How are systematic reviews of prevalence conducted? A methodological study

Abstract

Background: There is a notable lack of methodological and reporting guidance for systematic reviews of prevalence data. This information void has the potential to result in reviews that are inconsistent and inadequate to inform healthcare policy and decision making. The aim of this meta-epidemiological study is to describe the methodology of recently published prevalence systematic reviews. Methods: We searched MEDLINE (via PubMed) from February 2017 to February 2018 for systematic reviews of prevalence studies. We included systematic reviews assessing the prevalence of any clinical condition using patients as the unit of measurement and we summarized data related to reporting and methodology of the reviews. Results: A total of 235 systematic reviews of prevalence were analyzed. The median number of authors was 5 (interquartile range [IQR] 4-7), the median number of databases searched was 4 (3-6) and the median number of studies included in each review was 24 (IQR 15-41.5). Search strategies were presented for 68% of reviews. Forty five percent of reviews received external funding, and 24% did not provide funding information. Twenty three percent of included reviews had published or registered the systematic review protocol. Reporting guidelines were used in 72% of reviews. The quality of included studies was assessed in 80% of reviews. Nine reviews assessed the overall quality of evidence (4 using GRADE). Meta-analysis was conducted in 65% of reviews; 1% used Bayesian methods. Random effect meta-analysis was used in 94% of reviews; among them, 75% did not report the variance estimator used. Among the reviews with meta-analysis, 70% did not report how data was transformed; 59% percent conducted subgroup analysis, 38% conducted meta-regression and 2% estimated prediction interval; I 2 was estimated in 95% of analysis. Publication bias was examined in 48%. The most common software used was STATA (55%). Conclusions: Our results indicate that there are significant inconsistencies regarding how these reviews are conducted. Many of these differences arose in the assessment of methodological quality and the formal synthesis of comparable data. This variability indicates the need for clearer reporting standards and consensus on methodological guidance for systematic reviews of prevalence data.

Distribution and prevalence of musculoskeletal pain co-occurring with persistent low back pain: a systematic review

“…The risk of bias assessment is shown in Table 2 . In the overall rating, 14 articles were judged to have a low risk of bias [ 29 – 35 , 38 – 43 , 46 ], three articles a moderate risk of bias [ 28 , 36 , 37 ], and two articles a high risk of bias [ 44 , 45 ]. Overall, the internal validity was judged to be slightly better than the external validity, also, when the articles with an overall high risk of bias were excluded.…”

“…For co-occurring extremity pain in the hip, knee, and foot the prevalence in the general population ranged from 20 to 48% [ 29 , 30 , 32 – 34 ], while in the working population the prevalence of co-occurring knee pain was 27% [ 38 ]. In clinical populations , the prevalence co-occurring buttock, leg, or foot pain was 50% [ 46 ], the prevalence of pelvic and pelvic-groin pain ranged from 6 to 28% [ 40 , 46 ], and the prevalence of co-occurring shoulder-arm-hand pain was 17% in the only study that considered upper extremity pain [ 46 ].…”

“…In the general population the prevalence of any co-occurring pain in arms, legs, or joints were 43% [ 29 ] and other musculoskeletal pain 79% [ 37 ], while the prevalence of co-occurring pain in arms, legs, or joints was reported to be 89% and the prevalence of widespread pain (defined as pain in most of your body) was 30% in a clinical population [ 40 ]. Another clinical population study reported the prevalence of co-occurring chest-abdomen-groin pain (‘anterior trunk pain’) to be 20% [ 43 ]; yet another clinical population study reported the prevalence of co-occurring thorax pain to be 10%, and pain in other body sites 65% [ 46 ].…”

“…Another clinical population study reported the prevalence of co-occurring chest-abdomen-groin pain (‘anterior trunk pain’) to be 20% [ 43 ]; yet another clinical population study reported the prevalence of co-occurring thorax pain to be 10%, and pain in other body sites 65% [ 46 ]. Headache was not part of our search strategy, but we have included the prevalences of headache in studies that otherwise was eligible, and it was reported to be 22 to 32% in the general population [ 28 , 29 ] and 29% in a clinical population [ 40 ]. Additionally, headache was included in two studies that counted number of pain sites [ 35 , 42 ].…”

Response to ‘Correspondence on ‘Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis’’ by Shiet al

“…We agree that the GRADE approach theoretically has a limitation to assess the quality of evidence for observational studies or incidence/prevalence studies because it includes few criteria to upgrade the quality of evidence for observational studies and has limited applicability to incidence/ prevalence studies. 6 Given that several previous studies have used the GRADE approach to assess the quality of evidence for meta-analysis in such settings, [7][8][9] we think the GRADE approach would be a reasonable method if researchers are aware of the limitations.…”