title: Limitations of A Measurement Tool to Assess Systematic Reviews (AMSTAR) and suggestions for improvement.
abstract: A Measurement Tool to Assess Systematic Reviews (AMSTAR) is a commonly used tool to assess the quality of systematic reviews; however, modifications are needed to improve its usability, reliability, and validity. In this commentary, we summarize our experience and the experiences of others who have used AMSTAR and provide suggestions for its improvement. We propose that AMSTAR should modify a number of individual items and their instructions and responses to make them more congruent with an assessment of the methodologic quality of systematic reviews. We recommend adding new items and modifying existing items to assess the quality of the body of evidence and to address subgroup and sensitivity analyses. More detailed instructions are needed for scoring individual items across multiple reviewers, and we recommend that a total score should not be calculated. These suggestions need to be empirically tested prior to implementation.
authors.affiliation: Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR, 97227, USA. brittany.u.burda@gmail.com.
authors.forename: Brittany U
authors.initials: BU
authors.lastname: Burda
authors.affiliation: Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
authors.forename: Haley K
authors.initials: HK
authors.lastname: Holmer
authors.affiliation: World Health Organization, Av. Appia 20, CH-1211, Geneva, 27, Switzerland.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Norris
mesh_terms: D000068598:Data Accuracy; D017408:Guidelines as Topic; D017594:Publication Bias; D012107:Research Design / Q000592:standards; D012196:Review Literature as Topic
keywords: Quality assessment; Risk of bias; Systematic review