Page 101 - JCTR-11-2

Journal of Clinical and
Translational Research Review of research landscapes and quality

comprehensive baseline of research outputs and the pattern of research quality
in the participating countries and discipline. The findings may underscore the
presence of a valid classification method to guide future research and enhance
evidence-based practice in healthcare. Relevance for patients: By identifying
research strengths and gaps, this proposed systematic review supports the
development of robust study designs that generate reliable evidence, ultimately
enhancing patient care and health outcomes.

Keywords: Systematic review; Clinical research; Biomedical research; Research
characteristics; Research quality; Malaysia; Indonesia

1. Introduction randomized studies, identifying significant discrepancies
due to biases in study designs, and underscored the
There is currently an increasing number of clinical and importance of quality assessment tools for detecting
biomedical research and publications globally, especially and addressing these differences to ensure reliable
those originating from Asia. However, the increase in comparisons and synthesis across diverse research designs.
1
quantity does not correlate with the quality of research Zeng et al. reviewed methodological quality assessment
10
conducted. Instead, significant research waste has been tools across preclinical, clinical, and systematic review
reported due to irrelevancy, poor research design, domains, highlighting their strengths, gaps, and domain-
2
3
inaccessible research data, and incomplete reporting. specific challenges. Nevertheless, most tools available for
5,6
4
Moreover, John Ioannidis, one of the co-directors at the new assessing non-randomized studies are generally of poor
Meta-Research Innovation Center at Stanford, admitted methodological quality, making it consistently difficult or
that “it was very easy to make errors” when discussing the even impossible to assess the methodological quality and
challenges encountered throughout the research process, risk of bias across primary studies Many different tools
12
despite the noble intentions of the researchers. The clinical exist for different study designs, such as the Cochrane
7
and biomedical research landscape in Asia has been evolving Risk of Bias tool for randomized trials, the A Revised
13
throughout the past decades, beyond those reported from a Tool for the Quality Assessment of Diagnostic Accuracy
few sources, with growth seen more in terms of quantity Studies 2 tool for diagnostic test accuracy studies, the
14
than quality. Similarly, the quality of published research Assessment of Multiple Systematic Reviews and Risk of
1
15
in a country such as Malaysia and Indonesia has not been Bias in Systematic Reviews tools for systematic reviews,
16
examined over the past few decades. Comprehensive and the Risk of Bias In Non-Randomized Studies of
assessments and evidence are needed to inform existing Interventions for non-randomized studies of the effects of
17
researchers, research institutes, and stakeholders in these interventions. In addition, there are a few web-based tools
countries about the adequacy of current efforts or the need and checklists for different study designs: the National
to improvise existing research practices. Institutes of Health Study Quality Assessment Tool for
An estimated 200 tools were previously available for controlled intervention studies, systematic reviews and
evaluating research quality or biases in randomized and meta-analyses, observational cohort and cross-sectional
non-randomized studies. 8-10 A recent literature review studies, case–control, pre-post, and case series studies
up to April 2022 identified 417 appraisal tools for non- (https://www.nhlbi.nih.gov/health-topics/study-quality-
randomized studies of interventions. These tools serve assessment-tools); the Critical Appraisal Skills Program
11
critical functions in ensuring that studies adhere to robust checklists by Oxford-based Better Value Healthcare
methodological standards, minimizing bias, and enhancing Ltd. (https://casp-uk.net/casp-tools-checklists/); a web
the reliability of results. Deeks et al. evaluated non- application Critical Appraisal Tools (FLC 2.0) developed
8
randomized intervention studies, highlighting challenges by OSTEBA Spain to guide the critical appraisal process
like biases and confounding factors, and emphasized (http://www.lecturacritica.com/es/acerca.php).
the need for tailored tools to address these complexities. Among some of the more widely used and recommended
Their work reviewed tools designed to standardize tools are the Newcastle-Ottawa scale (NOS), the Downs
18
assessments and improve comparability, providing a and Black instrument, and the latter RTI item bank
19
framework for systematic quality evaluations. MacLehose (RTI-IB). The NOS, which has been used to illustrate
20
et al. compared effect sizes from randomized and non- issues in data extraction from primary non-randomized
9
Volume 11 Issue 2 (2025) 95 doi: 10.36922/jctr.24.00071