Article Text

Download PDFPDF

Ten simple rules for conducting umbrella reviews
  1. Paolo Fusar-Poli1,2,3,
  2. Joaquim Radua1,4,5
  1. 1 Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
  2. 2 OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
  3. 3 Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
  4. 4 FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain
  5. 5 Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
  1. Correspondence to Dr Paolo Fusar-Poli, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, UK; paolo.fusar-poli{at}


Objective Evidence syntheses such as systematic reviews and meta-analyses provide a rigorous and transparent knowledge base for translating clinical research into decisions, and thus they represent the basic unit of knowledge in medicine. Umbrella reviews are reviews of previously published systematic reviews or meta-analyses. Therefore, they represent one of the highest levels of evidence synthesis currently available, and are becoming increasingly influential in biomedical literature. However, practical guidance on how to conduct umbrella reviews is relatively limited.

Methods We present a critical educational review of published umbrella reviews, focusing on the essential practical steps required to produce robust umbrella reviews in the medical field.

Results The current manuscript discusses 10 key points to consider for conducting robust umbrella reviews. The points are: ensure that the umbrella review is really needed, prespecify the protocol, clearly define the variables of interest, estimate a common effect size, report the heterogeneity and potential biases, perform a stratification of the evidence, conduct sensitivity analyses, report transparent results, use appropriate software and acknowledge the limitations. We illustrate these points through recent examples from umbrella reviews and suggest specific practical recommendations.

Conclusions The current manuscript provides a practical guidance for conducting umbrella reviews in medical areas. Researchers, clinicians and policy makers might use the key points illustrated here to inform the planning, conduction and reporting of umbrella reviews in medicine.

View Full Text

Statistics from


  • Funding This research received no specific grant from any funding agency in thepublic, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.