Amstar Scale

AMSTAR 2
1. Did the research questions and inclusion criteria for the review include the components of
PICO?
For Yes: Optional (recommended)
 Population  Timeframe for follow-up  Yes
 Intervention  No
 Comparator group
 Outcome
2. Did the report of the review contain an explicit statement that the review methods were
established prior to the conduct of the review and did the report justify any significant
deviations from the protocol?
For Partial Yes: For Yes:
The authors state that they had a written As for partial yes, plus the protocol
protocol or guide that included ALL the should be registered and should also
following: have specified:
 Yes
 review question(s)  a meta-analysis/synthesis  Partial Yes
 a search strategy plan, if appropriate, and  No
 inclusion/exclusion criteria  a plan for investigating
causes of heterogeneity
 a risk of bias assessment
 justification for any
deviations from the protocol
3. Did the review authors explain their selection of the study designs for inclusion in the review?
For Yes, the review should satisfy ONE of the following:
 Explanation for including only RCTs  Yes
 OR Explanation for including only NRSI  No
 OR Explanation for including both RCTs and NRSI
4. Did the review authors use a comprehensive literature search strategy?
For Partial Yes (all the following): For Yes, should also have (all the
following):
 searched at least 2 databases  searched the reference  Yes
(relevant to research question) lists/bibliographies of  Partial Yes
 provided key word and/or included studies  No
search strategy  searched trial/study
 justified publication registries
restrictions (eg, language)  included/consulted content
experts in the field
 where relevant, searched for
grey literature
 conducted search within 24
months of completion of the
review
5. Did the review authors perform study selection in duplicate?
For Yes, either ONE of the following:
 at least two reviewers independently agreed on selection of eligible  Yes
studies and achieved consensus on which studies to include  No
 OR two reviewers selected a sample of eligible studies and achieved
good agreement (at least 80 per cent), with the remainder selected by
one reviewer
6. Did the review authors perform data extraction in duplicate?

For Yes, either ONE of the following:
 at least two reviewers achieved consensus on which data to extract  Yes
from included studies  No
 OR two reviewers extracted data from a sample of eligible studies and
achieved good agreement (at least 80 per cent), with the remainder
extracted by one reviewer
7. Did the review authors provide a list of excluded studies and justify the exclusions?
For Partial Yes: For Yes, must also have:
 provided a list of all  Justified the exclusion from  Yes
potentially relevant studies the review of each  Partial Yes
that were read in full text form potentially relevant study  No
but excluded from the review
8. Did the review authors describe the included studies in adequate detail?
For Partial Yes (ALL the following): For Yes, should also have ALL the
following:
 described populations  described population in  Yes
 described interventions detail  Partial Yes
 described comparators  described intervention and  No
comparator in detail
 described outcomes
(including doses where
 described research designs relevant)
 described study’s setting
 timeframe for follow-up
9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in
individual studies that were included in the review?
RCTs
For Partial Yes, must have assessed For Yes, must also have assessed
RoB from RoB from:
 unconcealed allocation, and  allocation sequence that was  Yes
 lack of blinding of patients not truly random, and  Partial Yes
and assessors when assessing  selection of the reported  No
outcomes (unnecessary for result from among multiple  Includes only
objective outcomes such as all measurements or analyses of NRSI
cause mortality) a specified outcome
NRSI
For Partial Yes, must have assessed For Yes, must also have assessed
RoB: RoB:  Yes
 from confounding, and  methods used to ascertain  Partial Yes
 from selection bias exposures and outcomes,  No
and  Includes only
 selection of the reported RCTs
result from among multiple
measurements or analyses of
a specified outcome
10. Did the review authors report on the sources of funding for the studies included in the review?
For Yes
 Must have reported on the sources of funding for individual studies included  Yes
in the review. Note: Reporting that the reviewers looked for this information  No
but it was not reported by study authors also qualifies
11. If meta-analysis was performed did the review authors use appropriate methods for statistical
combination of results?
RCTs
For Yes:
 The authors justified combining the data in a meta-analysis  Yes
 AND they used an appropriate weighted technique to combine  No
study results and adjusted for heterogeneity if present  No meta-analysis
 AND investigated the causes of any heterogeneity conducted
For NRSI
For Yes:
 The authors justified combining the data in a meta-analysis  Yes
 AND they used an appropriate weighted technique to combine  No
study results, adjusting for heterogeneity if present  No meta-analysis
 AND they statistically combined effect estimates from NRSI conducted
that were adjusted for confounding, rather than combining
raw data, or justified combining raw data when adjusted effect
estimates were not available
 AND they reported separate summary estimates for RCTs and
NRSI separately when both were included in the review
12. If meta-analysis was performed, did the review authors assess the potential impact of RoB in
individual studies on the results of the meta-analysis or other evidence synthesis?
For Yes:
 included only low risk of bias RCTs  Yes
 OR, if the pooled estimate was based on RCTs and/or NRSI at variable  No
RoB, the authors performed analyses to investigate possible impact of  No meta-analysis
RoB on summary estimates of effect conducted
13. Did the review authors account for RoB in individual studies when interpreting/discussing
the results of the review?
For Yes:
 included only low risk of bias RCTs  Yes
 OR, if RCTs with moderate or high RoB, or NRSI were included the  No
review provided a discussion of the likely impact of RoB on the results
14. Did the review authors provide a satisfactory explanation for, and discussion of, any
heterogeneity observed in the results of the review?
For Yes:
 There was no significant heterogeneity in the results
 OR if heterogeneity was present the authors performed an investigation  Yes
of sources of any heterogeneity in the results and discussed the impact  No
of this on the results of the review
15. If they performed quantitative synthesis did the review authors carry out an adequate
investigation of publication bias (small study bias) and discuss its likely impact on the results
of the review?
For Yes:
 performed graphical or statistical tests for publication bias and  Yes
discussed the likelihood and magnitude of impact of publication bias  No
 No meta-analysis
conducted
16. Did the review authors report any potential sources of conflict of interest, including any
funding they received for conducting the review?
For Yes:
 The authors reported no competing interests OR  Yes
 The authors described their funding sources and how they  No
managed potential conflicts of interest

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AMSTAR 2

6. Did the review authors perform data extraction in duplicate?

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