What is it about?
We read the following paper entitled “Telehealth Systems for Midwifery Care Management during the COVID-19 Pandemic: A Systematic Review” by Shamsabadi et al, in Journal of Iranian Medical Council, Volume 6, Issue 2, Spring 2023 with interest (1). We feel that while the manuscript addresses a number of important points regarding the provision of perinatal care during the COVID-19 era, there are several concerns considering methodology warranting the discussion. This manuscript focused on collecting data about midwifery care management during Covid-19, particularly related to telehealth applications for care delivery. Our research team has conducted several systematic reviews, and are they aware of the importance of proper assessment of quality of each of the manuscripts included in the review. Quality assessment can be somewhat complicated: each type of article has a different method for determination of quality, reliability, and generalizability of the manuscript (2,3). Thus, the present systematic review collects data from various types of articles including randomized clinical trials, qualitative studies, observational studies (including time series, cross-sectional study, retrospective cohort study, case report, and a pilot study, cross sectional and review). While inclusion of each of these manuscript subtypes can be acceptable, the substantial heterogeneity in article type further necessitates proper quality assessment of each of the included manuscripts. Proper quality assessment in systematic review warrants further discussion, and it is the subject of ongoing investigation. For example, Vo et al conducted an analysis of systematic reviews associated with mediation studies. These authors demonstrated that 23% of the reviews did not assess risk of bias at all, and 47% of the included studies used bias assessment tools that were not specifically designed for mediation studies. Perhaps, even more concerningly, 30.1% of the studies assessed the risk of bias using purely narrative means or with non-validated tools (4). Tran et al corroborate these results in the dental literature, demonstrating a high prevalence of utilization of author-developed tools to assess the quality of included manuscripts. They conclude by stating the need for the development of comprehensive guidelines for systematic reviews specifically within each field of research to more precisely assess the quality of the evidence included in the review (5).
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Why is it important?
While currently there is no widely accepted form of guidelines used to curate quality assessment for systematic reviews, several quality assessment tools have been broadly validated and used across the literature.
Perspectives
In addition to careful description of the methods used for quality assessment, the authors should more completely define cutoff points and exclusion and inclusion criteria used for article selection. Moreover, the type of technology used to provide telehealth services should be described in as detailed a manner as possible. The related applications for telehealth care provision warrant further discussion regarding their respective capabilities and requirements. The authors of this study have not clarified the methods used for quality assessment and have poorly defined the reasoning behind selection of various article types.
Dr Ardalan Shariat
Tehran University of Medical Sciences
Read the Original
This page is a summary of: A Note on the Importance of Quality Assessment in Systematic Review: Letter to the Editor, Journal of Iranian Medical Council, March 2024, Knowledge E,
DOI: 10.18502/jimc.v7i2.15052.
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