title: A critical appraisal of the methodology and quality of evidence of systematic reviews and meta-analyses of traditional Chinese medical nursing interventions: a systematic review of reviews.
abstract: To assess the methodology and quality of evidence of systematic reviews and meta-analyses of traditional Chinese medical nursing (TCMN) interventions in Chinese journals. These interventions include acupressure, massage, Tai Chi, Qi Gong, electroacupuncture and use of Chinese herbal medicines-for example, in enemas, foot massage and compressing the umbilicus.
  
  
  
  A systematic literature search for systematic reviews and meta-analyses of TCMN interventions was performed. Review characteristics were extracted. The methodological quality and the quality of the evidence were evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approaches.
  
  
  
  We included 20 systematic reviews and meta-analyses, and a total of 11 TCMN interventions were assessed in the 20 reviews. The compliance with AMSTAR checklist items ranged from 4.5 to 8 and systematic reviews/meta-analyses were, on average, of medium methodological quality. The quality of the evidence we assessed ranged from very low to moderate; no high-quality evidence was found. The top two causes for downrating confidence in effect estimates among the 31 bodies of evidence assessed were the risk of bias and inconsistency.
  
  
  
  There is room for improvement in the methodological quality of systematic reviews/meta-analyses of TCMN interventions published in Chinese journals. Greater efforts should be devoted to ensuring a more comprehensive search strategy, clearer specification of the interventions of interest in the eligibility criteria and identification of meaningful outcomes for clinicians and patients (consumers). The overall quality of evidence among reviews remains suboptimal, which raise concerns about their roles in influencing clinical practice. Thus, the conclusions in reviews we assessed must be treated with caution and their roles in influencing clinical practice should be limited. A critical appraisal of systematic reviews/meta-analyses of TCMN interventions is particularly important to provide sound guidance for TCMN.
authors.affiliation: Evidence-Based Nursing Center, School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
authors.forename: Ying-Hui
authors.initials: YH
authors.lastname: Jin
authors.affiliation: Nursing Department, North China University of Science and Technology Affiliated Hospital, TangShan, China.
authors.forename: Guo-Hao
authors.initials: GH
authors.lastname: Wang
authors.affiliation: Evidence-Based Nursing Center, School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
authors.forename: Yi-Rong
authors.initials: YR
authors.lastname: Sun
authors.affiliation: Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Li
authors.affiliation: Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Public Health Department of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
authors.forename: Ge
authors.initials: G
authors.lastname: Li
authors.affiliation: Library of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
authors.forename: Jin-Hua
authors.initials: JH
authors.lastname: Si
authors.affiliation: Evidence-Based Nursing Center, School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Emergency Department, Tianjin TEDA hospital, Tianjin, China.
authors.forename: Cui
authors.initials: C
authors.lastname: Lu
authors.affiliation: Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Hong-Cai
authors.initials: HC
authors.lastname: Shang
mesh_terms: D002908:Chronic Disease / Q000451:nursing / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D008516:Medicine, Chinese Traditional; D017410:Practice Guidelines as Topic; D011786:Quality Control; D012196:Review Literature as Topic
keywords: AMSTAR tool; GRADE approach; Meta-analysis; Systematic review; Traditional Chinese Medical Nursing