Questions to consider when interpreting a systematic review and meta-analysis

Were the systematic review and meta-analysis performed according to an explicitly defined protocol?

Were the research questions well formulated, and would their answers be clinically useful?

Did the authors clearly define the eligibility criteria for studies to be included?

Eligibility criteria should clearly define all of the following:

Were the eligibility criteria appropriate to capture all relevant studies?

Were the population, treatment(s), comparison(s), and outcome(s) relevant to clinical practice?
Were the study designs of included studies appropriate for addressing the key questions?

Was the search for relevant studies comprehensive/exhaustive?

Was the search strategy reported in sufficient detail that it could be reproduced?
Were all important concepts included in the search strategy?
Were the selection and assessment of studies reproducible (ie, done independently by 2 or more separate reviewers)?
Were adequate explanations given for exclusion of studies?
Were important sources of unpublished data (ie, "grey" literature) included?

Were the characteristics of the individual studies listed with sufficient detail to allow an assessment of the appropriateness of their inclusion?

Were the individual studies assessed for their methodologic quality (ie, risk of bias assessment)?

Was publication bias considered?

Were the statistical methods for combining results (meta-analysis) described?

Was the reporting of results clear?

Were the pooled effect estimates presented with corresponding confidence intervals (rather than p values)?
Were primary results for each individual study also included?

Was between-study heterogeneity assessed?

Did the review attempt to explain between-study heterogeneity (eg, by performing subgroup, meta-regression, or sensitivity analyses)?
If subgroup or meta-regression analyses were performed, were the factors selected appropriate, specified a priori, and limited to only a few?

Did the authors clearly explain their conclusions, and did they address the overall certainty of effect estimates?

Did they rate the certainty (or quality) of evidence for each outcome (eg, in a summary of findings table)?
Was the methodologic quality (risk of bias) of the individual studies considered in formulating the overall certainty ratings?

Were limitations of the meta-analysis discussed?

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