Abstract
We aimed to determine whether the existing risk of bias assessment tools addressed constructs other than risk of bias or internal validity, and whether they used numerical scores to express quality, which is discouraged and may be a misleading approach. We searched Ovid MEDLINE and Embase to identify quality appraisal tools across all disciplines in human health research. Tools designed specifically to evaluate reporting quality were excluded. Potentially eligible tools were screened by independent pairs of reviewers. We categorized tools according to conceptual constructs and evaluated their scoring methods. We included 230 tools published from 1995 to 2023. Access to the tool was limited to a peer-reviewed journal article in 63% of the sample. Most tools (76%) provided signaling questions whereas 39% produced an overall judgment across multiple domains. Most tools (93%) addressed concepts other than risk of bias such as the appropriateness of statistical analysis (65%), reporting quality (64%), indirectness (41%), imprecision (38%), and ethical considerations and funding (22%). Numerical scoring was used in 25% of tools. Currently available study quality assessment tools were not explicit about the constructs addressed by their items or signaling questions and addressed multiple constructs in addition to risk of bias. Many tools used numerical scoring systems which can be misleading. Limitations of the existing tools make the process of rating the certainty of evidence more difficult.
Published Version
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