TFOS Lifestyle - Evidence quality report: Advancing the evaluation and synthesis of research evidence

Abstract

Evidence-based practice is a dominant paradigm in healthcare that emphasizes the importance of ensuring the translation of the best available, relevant research evidence into practice. An Evidence Quality Subcommittee was established to provide specialized methodological support and expertise to promote rigorous and evidence-based approaches for the Tear Film and Ocular Surface Society (TFOS) Lifestyle Epidemic reports. The present report describes the purpose, scope, and activity of the Evidence Quality Subcommittee in the undertaking of high-quality narrative-style literature reviews, and leading prospectively registered, reliable systematic reviews of high priority research questions, using standardized methods for each topic area report. Identification of predominantly low or very low certainty evidence across the eight systematic reviews highlights a need for further research to define the efficacy and/or safety of specific lifestyle interventions on the ocular surface, and to clarify relationships between certain lifestyle factors and ocular surface disease. To support the citation of reliable systematic review evidence in the narrative review sections of each report, the Evidence Quality Subcommittee curated topic-specific systematic review databases and relevant systematic reviews underwent standardized reliability assessment. Inconsistent methodological rigor was noted in the published systematic review literature, emphasizing the importance of internal validity assessment. Based on the experience of implementing the Evidence Quality Subcommittee, this report makes suggestions for incorporation of such initiatives in future international taskforces and working groups. Content areas broadly relevant to the activity of the Evidence Quality Subcommittee, including the critical appraisal of research, clinical evidence hierarchies (levels of evidence), and risk of bias assessment, are also outlined.

Keywords: AMSTAR; Cochrane; Critical appraisal; Evidence hierarchy; Evidence synthesis; Evidence-based practice; Meta-analysis; Ocular surface; Risk of bias; Systematic review.

Fig. 1.

Representative evidence hierarchy for Intervention research questions, based on the National Health and Medical Research Council of Australia schema [9]. Image taken from the CrowdCARE database [7] tutorial.

Fig. 2.

PRISMA flow diagram summarizing the identification and reliability assessment of systematic review citations derived from the Cochrane Eyes and Vision United States Project (CEV@US) Database of Systematic Reviews in Eyes and Vision to populate systematic review databases for the TFOS Lifestyle Epidemic Workshop topic area narrative reviews.

Fig. 3.

Number of systematic reviews published on topics broadly relevant to the ocular surface and lifestyle factors, stratified by whether they were assessed as reliable or unreliable using a ‘rapid reliability assessment tool’ [42]. *Note: 2021 is an incomplete year (up to August 2021, in alignment with the Workshop time frame).