Cano Beatriz Hadassa Silva, da Silva Giulianna Faypher Morena Vieira, Bottari Gustavo Dias, Balbinot Eduarda Letícia, Uggioni Maria Laura Rodrigues, Roever Leonardo, da Rosa Maria Inês, Grande Antonio José
Laboratory of Evidence-based Practice, State University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
Laboratory of Translational Biomedicine, Postgraduate Program in Health Sciences, University of ExtremoSulCatarinense, Criciúma, SC, Brazil.
BMC Med Res Methodol. 2025 Apr 5;25(1):90. doi: 10.1186/s12874-025-02501-9.
Systematic Reviews (SRs) rigorously synthesize findings on a theme, but some articles with this design are redundant due to errors and conflicts. Meta-research aims to rigorously analyze research, assessing SRs' methodological quality and result reliability. This study evaluates SRs' overall quality in low- and middle-income countries (LMICs) on chronic non-communicable Diseases (NCDs) and key modifiable risk factors, using assessment tools.
A search strategy was conducted in the following databases: MEDLINE (via PubMed), Embase, (via Elsevier), Cochrane Library, and Grey Literature for published studies from January 1, 2014 - April 5, 2024. SRs addressing the association between at least one of the four most important modifiable behavioral risk factors (tobacco use, inadequate diet, alcohol consumption, and physical inactivity) and chronic NCDs in populations classified as LMICs according to the 'World Bank list of countries' were included. The selected studies were imported into the EndNote 20 software and analyzed using a form for the extraction of their main data and four tools were chosen to assess each of the most important domains of scientific evidence: Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) for article writing; Template for Intervention Description and Replication (TIDieR) for intervention description; A Measurement Tool for Evaluating Systematic Reviews (AMSTAR-2) for methodological assessment; and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) for certainty of evidence.
Nine studies were included in this analysis. The average Overall Score on the PRISMA 2020 checklist was 13.5 for articles published before 2020 and 25.67 for those published after 2020. TIDieR analysis revealed complete correspondence (100%) for item 'Brief Name', while other items, like 'Why' (89%), and 'What', 'Who Provided', and 'How' (78%), were partially met but significantly so. Regarding AMSTAR-2 criteria, only one study fulfilled all critical items, meeting item 7 by providing a detailed list of excluded studies and justifying each exclusion motive. Additionally, among critical items applicable to multiple articles, only item 11 was consistently fulfilled by all studies. In the final classification, one article achieved a moderate quality rating, three were critically low quality, and five had low quality among the nine evaluated articles. In the GRADE tool evaluation, limitations resulted in estimations for only 19 outcomes and 8 intervention-exposure sets.
The results demonstrated that the writing of recent scientific articles meets most of the PRISMA 2020 criteria, with a checklist being the most used tool. Interventions and exposure were also very well reported, with the TIDieR checklist not being cited in any study as a guiding tool. AMSTAR-2 revealed a methodological approach of varied quality, mainly low and critically low. The GRADE approach classified the certainty of the evidence as generally very low. Therefore, it is necessary to encourage adherence to these approaches to improve the methodological quality in SR studies on chronic NCDs and behavioral factors in LMICs.
系统评价（SRs）严格综合某一主题的研究结果，但一些采用这种设计的文章由于错误和冲突而存在冗余。元研究旨在严格分析研究，评估系统评价的方法学质量和结果可靠性。本研究使用评估工具评估低收入和中等收入国家（LMICs）关于慢性非传染性疾病（NCDs）和关键可改变风险因素的系统评价的整体质量。
在以下数据库中进行检索策略：MEDLINE（通过PubMed）、Embase（通过Elsevier）、Cochrane图书馆和灰色文献，检索2014年1月1日至2024年4月5日发表的研究。纳入根据“世界银行国家名单”分类为低收入和中等收入国家人群中，涉及四种最重要的可改变行为风险因素（烟草使用、饮食不足、饮酒和身体活动不足）中至少一种与慢性非传染性疾病之间关联的系统评价。将所选研究导入EndNote 20软件，并使用一个用于提取其主要数据的表格进行分析，选择四种工具来评估科学证据的每个最重要领域：用于文章撰写的系统评价和元分析的首选报告项目（PRISMA）；用于干预描述的干预描述和复制模板（TIDieR）；用于方法学评估的系统评价评估测量工具（AMSTAR-2）；以及用于证据确定性的推荐分级、评估、制定和评价（GRADE）。
本分析纳入了9项研究。2020年之前发表的文章在PRISMA 2020清单上的平均总分是13.5，2020年之后发表的文章是25.67。TIDieR分析显示，“简称”项完全对应（100%），而其他项，如“原因”（89%）以及“内容”“提供者”和“方式”（78%）部分符合但程度显著。关于AMSTAR-2标准，只有一项研究满足所有关键项，通过提供排除研究的详细列表并为每个排除动机提供理由来满足第7项。此外，在适用于多篇文章的关键项中，只有第11项所有研究都一致满足。在最终分类中，9篇评估文章中有1篇获得中等质量评级，3篇为极低质量，5篇为低质量。在GRADE工具评估中，局限性导致仅对19个结果和8个干预-暴露集进行了估计。
结果表明，近期科学文章的撰写符合PRISMA 2020的大多数标准，清单是最常用的工具。干预和暴露也报告得非常好，没有任何研究将TIDieR清单作为指导工具引用。AMSTAR-2显示出质量各异的方法学方法，主要是低质量和极低质量。GRADE方法将证据的确定性总体分类为非常低。因此，有必要鼓励遵守这些方法，以提高低收入和中等收入国家关于慢性非传染性疾病和行为因素的系统评价研究的方法学质量。
