Skip to Main Content

Systematic Reviews

Resources for planning and conducting a Systematic Review of the literature.

Critical Appraisal Tools: Examples

AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both
Cochrane Risk of Bias Tool: RoB 2: A revised Cochrane risk-of-bias tool for randomized trials
Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses
QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies
ROBINS-I tool (Risk Of Bias In Non-randomized Studies - of Interventions)

Evidence Synthesis: GRADE (Grades of Recommendation, Assessment, Development and Evaluation) for Quantitative Studies. Five Domains:

Risk of Bias:

Publication Bias:

Imprecision:

Inconsistency:

Indirectness:

Examples of the GRADE Approach

Mobile technologies to support healthcare provider to healthcare provider communication and management of care.
Summary of Findings tables 1-3 displays Certainty of the Evidence (GRADE) judgements.

Motor control using cranio-cervical flexion exercises versus other treatments for non-specific chronic neck pain: A systematic review and meta-analysis.
Table 4: GRADE Assessment, displays Quality of the Evidence based on the five domains.

Additional GRADE Resources

GRADE Handbook.
GRADE Training Materials.
GRADE guidelines: 9. Rating up the quality of evidence. (2011). Guyatt GH, Oxman AD, Sultan S, et al.
There are three specific instances which may qualify observational study evidence to be upgraded when: a large magnitude of effect exists; there is a dose–response gradient; all plausible confounders or other biases increase our confidence in the estimated effect.
Latest GRADE guidance for considering non-randomized studies. (2020).
GRADE Guidelines: 18. How ROBINS-I and other tools to assess risk of bias in non-randomized studies should be used to rate the certainty of a body of evidence. (2019). Schünemann HJ, Cuello C, Akl EA, Mustafa RA, et al.
Cochrane Handbook Chapter 14: Completing ‘Summary of findings’ tables and grading the certainty of the evidence. Schünemann HJ, Higgins JPT, Vist GE, et al.
Rating the certainty in evidence in the absence of a single estimate of effect. (2017). Murad, M. H., Mustafa, R. A., Schünemann HJ, Sultan S, & Santesso N.
Applying GRADE without a meta-analysis and data were summarized narratively.

Evidence Synthesis: GRADE-CERQual for Qualitative Studies

Introductory Resources:

Assessment is based upon four components: Methodological Limitations, Coherence, Adequacy of Data, Relevance of Data.

Methodological Limitations:

Coherence:

Adequacy of Data:

Relevance of Data: