Survey of Quality Assessment Methods of Included Studies in Overviews of Reviews_Chinese Journal of Evidence-Based Medicine

Authors：

YUAN Jinqiu ^1,2 ,  LIU Yali ^1,3 , YANG Kehu ^1,4 , CHEN Yaolong ¹ , YANG Man ^1,4

1. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China;2. School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China;3. Institute of Integrated Traditional Chinese and Western Medicine, Lanzhou University, Lanzhou, 730000, China;4. The First Clinical Medical College, Lanzhou University, Lanzhou 730000, China;

Corresponding author：

LIU Yali, Email: lyl_201006@126.com

Keywords：

Overview of reviews; Systematic review; Quality assessment method

DOI：

10.7507/1672-2531.20120038

Video：

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Objective 　To survey and analyze the quality assessment of the included studies in the Overviews of reviews (Overviews), so as to provide methodology references for Overviews authors.
Methods 　A computerized search was performed for collecting Overviews in The Cochrane Library (Issue 1, 2010), PubMed, EMBASE, and CBM, and the search time ended by December, 2009. Then the relevant data, such as assessment standard etc, were extracted, and the staple standards were analyzed.
Results 　A total of 43 typical Overviews were included. Thirty-two (74.4%) of them assessed the methodology quality of the included systematic reviews with different standards, including OQAQ (34.9%/15), AMSTAR (9.1%/3), Checklist from DARE (4.6%/2), Assendelft scale (4.6%/2), Effective Public Health Practice Project standards (2.3%/1), self-formulated standards (14.0%/ 6), syntaxic standards (2.3%/1), and other standards (4.6%/2). Ten Overviews (23.6%) assessed the quality of evidence, including eight (18.6%) applied the GRADE system. Only 7 studies (16.3%) assessed the quality of evidence and applied the GRADE system as well.
Conclusion 　The quality assessment in Overviews includes the assessment of both methodological quality and evidence quality. But most Overviews do not assess comprehensively. The methodological quality standards applied in current Overviews are numerous and no standard is acknowledged. Yet, the OQAQ and AMSTAR are applied widely and recommended because they are comprehensive and easy to be conducted. It suggests that Overviews authors should choose appropriate methodological quality assessment standards according to concrete conditions. The GRADE system is much more comprehensive and systematic than other systems, so it is recommended that Overviews authors should apply GRADE to assess the quality of evidence in their studies in order to make the study results more comprehensive and easier for clinical application.

Citation： YUAN Jinqiu,LIU Yali,YANG Kehu,CHEN Yaolong,YANG Man. Survey of Quality Assessment Methods of Included Studies in Overviews of Reviews. Chinese Journal of Evidence-Based Medicine, 2012, 12(2): 238-242. doi: 10.7507/1672-2531.20120038 Copy

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4.	Seida JK, Ospina MB, Karkhaneh M, et al. Systematic reviews of psychosocial interventions for autism: an umbrella review. Dev Med Child Neurol, 2009, 51(2): 95-104.
5.	Helfand M, Buckley DI, Freeman M, et al. Emerging risk factors for coronary heart disease: a summary of systematic reviews conducted for the U.S. Preventive Services Task Force. Ann Intern Med, 2009, 151(7): 496-507.
6.	Mikton C, Butchart A. Child maltreatment prevention: A systematic review of reviews. Bull World Health Organ, 2009, 87(5): 353-361.
7.	Peters LW, Kok G, Ten Dam GT, et al. Effective elements of school health promotion across behavioral domains: a systematic review of reviews. BMC Public Health, 2009, 9: 182.
8.	Moe RH, Haavardsholm EA, Christie A, et al. Effectiveness of nonpharmacological and nonsurgical interventions for hip osteoarthritis: an umbrella review of high-quality systematic reviews. Phys Ther, 2007, 87(12): 1716-1227.
9.	Jamtvedt G, Dahm KT, Christie A, et al. Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews. Phys Ther, 2008, 88(1): 123-136.
10.	Christie A, Jamtvedt G, Dahm KT, et al. Effectiveness of nonpharmacological and nonsurgical interventions for patients with rheumatoid arthritis: an overview of systematic reviews. Phys Ther, 2007, 87(12): 1697-1715.
11.	Bradley JM, Moran FM, Elborn JS. Evidence for physical therapies (airway clearance and physical training) in cystic fibrosis: An overview of five Cochrane systematic reviews. Respir Med, 2006, 100(2): 191-201.
12.	Krishnan JA, Segal JB, Streiff MB, et al. Treatment of venous thromboembolism with low-molecular-weight heparin: a synthesis of the evidence published in systematic literature reviews. RespirMed, 2004, 98(5): 376-386.
13.	Smith V, Devane D, Begley CM, et al. A systematic review and quality assessment of systematic reviews of randomised trials of interventions for preventing and treating preterm birth. Eur J Obstet Gynecol Reprod Biol, 2009, 142(1): 3-11.
14.	Main C, Thomas S, Ogilvie D, et al. Population tobacco control interventions and their effects on social inequalities in smoking: placing an equity lens on existing systematic reviews. BMC Public Health, 2008, 8: 178.
15.	Lewin S, Lavis JN, Oxman AD, et al. Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews. Lancet, 2008, 372(9642): 928-939.
16.	Franx G, Kroon H, Grimshaw J, et al. Organizational change to transfer knowledge and improve quality and outcomes of care for patients with severe mental illness: a systematic overview of reviews. Can J Psychiatry, 2008, 53(5): 294-305.
17.	Bambra C, Gibson M, Sowden AJ, et al. Working for health? Evidence from systematic reviews on the effects on health and health inequalities of organisational changes to the psychosocial work environment. Prev Med, 2009, 48(5): 454-461.
18.	Althabe F, Bergel E, Cafferata ML, et al. Strategies for improving the quality of health care in maternal and child health in low- and middle-income countries: an overview of systematic reviews. Paediatr Perinat Epidemiol, 2008, 22Suppl1: 42-60.
19.	Akl EA, Muti P, Schünemann HJ. Anticoagulation in patients with cancer: an overview of reviews. Pol Arch Med Wewn, 2008, 118(4): 183-193.
20.	Prior M, Guerin M, Grimmer-Somers K. The effectiveness of clinical guideline implementation strategies - A synthesis of systematic review findings. J Eval Clin Pract, 2008, 14(5): 888-897.
21.	Barton CJ, Webster KE, Menz HB. Evaluation of the scope and quality of systematic reviews on nonpharmacological conservative treatment for patellofemoral pain syndrome. J Orthop Sports Phys Ther, 2008, 38(9): 529-541.
22.	Clarke M. Systematic review of reviews of risk factors for intracranial aneurysms. Neuroradiology, 2008, 50(8): 653-664.
23.	Taylor NF, Dodd KJ, Shields N, et al. Therapeutic exercise in physiotherapy practice is beneficial: a summary of systematic reviews 2002-2005. Aust J Physiother, 2007, 53(1): 7-16.
24.	Kuukasjärvi P, Malmivaara A, Halinen M, et al. Overview of systematic reviews on invasive treatment of stable coronary artery disease. Int J Technol Assess Health Care, 2006, 22(2): 219-234.
25.	Wensing M, Wollersheim H, Grol R. Organizational interventions to implement improvements in patient care: a structured review of reviews. Implement Sci, 2006, 1: 2.
26.	Taylor NF, Dodd KJ, Damiano DL. Progressive resistance exercise in physical therapy: a summary of systematic reviews. Phys Ther, 2005, 85(11): 1208-1223.
27.	Smidt N, de Vet HC, Bouter LM, et al. Effectiveness of exercise therapy: a best-evidence summary of systematic reviews. Aust J Physiother, 2005, 51(2): 71-85.
28.	Sohn W, Ismail AI, Tellez M. Efficacy of educational interventions targeting primary care providers'practice behaviors: an overview of published systematic reviews. J Public Health Dent, 2004, 64(3): 164-172.
29.	Glazener CM, Evans JH, Peto RE. Treating nocturnal enuresis in children: review of evidence. J Wound Ostomy Continence Nurs, 2004, 31(4): 223-234.
30.	Linde K, ter Riet G, Hondras M, et al. Systematic reviews of herbal medicines--an annotated bibliography. Forsch Komplementarmed Klass Naturheilkd, 2003, 10 Suppl 1: 17-27.
31.	Grimshaw JM, Shirran L, Thomas R, et al. Changing provider behavior: an overview of systematic reviews of interventions. Med Care, 2001, 39(8 Suppl 2): II2-45.
32.	Furlan AD, Clarke J, Esmail R, et al. A critical review of reviews on the treatment of chronic low back pain. Spine, 2001, 26(7): E155-162.
33.	Anttila H, Suoranta J, Malmivaara A, et al. Effectiveness of physiotherapy and conductive education interventions in children with cerebral palsy: a focused review. Am J Phys Med Rehabil, 2008, 87(6): 478-501.
34.	Ozbilen M, Adams CE. Systematic overview of Cochrane reviews for anticholinergic effects of antipsychotic drugs . J Clin Psychopharmacol, 2009, 29(2): 141-146.
35.	Cnossen JS, ter Riet G, Mol BW, et al. Are tests for predicting pre-eclampsia good enough to make screening viable? A review of reviews and critical appraisal. Acta Obstet Gynecol Scand, 2009, 88(7): 758-765.
36.	Law J, Plunkett C, Taylor J, et al. Developing policy in the provision of parenting programmes: Integrating a review of reviews with the perspectives of both parents and professionals. Child Care Health Dev, 2009, 35(3): 302-312.
37.	Lemmens V, Oenema A, Knut IK, et al. Effectiveness of smoking cessation interventions among adults: A systematic review of reviews. Eur J Cancer Prev, 2008, 17(6): 535-544.
38.	Nilsen P, Yorkston E. Uncovering evidence on community-based injury prevention: A review of programme effectiveness and factors influencing effectiveness. Int J Inj Contr Saf Promot, 2007, 14(4): 241-250.
39.	van Dulmen S, Sluijs E, van Dijk L, et al. Patient adherence to medical treatment: A review of reviews. BMC Health Serv Res, 2007, 7: 55.
40.	Autti-Rämö I, Suoranta J, Anttila H, et al. Effectiveness of upper and lower limb casting and orthoses in children with cerebral palsy: an overview of review articles. Am J Phys Med Rehabil, 2006, 85(1): 89-103.
41.	Walker AE, McLeer SK; DAMOCLES Group. Small group processes relevant to data monitoring committees in controlled clinical trials: an overview of reviews. Clin Trials, 2004, 1(3): 282-296.
42.	Linde K, Vickers A, Hondras M, et al. Systematic reviews of complementary therapies - an annotated bibliography. Part 1: acupuncture. BMC Complement Altern Med, 2001, 1: 3.
43.	Linde K, Vickers A, Hondras M, et al. Systematic reviews of complementary therapies - an annotated bibliography. Part 2: herbal medicine. BMC Complement Altern Med, 2001, 1: 5.
44.	Linde K, Hondras M, Vickers A, et al. Systematic reviews of complementary therapies - an annotated bibliography. Part 3: homeopathy. BMC Complement Altern Med, 2001, 1: 4.
45.	Singh JA, Christensen R, Wells GA, et al. Biologics for rheumatoid arthritis: an overview of Cochrane reviews. Cochrane Database Syst Rev, 2009, (4): CD007848.
46.	Oxman AD, Guyatt GH, Singer J, et al. Agreement among reviewers of review articles. J Clin Epidemiol, 1991, 44: 91-98.
47.	Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol, 1991, 44: 1271-1278.
48.	Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Medical Research Methodology, 2007, 7: 10.
49.	Sacks H, Berrier J, Reitman D, et al. Meta-analyses of randomized controlled trials. N Engl J Med, 1987, 316(8): 450-455.
50.	Canadian Coordinating Office for Health Technology Assessment: Proposed Evaluation Tools for COMPUS, Available from https://www.ccohta.ca/compus/compus_pdfCOMPUS_Evaluation_Methodology_draft_e.pdf.
51.	Guyatt GH, Oxman AD, Kunz R, et al. What is "quality of evidence" and why is it important to clinicians?. BMJ, 2008, 336: 995-998.
52.	Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations. BMJ, 2008, 336: 924-926.
53.	Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328(7454): 1490.
54.	Holger J Schünemann, Andrew D Oxman, et al. Chapter 12: Interpreting results and drawing conclusions. Version 5.0.2 (updated September 2009). The Cochrane Collaboration, 2009.Available from www.cochrane-handbook.org.
55.	Schünemann H, Bro?ek J, Oxman A, editors. GRADE handbook for grading quality of evidence and strength of recommendation. Version 3.2 [updated March 2009]. The GRADE Working Group, 2009, Available from http://www.cc-ims.net/gradepro.

1. 杨克虎, 刘雅莉, 袁金秋, 等. 发展和完善中的“系统评价再评价”. 中国循证儿科杂志, 2011, (1): 321-324.
2. Becker LA, Oxman AD. Chapter 22: Overviews of reviews. In: Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.2 (updated September 2009). The Cochrane Collaboration, 2009. Available from www.cochrane-handbook.org.
3. Keus F, Gooszen HG, van Laarhoven CJ. Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis. An overview of Cochrane Hepato-Biliary Group reviews. Cochrane Database Syst Rev, 2010, (1): CD008318.
4. Seida JK, Ospina MB, Karkhaneh M, et al. Systematic reviews of psychosocial interventions for autism: an umbrella review. Dev Med Child Neurol, 2009, 51(2): 95-104.
5. Helfand M, Buckley DI, Freeman M, et al. Emerging risk factors for coronary heart disease: a summary of systematic reviews conducted for the U.S. Preventive Services Task Force. Ann Intern Med, 2009, 151(7): 496-507.
6. Mikton C, Butchart A. Child maltreatment prevention: A systematic review of reviews. Bull World Health Organ, 2009, 87(5): 353-361.
7. Peters LW, Kok G, Ten Dam GT, et al. Effective elements of school health promotion across behavioral domains: a systematic review of reviews. BMC Public Health, 2009, 9: 182.
8. Moe RH, Haavardsholm EA, Christie A, et al. Effectiveness of nonpharmacological and nonsurgical interventions for hip osteoarthritis: an umbrella review of high-quality systematic reviews. Phys Ther, 2007, 87(12): 1716-1227.
9. Jamtvedt G, Dahm KT, Christie A, et al. Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews. Phys Ther, 2008, 88(1): 123-136.
10. Christie A, Jamtvedt G, Dahm KT, et al. Effectiveness of nonpharmacological and nonsurgical interventions for patients with rheumatoid arthritis: an overview of systematic reviews. Phys Ther, 2007, 87(12): 1697-1715.
11. Bradley JM, Moran FM, Elborn JS. Evidence for physical therapies (airway clearance and physical training) in cystic fibrosis: An overview of five Cochrane systematic reviews. Respir Med, 2006, 100(2): 191-201.
12. Krishnan JA, Segal JB, Streiff MB, et al. Treatment of venous thromboembolism with low-molecular-weight heparin: a synthesis of the evidence published in systematic literature reviews. RespirMed, 2004, 98(5): 376-386.
13. Smith V, Devane D, Begley CM, et al. A systematic review and quality assessment of systematic reviews of randomised trials of interventions for preventing and treating preterm birth. Eur J Obstet Gynecol Reprod Biol, 2009, 142(1): 3-11.
14. Main C, Thomas S, Ogilvie D, et al. Population tobacco control interventions and their effects on social inequalities in smoking: placing an equity lens on existing systematic reviews. BMC Public Health, 2008, 8: 178.
15. Lewin S, Lavis JN, Oxman AD, et al. Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews. Lancet, 2008, 372(9642): 928-939.
16. Franx G, Kroon H, Grimshaw J, et al. Organizational change to transfer knowledge and improve quality and outcomes of care for patients with severe mental illness: a systematic overview of reviews. Can J Psychiatry, 2008, 53(5): 294-305.
17. Bambra C, Gibson M, Sowden AJ, et al. Working for health? Evidence from systematic reviews on the effects on health and health inequalities of organisational changes to the psychosocial work environment. Prev Med, 2009, 48(5): 454-461.
18. Althabe F, Bergel E, Cafferata ML, et al. Strategies for improving the quality of health care in maternal and child health in low- and middle-income countries: an overview of systematic reviews. Paediatr Perinat Epidemiol, 2008, 22Suppl1: 42-60.
19. Akl EA, Muti P, Schünemann HJ. Anticoagulation in patients with cancer: an overview of reviews. Pol Arch Med Wewn, 2008, 118(4): 183-193.
20. Prior M, Guerin M, Grimmer-Somers K. The effectiveness of clinical guideline implementation strategies - A synthesis of systematic review findings. J Eval Clin Pract, 2008, 14(5): 888-897.
21. Barton CJ, Webster KE, Menz HB. Evaluation of the scope and quality of systematic reviews on nonpharmacological conservative treatment for patellofemoral pain syndrome. J Orthop Sports Phys Ther, 2008, 38(9): 529-541.
22. Clarke M. Systematic review of reviews of risk factors for intracranial aneurysms. Neuroradiology, 2008, 50(8): 653-664.
23. Taylor NF, Dodd KJ, Shields N, et al. Therapeutic exercise in physiotherapy practice is beneficial: a summary of systematic reviews 2002-2005. Aust J Physiother, 2007, 53(1): 7-16.
24. Kuukasjärvi P, Malmivaara A, Halinen M, et al. Overview of systematic reviews on invasive treatment of stable coronary artery disease. Int J Technol Assess Health Care, 2006, 22(2): 219-234.
25. Wensing M, Wollersheim H, Grol R. Organizational interventions to implement improvements in patient care: a structured review of reviews. Implement Sci, 2006, 1: 2.
26. Taylor NF, Dodd KJ, Damiano DL. Progressive resistance exercise in physical therapy: a summary of systematic reviews. Phys Ther, 2005, 85(11): 1208-1223.
27. Smidt N, de Vet HC, Bouter LM, et al. Effectiveness of exercise therapy: a best-evidence summary of systematic reviews. Aust J Physiother, 2005, 51(2): 71-85.
28. Sohn W, Ismail AI, Tellez M. Efficacy of educational interventions targeting primary care providers'practice behaviors: an overview of published systematic reviews. J Public Health Dent, 2004, 64(3): 164-172.
29. Glazener CM, Evans JH, Peto RE. Treating nocturnal enuresis in children: review of evidence. J Wound Ostomy Continence Nurs, 2004, 31(4): 223-234.
30. Linde K, ter Riet G, Hondras M, et al. Systematic reviews of herbal medicines--an annotated bibliography. Forsch Komplementarmed Klass Naturheilkd, 2003, 10 Suppl 1: 17-27.
31. Grimshaw JM, Shirran L, Thomas R, et al. Changing provider behavior: an overview of systematic reviews of interventions. Med Care, 2001, 39(8 Suppl 2): II2-45.
32. Furlan AD, Clarke J, Esmail R, et al. A critical review of reviews on the treatment of chronic low back pain. Spine, 2001, 26(7): E155-162.
33. Anttila H, Suoranta J, Malmivaara A, et al. Effectiveness of physiotherapy and conductive education interventions in children with cerebral palsy: a focused review. Am J Phys Med Rehabil, 2008, 87(6): 478-501.
34. Ozbilen M, Adams CE. Systematic overview of Cochrane reviews for anticholinergic effects of antipsychotic drugs . J Clin Psychopharmacol, 2009, 29(2): 141-146.
35. Cnossen JS, ter Riet G, Mol BW, et al. Are tests for predicting pre-eclampsia good enough to make screening viable? A review of reviews and critical appraisal. Acta Obstet Gynecol Scand, 2009, 88(7): 758-765.
36. Law J, Plunkett C, Taylor J, et al. Developing policy in the provision of parenting programmes: Integrating a review of reviews with the perspectives of both parents and professionals. Child Care Health Dev, 2009, 35(3): 302-312.
37. Lemmens V, Oenema A, Knut IK, et al. Effectiveness of smoking cessation interventions among adults: A systematic review of reviews. Eur J Cancer Prev, 2008, 17(6): 535-544.
38. Nilsen P, Yorkston E. Uncovering evidence on community-based injury prevention: A review of programme effectiveness and factors influencing effectiveness. Int J Inj Contr Saf Promot, 2007, 14(4): 241-250.
39. van Dulmen S, Sluijs E, van Dijk L, et al. Patient adherence to medical treatment: A review of reviews. BMC Health Serv Res, 2007, 7: 55.
40. Autti-Rämö I, Suoranta J, Anttila H, et al. Effectiveness of upper and lower limb casting and orthoses in children with cerebral palsy: an overview of review articles. Am J Phys Med Rehabil, 2006, 85(1): 89-103.
41. Walker AE, McLeer SK; DAMOCLES Group. Small group processes relevant to data monitoring committees in controlled clinical trials: an overview of reviews. Clin Trials, 2004, 1(3): 282-296.
42. Linde K, Vickers A, Hondras M, et al. Systematic reviews of complementary therapies - an annotated bibliography. Part 1: acupuncture. BMC Complement Altern Med, 2001, 1: 3.
43. Linde K, Vickers A, Hondras M, et al. Systematic reviews of complementary therapies - an annotated bibliography. Part 2: herbal medicine. BMC Complement Altern Med, 2001, 1: 5.
44. Linde K, Hondras M, Vickers A, et al. Systematic reviews of complementary therapies - an annotated bibliography. Part 3: homeopathy. BMC Complement Altern Med, 2001, 1: 4.
45. Singh JA, Christensen R, Wells GA, et al. Biologics for rheumatoid arthritis: an overview of Cochrane reviews. Cochrane Database Syst Rev, 2009, (4): CD007848.
46. Oxman AD, Guyatt GH, Singer J, et al. Agreement among reviewers of review articles. J Clin Epidemiol, 1991, 44: 91-98.
47. Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol, 1991, 44: 1271-1278.
48. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Medical Research Methodology, 2007, 7: 10.
49. Sacks H, Berrier J, Reitman D, et al. Meta-analyses of randomized controlled trials. N Engl J Med, 1987, 316(8): 450-455.
50. Canadian Coordinating Office for Health Technology Assessment: Proposed Evaluation Tools for COMPUS, Available from https://www.ccohta.ca/compus/compus_pdfCOMPUS_Evaluation_Methodology_draft_e.pdf.
51. Guyatt GH, Oxman AD, Kunz R, et al. What is "quality of evidence" and why is it important to clinicians?. BMJ, 2008, 336: 995-998.
52. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations. BMJ, 2008, 336: 924-926.
53. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328(7454): 1490.
54. Holger J Schünemann, Andrew D Oxman, et al. Chapter 12: Interpreting results and drawing conclusions. Version 5.0.2 (updated September 2009). The Cochrane Collaboration, 2009.Available from www.cochrane-handbook.org.
55. Schünemann H, Bro?ek J, Oxman A, editors. GRADE handbook for grading quality of evidence and strength of recommendation. Version 3.2 [updated March 2009]. The GRADE Working Group, 2009, Available from http://www.cc-ims.net/gradepro.

Chinese Journal of Evidence-Based Medicine

Survey of Quality Assessment Methods of Included Studies in Overviews of Reviews

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