Developing critical appraisal of systematic reviews reporting network meta-analysis

Thesis

The aim of the research presented in this thesis was to advance the critical appraisal of systematic reviews using network meta-analysis (NMA) methods for synthesis. My review of systematic reviews using NMA methodology for synthesis and their characteristics found a rapid increase in publication of such reviews between 2008 and 2012, which has since continued. My survey of the authors of these reviews identified standards for reporting such reviews that were consistent with those subsequently included in the 2015 PRISMA extension statement for reporting of NMA. My programme of research then moved on to summarise how evidence from synthesis using NMA was used in NICE clinical guidelines published or updated during 2015-16. This found that although NMA methods were used far less often than pair-wise meta-analysis, they were used or considered for nearly one quarter of the guidelines reviewed. However, recommendations in the guidelines were more often based on results of NMA conducted by the Guideline Development Group than on results from previously published systematic reviews using NMA methodology. This finding, and reservations expressed by authors in my survey, supported the need to identify a critical appraisal tool to help users identify the quality of systematic reviews that use NMA methodology. After my review of existing critical appraisal tools failed to identify one suitable for systematic reviews using NMA methods for synthesis, I constructed a new tool, using the CASP format and based on items contained in the most current and most widely used related tools. The new tool was tested for inter-rater reliability and the findings of that testing and those from other elements in this programme of research allow the thesis to conclude with implications and some recommendations for further optimisation and validation of the tool.

Authors: Lee, A

• DOI: 10.5287/ora-x5nyejybm
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: systematic review; network meta-analysis; critical appraisal
• Subjects: Systematic reviews (Medical research); Statistical methods; Evidence-based medicine