Lack of transparency in reporting narrative synthesis of quantitative data:a methodological assessment of systematic reviews

OBJECTIVE: To assess the adequacy of reporting and conduct of narrative synthesis of quantitative data (NS) in reviews evaluating the effectiveness of public health interventions. STUDY DESIGN AND SETTING: A retrospective comparison of a 20% (n=474/2372) random sample of public health systematic reviews from the McMaster Health Evidence database (January 2010-October 2015) to establish the proportion of reviews using NS. From those reviews using NS, 30% (n=75/251) were randomly selected and data extracted for detailed assessment of: reporting NS methods; management and investigation of heterogeneity; transparency of data presentation; and assessment of robustness of the synthesis. RESULTS: Most reviews used NS (56%, n=251/446), meta-analysis was the primary method of synthesis for 44%. In the detailed assessment of NS: 95% (n=71/75) did not describe NS methods; 43% (n=32) did not provide transparent links between the synthesis data and the synthesis reported in the text; of 14 reviews that identified heterogeneity in direction of effect, only one investigated the heterogeneity; and 36% (n=27) did not reflect on limitations of the synthesis. CONCLUSION: NS methods are rarely reported in systematic reviews of public health interventions and many NS reviews lack transparency in how the data are presented and the conclusions are reached. This threatens the validity of much of the evidence synthesis used to support public health. Improved guidance on reporting and conduct of NS will contribute to improved utility of NS systematic reviews.