The methodological quality and clinical applicability of meta-analyses on probiotics in 2020: A cross-sectional study

Systematic reviews with meta-analyses (SR/MA) are frequently conducted to investigate clinical efficacy of probiotics. However, only rigorously prepared analyses can serve as the highest level of evidence for a specified research question. We have aimed to determine (1) what is the methodological quality of recent SR/MA conducted to assess the efficacy of probiotics; (2) whether the results of SR/MA have a clinical application; and (3) what are factors associated with better quality and applicability of the SR/MA. We systematically searched 4 databases for SR/MA on the probiotics efficacy published in 2020 (PROSPERO CRD42020222716). The AMSTAR 2 tool and pre-defined authors' criteria were used to evaluate methodological quality and clinical applicability, respectively. A total of 114 SR/MA were appraised. In the case of 88 papers (77%), the overall confidence in the results was rated as critically low. The most prevalent flaws were lack of list of excluded studies with justification (79.8%), lack of study protocol (60.5%), and problems with appropriate results combination(54.4%). A declaration of conduction a probiotic efficacy SR/MA could have been misleading in case of 18 studies that included also synbiotics, paraprobiotics, and prebiotics trials in analyses. Only 14 SR/MA provided results that can be apply in clinical practice. Higher journal impact factor and European affiliation of the 1st and corresponding authors were most consistently associated with higher odds of AMSTAR 2 items fulfillments. Based on our findings, SR/MA of probiotics trials cannot be treated as the highest level of evidence without a careful evaluation of their methodological validity.

Automated summary

Systematic reviews with meta-analyses on probiotics efficacy often lack methodological quality and clinical applicability. Critical flaws, such as lack of excluded studies list and study protocol, are common. Only a small percentage of studies provide results applicable to clinical practice, with higher journal impact factor and European author affiliation associated with better methodological quality.