AMSTAR was developed to evaluate systematic reviews of randomised trials.
In this paper, we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both.
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The revisions were not intended to deal with the special requirements of diagnostic test reviews, individual patient data meta-analyses or network meta-analyses, scoping reviews, or realist reviews.3738394041We used a nominal group technique to propose and then prioritise specific changes to the instrument and to agree on the draft wording of items.
Based on their experience of the instrument and the presentations made at the meeting, participants were asked to record their ideas independently and privately.
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Many instruments have been designed to evaluate different aspects of reviews, but there are few comprehensive critical appraisal instruments.
This review identified many over-lapping appraisal items, mainly from two extensively cited reports.1617 The lists of items from these reports were combined and reduced by factor analysis.
After pilot testing, items were reworded as needed and the reliability and usability of the tool was assessed.
This underscores the need for guidelines that evaluate the way in which reviews are planned and conducted.56The Cochrane Collaboration Handbook provides a comprehensive guide for review authors, but it does not provide a concise critical appraisal instrument for completed reviews.5 Several instruments have been designed to evaluate individual studies that are being included in systematic reviews or how certain steps (eg, meta-analysis, testing for publication bias) should be conducted.789101112131415 But relatively few instruments assess all important steps in the conduct of a review.161718192021AMSTAR (A Mea Surement Tool to Assess systematic Reviews), published in 2007, is one of the most widely used instruments.222324 AMSTAR was designed by us and our colleagues as a practical critical appraisal tool for use by health professionals and policy makers who do not necessarily have advanced training in epidemiology, to enable them to carry out rapid and reproducible assessments of the quality of conduct of systematic reviews of randomised controlled trials of interventions.
Since publication, several critiques of the instrument have been published.25262728293031 These critiques plus feedback received at workshops and developments in the science of systematic reviews pointed to a need to revise and update the original AMSTAR instrument.