The quality of evidence for medical interventions does not improve or worsen: a metaepidemiological study of Cochrane reviews

J Clin Epidemiol. 2020 Oct;126:154-159. doi: 10.1016/j.jclinepi.2020.08.005. Epub 2020 Sep 2.


Objectives: The objective of the study was to determine the change in quality of evidence in updates of Cochrane reviews that were initially published between January 1, 2013 and June 30, 2014. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to document evidence quality.

Study design and setting: We searched the Cochrane Database of Systematic Reviews on March 20, 2020 to identify which of the reviews from the initial (2013/14) sample had been updated. Using the same methods to determine the quality of evidence in the previous analysis, we assessed the quality of evidence for the first-listed primary outcomes in the updated reviews.

Results: Of the 608 reviews in the original sample, 154 had been updated with and 151 contained available data for both original and updated systematic reviews (24.8%). The updated reviews included: 15 (9.9%) with high-quality evidence, 56 (37.1%) with moderate-quality evidence, 47 (31.1%) with low-quality evidence, and 33 (21.9%) with very low-quality evidence. No change in the GRADE quality of evidence was found for most (103, 68.2%) of the updated reviews. The quality of evidence rating was downgraded in 28 reviews (58.3%) and upgraded in 20 (41.7%), although only six reviews were promoted to high quality.

Conclusion: Updated systematic reviews continued to suggest that only a minority of outcomes for health care interventions are supported by high-quality evidence. The quality of the evidence did not consistently improve or worsen in updated reviews.

Keywords: Effectiveness; Evidence; GRADE; Meta-analysis; Quality score; Systematic review.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Data Management / methods*
  • Epidemiologic Studies
  • Humans
  • Outcome Assessment, Health Care / methods
  • Outcome Assessment, Health Care / standards*
  • Outcome Assessment, Health Care / statistics & numerical data
  • Quality Indicators, Health Care / statistics & numerical data*
  • Systematic Reviews as Topic