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Methodological quality of systematic reviews on treatments in stroke rehabilitation: A cross-sectional study
Yin Ting Chan1, Sheung Yuen Siu2, Chung Hei Mak1
1The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
Objective:
Although high-quality systematic reviews (SRs) could provide reliable evidence on the effectiveness of stroke rehabilitation treatments, methodological flaws may weaken their trustworthiness. This study aimed to evaluate the methodological quality of an up-to-date sample of SRs on stroke rehabilitation treatments.
Literature Survey:
A comprehensive search was conducted in four electronic databases (MEDLINE, EMBASE, PsycINFO, and Cochrane Database of Systematic Reviews) for SRs published between January 2021 and September 2023. Eligible SRs focused on randomized controlled trials and included at least one meta-analysis assessing the effectiveness of stroke rehabilitation treatments.
Methodology:
After systematic screening, bibliographical data were extracted from included SRs using a predesigned form. The methodological quality was assessed using the 16-item A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) instrument. Associations between characteristics and methodological quality were examined using Kruskal-Wallis rank test, Spearman's rank correlation coefficient, and multivariable logistic regression models. Meta-analysis was not performed.
Synthesis:
A total of 140 SRs were appraised. Only two (1.4%) SRs were rated as having high overall methodological quality. The remaining SRs were rated as moderate (n = 2, 1.4%), low (n = 6, 4.3%), or critically low quality (n = 130, 92.9%). Cochrane SRs, SRs led by a corresponding author from the United States or Europe, SRs supported by European funding or those without funding support, SRs reporting intervention harms, and SRs published in journals with higher journal impact factors had a higher overall methodological quality than their counterparts. Only 4.3% of SRs conducted a comprehensive literature search, 12.9% provided a list of excluded studies with justifications, 7.1% explained study design selection for inclusion, 10.7% described the included primary studies in adequate detail, and 7.9% reported funding sources of primary studies.
Conclusions:
The methodological quality of SRs on stroke rehabilitation treatment is unsatisfactory. Findings of this study can shed light on potential areas of methodological improvements for future review authors.