(56) Evidence Based Practice in Action: Ten Tips for Assessing and Appraising Meta-Analyses

Objective : Meta-analyses are meant to be at the top of the evidence pyramid, and are relied upon by clinicians, researchers, and trainees across many disciplines for expert synthesis of research, however they often fall short in methods and presentation of results. Studies have shown systematic reviews and meta-analyses’ methods have errors in search strategies, sub-optimal methods, and lack of compliance with guidelines across fields and topics by authors and journals. It is crucial to critically assess meta-analyses and to determine their quality before relying on them for research or evidence-based practice, but current guidance on interpreting meta-analyses is scattered across many publications in various fields; this project fills this research gap.

Methods: Two pharmacy librarians and a pharmacy educator conducted a literature review on the methods, appraisal, and application of meta-analyses to synthesize the available evidence. This information was summarized into digestible points.

Results: The ten tips, based on the best publications from the critical appraisal and meta-analysis methodology literature, span a meta-analysis manuscript from introduction to conclusion, with visualizations of important figures. The tips include: understanding the paper’s prerequisite context; appraising the quality of the literature search; assessing the application of inclusion criteria; evaluating the data extraction and management methods; determining the risk for inherited limitations; assessing the potential for publication bias; checking for clinical, methodological, and statistical heterogeneity; and appraising the statistical and clinical significance of the results.

Conclusions: Each of these tips summarize an approach to making an assessment of the quality and reproducibility of meta-analyses.The ten tips and visuals will help pharmacy learners and educators to more confidently critically examine all elements of a meta-analysis, determine its quality, and teach others to do the same.