8.3.3  Quality scales and Cochrane reviews

The use of scales for assessing quality or risk of bias is explicitly discouraged in Cochrane reviews. While the approach offers appealing simplicity, it is not supported by empirical evidence (Emerson 1990, Schulz 1995b). Calculating a summary score inevitably involves assigning ‘weights’ to different items in the scale, and it is difficult to justify the weights assigned. Furthermore, scales have been shown to be unreliable assessments of validity (Jüni 1999) and they are less likely to be transparent to users of the review. It is preferable to use simple approaches for assessing validity that can be fully reported (i.e. how each trial was rated on each criterion).


One commonly-used scale was developed by Jadad and colleagues for randomized trials in pain research (Jadad 1996). The use of this scale is explicitly discouraged. As well as suffering from the generic problems of scales, it has a strong emphasis on reporting rather than conduct, and does not cover one of the most important potential biases in randomized trials, namely allocation concealment (see Section 8.10.1).