Materials and methods
This study was performed according to The Joanna Briggs Institute
Reviewers’ Manual 2014: Methodology for JBI Umbrella Reviews and
Cochrane Handbook for Systematic Reviews of Interventions Version
6.2.13 The review protocol was registered at The Open
Science Framework under osf.io/74cej.
An extensive literature search was performed among seven electronic
databases for articles published up to February 5, 2022: MEDLINE/PubMed,
Web of Science, Cochrane Library, Embase, Scopus, LILACS and BBO. Other
sources were consulted through Google Scholar and System for Information
on Grey Literature in Europe (SIGLE) through OpenGrey databases. The
protocol registration databases included PROSPERO and Open Science
Framework – OSF. Hand-searches were also performed in specialized
periodicals (Step 1): Journal of Oral and Maxillofacial Surgery;
International Journal of Oral and Maxillofacial Surgery; Journal of
Cranio-Maxillo-Facial Surgery; British Journal of Oral and Maxillofacial
Surgery; Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology;
Journal of Dentistry, Medicine and Medical Sciences; and Journal of Oral
Rehabilitation; and in reference lists of selected articles (Step 2).
To keep the search strategy updated, alerts were established for each
database.
This overview aimed to answer the focused question: “What is the
quality of evidence of secondary studies on the treatment of DDwoR of
the TMJ?” The terms and keywords of the search strategy (Table 1) were
defined to identify SRs based on the elements of the PICO question:
- Population (P) = patients with DDwoR of the TMJ
- Intervention/Comparison (I/C) = types of non-invasive treatment,
minimally invasive treatment and open surgery of the TMJ
- Outcomes (O) = pain and mandibular function
We included SRs and meta-analyses on the comparison of different types
of treatment for DDwoR of the TMJ. Systematic reviews based on animal
studies and data from observational studies, and that did not report the
eligibility criteria or quality assessment of the primary studies were
excluded. Unavailability of the full paper was described in the PRISMA
flow diagram. There was no restriction of studies by date and language
of publication.
The selection process was conducted in two phases: Phase 1, two
researchers (L.M.B. and D.S.B.) independently assessed all titles and
abstracts, applying the including process (blind process); and Phase 2,
the same two reviewers independently applied the exclusion criteria to
the remaining studies, based on reading the full text. Inter-reviewer
reliability in the study selection process was determined by the Cohen κ
test, assuming an acceptable threshold value of
0.80.14 The disagreement at any stage was resolved by
discussion, and a third reviewer (B.C.E.V.) will be consulted (consensus
meeting). The final decision/selection was always based on the full text
of the publication.
Data was independently extracted by two blinded reviewers (L.M.B. and
D.S.B) using a standardized sheet, as recommended by the Cochrane
Handbook for Systematic Reviews of Interventions Version
6.2,13 ordered in the PICO sequence: authors, year of
publication, country where trials were performed, trial design,
objectives, patient population characteristics, number of participants
randomly assigned to each treatment group, clinical setting, detail of
interventions in each group, details of comparators in each group,
outcomes, measured outcomes (including assessment methods), results,
duration of follow-up, number of withdrawals, and source of funding.
When there were unclear or missed information, lack of data or when the
full text was not available, weekly attempts were made for up to five
weeks to contact the authors. The accuracy of extracted data was
confirmed by another author (M.C.M.B.). The synthesis of qualitative
results followed the SWiM reporting guideline.15
The quality of evidence and the possibility of biased results (bias)
from the included systematic reviews and meta-analyses were
independently assessed by two researchers (L.M.B. and D.S.B.) using the
tools: ”A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR
2)”,16 ”Overview Quality Assessment Questionnaire
(OQAQ)”17 and ”Critical Appraisal Skills Programme
(CASP)”.18 The risk of bias in SRs was assessed using
the “Risk of Bias in Systematic Reviews” (ROBIS)
tool.19