AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both

Beverley J Shea,David A Henry,George Wells,David Moher,Barnaby C Reeves,Elizabeth Kristjansson,Micere Thuku,Peter Tugwell,Vivian Welch,Julian Moran,Candyce Hamel

doi:10.1136/bmj.j4008

Abstract

The number of published systematic reviews of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions. Systematic reviews are subject to a...

Highlights

With moves to base more decisions on real world observational evidence, AMSTAR 2 should assist in the identification of high quality systematic reviews assist decision makers in the identification of high quality systematic reviews, including those based on non-randomised studies of healthcare interventions
AMSTAR 2 is a major revision of the original AMSTAR instrument, which was designed to appraise systematic reviews that included randomised controlled trials.[22,23,24]
The main modifications include simplified response categories; a more detailed consideration of risk of bias with included studies, and how this was handled by review authors in summarising and interpreting the results of their reviews; better alignment with the PICO framework for research questions; a more detailed justification of selection of study designs for inclusion in a review; and more information on studies that were excluded from reviews

Summary

RESEARCH Methods and Reporting

AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. The number of published systematic reviews of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions. Systematic reviews are subject to a range of biases and increasingly include nonrandomised studies of interventions. Many instruments have been designed to evaluate different aspects of reviews, but there are few comprehensive critical appraisal instruments. AMSTAR was developed to evaluate systematic reviews of randomised trials. We report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will

Summary points

Discussion

60 Scottish Intercollegiate Guidelines Network SIGN 50: Methodology Checklist 3