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Graduate Student, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
Research Associate, Toronto Health Technology Assessment Collaborative, University of Toronto
Associate Professor, Leslie Dan Faculty of Pharmacy, University of Toronto
Reprints: Mr. Bereza, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, ON M5S 3M2 Canada, basil.bereza{at}utoronto.ca
BACKGROUND: Meta-analyses of randomized controlled trials (RCTs) constitute the highest level of evidence, but their usefulness depends on their quality.
OBJECTIVE: To assess the reporting and scientific quality of meta-analyses of RCTs on treatments for anxiety disorders.
METHODS: Criteria for peer-reviewed, full-text retrieval included
meta-analyses of RCTs of drugs versus active ingredient placebo, standard
care, or psychotherapy. Sample populations were required to meet
Diagnostic and Statistical Manual of Mental Disorders or
International Classification of Diseases and Related Health Problems
diagnostic criteria for anxiety disorders. Two reviewers independently
searched EMBASE, EBM Reviews, Ovid MEDLINE, Ovid HealthSTAR, and
International Pharmaceutical Abstracts from inception to August 2007.
Search terms included meta-analysis, randomized controlled trials, anxiety,
anxiolytic, anti-depressant/antidepressant, and pharmacotherapy, without
language restrictions. References and reviews were searched manually. Quality
was assessed independently by 2 raters, using the Quality of Reporting of
Meta-analyses (QUOROM) and the Overview Quality Assessment Questionnaire
(OQAQ). The QUOROM was used to assess the reporting quality of the study,
using an 18-item checklist, and the scientific quality was assessed with the
OQAQ's 10-item checklist. Kendall's 
measured interrater reliability with
statistical significance at p less than or equal to 0.01. Means and standard
deviations described the overall quality. A time series analysis was
performed.
RESULTS: A total of 136 titles and abstracts were reviewed; 48 were
retrieved, including 6 from the manual search. Thirty-two were excluded (not
pooled analyses, inappropriate condition/treatment, duplications), leaving 16
studies published between 1995 and 2007. Agreement was high: = 0.801 (p
< 0.01) for QUOROM and 0.834 (p < 0.01) for OQAQ. QUOROM quality scored
61% ± 19%. Overall, the results sections of the studies scored lowest,
while the introduction and discussion sections scored highest. The overall
scientific quality was 58% ± 28%. Most studies appropriately linked
results to primary objectives but did not report how bias was avoided or how
study validity was assessed. Quality increased nonsignificantly over time.
CONCLUSIONS: Reporting/scientific quality was considered less than fair-to-good. Stakeholders should strive for higher scientific quality of meta-analyses.
Key Words: anxiety disorder, meta-analysis, quality assessment
Published Online, August 26, 2008. www.theannals.com, DOI 10.1345/aph.1L204
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