DiSilvestro Kevin J, Tjoumakaris Fotios P, Maltenfort Mitchell G, Spindler Kurt P, Freedman Kevin B
University of Maryland School of Medicine, Baltimore, Maryland, USA.
Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Am J Sports Med. 2016 Feb;44(2):533-8. doi: 10.1177/0363546515580290. Epub 2015 Apr 21.
The number of systematic reviews published in the orthopaedic literature has increased, and these reviews can help guide clinical decision making. However, the quality of these reviews can affect the reader's ability to use the data to arrive at accurate conclusions and make clinical decisions.
To evaluate the methodological and reporting quality of systematic reviews and meta-analyses in the sports medicine literature to determine whether such reviews should be used to guide treatment decisions. The hypothesis was that many systematic reviews in the orthopaedic sports medicine literature may not follow the appropriate reporting guidelines or methodological criteria recommended for systematic reviews.
Systematic review.
All clinical sports medicine systematic reviews and meta-analyses from 2009 to 2013 published in The American Journal of Sports Medicine (AJSM), The Journal of Bone and Joint Surgery (JBJS), Arthroscopy, Sports Health, and Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA) were reviewed and evaluated for level of evidence according to the guidelines from the Oxford Centre for Evidence-Based Medicine, for reporting quality according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and for methodological quality according to the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Analysis was performed by year and journal of publication, and the levels of evidence included in the systematic reviews were also analyzed.
A total of 200 systematic reviews and meta-analyses were identified over the study period. Of these, 53% included evidence levels 4 and 5 in their analyses, with just 32% including evidence levels 1 and 2 only. There were significant differences in the proportion of articles with high levels of evidence (P < .001) and low levels of evidence (P = .005) by journal. The average PRISMA score was 87% and the average AMSTAR score was 73% among all journals. The average AMSTAR and PRISMA scores were significantly different by journal (P = .002 and .001, respectively) and by year (P = .046 and .019, respectively). Arthroscopy, AJSM, and JBJS all scored higher than Sports Health and KSSTA on the PRISMA and AMSTAR. The average PRISMA score by year varied from 85% to 89%, and the average AMSTAR score varied from 70% to 76%.
Systematic reviews and meta-analyses in orthopaedics sports medicine literature relied on evidence levels 4 and 5 in 53% of studies over the 5-year study period. Overall, PRISMA and AMSTAR scores are high and may be better than those in other disciplines. Readers need to be conscious of potential shortcomings when reading systematic reviews and using them in practice.
骨科文献中发表的系统评价数量有所增加，这些评价有助于指导临床决策。然而，这些评价的质量可能会影响读者利用数据得出准确结论并做出临床决策的能力。
评估运动医学文献中系统评价和荟萃分析的方法学和报告质量，以确定此类评价是否应用于指导治疗决策。假设是骨科运动医学文献中的许多系统评价可能未遵循系统评价推荐的适当报告指南或方法学标准。
系统评价。
对2009年至2013年发表在《美国运动医学杂志》（AJSM）、《骨与关节外科杂志》（JBJS）、《关节镜检查》、《运动健康》以及《膝关节外科、运动创伤学、关节镜检查》（KSSTA）上的所有临床运动医学系统评价和荟萃分析进行审查，并根据牛津循证医学中心的指南评估证据水平，根据系统评价和荟萃分析的首选报告项目（PRISMA）声明评估报告质量，根据多重系统评价评估（AMSTAR）工具评估方法学质量。按发表年份和期刊进行分析，还分析了系统评价中纳入的证据水平。
在研究期间共识别出200项系统评价和荟萃分析。其中，53%的分析纳入了4级和5级证据，仅有32%仅纳入了1级和2级证据。不同期刊中具有高证据水平（P <.001）和低证据水平（P =.005）的文章比例存在显著差异。所有期刊中PRISMA平均得分87%，AMSTAR平均得分73%。不同期刊（分别为P =.002和.001）以及不同年份（分别为P =.046和.019）的AMSTAR和PRISMA平均得分存在显著差异。在PRISMA和AMSTAR方面，《关节镜检查》、AJSM和JBJS的得分均高于《运动健康》和KSSTA。每年的PRISMA平均得分在85%至89%之间，AMSTAR平均得分在70%至76%之间。
在为期5年的研究期间，53%的骨科运动医学文献中的系统评价和荟萃分析依赖于4级和5级证据。总体而言，PRISMA和AMSTAR得分较高，可能优于其他学科。读者在阅读系统评价并在实践中使用时需要意识到潜在的缺点。
