ObjectivesTo comprehensively evaluate the methodological quality and applicability of the results of systematic reviews on acupuncture treatment for primary depression.MethodsWeb of Science, EMbase, PubMed, The Cochrane Library, CNKI, CBM, WanFang Data and VIP databases were electronically searched to collect systematic reviews/meta-analyses on acupuncture treatment for primary depression from inception to December 5th, 2018. Two researchers independently screened and extracted data by using tools of AMSTAR 2 to evaluate the methodological quality, using ROBIS to assess risk of bias, and using CASP-S.R to evaluate the applicability of the results.ResultsA total of 18 systematic reviews/meta-analyses were included, and all focused on acupuncture intervention, including 2 primary outcome indicators. According to AMSTAR 2 evaluation results, there were 4 high quality studies, 12 medium quality studies and 2 low quality studies; ROBIS results found 10 high bias risk studies, 7 low bias risk studies and 1 unclear; CASP-S.R showed only 4 design studies applicable to local individuals, and there were no studies on the relationship between design benefits, hazards and costs.ConclusionsThe quality of systematic reviews/meta-analyses for acupuncture treatment of primary depression is moderate, however with a certain bias. Most studies may not directly benefit local individuals. All studies have no relationship with cost hazards. It is expected for further reviewers to strictly follow systematic evaluation method to improve research quality and reduce bias, while the applicability of the systematic review to individuals from different regions should be considered as well as the relationship between the benefit and cost hazard. In addition, more valid RCTs are required to provide higher quality evidence and explore correlated and comprehensive mechanism.
ObjectivesTo conduct an overview of systematic reviews (SRs) on Tuina from 2013 to 2017, and to explore recent research improvements on Tuina.MethodsPubMed, Web of Science, The Cochrane Library, SpringerLink e-book database, CNKI, VIP, WanFang Data and CBM databases were searched to collect SRs including randomized controlled clinical trials on Tuina from January 1st, 2013 to December 31st, 2017. Two reviewers independently screened literature, extracted data, and used AMSTAR 2 tool and PRISMA statement to assess methodology quality and reporting quality of included studies, respectively. The R 3.4.3 software was used to analyze data.ResultsA total of 8 SRs studies were included in the overview. The studied diseases involved radiculopathy cervical spondylotic, myelopathy cervical spondylotic, constipation, child anorexia, child diarrhea and external humeral epicondylitis. The results of above SRs showed that massage might be superior to other interventions in clinical efficacy, curative effects or total effective rate. However, due to the low quality of included studies of SRs, further evidence from high-quality clinical studies is required to verify above conclusions. For the results of AMSTAR 2 assessment, all 8 SRs were rated as very low quality. The quantity of items accomplished for each SR ranged from 7 to 13, 2 SRs had low methodological quality (percentage of accomplishment or partial accomplishment <50.0%) and 6 SRs with high methodological quality (percentage of accomplishment or partial accomplishment ≥50.0%). All 8 SRs did not report item 2 "Whether to declare research methods", item 10 "Whether reports have included funding sources for each study" and item 11 "Whether reports used the correct statistical method". The results of PRISMA assessment showed that all SR had good quality of reporting. The accomplished items number of each SR ranged from 22 to 26. However, there were defects in item 5(0), item 16(25.0%) and item 23(25.0%). All SRs did not report item 5 "Whether to declare research program".ConclusionsThis study finds that Tuina has supportive evidence-based medical evidence for treating anorexia, cervical spondylosis and other diseases, however, the SRs of Tuina are yet needed to be improved in terms of standardized degree. Therefore, establishing a reporting consolidated standard for evidence-based medicine on Tuina in order to improve the quality of clinical studies so as to provide clinicians with high-quality evidence is the focus of our further research.
ObjectiveTo overview the systematic reviews on efficacy and safety of hyperbaric oxygen in treatment of diabetic foot.MethodsCNKI, CBM, VIP, WanFang Data, The Cochrane Library, PubMed and EMbase databases were searched to collect systematic reviews or meta-analyses on the efficacy and safety of hyperbaric oxygen therapy for diabetic foot from inception to November 17th, 2019. Two researchers independently screened literature and extracted data. Then, AMSTAR 2 tool and PRISMA statement were used to evaluate the methodological quality and reporting quality of included systematic reviews, and the outcome indicators were comprehensively analyzed.ResultsA total of 10 systematic reviews were included. The results of AMSTAR 2 suggested that 6 systematic reviews were of extremely low quality, 3 of low quality, and 1 of high quality. The PRISMA score ranged from 16.5 to 27. The results of the included systematic reviews showed that hyperbaric oxygen therapy might be superior to other interventions in ulcer healing rate and large amputation rate without increasing the risk of adverse events. ConclusionsThe existing systematic reviews/meta-analysis evidence shows that hyperbaric oxygen therapy may have certain curative effect on diabetic foot, however, its methodology and report quality evaluation are insufficient.
AMSTAR (Assessment of Multiple Systematic Reviews) is currently developed as a measurement tool with extensive application to assess the methodological quality of systematic review/meta-analysis. It has good reliability, validity, and responsibility, and has been widely applied. This paper introduces AMSTAR to researchers and users in China, in view of development procedure, assessment items, and application status.
ObjectivesTo evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) on the treatment for acute gout.MethodsPubMed, EMbase, The Cochrane Library, Epistemonikos, CBM, WanFang Data and CNKI databases were electronically searched to collect published systematic reviews and meta-analyses evaluating drug interventions therapy in acute gout from inception to April 8th 2017. Two reviewers independently screened literature, extracted data, assessed the methodological quality of included SRs by the AMSTAR tool, and assessed the quality of the body of evidence for each outcome by the GRADE approach.ResultsA total of seven relevant SRs were included, which contains three main outcome measures. Four SRs contained non-steroidal anti-inflammatory drugs (NSAIDS), three SRs contained colchicine and two SRs contained glucocorticoids. All SRs assessed risk of bias of included original studies. Two used the Jadad scale or modified Jadad scale in this assessment while others used the " assessing risk of bias” tool recommended by Cochrane Collaboration. The assessment results of AMSTAR tool suggested that: three SRs were considered high quality (scores≥9), and the other four were considered moderate quality. GRADE results showed: the quality of the evidence of 11 outcomes was low or very low, and five outcomes was moderate.ConclusionsThe current evidence confirms the effectiveness and safety of several drug interventions in the treatment of acute gout, however, the priority of these drugs is still unclear. We suggest conducting new SRs and updating relevant SRs, to systematically compare different drug interventions therapy in acute gout with the latest evidence. In addition, we still expect to put more efforts in conducting high-quality original studies, in order to fill the gap of relevant fields and improve the level of evidence quality.
ObjectivesTo assess the methodological and reporting quality of surgical meta-analyses published in English in 2014.MethodsAll meta-analyses investigating surgical procedures published in 2014 were selected from PubMed and EMbase. The characteristics of these meta-analyses were collected, and their reporting and methodological quality were assessed by the PRISMA and AMSTAR, respectively. Independent predictive factors associated with these two qualities were evaluated by univariate and multivariate analyses.ResultsA total of 197 meta-analyses covering 10 surgical subspecialties were included. The mean PRISMA and AMSTAR score (by items) were 22.2±2.4 and 7.8±1.2, respectively, and a positive linear correlation was found between them with a R2 of 0.754. Those meta-analyses conducted by the first authors who had previously published meta-analysis was significantly higher in reporting and methodological quality than those who had not (P<0.001). Meanwhile, there were also significant differences in these reporting (P<0.001) and methodological (P<0.001) quality between studies published in Q1 ranked journals and (Q2+Q3) ranked jounals. On multivariate analyses, region of origin (non-Asiavs. Asia), publishing experience of first authors (ever vs. never), rank of publishing journals (Q1 vs. Q2+Q3), and preregistration (presence vs. absence) were associated with better reporting and methodologic quality, independently.ConclusionThe reporting and methodological quality of current surgical meta-analyses remained suboptimal, and first authors' experience and ranking of publishing journals were independently associated with both qualities. Preregistration may be an effective measure to improve the quality of meta-analysis, which deserves more attention from future meta-analysis reviewers.
Objective To evaluate the relevant systematic reviews/meta-analyses that focused on the prevention and treatment of complications after impacted tooth extraction. Methods The systematic reviews/meta-analyses on the prevention and treatment of complications after impacted tooth extraction were searched in PubMed, The Cochrane Library, CBM, CNKI and WanFang Data from inception to September 30th, 2012, and a total of 15 professional journals and the references of included studies were also retrieved manually. Two reviewers screened the literature according to the inclusion criteria and extracted the data. Then the AMSTAR was used to evaluate the quality of the included studies, and the GRADE system was used to evaluate the quality of evidence. Results A total of twelve relevant systematic reviews/meta-analyses were included, of which five focused on the prevention and treatment of dry socket, six on the prevention of swelling, seven on the prevention and treatment of pain, six on the prevention of limitation of mouth opening, two on the prevention of infection, three on the prevention of bleeding, and one on the treatment of nerve damage after tooth extraction. Based on AMSTAR, seven studies were minor limitations and five studies were moderate limitations. Based on GRADE system, two was high quality of evidence, twelve were moderate, nine were low, and seven were very low. Conclusion Currently, the systematic reviews/meta-analyses on the prevention and treatment of complications after impacted tooth extraction can provide some references for clinical practice, which should be combined with the real condition by clinical doctors when making an evidence-based decision. However, it also suggests performing more high quality and large sample studies to prove this conclusion.
ObjectivesTo evaluate the methodology quality and report quality of the published systematic reviews/meta-analyses (SRs/MAs) of pediatric tuina domestically and abroad.MethodsCBM, VIP, CNKI, WanFang Data, PubMed, EMbase, and The Cochrane Library were electronically searched to collect published pediatric tuina SRs/MAs from inception to December 10th, 2018. The SRs/MAs which includes scale evaluation used AMSTAR2 and the PRISMA report quality evaluation tool to systematically review methodology, adopts Excel to carry out data collation and statistical analysis. ResultsA total of 18 studies (14 in Chinese and 4 in English) on the SRs/MAs of pediatric tuina were finally included. In terms of methodological quality, 6 studies were of low quality and 12 studies were of very low quality. All studies did not explain the reasons for adopting a particular research design type, and few of them explained the pre-plan, exclusion list, reasons and funding. In terms of report quality, 7 studies were relatively complete, 10 studies had certain defects and one study had serious defects. The existing problems were program and registration, comprehensive retrieval, information sources, financial support and so on. ConclusionsSRs/MAs of pediatric tuina have different degrees of issues in terms of methodological quality and report quality which still require further improvement and continuous strengthening.
ObjectiveTo investigate the status of research and development methods of Cochrane overviews. MethodsThe Cochrane Library and PubMed were searched up to March 2014 to identify Cochrane overviews. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed and analyzed search strategy, quality assessment method, data analysis, and study results. ResultsA total of 18 Cochrane overviews were included. Among them, 4 (22.2%) overviews included formal statistical indirect comparison; 8 (44.4%) included only results from direct comparison; 6 (33.4%) only systematically analyzed current studies without data pooling; 12 (66.7%) only searched The Cochrane Library, while 6 (33.3%) expanded search to other databases; 14 (77.8%) applied the AMSTAR tool to assess methodological quality of included literature; 12 (66.7%) applied the GRADE system to assess the quality of evidence; and 9 (50%) yielded new outcomes. ConclusionCurrently, the development and reporting standards of Cochrane overviews are still immature. Investigators should choose proper methods based on research objectives when developing Cochrane overviews.
ObjectivesTo evaluate the quality of methodology and evidence of the exiting systematic reviews (SRs) of acupuncture therapy for post-stroke spastic paralysis.MethodsCNKI, CBM, The Cochrane Library, PubMed and EMbase databases were electronically searched to collect SRs of acupuncture therapy for post-stroke spastic paralysis from inception to December 16th, 2018. Two reviewers independently screened literature, extracted data, and evaluated the quality of methodology and evidence by AMSTAR 2 scale and GRADE system.ResultsA total of 7 SRs were included. The results showed that acupuncture therapy had obvious advantages in treating post-stroke spastic paralysis without obvious adverse reactions. The results of AMSTAR 2 scale showed that the failure of key items 2 and 7 resulted in extremely low methodological quality. The results of GRADE system showed that 46.15% of which were low-level evidence quality, 42.31% were medium, 11.54% were extremely low, and no evidence quality were high.ConclusionsCurrent evidence shows that acupuncture and moxibustion therapy is effective in treating spastic paralysis after stroke, however, the quality of the SRs is low. The studies are required to be standardized and combined with the characteristics of TCM to obtain high quality evidence in the future.