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242 de Almeida et al. | Journal of Clinical and Translational Research 2024; 10(4): 237-245
Table 3. Glenny scale of the included studies
No. Questions Studies
a b c d e f g h
1 Did the review address a focused question? 1 1 1 1 1 1 1 1
2 Did the authors look for appropriate papers? 1 1 1 1 1 1 1 1
3 Do you think the authors attempted to identify all relevant studies? 1 1 1 1 1 1 1 1
4 Was there a search for published and unpublished literature? 0 0 0 0 0 0 0 0
5 Were all languages considered? 0 0 0 0 0 0 1 0
6 Was any hand-searching carried out? 1 0 1 0 0 1 1 0
7 Was it stated that the inclusion criteria reviewers? 1 1 1 1 1 1 1 1
8 Did reviewers attempt to assess the quality of the included studies? 1 0 1 1 1 1 1 1
9 If so, did they include this in the analysis? 1 0 1 1 1 1 1 1
10 Was it stated that the quality assessment was carried out by at least two reviewers? 1 0 0 0 1 0 1 0
11 Are the results given in a narrative or pooled statistical analysis? 1 1 1 1 1 1 1 1
12 If the results have been combined, was it reasonable to do so? 1 1 1 1 1 1 1 1
13 Are the results clearly displayed? 1 1 1 1 1 1 1 1
14 Was an assessment of heterogeneity made and reasons for variation discussed? 1 0 0 0 0 0 1 1
15 Were results of the review interpreted appropriately? 1 1 1 1 1 1 1 1
Total 13 8 11 10 11 11 14 11
Note: Studies a–h refer to references [5,9,15-20], respectively.
The gray literature is relevant and may influence the results of with amitriptyline are mainly related to its anticholinergic
the analysis. effects, including dry mouth.
The risk of bias (item 9 of AMSTAR 2) is evident in six Therefore, to validate the data obtained, the studies must
articles [5,9,15,16,18,19] due to flaws in the methodological include an umbrella review based on the registration protocol
construction, such as statistical heterogeneity, lack of blinding and checklist of indispensable items (PRISMA). Systematic
of patients and evaluators when assessing results, without reviews should be designed with methodological assessment
previously establishing the risks of confounding bias and scales to include the items necessary for high-quality scientific
selection of studies. Thus, the quality was classified as critically evidence.
low according to AMSTAR 2 for the presence of critical flaws 5. Conclusion
in terms of bias, a small sample size of the included studies, and
heterogeneity of the results. Two articles were rated positively The pharmacological use of clonazepam and non-
in evaluating item 9 of AMSTAR 2 [17,20]. pharmacological management, such as psychotherapy and
Randomized clinical trials included in systematic reviews placebo, effectively relieve BMS symptoms. However, new
should be designed according to the Consolidated Standards of randomized clinical trials are suggested to investigate treatment
Reporting Trials (CONSORT) and include accurate sample size protocols for the condition.
calculations. In addition, it is pertinent to include variables that
enable a more comprehensive assessment of BMS symptoms, Acknowledgments
such as anxiety level, depression, and quality of life. Authors are grateful to Coordenação de Aperfeiçoamento de
The umbrella review of systematic reviews is a new Pessoal de Nível Superior for encouraging postgraduate studies
approach to evaluating and summarizing the results in a single through grant number 001.
document that can be used to guide health professionals and
policymakers and is considered the highest level of scientific Funding
evidence [28]. However, limitations of this type of study This study was funded by the Academic Strengthening
include the lack of detailed analysis of the primary studies; Program at the University of Pernambuco (PFA), Brazil.
the use of data retrieved from existing systematic reviews; and
heterogeneity among the selected studies, which may increase Conflicts of Interest
the risk of bias.
There are no high-quality randomized controlled trials The authors declare that they have no conflicts of interest.
addressing drug therapy in BMS. Hence, more randomized Ethics Approval and Consent to Participate
controlled trials need to be conducted in the future. Recently,
a study reported that low doses of amitriptyline are effective Not applicable.
against irritable bowel syndrome [30]. Amitriptyline may either Consent for Publication
be effective or increase pain, making it important to discuss its
role in BMS treatment from a pain perspective. Adverse events Not applicable.

DOI: http://doi.org/10.36922/jctr.24.00018