Library of risk of bias tools


Study design(s) targeted by the tool Systematic reviewssystematic-review
Additional details on designs Systematic reviews of randomized controlled trials (RCTs)
Tool area Health
Link to the tool Access the paper reporting the AMSTAR tool


Primary publication Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7:10.
DOI 10.1186/1471-2288-7-10
Guidance document

None known – please contact us if you are aware of any training that should be listed here.

Language English

None known – please contact us if you are aware of any translations that should be listed here.

Record last updated 02/02/2024

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Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, Grimshaw J, Henry DA, Boers M. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. Journal of clinical epidemiology. 2009 Oct 1;62(10):1013-20.

Shea BJ, Bouter LM, Peterson J, Boers M, Andersson N, Ortiz Z, Ramsay T, Bai A, Shukla VK, Grimshaw JM. External validation of a measurement tool to assess systematic reviews (AMSTAR). PloS one. 2007 Dec 26;2(12):e1350.

Pollock M, Fernandes RM, Hartling L. Evaluation of AMSTAR to assess the methodological quality of systematic reviews in overviews of reviews of healthcare interventions. BMC Medical Research Methodology. 2017 Dec;17:1-3.

Faggion CM. Critical appraisal of AMSTAR: challenges, limitations, and potential solutions from the perspective of an assessor. BMC Medical Research Methodology. 2015 Dec;15(1):1-5.

Burda BU, Holmer HK, Norris SL. Limitations of A Measurement Tool to Assess Systematic Reviews (AMSTAR) and suggestions for improvement. Systematic Reviews. 2016 Dec;5(1):1-0.

Banzi R, Cinquini M, Gonzalez-Lorenzo M, Pecoraro V, Capobussi M, Minozzi S. Quality assessment versus risk of bias in systematic reviews: AMSTAR and ROBIS had similar reliability but differed in their construct and applicability. Journal of clinical epidemiology. 2018 Jul 1;99:24-32.

Gates A, Gates M, Duarte G, Cary M, Becker M, Prediger B, Vandermeer B, Fernandes RM, Pieper D, Hartling L. Evaluation of the reliability, usability, and applicability of AMSTAR, AMSTAR 2, and ROBIS: protocol for a descriptive analytic study. Systematic Reviews. 2018 Dec;7(1):1-7.

Perry R, Whitmarsh A, Leach V, Davies P. A comparison of two assessment tools used in overviews of systematic reviews: ROBIS versus AMSTAR-2. Systematic reviews. 2021 Dec;10:1-20.

Pieper D, Jacobs A, Weikert B, Fishta A, Wegewitz U. Inter-rater reliability of AMSTAR is dependent on the pair of reviewers. BMC Medical Research Methodology. 2017 Dec;17(1):1-8.

Kang D, Wu Y, Hu D, Hong Q, Wang J, Zhang X. Reliability and external validity of AMSTAR in assessing quality of TCM systematic reviews. Evidence-Based Complementary and Alternative Medicine. 2012 Oct;2012.

Other publications

Scoring guidance for AMSTAR, known  as R-AMSTAR, has been developed by a group that did not involve the study authors:

Kung J, Chiappelli F, Cajulis OO, Avezova R, Kossan G, Chew L, Maida CA. From Systematic Reviews to Clinical Recommendations for Evidence-Based Health Care: Validation of Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) for Grading of Clinical Relevance. Open Dent J. 2010 Jul 16;4:84-91.

Key Criteria

Focuses on risk of bias, or makes a distinction between items that assess risk of bias and other aspects of study quality No
Offers a method to reach either a domain specific or overall assessment of risk of bias No
Tool development involving a range of stakeholders from different disciplines (e.g. methodologists, statisticians, clinicians) Yes
Avoids recommending use of summary numerical quality scores Yes