#HEORInsights

Systematic reviews (SRs) are crucial in health and scientific research as they offer a thorough understanding of the findings from research. (1) They provide critical information on different aspects of research, such as answers to the questions not often addressed by individual studies, problems in primary research that need to be avoided in future studies, and theories on how’s and why’s. Therefore, they create a knowledge base for different types of stakeholders, viz. healthcare providers, patients, fellow researchers, as well as regulators and policymakers. (2)

An SR is valuable only when it is prepared with transparent, comprehensive, and precise objectives. If the information presented in SRs is ambiguous, the readers may not interpret or reproduce the findings precisely. Additionally, it may also lead to the failure to implement the SR findings into clinical practice. (3) Adherence to clear, up-to-date reporting guidelines enables authors to achieve reliable, good-quality SRs. (4,5)

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement is a reporting guideline published in 2009, developed to curb poor reporting of SRs. (6) This statement comprises a checklist of 27 items recommended for reporting in SRs, as well as an “explanation and elaboration” paper that provides additional regulations for an individual item, along with examples of exemplar reporting. (7) As observed in 2017, the PRISMA 2009 statement reportedly had a very high uptake from the biomedical research community. However, not all published SRs were observed to cite the guideline. (8) As of 2020, the endorsement and adoption of the statement were more expansive, as observed through its co-publication in several journals, citation in over 60,000 reports, (9) commendation from nearly 200 journals, SR organizations, and uptake in various fields.(2)

The PRISMA 2009 statement and extensions certainly helped in facilitating meta-research. Evidence also suggests that adherence to some PRISMA items was better than others. (3) Moreover, findings from observational studies have shown the use of the PRISMA 2009 statement to result in thorough reporting of SRs,(8) although with more scope to improve adherence to the same. (3) A scoping review was conducted to analyze the uptake and impact of the PRISMA 2009 statement, which considered 57 studies assessing adherence to the statement (reporting of SRs in line with PRISMA 2009 guidance).(3) Findings of this review showed, out of 57 studies considered, adherence to the statement was reported in 27 studies. However, lack of transparency was still an issue for many published SRs, which was shown with adherence shown to very few items from the statement among very few SRs.(3)

In 2020, the PRISMA 2009 statement was updated and replaced by PRISMA 2020 statement. This update can be attributed to the perpetual changes in the health and life sciences research domain, such as technological advancements like natural language processing (NLP) and machine learning (ML) for robust identification of relevant evidence, development of novel methods for assessing the risk of bias, and transformation of publishing landscape, among others.² The PRISMA 2020 statement provides updated reporting recommendations for SRs that consider advancements in methods to identify, select, and assess studies. This updated statement comprises a checklist of 27 items, an extended checklist detailing guidance for an individual item, the PRISMA 2020 abstract checklist, and amended flow diagrams for original and updated reviews.(2)

It is believed that the use of PRISMA 2020 will potentially benefit many stakeholders, including authors, editors, peer reviewers for SRs, along with a varied range of SR audiences, including guideline developers, policymakers, healthcare providers, and patients among others. Furthermore, the uptake of the PRISMA 2020 guidance will lead to a more transparent, comprehensive, and precise SR reporting, thus enabling informed and evidence-based decision-making.(2)

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References  

1. Peričić T, Tanveer S. Why systematic reviews matter – A brief history, overview and practical guide for authors. Author’s Update. Elsevier. July 2019. Available at: https://www.elsevier.com/connect/authors-update/why-systematic-reviews-matter
2. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372:n71.
3. Page MJ, Moher D. Evaluations of the uptake and impact of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement and extensions: a scoping review. Syst Rev 2017; 6:263.
4. Moher D, Tetzlaff J, Tricco AC, Sampson M, Altman DG. Epidemiology and reporting characteristics of systematic reviews. PLoS Med 2007; 4:e78.
5. Page MJ, Moher D. Mass production of systematic reviews and metaanalyses: an exercise in mega-silliness? Milbank Q 2016; 94(3):515-9.
6. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151:264-9, W64.
7. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009; 62:e1-34.
8. Page MJ, Shamseer L, Altman DG, et al. Epidemiology and reporting characteristics of systematic reviews of biomedical research: a cross-sectional study. PLoS Med 2016; 13(5):e1002028.
9. Scopus Preview. August 2020. Available at: https://www.scopus.com/home.uri?zone=header&origin=