OBJECTIVES: Systematic review (SRs) and meta-analysis (MAs) are considered as highest quality evidence and used for decision making. Assessment of quality of these SRs/MAs is important as poor reporting and flaws in methodological quality can impair the evidence level. The objective was to compare the most commonly used quality tools AMSTAR-2 and ROBIS and determine the methodological quality of SRs/MAs published in irritable bowel syndrome with constipation (IBS-C).

METHODS: Searches were performed on Medline and other supplementary sources to identify SRs/MAs between 2010-2020. All randomized controlled trials with no restriction on interventions and evaluating clinical outcomes were included. Two authors independently performed quality assessment; discrepancies were resolved by third reviewer. In both the tools, questions are well defined around SRs/MAs. SRs/MAs were rated as high, low and unclear risk of bias through ROBIS; and high, moderate, low and critically low, as per critical and non-critical weakness levels by AMSTAR-2.

RESULTS: A total of 10 relevant SRs/MAs (including 9 MAs) were identified from 148 publications. In AMSTAR-2 tool, most of the SAs/MAs were rated low (80%) and critically low (20%) indicating low quality based on the critical domains. However, ROBIS tool showed high risk of bias (60%) indicating low quality, while low and unclear risk of bias were observed to be 30% and 10%, respectively.

According to AMSTAR-2, 80% of the SAs/MAs did not focus on protocol writing and 20% were missing on quality assessment reporting. In ROBIS, search strategy presented was incomplete in 50% of publications and additional searches were also not performed. As per both tools, most of the MAs used appropriate analytical techniques and were well presented.

CONCLUSIONS: ROBIS is rigorous tool in assessing the methodological quality compared to AMSTAR-2. Results should be interpreted with caution and more studies will aid in drawing conclusions and grading the outcomes level of evidence further.