AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews, version 2) is the standard critical appraisal instrument for evaluating the methodological quality of systematic reviews. Published in 2017 by Shea and colleagues, AMSTAR 2 contains 16 items organized into critical and non-critical domains that assess whether a systematic review was conducted with sufficient rigor to produce reliable results.
AMSTAR 2 is used in umbrella reviews to assess included systematic reviews, by clinical guideline development groups to evaluate evidence quality, by peer reviewers assessing manuscripts, and by researchers and clinicians who need to determine whether a systematic review's conclusions can be trusted. Understanding how to apply and interpret AMSTAR 2 is essential for anyone who reads, conducts, or commissions systematic reviews.
The 16 AMSTAR 2 Items
AMSTAR 2 evaluates systematic reviews across 16 methodological domains. Seven are designated as critical domains (marked with an asterisk below) that can independently lower the overall confidence rating.
| # | Item | Critical? |
|---|---|---|
| 1 | Did the research questions and inclusion criteria include PICO components? | No |
| 2 | Was the review protocol registered before the review began, and were significant deviations reported?* | Yes |
| 3 | Did the review authors explain their selection of study designs for inclusion? | No |
| 4 | Did the review authors use a comprehensive literature search strategy?* | Yes |
| 5 | Was study selection performed in duplicate? | No |
| 6 | Was data extraction performed in duplicate? | No |
| 7 | Did the review authors provide a list of excluded studies and justify the exclusions?* | Yes |
| 8 | Did the review describe the included studies in adequate detail? | No |
| 9 | Did the review use a satisfactory technique to assess risk of bias in individual studies?* | Yes |
| 10 | Did the review report funding sources for included studies? | No |
| 11 | If meta-analysis was performed, did the review use appropriate methods for statistical combination?* | Yes |
| 12 | If meta-analysis was performed, did the review assess the potential impact of risk of bias on the results?* | Yes |
| 13 | Did the review account for risk of bias when interpreting and discussing results?* | Yes |
| 14 | Did the review provide a satisfactory explanation for any heterogeneity observed? | No |
| 15 | If quantitative synthesis was performed, did the review carry out adequate investigation of publication bias and discuss its likely impact?* | Yes |
| 16 | Did the review authors report any potential sources of conflict of interest, including funding? | No |