Evidence map›Paper›PMID 31730014›Full record

ArticleSystematic reviews2019

Risk of bias tools in systematic reviews of health interventions: an analysis of PROSPERO-registered protocols.

Kelly Farrah, Kelsey Young, Matthew C Tunis, Linlu Zhao

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Systematic reviews, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 117 papers, 52 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
117citing papers in PubMed, 52 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

117 citing papers in PubMed, 52 syntheses or guidelines pooled it.

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  14. Donor-Related Risk Factors for Normothermic Machine Perfusion in Liver Transplantation: A Meta-Analysis.Liver international : official journal of the International Association for the Study of the Liver · 2025
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57 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Kelly FarrahCentre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Canada.
Kelsey YoungCentre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Canada.
Matthew C TunisCentre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Canada.
Linlu ZhaoCentre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Canada. linlu.zhao@canada.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSystematic reviews of health interventions are increasingly incorporating evidence outside of randomized controlled trials (RCT). While non-randomized study (NRS) types may be more prone to bias compared to RCT, the tools used to evaluate risk of bias (RoB) in NRS are less straightforward and no gold standard tool exists. The objective of this study was to evaluate the planned use of RoB tools in systematic reviews of health interventions, specifically for reviews that planned to incorporate evidence from RCT and/or NRS.

methodsWe evaluated a random sample of non-Cochrane protocols for systematic reviews of interventions registered in PROSPERO between January 1 and October 12, 2018. For each protocol, we extracted data on the types of studies to be included (RCT and/or NRS) as well as the name and number of RoB tools planned to be used according to study design. We then conducted a longitudinal analysis of the most commonly reported tools in the random sample. Using keywords and name variants for each tool, we searched PROSPERO records by year since the inception of the database (2011 to December 7, 2018), restricting the keyword search to the "Risk of bias (quality) assessment" field.

resultsIn total, 471 randomly sampled PROSPERO protocols from 2018 were included in the analysis. About two-thirds (63%) of these planned to include NRS, while 37% restricted study design to RCT or quasi-RCT. Over half of the protocols that planned to include NRS listed only a single RoB tool, most frequently the Cochrane RoB Tool. The Newcastle-Ottawa Scale and ROBINS-I were the most commonly reported tools for NRS (39% and 33% respectively) for systematic reviews that planned to use multiple RoB tools. Looking at trends over time, the planned use of the Cochrane RoB Tool and ROBINS-I seems to be increasing.

conclusionsWhile RoB tool selection for RCT was consistent, with the Cochrane RoB Tool being the most frequently reported in PROSPERO protocols, RoB tools for NRS varied widely. Results suggest a need for more education and awareness on the appropriate use of RoB tools for NRS. Given the heterogeneity of study designs comprising NRS, multiple RoB tools tailored to specific designs may be required.

Indexed as

BiasSystematic Reviews as TopicBiomedical ResearchHumansRegistriesResearch DesignSelection BiasCritical appraisalNon-randomized studiesPROSPERORisk of biasSystematic reviews

Identifiers

PMID31730014
PMCPMC6857304

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.