Quality Of Evidence In Reviews Research Articles

Five indicators were developed to assess the quality of reviews on preventive interventions

ObjectivesThe objective of the study was to develop quality indicators for preventive effectiveness and to evaluate their use with Cochrane Reviews of primary preventive interventions. Study Design and SettingBased on the quality of care framework, we searched the literature to develop a set of quality indicators. Two authors applied the quality indicators independently to a sample of Cochrane systematic reviews of primary prevention. ResultsFive quality indicators were developed: sample size, directness of evidence, adherence, harm, and costs. We applied the quality indicators to a random sample of 84 of a total of 264 Cochrane reviews of primary preventive interventions. Only 70% reviews (n = 59) complied with the indicator sample size, whereas 61% (n = 51) complied with directness of the outcome, 48% (n = 40) with adherence, 76% (n = 64) with harm, and 46% (n = 39) with the indicator cost. ConclusionApplying the five quality indicators is feasible. The quality of evidence in reviews of primary prevention can be substantially improved. Trialists and review authors should provide more information especially on adherence, costs, and indirectness of the outcome. Methodological research is needed on how to incorporate cost information in systematic reviews and how to better deal with indirectness.

It is time to develop appropriate tools for assessing minimal clinically important differences, performance bias and quality of evidence in reviews of behavioral interventions.

It is time to develop appropriate tools for assessing minimal clinically important differences, performance bias and quality of evidence in reviews of behavioral interventions.

Judging the quality of evidence in reviews of prognostic factor research: adapting the GRADE framework

BackgroundPrognosis research aims to identify factors associated with the course of health conditions. It is often challenging to judge the overall quality of research evidence in systematic reviews about prognosis due to the nature of the primary studies. Standards aimed at improving the quality of primary studies on the prognosis of health conditions have been created, but these standards are often not adequately followed causing confusion about how to judge the evidence.MethodsThis article presents a proposed adaptation of Grading of Recommendations Assessment, Development and Evaluation (GRADE), which was developed to rate the quality of evidence in intervention research, to judge the quality of prognostic evidence.ResultsWe propose modifications to the GRADE framework for use in prognosis research along with illustrative examples from an ongoing systematic review in the pediatric pain literature. We propose six factors that can decrease the quality of evidence (phase of investigation, study limitations, inconsistency, indirectness, imprecision, publication bias) and two factors that can increase it (moderate or large effect size, exposure-response gradient).ConclusionsWe describe criteria for evaluating the potential impact of each of these factors on the quality of evidence when conducting a review including a narrative synthesis or a meta-analysis. These recommendations require further investigation and testing.