The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

The Medical Review Article Revisited: Has the Science Improved?

Finlay A. McAlister, MD, MSc; Heather D. Clark, MD; Carl van Walraven, MD, MSc; Sharon E. Straus, MD; Fiona M.E. Lawson, MB; David Moher, MSc; and Cynthia D. Mulrow, MD, MSc
[+] Article, Author, and Disclosure Information

From University of Oxford, Oxford, United Kingdom; University of Alberta, Edmonton, Alberta, Canada; University of Ottawa, Loeb Health Research Institute, and The Thomas C. Chalmers Centre for Systematic Reviews, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Otario, Canada; University of Toronto, Toronto, Ontario, Canada; and Audie L. Murphy Veterans Affairs Hospital, San Antonio, Texas.

Acknowledgments: The authors thank David Sackett for helpful comments on an earlier version of this manuscript, Brian Haynes for details on how ACP Journal Club selects journals for review, and Bridget Burchill for secretarial support.

Grant Support: Dr. McAlister is a Population Health Investigator of the Alberta Heritage Foundation for Medical Research. Dr. van Walraven is an Arthur Bond Scholar of the PSI Foundation of Ontario, Canada.

Requests for Reprints: Finlay McAlister, MD, 2E3.24 WMC, University of Alberta Hospital, 8440 112 Street, Edmonton, Alberta T6G 2R7, Canada; e-mail, Finlay.McAlister@ualberta.ca. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Drs. McAlister and Lawson: Department of Medicine, 2E3.24 Walter Mackenzie Centre, University of Alberta Hospital, 8440 112 Street, Edmonton, Alberta T6G 2R7, Canada.

Dr. Clark: Room 405, 737 Parkdale Avenue, Ottawa Hospital-Civic Campus, Ottawa, Ontario K1Y 1J8, Canada.

Dr. van Walraven: F660 Clinical Epidemiology Unit, Ottawa Hospital-Civic Campus, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada.

Dr. Straus: Department of Medicine, Mount Sinai Hospital, Suite 427, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.

Mr. Moher: The Thomas C. Chalmers Centre for Systematic Reviews, Children's Hospital of Eastern Ontario Research Institute, 451 Smyth Road, Ottawa, Ontario, Canada.

Dr. Mulrow: Audie L. Murphy Memorial Veterans Hospital (11C6), 7400 Merton Minter Boulevard, San Antonio, TX, 78284.

Ann Intern Med. 1999;131(12):947-951. doi:10.7326/0003-4819-131-12-199912210-00007
Text Size: A A A

Background: The validity of a review depends on its methodologic quality.

Objective: To determine the methodologic quality of recently published review articles.

Design: Critical appraisal.

Setting: All reviews of clinical topics published in six general medical journals in 1996.

Measurements: Explicit criteria that have been published and validated were used.

Results: Of 158 review articles, only 2 satisfied all 10 methodologic criteria (median number of criteria satisfied, 1). Less than a quarter of the articles described how evidence was identified, evaluated, or integrated; 34% addressed a focused clinical question; and 39% identified gaps in existing knowledge. Of the 111 reviews that made treatment recommendations, 48% provided an estimate of the magnitude of potential benefits (and 34%, the potential adverse effects) of the treatment options, 45% cited randomized clinical trials to support their recommendations, and only 6% made any reference to costs.

Conclusions: The methodologic quality of clinical review articles is highly variable, and many of these articles do not specify systematic methods.


Grahic Jump Location
Percentage of 158 review articles published in 1996 that fulfilled specific methodologic criteria.Appendix Table

The numbers on the x axis refer to the first 10 criteria listed in the .

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

The Medical Review Article Revisited: Has the Science Improved?

The summary below is from the full report titled “The Medical Review Article Revisited: Has the Science Improved?” It is in the 12 December 1999 issue of Annals of Internal Medicine (volume 131, pages 947-951). The authors are A. McAlister, H.D. Clark, C. van Walraven, S.E. Straus, F.M.E. Lawson, D. Moher, and C.D. Mulrow.


Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.