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Questions for Meta-Analysis and Review Articles

Creighton-Nebraska Universities Health Foundation

1. Why was the study done, and what questions were the authors addressing?
    Can you find an important clinical question that the review examined?

2. What type of study was done?  Was this design appropriate to the objectives?
    Have the study methods been explicitly defined and reported?
    Are the results reproducible if the same methods were carried out by others?

3. Which articles were included in the study?
    How were articles identified?
    Was a thorough search done of the appropriate databases and were other potentially important sources explored?
    Which articles were included in the study?
    Which articles were excluded from the study?

4. Was the design of the study sensible?
    Was methodological quality assessed and the trials weighted accordingly?

5. Was systematic bias avoided or minimized?
    Were sensitivity analyses or other evaluations of included articles completed?
    How sensitive are the results to the way the review has been done?
    How heterogeneous are the findings across included studies?  What are the reasons for heterogeneity?

6 Were the preliminary statistical questions dealt with?
    Sample size

7 Have the authors set the scene correctly?
    Have they determined whether the articles are comparable, and if necessary, adjusted or explained baseline differences?
    What sort of data have they got, and have they used appropriate statistical tests?

8. Probability and confidence
    Have AP values and/or confidence limits been calculated and interpreted appropriately? In other words, are they reading the statistical tests correctly?

9.  What can be concluded from this study?
    Are these authors conclusions based on the study findings taking into account the study limitations? Do they overextend their conclusions?
    What conclusions do you think can be made based on the study?

10.  How could this study have been strengthened?

11. Are these findings generalized?  Can I apply these findings in my practice and/or in my community?