R-AMSTAR Checklist OSH Evidence

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APPENDIX 1: R-AMSTAR checklist - quality assessment for
Systematic Reviews
How to use the R-AMSTAR tool?
The tool contains 11 questions with regard to the quality of the review. These questions are in the left
column. Based on the criteria mentioned in the right column, every question should be assigned a
score from 1 to 4. The sum of all scores is the overall quality score of the systematic review.
AMSTAR items
1. Was an ‘‘a priori’’ design provided?
The research question and inclusion criteria should be
established before the conduct of the review.
Criteria
A A clearly focused (PICO-based)
question
B Description of inclusion criteria
C Study protocol is published and/or
registered in advance
3 criteria 4, 2 3, 1 2, 0 1
Explanation: A. It should be explicitly mentioned that a protocol was published or registered, for
example in PROSPERO an online international prospective register of systematic reviews.
C. The question contains Population, Intervention/exposure, Comparator/control and Outcome.
2. Was there duplicate study selection and data
extraction?
There should be at least two persons who
independently extracted data and a consensus
procedure for disagreements should be in place.
A
At least two persons independently
extracted the data, explicitly stated
B Statement of consensus procedure for
disagreements
C Disagreements among extractors
resolved properly as stated or implied
3 criteria 4, 2 3, 1 2, 0 1
A At least two electronic sources are
3. Was a comprehensive literature search
searched
performed?
At least two electronic sources should be searched.
B Years and databases used are
mentioned
The report must include years and databases used
(e.g., Central, EMBASE, and MEDLINE). Key words C Key words and/or MESH terms are
stated and where feasible the search
and/or MESH terms must be stated, and where
feasible, the search strategy should be provided. All
strategy outline is provided
searches should be supplemented by consulting
D Searches should are supplemented by
consulting current contents, reviews,
current contents, reviews, textbooks, specialized
textbooks, registers and by reviewing
registers, or experts in the particular field of study,
and by reviewing the references in the studies found.
the references in the studies found
E Journals are hand-searched or manual
searched
4 or 5 criteria 4, 3 3, 2 2, 1 or 0 1
Explanation: E. hand-searched means identifying highly relevant journals and conducting a manual,
page-by-page search of their contents looking for potentially eligible studies.
4. Was the status of publication (i.e., grey
literature) used as an inclusion criterion?
The authors should state that they searched for reports
regardless of their publication type. The authors
should state whether or not they excluded any reports
(from the systematic review), based on their
publication status, language etc.
A
The authors state that they searched for
reports regardless of their publication
type.
B The authors state whether or not they
excluded any reports based on their
publication status, language etc.
C “Non-English papers were
translated”or readers sufficiently
trained in foreign language
D No language restriction or recognition
of non-English articles
3 or 4 criteria 4, 2 3, 1 2, 0 1
AMSTAR items
5. Was a list of studies (included and excluded)
provided?
A list of included and excluded studies should be
provided.
Criteria
A Table/list/figure of included studies, a
reference list does not suffice
B Table/list/figure of excluded studies
either in the article or in a
supplemental source
C Satisfactory/sufficient statement of the
reason for exclusion of the seriously
considered studies
D Reader is able to retrace the included
and the excluded studies anywhere in
the article bibliography, reference or
supplemental source
4 criteria 4, 3 3, 2 2, 1 1
Explanation: “Excluded studies” refers to those studies seriously considered on the basis of title
and/or abstract, but rejected after reading the body of the text.
A In an aggregated form such as a table,
6. Were the characteristics of the included studies
data from the original studies are
provided?
In an aggregated form, such as a table, data from the
provided on the participants,
original studies should be provided on the
interventions/exposure and outcomes
participants, interventions/exposure, and outcomes.
B Ranges are provided of the relevant
The ranges of characteristics in all the studies
characteristics in the studies analyzed
analyzed, e.g., age, race, sex, relevant socioeconomic C The information provided appears to
data, disease status, duration, severity, or other
be complete and accurate
diseases should be reported.
3 criteria 4, 2 3, 1 2, 0 1
7. Was the scientific quality of the included studies A ‘A priori’methods are provided
B The scientific quality of the included
assessed and documented?
‘‘A priori’’ methods of assessment should be
studies appears to be meaningful
provided (e.g., for effectiveness studies if the
C Discussion/recognition/awareness of
author(s) chose to include only randomized, doublelevel of evidence is present
blind, placebo-controlled studies, or allocation
D Quality of evidence is rated/ranked
concealment as inclusion criteria); for other types of
base on characterized instruments
studies, alternative items will be relevant.
4 criteria 4, 3 3, 2 2, 1 or 0 1
Explanation: D. A characterized instrument is a created instrument that ranks the level of evidence,
e.g. GRADE [Grading of Recommendations Assessment, Development and Evaluation].
8. Was the scientific quality of the included studies
used appropriately in formulating conclusions?
The results of the methodological rigor and scientific
quality should be considered in the analysis and the
conclusions of the review, and explicitly stated in
formulating recommendations.
9. Were the methods used to combine the findings
of studies appropriate?
For the pooled results, a test should be done to ensure
the studies were combinable, to assess their
homogeneity (i.e., Chi-squared test for homogeneity,
I2). If heterogeneity exists, a random effects model
should be used and/or the clinical appropriateness of
combining should be taken into consideration (i.e., is
it sensible to combine?).
A
The scientific quality is considered in
the analysis and the conclusions of the
review
B The scientific quality is explicitly
stated in formulating recommendations
C Conclusions integrated/drives towards
practice guidelines
D Clinical consensus statement drives
toward revision or confirmation of
practice guidelines
4 criteria 4, 3 3, 2 2, 1 or 0 1
A Statement of criteria that were used to
decide that the studies analyzed were
similar enough to be pooled
B For the pooled results, a test is done to
ensure the studies were combinable, to
assess their homogeneity
C a recoginition of heterogeneity or lack
of thereof is present
D If heterogeneity exists a ‘random
effects model’ is used and/or the
PEROSH OSH Evidence Methods
AMSTAR items
10. Was the likelihood of publication bias
assessed?
An assessment of publication bias should include a
combination of graphical aids (e.g., funnel plot, other
available tests) and/or statistical tests (e.g., Egger
regression test).
11. Was the conflict of interest included?
Potential sources of support should be clearly
acknowledged in both the systematic review and the
included studies.
Criteria
rationale of combining is taken into
consideration
E If homogeneity exists, author state a
rationale or a statistical test
4 or 5 criteria 4, 3 3, 2 2, 1 or 0 1
A Recognition of publication bias or filedrawer effect
B Graphical aids (e.g. funnel plot)
C Statistical tests (e.g. Egger regression
test)
3 criteria 4, 2 3, 1 2, 0 1
A Statement of sources of support
B No conflict of interest. This is
subjective and may require some
deduction or searching.
C An awareness/statement of support or
conflict of interest in the primary
inclusion studies
3 criteria 4, 2 3, 1 2, 0 1
Maximum quality score sum: 44
PEROSH OSH Evidence Methods

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