2. • Systematic reviews were
introduced and described as
instrumental for
implementing evidence-
based practice, taking stock
relative to a particular
question(s) and shaping of
future research.
2
3. • Applying AMSTAR checklist
supposedly carries clear-cut
YES/NO answer. However,
sometimes a number of
questions reside in the grey
zone creating some sort of
confusion, controversy and
intensive debate in the process
of critical appraisal.
3
4. 1.Was a priori design provided?
• YES, the research question was
established based on PICOS. In
addition, a protocol was written and
available on request.
4
5. 2.Was there duplicate study
selection and data extraction?
• Only data extraction was performed
by two independent reviewers, but
the method of study selection was
not mentioned. In addition, no clear
consensus procedure, only
disagreements to be resolved by
discussion.
5
6. 3.Was a comprehensive
literature search performed?
• Despite two electronic sources were
searched and search was
supplemented through approved
strategies, the reported information was
partial as a missing year was clearly
noticed.
6
7. 4.Was status of publication (e.g. grey
literature) used as an inclusion criterion?
• YES, the authors explicitly stated that
they did not exclude reports based on
their language and they searched for
articles irrespective of publication
type. They also included conference
proceedings,unpublished and
ongoing trials.
7
8. 5.was a list of studies(included
and excluded)provided?
• NO, the list of included and
excluded studies was not
provided.
8
9. 6.were the characteristics of
included studies provided?
• YES, both in a table form as well as
in the result section where age, sex,
disease status and staging were
included too.
9
10. 7.was the scientific quality of the included
studies assessed and reported?
• YES. the authors assessed only
RCTs,reported the available method
of randomization and allocation
concealment when feasible, perform
sensitivity analysis of outcomes and
describe quality items as high/low.
10
11. 8.was the scientific quality of the included
studies used appropriately in formulating
conclusions?
• YES, it was stated clearly that
results from the data of five out of
seven studies have low power, are
limited and should be interpreted
cautiously.
11
12. 9.were the methods used to combine
the findings of studies appropriate ?
• YES, pooled results were tested to
ensure that studies were combinable
through statistical tests(Chi-square
and I square) which revealed no
heterogeneity (p=0.98, Isq=0).
12
13. 10.was the likelihood of
publication bias assessed?
• YES, publication bias was explicitly
considered and assessed through
Begg's funnel plot and Egger's test.
13
14. 11.was the conflict of interest
stated?
• There is no statement addressing
any conflict of interest .
14
