Where does risk of bias belong?

Risk of bias should appear in multiple places in your systematic review report:

1. Methods

Because risk of bias assessments are subjective, it’s important to be as transparent as possible about how you made your decisions. Be sure to devote some space in your methods section to describe your process.

2. Results

This is where the bulk of your risk of bias assessment will appear. Summarize your risk of bias assessment across studies for each domain, and where relevant, for each outcome. Note that within studies, the risk of bias may be different for different outcomes. This is also where you’ll put charts and graphs (examples below) describing the findings of your risk of bias assessment.

3. Discussion

In the Discussion, you should talk about risk of bias in the included studies, particularly if your assessment found something worth discussing. Maybe you found a high risk of bias in a large number of your studies, raising concerns about the adequacy of the data and systematic review conclusions. Maybe one study was of particularly high risk of bias and therefore worthy of comment.

Often, based on the risk of bias assessments, you could make recommendations for the conduct and reporting of future studies (or maybe even the re-analysis of existing studies). On the flip side, an evidence base with low risk of bias may be worth commenting on, to provide credence to the conclusions you are making in your systematic review.

4. Appendix

This is where you provide additional tables or charts detailing the risk of bias decisions you made for each study, domain and outcome. For example, if you rated Study 6 as high risk of reporting bias due to incomplete outcome reporting, you might want to specify what was missing alongside the “high” rating.