Assessment of methodological quality (QUADAS-2 and QUADAS-C) in DTA reviews

For data entry purposes, due to considerable overlap between the expected content of the Study characteristics table and that of the description expected for each domain of QUADAS-2, each included study has a study characteristics table integrated with a methodological quality table. However, when the review is published the tables are rendered separately. The tables can be previewed by generating a view from the Dashboard and navigating to Characteristics of studies.

The four domains—Participant Selection, Index Test, Reference Standard, and Flow and Timing—are mandatory. All domains are assessed in terms of risk of bias and the first three domains are also assessed in terms of concerns regarding applicability. Signalling questions can be added or removed in each domain as appropriate for each review. For comparative accuracy studies in a comparative review, the QUADAS-C tool is recommended in addition to QUADAS-2. RevMan does not currently support QUADAS-C and so review authors will need to perform the assessment outside RevMan and report the results using additional tables and may also import relevant.

Edit methodological quality set up 

To edit the methodological quality setup:  

  1. Open the Review Criteria section and navigate to the tab Methodological quality.
  2. Choose the signalling question you wish to activate or deactivate.
  3. You can also add new questions.  

Index Test domain

Unlike the other domains, the Index test domain is assessed for each index test or group of tests in the review. To enable assessment by test, the various index tests should have been defined in the Review Criteria Test tab. You can add one or more test groups.  

To add a test group:

  1. Open the Review Criteria section in the left-hand navigation and navigate to the tab Methodological quality.
  2. Under the domain Index Test domain, click Add test group.
  3. Give the test group a name and select which tests to include in the group and select which studies that should be linked to the test group. 
  4. If you defined multiple test groups, there will be a domain with signalling questions for each test within each study. Note there is only one descriptive text box for all test groups.  


Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM; QUADAS-2 Group. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529-36.  

Yang B, Mallett S, Takwoingi Y, Davenport CF, Hyde CJ, Whiting PF, Deeks JJ, Leeflang MMG; QUADAS-C Group†, Bossuyt PMM, Brazzelli MG, Dinnes J, Gurusamy KS, Jones HE, Lange S, Langendam MW, Macaskill P, McInnes MDF, Reitsma JB, Rutjes AWS, Sinclair A, de Vet HCW, Virgili G, Wade R, Westwood ME. QUADAS-C: A Tool for Assessing Risk of Bias in Comparative Diagnostic Accuracy Studies. Ann Intern Med. 2021 Nov;174(11):1592-1599. doi: 10.7326/M21-2234. Epub 2021 Oct 26. PMID: 34698503. 

Reitsma JB, Rutjes A, Whiting P, Yang B, Leeflang MM, Bossuyt PM, Deeks JJ. Chapter 8: Assessing risk of bias and applicability. Draft version (4 October 2022) for inclusion in: Deeks JJ, Bossuyt PM, Leeflang MM, Takwoingi Y, editor(s). Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 2. London: Cochrane.