How to Choose the Right Quality Assessment Tool for Your Systematic Review

Quality assessment is a critical component of systematic reviews, helping researchers evaluate the trustworthiness of individual studies and the overall body of evidence. However, with numerous tools available, selecting the most appropriate one can be challenging. This guide will help you navigate this decision-making process.

Understanding Quality Assessment

Quality assessment (also called critical appraisal or risk of bias assessment) evaluates the methodological rigor of included studies and identifies potential sources of bias. This assessment:

• Helps interpret findings
• Explains heterogeneity in results
• Guides sensitivity analyses
• Informs strength of evidence determinations
• Contributes to transparent reporting

Key Considerations When Choosing a Tool

1. Match the Tool to Your Study Designs

Different study designs require different assessment approaches. Here's a guide for common study types:

Randomized Controlled Trials (RCTs)

• Cochrane Risk of Bias Tool 2.0 (RoB 2): The gold standard for assessing RCTs
• JADAD Scale: A simple, quick assessment focused on randomization, blinding, and withdrawals
• PEDro Scale: Particularly useful for physical therapy interventions

Non-Randomized Studies of Interventions

• ROBINS-I: Comprehensive tool for cohort-like studies
• Newcastle-Ottawa Scale (NOS): Widely used for cohort and case-control studies
• JBI Critical Appraisal Tools: Various tools for different non-randomized designs

Diagnostic Accuracy Studies

• QUADAS-2: Specifically designed for diagnostic accuracy studies

Prevalence Studies

• JBI Critical Appraisal Checklist for Prevalence Studies
• Hoy's Risk of Bias Tool for Population-Based Prevalence Studies

Qualitative Research

• CASP Qualitative Checklist
• JBI Critical Appraisal Checklist for Qualitative Research

Systematic Reviews

• AMSTAR-2: Comprehensive assessment of systematic reviews
• ROBIS: Focuses on risk of bias in systematic reviews

2. Consider the Depth and Breadth Needed

Tools vary in their comprehensiveness:

• Brief tools (e.g., JADAD) are quick but may miss important biases
• Comprehensive tools (e.g., RoB 2, ROBINS-I) provide thorough assessment but require more time and expertise

Select based on:

• Available resources and expertise
• The importance of quality assessment to your review questions
• The anticipated methodological variability among included studies

3. Evaluate Ease of Use and Resources Required

Consider practical aspects:

• Training requirements
• Time needed per study
• Available expertise in your team
• Support tools (manuals, training materials)

4. Check Alignment with Reporting Guidelines

Your chosen tool should align with relevant reporting guidelines:

• PRISMA for systematic reviews
• PRISMA-DTA for diagnostic test accuracy reviews
• PRISMA-ScR for scoping reviews

5. Consider Domain-Specific Tools

Some fields have developed specialized assessment tools:

• Environmental health: OHAT Risk of Bias Rating Tool
• Nutrition: NutriGrade
• Economic evaluations: CHEC Checklist

Implementing Your Quality Assessment

Once you've selected an appropriate tool:

1. Pilot Test the Tool

Apply the tool to a sample of studies to:

• Ensure consistent understanding among reviewers
• Identify ambiguous items requiring clarification
• Estimate time requirements

2. Use Independent Assessment

Have at least two reviewers independently assess each study, then:

• Compare assessments
• Resolve disagreements through consensus or a third reviewer
• Calculate inter-rater reliability

3. Document Your Process

Clearly describe:

• Which tool(s) you selected and why
• Any modifications made to standard tools
• How assessments were conducted and disagreements resolved
• How quality assessments informed your synthesis

4. Incorporate Results into Your Synthesis

Consider using quality assessments to:

• Conduct sensitivity analyses excluding lower quality studies
• Weight studies in meta-analyses
• Contextualize findings in narrative synthesis
• Grade the overall certainty of evidence

Conclusion

Choosing the right quality assessment tool is an important decision that should be made early in the systematic review process. By matching the tool to your study designs, considering practical constraints, and implementing the assessment rigorously, you can ensure that quality considerations appropriately inform your review's conclusions.

Evidence Table Builder helps streamline the quality assessment process by incorporating common assessment tools and facilitating collaboration among reviewers. This integrated approach ensures that quality assessment is seamlessly incorporated into your systematic review workflow.