Quality of systematic reviews on timing of complementary feeding for early childhood allergy prevention

The confidence in the results of physiotherapy systematic reviews in the musculoskeletal field is not increasing over time: a meta-epidemiological study using AMSTAR 2 tool

OBJECTIVES

To assess the confidence in the results of systematic reviews on the effectiveness of physiotherapy for musculoskeletal conditions in the past 10 years and to analyze trends and factors associated.

METHODS

This is a metaepidemiological study on systematic reviews (SRs) with meta-analysis of randomized controlled trials (RCTs). MEDLINE, Cochrane Database of Systematic Reviews, CINAHL, and PEDro were searched for SRs of RCT on physiotherapy interventions for musculoskeletal disorders from December 2012 to December 2022. Two researchers independently screened the records based on the inclusion criteria; a random sample of 100 studies was selected, and each journal, author, and study variable was extracted. The methodological quality of SRs was independently assessed with the AMSTAR 2 tool. Any disagreement was solved by consensus.

RESULTS

The confidence in SRs results was critically low in 90% of the studies, and it did not increase over time. Cochrane reviews are predominantly represented in the higher AMSTAR 2 confidence levels, with a statistically significant difference compared to non-Cochrane reviews. The last author's H-index is the only predictor of higher confidence among the variables analyzed (OR 1.04; 95% CI: 1.01, 1.06).

CONCLUSION

The confidence in SRs results is unacceptably low. Given the relevance of musculoskeletal disorders and the impact of evidence synthesis on the clinical decision-making process, there is an urgent need to improve the quality of secondary research by adopting more rigorous methods.

Value of preclinical systematic reviews and meta-analyses in pediatric research

Similar to systematic reviews (SRs) in clinical fields, preclinical SRs address a specific research area, furnishing information on current knowledge, possible gaps, and potential methodological flaws of study design, conduct, and report. One of the main goals of preclinical SRs is to identify aspiring treatment strategies and evaluate if currently available data is solid enough to translate to clinical trials or highlight the gaps, thus justifying the need for new studies. It is imperative to rigorously follow the methodological standards that are widely available. These include registration of the protocol and adherence to guidelines for assessing the risk of bias, study quality, and certainty of evidence. A special consideration should be made for pediatric SRs, clinical and preclinical, due to the unique characteristics of this age group. These include rationale for intervention and comparison of primary and secondary outcomes. Outcomes measured should acknowledge age-related physiological changes and maturational processes of different organ systems. It is crucial to choose the age of the animals appropriately and its possible correspondence for specific pediatric age groups. The findings of well-conducted SRs of preclinical studies have the potential to provide a reliable evidence synthesis to guide the design of future preclinical and clinical studies. IMPACT: This narrative review highlights the importance of rigorous design, conduct and reporting of preclinical primary studies and systematic reviews. A special consideration should be made for pediatric systematic reviews of preclinical studies, due to the unique characteristics of this age group.

Most systematic reviews reporting adherence to AMSTAR 2 had critically low methodological quality: a cross-sectional meta-research study

OBJECTIVES

To analyze the methodological quality and characteristics of systematic reviews (SRs) that reported they were conducted in line with the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews).

STUDY DESIGN AND SETTING

This was a cross-sectional meta-research study. We searched MEDLINE and Embase. We included full reports of SRs reporting the study was conducted, prepared, or designed in line with the AMSTAR 2. Eligible SRs were those published from January 1, 2018, until May 3, 2022. We assessed the methodological quality of the included SRs using AMSTAR 2.

RESULTS

We included a total of 45 records. There were 43 SRs and 2 SR protocols. Among them, most were SRs of interventions that included primary studies on humans. More than half had a meta-analysis. According to our overall AMSTAR 2 assessments of included SRs, 35 SRs were of critically low confidence, 7 SRs were of low confidence, and one SR was of high confidence. There were no SRs of moderate confidence.

CONCLUSION

Even when authors indicate in their manuscripts that the SR was conducted/prepared/designed in line with the AMSTAR 2, it does not necessarily imply it is of high or even moderate confidence according to AMSTAR 2. A self-assessment with AMSTAR 2 could be required for submission and carefully checked by the editors/peer reviewers.

Timing of complementary feeding for early childhood allergy prevention: An overview of systematic reviews

OBJECTIVE

To summarise and critically appraise systematic review (SR) evidence on the effects of timing of complementary feeding (CF) on the occurrence of allergic sensitisation and disease.

DESIGN

Overview of SRs. AMSTAR-2 and ROBIS were used to assess methodological quality and risk of bias (RoB) of SRs. RoB 2 Tool was used to assess RoB of primary randomised controlled trials (RCTs) (or extracted). The certainty of evidence (CoE) was assessed using GRADE. Findings were synthesised narratively.

DATA SOURCES

MEDLINE (via PubMed and Ovid), the Cochrane Library and Web of Science Core Collection (2010 to 27 February 2023).

ELIGIBILITY CRITERIA

SRs investigating the effects of timing of CF in infants or young children (0-3 years) on risk of developing food allergy (FA), allergic sensitisation, asthma, allergic rhinitis, atopic eczema and adverse events based on RCT evidence.

RESULTS

Eleven SRs were included. Only two SRs had low RoB; common issues were failure to report on funding of primary studies and failure to provide a list of excluded trials. Common limitations of included trials were lack of blinding of outcome assessment or detailed trial preregistration, and inadequate handling of high loss to follow up. Primary study overlap was very high for specific FA and slight to moderate for FA in general and other primary outcomes. Introducing specific foods (peanut, cooked egg) early probably reduces the risk of specific FA. Evidence for other allergic outcomes was mostly very uncertain and based on few primary studies. Trials varied regarding timing of CF, nature of complementary foods and population risk, which limited comparability between SRs.

CONCLUSIONS

For developing guidelines to support decision-making on the timing of CF as a preventive strategy, early introduction of specific foods (i.e. egg and peanut) seems promising and safe, whereas more extensive research is required regarding other allergic outcomes and potential adverse events.