Assessing the methodological quality of systematic reviews using the AMSTAR tool
Introduction: Making decisions based on evidence has been a challenge for health professionals, given the need to have the tools and skills to carry out a critical appraisal of the evidence and assess the validity of the results. Systematic reviews of the literature (SRL) have been used widely to answer questions in the clinical field. Tools have been developed that support the appraisal of the quality of the studies. AMSTAR is one of these, validated and supported by reproducible evidence, which guides the methodological quality of the SRL.
Objectives: To show a historical, theoretical and practical guide for critical assessment of systematic reviews using AMSTAR to guide the argumental bases for their use according to the components of this methodological structure in health research, and to provide practical examples of how to apply this checklist.
Methods: We conducted a non-exhaustive review of literature in Pubmed and Cochrane Library using “AMSTAR” and “Systematic Reviews” as free terms without language or publication date limit; we also collected information from experts in the evaluation of the quality of the evidence.
Conclusions: AMSTAR is an instrument used, validated and supported by reproducible evidence for the evaluation of the internal validity of systematic reviews of the literature. It consists of 16 items that assess the overall methodological quality of an SRL. It is currently used indiscriminately and favorably, but it is not exempt from limitations and future updates based on new reproducibility and validation studies.
Gaitán Duarte HG, Rojas Reyes MX, Feliciano-Alfonso J. Búsqueda, evaluación y síntesis de la evidencia de efectividad y seguridad en evaluaciones de tecnología: Manual metodológico. Washington, D.C.; BID; 2017. DOI: http://dx.doi.org/10.18235/0000748
Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions Version 5.1.0. The Cochrane Collaboration; 2011.
Cañón M, Buitrago-Gómez Q. La pregunta de investigación en la práctica clínica: guía para formularla. Rev Colomb Psiquiatr. 2018;47(3):193-200. DOI: http://dx.doi.org/10.1016/j.rcp.2016.06.004
Beltrán Ó. Revisiones sistemáticas de la literatura. Rev Colomb Gastroenterol. 2005;(20):60-9.
Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312(7023):71-2. DOI: http://dx.doi.org/10.1136/bmj.312.7023.71
Al-Jundi A, Sakka S. Critical appraisal of clinical research. J Clin Diagn Res. 2017;11(5):JE01-5. DOI: http://dx.doi.org/10.7860/JCDR/2017/26047.9942
Gopalakrishnan S, Ganeshkumar P. Systematic reviews and meta-analysis: understanding the best evidence in primary healthcare. J Fam Med Prim Care. 2013. DOI: http://dx.doi.org/10.4103/2249-4863.109934
Robinson P, Lowe J. Literature reviews vs systematic reviews. Aust N Z J Public Health. 2015;39(2):103. DOI: http://dx.doi.org/10.1111/1753-6405.12393
Evidence-Based Medicine Working Group. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA. 1992;268(17):2420-5. DOI: http://dx.doi.org/10.1001/jama.1992.03490170092032
Ruiz Morales A, Gómez-Restrepo C. Epidemiología clínica: investigación clínica aplicada. Bogotá: Médica Panamericana; 2015.
Guyatt G, Rennie D, Meade M, Cook D. Users’ Guides to the medical literature: A Manual for evidence-based clinical practice, 3rd ed. McGraw-Hill Medical; 2008.
Oxman AD. Checklists for review articles. BMJ.1994;309(6955):648-51. DOI: http://dx.doi.org/10.1136/bmj.309.6955.648
Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol. 1991;44(11):1271-8. DOI: http://dx.doi.org/10.1016/0895-4356(91)90160-b
Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet (London, England). 1999;354(9193):1896-900. DOI: http://dx.doi.org/10.1016/s0140-6736(99)04149-5
Pussegoda K, Turner L, Garritty C, Mayhew A, Skidmore B, Stevens A, et al. Identifying approaches for assessing methodological and reporting quality of systematic reviews: a descriptive study. Syst Rev. 2017;6(1):117. DOI: https://doi.org/10.1186/s13643-017-0507-6
Shea B, Dub C, Moher D. Assessing the quality of reports of systematic reviews: The QUOROM statement compared to other tools. En: Systematic reviews in health care. London, UK: BMJ Publishing Group; 2001. p. 122-39.
Pussegoda K, Turner L, Garritty C, Mayhew A, Skidmore B, Stevens A, et al. Systematic review adherence to methodological or reporting quality. Syst Rev. 2017;6(1):131. DOI: http://dx.doi.org/10.1186/s13643-017-0527-2
Pieper D, Koensgen N, Breuing J, Ge L, Wegewitz U. How is AMSTAR applied by authors - a call for better reporting. BMC Med Res Methodol. 2018. DOI: https://doi.org/10.1186/s12874-018-0520-z
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;58:j4008 DOI: https://doi.org/10.1136/bmj.j4008
AMSTAR Assesing the Methodological Quality of Systematic Reviews The Development of Amstar [Internet]. Bruyère Research Institute, Ottawa, ON Canada; c2017 [citado 2020 ene. 9]. Disponible en: https://amstar.ca/contact_us.php
Egger M, Schneider M, Davey Smith G. Spurious precision? Meta-analysis of observational studies. BMJ. 1998;316(7125):140-4. DOI: http://dx.doi.org/10.1136/bmj.316.7125.140
Shea BJ, Bouter LM, Peterson J, Boers M, Andersson N, Ortiz Z, et al. External validation of a measurement tool to assess systematic reviews (AMSTAR). Gagnier J, editor. PLoS One. 2007;2(12):e1350. DOI: http://dx.doi.org/10.1371/journal.pone.0001350
Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, Grimshaw J, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol. 2009;62(10):1013-20. DOI: http://dx.doi.org/10.1016/j.jclinepi.2008.10.009
Sterne JAC, Egger M MD. Chapter 10: Addressing reporting biases. En: Higgins JPT, Green S (editors). Cochrane handbook for systematic reviews of intervention. 2011.
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