence, we propose conducting network meta-analyses (NMA) of intervention trials, mostly on intermediate disease markers. To rank food groups according to their impact, disability-adjusted life years can be used for the various clinical outcomes and the overall results can be compared across the food groups. For future FBDG, we recommend to implement evidence from pairwise and NMA and to quantify the health impact of diet-disease relationships.

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AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both

Cited by 6,218 publications

References 56 publications

Medication adherence interventions and outcomes: an overview of systematic reviews

Medication adherence interventions and outcomes: an overview of systematic reviews

Methodologic Assessment of the Systematic Reviews of Ophthalmic Adverse Drug Reactions Published in Ophthalmology Journals: A Systematic Review

Generating the evidence for risk reduction: a contribution to the future of food-based dietary guidelines

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