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The Quality of Systematic Reviews Addressing Peripheral Nerve Repair and Reconstruction
Beatrice J. Sun, BS1,2; Uchenna N. Agbim, BS2,3; Jonathan Tijerina, BS, MA2; Gordon K. Lee, MD, FACS2; Rahim S. Nazerali, MD, MHS2
1UC Irvine Medical Center, Orange, CA, 2Stanford University Medical Center, Stanford, CA, 3Wright State University, Dayton, OH
Introduction: While systematic reviews are regarded as the strongest level of medical evidence, not all systematic reviews are equally reliable. Inconsistency in the quality and rigor of systematic reviews raises concerns about their use as a tool in guiding quality delivery in evidence-based clinical practice. The objective of this present study was to assess methodological soundness of systematic reviews with a particular focus on peripheral nerve repair and reconstruction.
Materials & Methods: We performed a comprehensive search using PubMed and Scopus to identify all systematic reviews published on peripheral nerve reconstruction in 9 high-impact surgical journals. Literature searches, abstract screening, and data extraction were independently performed by two separate authors. Discrepancies were resolved by consensus. The quality of systematic reviews was assessed using AMSTAR criteria.
Results: Initial search retrieved 184 articles. Forty-six duplicates were removed, leaving 138 for review. After screening titles, abstracts, and conducting full text reviews, 26 studies met inclusion criteria. Of those, 18 (65%) were published by Plastic Surgery, 7 (27%) by Orthopedic Surgery, and 1 (4%) by Occupational Therapy. The vast majority (20; 77%) focused on upper extremity nerves only, whereas 4 (15%) focused on lower extremity nerves only, 1 (4%) addressed both upper and lower extremity nerves, and 1 (4%) focused on nerves of the trunk. The total number of systematic reviews published on peripheral nerves each year has shown an increasing trend from 2004 through 2015. Overall median AMSTAR score was 5, reflecting a "fair" quality. There was no evidence of AMSTAR score improvement over time.
Conclusion: Although the number of systematic reviews published on peripheral nerve repair has risen over the last decade, their quality has unfortunately not exhibited the same increase. This highlights the necessity to increase familiarity with and conform to methodological quality criteria to improve the integrity of evidence-based medicine in peripheral nerve repair and reconstruction. 
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