Selecting Risk of Bias Tools for Observational Studies for a Systematic Review of Anthropometric Measurements and Dental Caries among Children.

Rokiah Mamikutty,Jamaludin Marhazlinda,Ameera Syafiqah Aly

doi:10.3390/ijerph18168623

Abstract

In conducting a systematic review, assessing the risk of bias of the included studies is a vital step; thus, choosing the most pertinent risk of bias (ROB) tools is crucial. This paper determined the most appropriate ROB tools for assessing observational studies in a systematic review assessing the association between anthropometric measurements and dental caries among children. First, we determined the ROB tools used in previous reviews on a similar topic. Subsequently, we reviewed articles on ROB tools to identify the most recommended ROB tools for observational studies. Of the twelve ROB tools identified from the previous steps, three ROB tools that best fit the eight criteria of a good ROB tool were the Newcastle–Ottawa Scale (NOS) for cohort and case-control studies, and Agency for Healthcare Research and Quality (AHRQ) and the Effective Public Health Practice Project (EPHPP) for a cross-sectional study. We further assessed the inter-rater reliability for all three tools by analysing the percentage agreement, inter-class correlation coefficient (ICC) and kappa score. The overall percentage agreements and reliability scores of these tools ranged from good to excellent. Two ROB tools for the cross-sectional study were further evaluated qualitatively against nine of a tool’s advantages and disadvantages. Finally, the AHRQ and NOS were selected as the most appropriate ROB tool to assess cross-sectional and cohort studies in the present review.

Highlights

Assessment of the risk of bias (ROB) or the methodological quality of a study is an essential process in a systematic review and meta-analysis
This study was performed within a systematic review and meta-analysis, exploring the association between anthropometric measurements and dental caries among children in Asia to select the most appropriate ROB tool for observational studies (International prospective register of systematic review PROSPERO ID: CRD42019120547)
Of the eleven ROB tools, three tools were not identified by a specific name, four were multi-design tools

Summary

Introduction

Assessment of the risk of bias (ROB) or the methodological quality of a study is an essential process in a systematic review and meta-analysis. As recommended by the Cochrane Collaboration, the tools that evaluate the risk of bias assess internal validity, i.e., bias due to flaws in the design, conduct, or analysis of a study that affect its results [1]. The ROB tools focus on assessing six domains of bias, i.e., selection bias, performance bias, detection bias, attrition bias, reporting bias, and other study biases [2]. It is important to note that the ROB assessment differs from the overall quality assessment of a study, which refers to assessing internal and external validity, quality of reporting and best research practices, e.g., ethical approval [1,3]

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Discussion

Conclusion