Revised Assessment Of Multiple Systematic Reviews Research Articles

Hamstring autografts demonstrate either similar or inferior outcomes to quadriceps or bone-patellar tendon-bone autografts in revision anterior cruciate ligament reconstruction: A systematic review of comparative studies.

To evaluate the clinical outcomes in patients undergoing revision anterior cruciate ligament reconstruction (r-ACLR) using hamstring tendon (HT) autografts with those using either quadriceps tendon (QT) or bone-patellar tendon-bone (BPTB) autografts or allografts. Three databases were searched on 8 August 2023. The authors adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, surgical details, patient-reported outcome measures (PROMs), rates of instability, failure and return to sport (RTS) were extracted. Eleven studies comprising 859 patients were included in this review. Five studies compared HT and QT autografts. One study each reported greater IKDC scores (p = 0.04) and Tegner scores (p = 0.04) in the QT group, while one study each reported higher anterior translation (p = 0.04), rates of positive pivot shift (p = 0.03) and rates of failure (p = 0.03) in the HT group. Six studies compared HT and BPTB autografts with one study each reporting greater Lysholm scores (p = 0.02) and less side-to-side anterior laxity (p < 0.01) in the BPTB group. Two studies compared HT autografts with allografts with only one study reporting a faster time to RTS in the HT group than the allograft group (p < 0.001). All other comparisons were not significant. HT autografts result in either similar or inferior outcomes in r-ACLR when compared to QT or BPTB autograft options. Allografts resulted in similar outcomes to HT autografts apart from greater time to RTS for r-ACLR. Level III.

The Efficacy of Cognitive Remediation Therapy for Anorexia Nervosa: A Systematic Review of Systematic Reviews.

Cognitive remediation therapy (CRT) for anorexia nervosa (AN) is an intervention specifically focused on addressing cognitive difficulties associated with the eating disorder. This systematic review of systematic reviews and meta-analysis aimed to provide a summary of the existing literature examining the efficacy of CRT in improving the neuropsychological, psychological, and clinical parameters of patients with AN. Systematic reviews and meta-analyses were sought in electronic databases, encompassing studies that explored the impact of CRT on AN. Three eligible reviews were identified based on the inclusion criteria. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was employed to evaluate the methodological quality of the reviews, and all included reviews demonstrated satisfactory methodological quality with an R-AMSTAR score of ≥22. Relevant information was extracted from each review and qualitatively compiled. Findings suggest that CRT can help people increase their awareness of cognitive styles and information processing and have a positive effect on patients' responses to treatment. Further research is required to better understand its impact on other relevant outcomes, including psychological variables, to optimize the treatment's benefits.

Anti-Inflammatory Treatment Efficacy in Major Depressive Disorder: A Systematic Review of Meta-Analyses.

Immune imbalances in major depressive disorder (MDD) have been targeted by anti-inflammatory treatment approaches in clinical trials to increase responsiveness to therapy. However, even after several meta-analyses, no translation of evidence into clinical practice has taken place. We performed a systematic review to evaluate meta-analytic evidence of randomized controlled trials on the use of anti-inflammatory agents for MDD to summarize efficacy estimates and elucidate shortcomings. Pooled effect estimates and heterogeneity indices were primary outcomes. Characteristics of the included meta-analyses were extracted. Scientific quality of meta-analyses was assessed using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR). N=20 meta-analyses met the eligibility criteria. Study characteristics like outcome scales, composition of patient populations, and add-on or monotherapy regimen varied very little for celecoxib studies, varied little for minocycline studies, and were rather variable for omega 3 fatty acids studies. R-AMSTAR scores ranged from 26 to 39 out of 44 points indicating variable quality, where a comprehensive literature search was the strongest and the consideration of scientific quality in the conclusions was the weakest domain across all meta-analyses. For minocycline and celecoxib, superiority was demonstrated with medium to large effect size with substantial heterogeneity and with large to very large effect size with negligible heterogeneity, respectively. For omega 3 fatty acids, superiority was also demonstrated with mainly small and medium effect sizes with substantial heterogeneity. However, for minocycline and omega 3 fatty acids, non-significant meta-analyses were found also. Even in our synthesized approach, no clear recommendations could be derived on the use of anti-inflammatory treatment for MDD due to several critical aspects like heterogeneity, diversity of patient populations, treatment regimen, and outcomes, and limited scientific quality. However, we observed clear inter-substance differences with meta-analytic evidence being strongest for celecoxib and weakest for omega 3 fatty acids.

A quality assessment of a sample of herbal medicine systematic reviews using R-AMSTAR

The numbers of herbal medicine systematic reviews (SR) are increasing, and reviews need to be good quality to inform practice and research. This study assesses the quality of herbal medicine SR and makes recommendations to those reading and writing them. Two open datasets from published meta-reviews were used as a sample, in which R-AMSTAR (Revised Assessment of Multiple Systematic Reviews) was used to assess the method quality of 94 SR. This scrutinises 11 domains including search strategy, risk of bias and other components, and compiles a score. The datasets were examined in Microsoft Excel.For the herbs studied, the numbers of SRs published had increased over time but quality standards had not altered. Reviews published with specialist groups and those with meta-analyses were higher quality. Overall, some methodological steps were performed well such as article searching. Other steps like pre-registering a protocol and providing a clear basis for selecting articles to assess could be enhanced.To conclude, the quality of SR was variable in this sample, on par with other medical areas. The use of quality assurance tools could help improve authors’ skills, although some aspects of quality assessed were influenced by the complexity of botanical material and herbal medicine.

Volar locking plate versus external fixation in distal radius fractures: A meta-analysis.

The purpose of this meta-analysis is to evaluate the efficacy of plate or external fixator treatments in distal radius fractures, based not only on clinical and radiographic parameters but on Health Related Quality of Life (HRQOL) parameters. The Preferred Reporting Items for Systematic Reviews and Metanalyses (PRISMA) guidelines were followed when conducting this systematic review. The Revised Assessment of Multiple Systematic Reviews (RAMSTAR) checklist was additionally consulted in order to ensure a high-quality methodological process, encompassing such elements as an ‘a priori’ design, independent reviews and comprehensive search. The literature search was carried out on PubMed, MEDLINE and Scopus. The search terms used were “Radius fracture AND osteosynthesis”, “Wrist fracture AND external fixator” and “Wrist fracture AND plate”. Two reviewers independently screened titles, abstracts and full texts. To determine inter-reviewer agreement, a k score was calculated after each screening state. Of the 5753 studies collected through the initial databases search, two studies were included in the final meta-analysis (125 treated with external fixator vs 132 with volar plate). There was a substantial inter-reviewer agreement as to the title (0.73; 95% confidence interval, 0.67-0.79) abstract (0.65; 95% CI, 0.46-0.83) and fulltext screening stages (0.89; 95%CI, 0.67-1). The meta-analysis reported a mean difference equal to 0.00 (95%CI= -0.05 – 0.05), in accordance with I2= 0% and p test for the heterogeneity value=0.089. This meta analysis confirms and quantifies that the two techniques are superimposable as regards the quality of life reported by patients at least one year of follow-up.

O uso da hidroterapia como recurso na melhora da espasticidade muscular em pacientes com sequelas do avc: uma revisão sistemática

O objetivo do presente estudo foi analisar através de uma revisão sistemática a respeito dos efeitos da hidroterapia na diminuição da espasticidade muscular resultando na melhora da marcha de pacientes com sequelas de Acidente Vascular Cerebral (AVC). Foi realizada uma revisão de literatura a partir da coleta de estudos disponíveis nas bibliotecas virtuais PubMED, SciELO e MEDLINE no período de março a abril de 2020, onde foram selecionados os artigos cujo o tema e resumo se apresentavam de acordo com a proposta do trabalho e as revisões foram avaliadas pela escala Revised Assessment of Multiple Systematic Reviews (R-AMSTAR). Foram encontrados 156 estudos, no entanto, 152 foram excluídos, restando apenas 4 estudos que se enquadravam nos critérios de inclusão e exclusão para inclusão nesta revisão. Concluímos que a hidroterapia oferece resultados satisfatórios quando combinada com outros métodos de tratamento, é um recurso eficaz na melhora do equilíbrio, no ganho de força muscular e na diminuição da espasticidade muscular.

M63. TRANSDIAGNOSTIC NEUROCOGNITIVE DEFICITS IN PSYCHIATRY: A REVIEW OF META-ANALYSES

BackgroundIn recent decades, several meta-analyses have documented the severity of neurocognitive impairments in various domains and psychiatric disorders. There is also a growing body of literature on the common factors among psychiatric disorders (e.g., common psychological factors, neurobiological alterations or genetic variants). The first objective of this review was to investigate transdiagnostic neurocognitive impairments across several psychiatric disorders. The second objective was to document transdiagnostic neurocognitive impairments across the life span, to establish whether they are consistent across age.MethodsA literature search was conducted in Pubmed, PsycINFO and Embase to identify all meta-analyses of neurocognitive deficits in psychiatry published prior to August, 2017. The following psychiatric disorders were considered: mood disorders, psychotic disorders, autism spectrum disorders, attention-deficit/hyperactivity disorder (ADHD), and anxiety disorders. The R-AMSTAR (Revised Assessment of Multiple Systematic Reviews) was used to assess methodological quality of all retrieved meta-analyses. The final selection included only the most rigorous meta-analyses.ResultsA total of 36 meta-analyses were included. They documented neurocognitive impairments in schizophrenia, autism spectrum disorder, ADHD, bipolar disorder, depression, obsessive-compulsive disorder, and posttraumatic stress disorder. Neurocognitive impairments were observed in the majority of psychiatric disorders, regardless of age group (childhood/adolescence, first episode, adulthood, elderly). Across all disorders, deficits in executive functions and in episodic memory were the most severe and the most frequently reported. Moreover, severe deficits in executive functions were frequently reported across age groups. Neurocognitive deficits were consistently more severe in schizophrenia compared to other psychiatric disorders, across all age groups.DiscussionNeurocognitive impairments were observed in almost all disorders, in all age groups. Some neurocognitive impairments were more frequently reported across all disorders. Indeed, executive functions and episodic memory were severely impaired in almost every age group and psychiatric disorder considered in this review. Deficits in these two domains appear to be transdiagnostic and they remain relatively stable across the life span. Transdiagnostic factors could be key targets for transdiagnostic cognitive interventions in psychiatric populations. Neurobiological, neuropsychological, and genetic hypotheses of transdiagnostic neurocognitive impairments are discussed.

The Aachen Falls Prevention Scale: Multi-Study Evaluation and Comparison.

BackgroundFall risk assessment is a time-consuming and resource-intensive activity. Patient-driven self-assessment as a preventive measure might be a solution to reduce the number of patients undergoing a full clinical fall risk assessment.ObjectiveThe aim of this study was (1) to analyze test accuracy of the Aachen Falls Prevention Scale (AFPS) and (2) to compare these results with established fall risk assessment measures identified by a review of systematic reviews.MethodsSensitivity, specificity, and receiver operating curves (ROC) of the AFPS were calculated based on data retrieved from 2 independent studies using the AFPS. Comparison with established fall risk assessment measures was made by conducting a review of systematic reviews and corresponding meta-analysis. Electronic databases PubMed, Web of Science, and EMBASE were searched for systematic reviews and meta-analyses that reviewed fall risk assessment measures between the years 2000 and 2018. The review of systematic reviews was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was used to assess the methodological quality of reviews. Sensitivity, specificity, and ROC were extracted from each review and compared with the calculated values of the AFPS.ResultsSensitivity, specificity, and ROC of the AFPS were evaluated based on 2 studies including a total of 259 older adults. Regarding the primary outcome of the AFPS subjective risk of falling, pooled sensitivity is 57.0% (95% CI 0.467-0.669) and specificity is 76.7% (95% CI 0.694-0.831). If 1 out of the 3 subscales of the AFPS is used to predict a fall risk, pooled sensitivity could be increased up to 90.0% (95% CI 0.824-0.951), whereas mean specificity thereby decreases to 50.0% (95% CI 0.42-0.58). A systematic review for fall risk assessment measures produced 1478 articles during the study period, with 771 coming from PubMed, 530 from Web of Science, and 177 from EMBASE. After eliminating doublets and assessing full text, 8 reviews met the inclusion criteria. All were of sufficient methodological quality (R-AMSTAR score ≥22). A total number of 9 functional or multifactorial fall risk assessment measures were extracted from identified reviews, including Timed Up and Go test, Berg Balance Scale, Performance-Oriented Mobility Assessment, St Thomas’s Risk Assessment Tool in Falling Elderly, and Hendrich II Fall Risk Model. Comparison of these measures with pooled sensitivity and specificity of the AFPS revealed a sufficient quality of the AFPS in terms of a patient-driven self-assessment tool.ConclusionsIt could be shown that the AFPS reaches a test accuracy comparable with that of the established methods in this initial investigation. However, it offers the advantage that the users can perform the self-assessment independently at home without involving trained health care professionals.

Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews.

Multiple sclerosis (MS) is a major cause of chronic, neurological disability, with a significant long-term disability burden, often requiring comprehensive rehabilitation. To systematically evaluate evidence from published Cochrane Reviews of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS (pwMS), to improve patient outcomes, and to highlight current gaps in knowledge. We searched the Cochrane Database of Systematic Reviews up to December 2017, to identify Cochrane Reviews that assessed the effectiveness of organised rehabilitation interventions for pwMS. Two reviewers independently assessed the quality of included reviews, using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool, and the quality of the evidence for reported outcomes, using the GRADE framework. Overall, we included 15 reviews published in the Cochrane Library, comprising 164 randomised controlled trials (RCTs) and four controlled clinical trials, with a total of 10,396 participants. The included reviews evaluated a wide range of rehabilitation interventions, including: physical activity and exercise therapy, hyperbaric oxygen therapy (HBOT), whole-body vibration, occupational therapy, cognitive and psychological interventions, nutritional and dietary supplements, vocational rehabilitation, information provision, telerehabilitation, and interventions for the management of spasticity. We assessed all reviews to be of high to moderate methodological quality, based on R-AMSTAR criteria.Moderate-quality evidence suggested that physical therapeutic modalities (exercise and physical activities) improved functional outcomes (mobility, muscular strength), reduced impairment (fatigue), and improved participation (quality of life). Moderate-quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer-term gains at the levels of activity and participation, and interventions that provided information improved patient knowledge. Low-qualitty evidence suggested that neuropsychological interventions, symptom-management programmes (spasticity), whole body vibration, and telerehabilitation improved some patient outcomes. Evidence for other rehabilitation modalities was inconclusive, due to lack of robust studies. The evidence suggests that regular specialist evaluation and follow-up to assess the needs of patients with all types of MS for appropriate rehabilitation interventions may be of benefit, although the certainty of evidence varies across the different types of interventions evaluated by the reviews. Structured, multidisciplinary rehabilitation programmes and physical therapy (exercise or physical activities) can improve functional outcomes (mobility, muscle strength, aerobic capacity), and quality of life. Overall, the evidence for many rehabilitation interventions should be interpreted cautiously, as the majority of included reviews did not include data from current studies. More studies, with appropriate design, which report the type and intensity of modalities and their cost-effectiveness are needed to address the current gaps in knowledge.

Supported self-management for people with type 2 diabetes: a meta-review of quantitative systematic reviews

ObjectivesSelf-management support aims to give people with chronic disease confidence to actively manage their disease, in partnership with their healthcare provider. A meta-review can inform policy-makers and healthcare managers about...

The management strategies of cancer-associated anorexia: a critical appraisal of systematic reviews

BackgroundCancer-related anorexia remains one of the most prevalent and troublesome clinical problems experienced by patients with cancer during and after therapy. To ensure high-quality care, systematic reviews (SRs) are seen as the best guide. Considering the methodology quality of SRs varies, we undertook a comprehensive overview, and critical appraisal of pertinent SRs.MethodsEight databases (between the inception of each database and September 1, 2017) were searched for SRs on the management of cancer-related anorexia. Two researchers evaluated the methodological quality of each SR by using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) checklist. Characteristics of the “high quality” SRs were abstracted, included information on relevant studies numbers, study design, population, intervention, control, outcome and result.ResultsEighteen SRs met the inclusion criteria. The R-AMSTAR scores of methodological quality ranged from 18 to 41 out of 44, with an average score of 30. Totally eight SRs scored ≥31 points, which showed high methodological quality, and would be used for data extraction to make summaries. Anamorelin had some positive effects to relieve cancer anorexia-cachexia syndrome (CACS) and improve the quality of life (QoL). Megestrol Acetate (MA) could improve appetite, and was associated with slight weight gain for CACS. Oral nutritional interventions were effective in increasing nutritional intake and improving some aspects of QoL in patients with cancer who were malnourished or at nutritional risk. The use of thalidomide, Eicosapentaenoic Acid, and minerals, vitamins, proteins, or other supplements for the treatment of cachexia in cancer were uncertain, and there was inadequate evidence to recommend it to clinical practices, the same situation in Chinese Herb Medicine and acupuncture (acupuncture and related therapies were effective in improving QoL) for treating anorexia in cancer patients, warranting further RCTs in these areas.ConclusionsAnamorelin, MA, oral nutrition interventions, and acupuncture could be considered to be applied in patients with cancer-related anorexia. Future RCTs and SRs with high quality on the pharmaceutical or non-pharmaceutical interventions of anorexia in cancer patients are warranted.

Impact on process results of clinical decision support systems (CDSSs) applied to medication use: overview of systematic reviews.

Objective:The purpose of this overview (systematic review of systematic reviews) is to evaluate the impact of clinical decision support systems (CDSS) applied to medication use in the care process.Methods:A search for systematic reviews that address CDSS was performed on Medline following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane recommendations. Terms related to CDSS and systematic reviews were used in combination with Boolean operators and search field tags to build the electronic search strategy. There was no limitation of date or language for inclusion. We included revisions that investigated, as a main or secondary objective, changes in process outcomes. The Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) score was used to evaluate the quality of the studies.Results:The search retrieved 954 articles. Five articles were added through manual search, totaling an initial sample of 959 articles. After screening and reading in full, 44 systematic reviews met the inclusion criteria. In the medication-use processes where CDSS was used, the most common stages were prescribing (n=38 (86.36%) and administering (n=12 (27.27%)). Most of the systematic reviews demonstrated improvement in the health care process (30/44 – 68.2%). The main positive results were related to improvement of the quality of prescription by the physicians (14/30 – 46.6%) and reduction of errors in prescribing (5/30 - 16.6%). However, the quality of the studies was poor, according to the score used.Conclusion:CDSSs represent a promising technology to optimize the medication-use process, especially related to improvement in the quality of prescriptions and reduction of prescribing errors, although higher quality studies are needed to establish the predictors of success in these systems.

Methodological quality of meta-analyses of single-case experimental studies

BackgroundMethodological rigor is a fundamental factor in the validity and credibility of the results of a meta-analysis. AimFollowing an increasing interest in single-case experimental design (SCED) meta-analyses, the current study investigates the methodological quality of SCED meta-analyses. Methods and proceduresWe assessed the methodological quality of 178 SCED meta-analyses published between 1985 and 2015 through the modified Revised-Assessment of Multiple Systematic Reviews (R-AMSTAR) checklist. Outcomes and resultsThe main finding of the current review is that the methodological quality of the SCED meta-analyses has increased over time, but is still low according to the R-AMSTAR checklist. A remarkable percentage of the studies (93.80% of the included SCED meta-analyses) did not even reach the midpoint score (22, on a scale of 0–44). The mean and median methodological quality scores were 15.57 and 16, respectively. Relatively high scores were observed for “providing the characteristics of the included studies” and “doing comprehensive literature search”. The key areas of deficiency were “reporting an assessment of the likelihood of publication bias” and “using the methods appropriately to combine the findings of studies”. Conclusions and implicationsAlthough the results of the current review reveal that the methodological quality of the SCED meta-analyses has increased over time, still more efforts are needed to improve their methodological quality.

The effectiveness of e-Interventions on reducing social isolation in older persons: A systematic review of systematic reviews.

As the older adult population group has been increasing in size, there has been evidence of growing social isolation and loneliness in their lives. The increased use of information communication technology and Internet-supported interventions has stimulated an interest in the benefits of e-Interventions for older people and specifically in having a role in increasing social networks and decreasing loneliness. A systematic review of e-Interventions to reduce loneliness in older people was conducted with the aim to synthesize high quality evidence on the effectiveness of e-Interventions to decrease social isolation/loneliness for older people living in community/residential care. A systematic search of 12 databases for reviews published between 2000-2017 was conducted using search term synonyms for older people, social isolation and interventions. Three independent researchers screened articles and two reviewers extracted data. The Revised-Assessment of Multiple Systematic Reviews was used to assess the quality of reviews. The final search identified 12 reviews, which included 22 unique primary research studies evaluating e-Interventions for social isolation or loneliness. The reviews were of moderate quality and the primary studies showed a lack of rigor. Loneliness was most frequently measured using the University California Los Angeles Loneliness Scale. Despite the limitations of the reviewed studies, there is inconsistent and weak evidence on using e-Interventions for loneliness in older people.

Web-Based Interventions for Weight Loss or Weight Loss Maintenance in Overweight and Obese People: A Systematic Review of Systematic Reviews

BackgroundWeight loss is challenging and maintenance of weight loss is problematic. Web-based programs offer good potential for delivery of interventions for weight loss or weight loss maintenance. However, the precise impact of Web-based weight management programs is still unclear.ObjectiveThe purpose of this meta-systematic review was to provide a comprehensive summary of the efficacy of Web-based interventions for weight loss and weight loss maintenance.MethodsElectronic databases were searched for systematic reviews and meta-analyses that included at least one study investigating the effect of a Web-based intervention on weight loss and/or weight loss maintenance among samples of overweight and/or obese individuals. Twenty identified reviews met the inclusion criteria. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was used to assess methodological quality of reviews. All included reviews were of sufficient methodological quality (R-AMSTAR score ≥22). Key methodological and outcome data were extracted from each review.ResultsWeb-based interventions for both weight loss and weight loss maintenance were more effective than minimal or control conditions. However, when contrasted with comparable non-Web-based interventions, results were less consistent across reviews.ConclusionsOverall, the efficacy of weight loss maintenance interventions was stronger than the efficacy of weight loss interventions, but further evidence is needed to more clearly understand the efficacy of both types of Web-based interventions.Trial RegistrationPROSPERO 2015: CRD42015029377; http://www.crd.york.ac.uk/PROSPERO/display_record.asp? ID=CRD42015029377 (Archived by WebCite at http://www.webcitation.org/6qkSafdCZ)

Quality Assessment of Meta-analyses Published in Leading Anesthesiology Journals From 2005 to 2014.

Meta-analysis, when preceded by a systematic review, is considered the "gold standard" in data aggregation; however, the quality of meta-analyses is often questionable, leading to uncertainty about the accuracy of results. In this study, we evaluate the quality of meta-analyses published in 5 leading anesthesiology journals from 2005 to 2014. A total of 220 meta-analyses published in Anesthesiology, Pain, British Journal of Anaesthesia, Anaesthesia, or Anesthesia & Analgesia were identified for inclusion. The quality of each meta-analysis was determined using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR). R-AMSTAR rated 11 questions related to systematic reviews and meta-analyses on a scale of 1-4, with 4 representing the highest quality. Overall meta-analyses quality was evaluated using a Spearmen regression analysis and found to positively correlate with time (rs = 0.24, P < .001). Similarly, a temporal association was found for conflict of interest (rs = 0.51, P < .001) and comprised a list of included and excluded studies (rs = 0.32, P < .001). In conclusion, the quality of meta-analyses published in leading anesthesiology journals has increased over the last decade. Furthermore, assessing the scientific quality of included studies in meta-analyses (P = .60) and using this assessment to formulate conclusions and/or recommendations (P = .67) remains relatively low (median R-AMSTAR: 2, interquartile range [IQR]: 2-3]; median R-AMSTAR: 2, IQR: 1-2, respectively).

Technology Integration in Mathematics Education: Examining the Quality of Meta-Analytic Research

The aim of this study was to evaluate the methodological quality of meta-analyses in mathematics education research. Computerized searches were conducted in ERIC, PsycINFO, ProQuest, and JSTOR through January 2016 for meta-analyses pertinent to technology integration in the mathematics classroom. To identify studies, mathematics subject matter terms such as ‘systematic review’, literature review’ and ‘meta-analysis’ were used. Retrieved studies were screened, extracted, and the methodological quality was evaluated using the 11-item Revised Assessment of Multiple Systematic Reviews (R-AMSTAR). The characteristics of meta-analyses associated with the methodological reporting quality were identified. Results suggest that on average the quality of methodological reporting is good, but there are several areas of concern. Implications are provided to improve research and classroom practice in this area.

Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews.

Overviews are a new approach to summarising evidence and synthesising results from related systematic reviews. To conduct an overview of Cochrane systematic reviews to provide a contemporary review of the evidence for delivery of cardiac rehabilitation, to identify opportunities for merging or splitting existing Cochrane reviews, and to identify current evidence gaps to inform new cardiac rehabilitation systematic review titles. We searched The Cochrane Database of Systematic Reviews (2014, Issue 10) to identify systematic reviews that addressed the objectives of this overview. We assessed the quality of included reviews using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) measurement tool and the quality of the evidence for reported outcomes using the GRADE framework. The focus of the data presentation was descriptive with detailed tabular presentations of review level and trial level characteristics and results. We found six Cochrane systematic reviews and judged them to be of high methodological quality. They included 148 randomised controlled trials (RCTs) in 98,093 participants. Compared with usual care alone, the addition of exercise-based cardiac rehabilitation in low-risk people after myocardial infarction or percutaneous coronary intervention or with heart failure appeared to have no impact on mortality, but did reduce hospital admissions and improved health-related quality of life. Psychological- and education-based interventions alone appeared to have little or no impact on mortality or morbidity but may have improved health-related quality of life. Home- and centre-based programmes were equally effective in improving quality of life outcomes at similar healthcare costs. Selected interventions can increase the uptake of cardiac rehabilitation programmes whilst there is currently only weak evidence to support interventions that improve adherence to cardiac rehabilitation programmes. The quality of the primary RCTs in the included systematic reviews was variable, and limitations in the methodological quality of the RCTs led to downgrading of the quality of the evidence, which varied widely by review and by outcome. Exercise-based cardiac rehabilitation is an effective and safe therapy to be used in the management of clinically stable people following myocardial infarction or percutaneous coronary intervention or who have heart failure. Future RCTs of cardiac rehabilitation need to improve their reporting methods and reflect the real world practice better including the recruitment of higher risk people and consideration of contemporary models of cardiac rehabilitation delivery, and identify effective interventions for enhancing adherence to rehabilitation.

Methodological quality of systematic reviews addressing femoroacetabular impingement.

As the body of literature on femoroacetabular impingement (FAI) continues to grow, clinicians turn to systematic reviews to remain current with the best available evidence. The quality of systematic reviews in the FAI literature is currently unknown. The goal of this study was to assess the quality of the reporting of systematic reviews addressing FAI over the last 11 years (2003-2014) and to identify the specific methodological shortcomings and strengths. A search of the electronic databases, MEDLINE, EMBASE and PubMed, was performed to identify relevant systematic reviews. Methodological quality was assessed by two reviewers using the revised assessment of multiple systematic reviews (R-AMSTAR) scoring tool. An intraclass correlation coefficient (ICC) with 95 % confidence intervals (CI) was used to determine agreement between reviewers on R-AMSTAR quality scores. A total of 22 systematic reviews were assessed for methodological quality. The mean consensus R-AMSTAR score across all studies was 26.7 out of 40.0, indicating fair methodological quality. An ICC of 0.931, 95 % CI 0.843-0.971 indicated excellent agreement between reviewers during the scoring process. The systematic reviews addressing FAI are generally of fair methodological quality. Use of tools such as the R-AMSTAR score or PRISMA guidelines while designing future systematic reviews can assist in eliminating methodological shortcomings identified in this review. These shortcomings need to be kept in mind by clinicians when applying the current literature to their patient populations and making treatment decisions. Systematic reviews of highest methodological quality should be used by clinicians when possible to answer clinical questions.

Nonallergic comorbidities of atopic eczema: an overview of systematic reviews

The aims of this overview are to synthesize the current evidence of published systematic reviews (SRs) on nonallergic comorbidities of atopic eczema (AE). EMBASE and MEDLINE were searched for SRs published from inception to November 2012. SRs were selected independently based on predefined inclusion criteria. Methodological quality of SRs included was assessed by two independent reviewers using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) checklist. Nine SRs met all inclusion criteria. Six reviews addressing the association between AE and cancer suggest a decreased risk of glioma, meningioma, and acute lymphoblastic leukemia in patients with current or previous AE. One SR reported a consistent positive association of AE with attention-deficit hyperactivity disorder (ADHD). Diabetes mellitus type 1 and multiple sclerosis (MS) were not significantly related to AE in reviews based on cross-sectional and case-control studies. Patients with AE appear to be at decreased risk of brain tumors. The relationship of AE with Th1- and Th17-mediated (auto-)inflammatory conditions such as diabetes mellitus type 1 and MS should be clarified in prospective observational studies. Children with AE are at increased risk of ADHD. SRs on the risk of depression and Th17-mediated disorders such as inflammatory bowel disease of patients with AE are missing.