The Medical Review Article Revisited: Has the Science Improved?

21 December 1999 | Volume 131 Issue 12 | Pages 947-951

Background: The validity of a review depends on its methodologic quality.

Objective: To determine the methodologic quality of recently published review articles.

Design: Critical appraisal.

Setting: All reviews of clinical topics published in six general medical journals in 1996.

Measurements: Explicit criteria that have been published and validated were used.

Results: Of 158 review articles, only 2 satisfied all 10 methodologic criteria (median number of criteria satisfied, 1). Less than a quarter of the articles described how evidence was identified, evaluated, or integrated; 34% addressed a focused clinical question; and 39% identified gaps in existing knowledge. Of the 111 reviews that made treatment recommendations, 48% provided an estimate of the magnitude of potential benefits (and 34%, the potential adverse effects) of the treatment options, 45% cited randomized clinical trials to support their recommendations, and only 6% made any reference to costs.

Conclusions: The methodologic quality of clinical review articles is highly variable, and many of these articles do not specify systematic methods.

Author and Article Information

From University of Oxford, Oxford, United Kingdom; University of Alberta, Edmonton, Alberta, Canada; University of Ottawa, Loeb Health Research Institute, and The Thomas C. Chalmers Centre for Systematic Reviews, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Otario, Canada; University of Toronto, Toronto, Ontario, Canada; and Audie L. Murphy Veterans Affairs Hospital, San Antonio, Texas.

Acknowledgments: The authors thank David Sackett for helpful comments on an earlier version of this manuscript, Brian Haynes for details on how ACP Journal Club selects journals for review, and Bridget Burchill for secretarial support.

Grant Support: Dr. McAlister is a Population Health Investigator of the Alberta Heritage Foundation for Medical Research. Dr. van Walraven is an Arthur Bond Scholar of the PSI Foundation of Ontario, Canada.

Requests for Reprints: Finlay McAlister, MD, 2E3.24 WMC, University of Alberta Hospital, 8440 112 Street, Edmonton, Alberta T6G 2R7, Canada; e-mail, Finlay.McAlister{at}ualberta.ca. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.

Current Author Addresses: Drs. McAlister and Lawson: Department of Medicine, 2E3.24 Walter Mackenzie Centre, University of Alberta Hospital, 8440 112 Street, Edmonton, Alberta T6G 2R7, Canada.

Dr. Clark: Room 405, 737 Parkdale Avenue, Ottawa Hospital-Civic Campus, Ottawa, Ontario K1Y 1J8, Canada.

Dr. van Walraven: F660 Clinical Epidemiology Unit, Ottawa Hospital-Civic Campus, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada.

Dr. Straus: Department of Medicine, Mount Sinai Hospital, Suite 427, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.

Mr. Moher: The Thomas C. Chalmers Centre for Systematic Reviews, Children's Hospital of Eastern Ontario Research Institute, 451 Smyth Road, Ottawa, Ontario, Canada.

Dr. Mulrow: Audie L. Murphy Memorial Veterans Hospital (11C6), 7400 Merton Minter Boulevard, San Antonio, TX, 78284.