Article type
Abstract
Objective Rigorous systematic reviews (SRs) on Chinese herbal medicine (CHM) are invaluable in informing clinical decisions and advancing evidence-based practices in Chinese Medicine. CHM SRs published in Chinese are widely read but their methodological quality remains uncertain. This cross-sectional study evaluated the methodological quality of Chinese language CHM SRs published between 2021 to 2022.
Method Chinese language CHM SRs were identified through literature searches across three international and four Chinese databases. Eligible SRs should include at least one meta-analysis pertaining to the treatment effect of any orally administered CHM mentioned in the Chinese Pharmacopoeia 2020. Methodological quality was appraised using AMSTAR 2. Logistic regressions were conducted to explore the associations between the bibliographical characteristics and quality.
Results In terms of overall quality of the 213 sampled SRs(including 4,248 RCTs and 369,049 patients), 69.5% were critically low, and 30.5% were low quality. None achieved high or moderate quality. None provided a list of excluded studies with justification or disclosed funding sources of the included trials. Only 0.9% considered the potential impact of risk of bias from trials on SRs’ conclusion. Logistic regressions revealed that SRs led by corresponding authors affiliated with universities or academic institutions had lower overall quality compared to those led by corresponding authors affiliated with hospitals or clinical settings. (adjusted odds ratio: 0.333, 95% confidence interval: [0.15, 0.738], P=0.007). These authors were also less likely to perform study selection in duplicate or report conflict of interest clearly.
Conclusions Methodological quality of recent Chinese language CHM SRs is disappointing. These SRs are unlikely to be useful for supporting clinical practice guideline development. To make SRs relevant for Chinese medicine development, there is an urgent need in enhancing SR methodology training for researchers, peer-reviewers and editors, and in adopting of PRISMA reporting guidelines among Chinese language journals as a publication requirement.
Method Chinese language CHM SRs were identified through literature searches across three international and four Chinese databases. Eligible SRs should include at least one meta-analysis pertaining to the treatment effect of any orally administered CHM mentioned in the Chinese Pharmacopoeia 2020. Methodological quality was appraised using AMSTAR 2. Logistic regressions were conducted to explore the associations between the bibliographical characteristics and quality.
Results In terms of overall quality of the 213 sampled SRs(including 4,248 RCTs and 369,049 patients), 69.5% were critically low, and 30.5% were low quality. None achieved high or moderate quality. None provided a list of excluded studies with justification or disclosed funding sources of the included trials. Only 0.9% considered the potential impact of risk of bias from trials on SRs’ conclusion. Logistic regressions revealed that SRs led by corresponding authors affiliated with universities or academic institutions had lower overall quality compared to those led by corresponding authors affiliated with hospitals or clinical settings. (adjusted odds ratio: 0.333, 95% confidence interval: [0.15, 0.738], P=0.007). These authors were also less likely to perform study selection in duplicate or report conflict of interest clearly.
Conclusions Methodological quality of recent Chinese language CHM SRs is disappointing. These SRs are unlikely to be useful for supporting clinical practice guideline development. To make SRs relevant for Chinese medicine development, there is an urgent need in enhancing SR methodology training for researchers, peer-reviewers and editors, and in adopting of PRISMA reporting guidelines among Chinese language journals as a publication requirement.