Abstract
BackgroundAMSTAR-2 is a 16-item assessment tool to check the quality of a systematic review and establish whether the most important elements are reported. ROBIS is another assessment tool which was designed to evaluate the level of bias present within a systematic review. Our objective was to compare, contrast and establish both inter-rater reliability and usability of both tools as part of two overviews of systematic reviews. Strictly speaking, one tool assesses methodological quality (AMSTAR-2) and the other assesses risk of bias (ROBIS), but there is considerable overlap between the tools in terms of the signalling questions.MethodsThree reviewers independently assessed 31 systematic reviews using both tools. The inter-rater reliability of all sub-sections using each instrument (AMSTAR-2 and ROBIS) was calculated using Gwet’s agreement coefficient (AC1 for unweighted analysis and AC2 for weighted analysis).ResultsThirty-one systematic reviews were included. For AMSTAR-2, the median agreement for all questions was 0.61. Eight of the 16 AMSTAR-2 questions had substantial agreement or higher (> 0.61). For ROBIS, the median agreement for all questions was also 0.61. Eleven of the 24 ROBIS questions had substantial agreement or higher.ConclusionROBIS is an effective tool for assessing risk of bias in systematic reviews and AMSTAR-2 is an effective tool at assessing quality. The median agreement between raters for both tools was identical (0.61). Reviews that included a meta-analysis were easier to rate with ROBIS; however, further developmental work could improve its use in reviews without a formal synthesis. AMSTAR-2 was more straightforward to use; however, more response options would be beneficial.
Highlights
Assessment of Multiple Systematic Reviews (AMSTAR)-2 is a 16-item assessment tool to check the quality of a systematic review and establish whether the most important elements are reported
AMSTAR-2 assessed possible conflicts of interest, which is not assessed in ROBIS, despite being a potential risk of bias
In terms of quality assessment, ROBIS is an effective tool for assessing risk of bias in a systematic review but is more difficult to use compared to AMSTAR-2
Summary
AMSTAR-2 is a 16-item assessment tool to check the quality of a systematic review and establish whether the most important elements are reported. ROBIS is another assessment tool which was designed to evaluate the level of bias present within a systematic review. The quality and standard of reviews varies considerably. One previously heavily cited tool is the Assessment of Multiple Systematic Reviews (AMSTAR) scale [2] which has been widely used since its development in 2007. This scale was shown to be both reliable and valid [3]. It came under criticism for some issues with its design. It was argued by Burda et al [4] that AMSTAR was lacking in some key constructs, in particular, the
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