Preferred Reporting Items for Systematic Reviews and Meta-Analyses

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The PRISMA flow diagram, depicting the flow of information through the different phases of a systematic review. PRISMA flow diagram.jpg
The PRISMA flow diagram, depicting the flow of information through the different phases of a systematic review.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) is an evidence-based minimum set of items aimed at helping scientific authors to report a wide array of systematic reviews and meta-analyses, primarily used to assess the benefits and harms of a health care intervention. PRISMA focuses on ways in which authors can ensure a transparent and complete reporting of this type of research. [1] The PRISMA standard superseded the earlier QUOROM standard. It offers the replicability of a systematic literature review. Researchers have to figure out research objectives that answer the research question, states the keywords, a set of exclusion and inclusion criteria. In the review stage, relevant articles were searched, irrelevant ones are removed. Articles are analyzed according to some pre-defined categories. [2]

Contents

The PRISMA statement

The aim of the PRISMA statement is to help authors improve the reporting of systematic reviews and meta-analyses. [3] PRISMA has mainly focused on systematic reviews and meta-analysis of randomized trials, but it can also be used as a basis for reporting reviews of other types of research (e.g., diagnostic studies, observational studies).[ citation needed ]

History

In 1987, Cynthia Mulrow examined for the first time the methodological quality of a sample of 50 review articles published in four leading medical journals between 1985 and 1986. She found that none met a set of eight explicit scientific criteria, and that the lack of quality assessment of primary studies was a major pitfall in these reviews. [4] In 1987, Sacks and colleagues [5] evaluated the quality of 83 meta-analyses, using a scoring method that considered 23 items in six major areas: study design, combinability, control of bias, statistical analysis, sensitivity analysis, and application of results. Results of this research showed that reporting was generally poor; and pointed out an urgent need for improved methods in literature searching, quality evaluation of trials, and synthesizing of the results.[ citation needed ]

An example of a QUOROM flow diagram QUOROM Flow Chart - journal.pmed.0050045.g001.png
An example of a QUOROM flow diagram

In 1996, an international group of 30 clinical epidemiologists, clinicians, statisticians, editors, and researchers convened The Quality of Reporting of Meta-analyses (QUOROM) conference to address standards for improving the quality of reporting of meta-analyses of clinical randomized controlled trials (RCTs). [6] This conference resulted in the QUOROM checklist and a flow diagram that described the preferred way to present the abstract, introduction, methods, results, and discussion sections of a report of a systematic review or a meta-analysis. [6] Eight of the original 18 items formed the basis of the QUOROM reporting. Evaluation of reporting was organized into headings and subheadings regarding searches, selection, validity assessment, data abstraction, study characteristics, and quantitative data synthesis. The rationale behind the inclusion of such a diagram is to increase the transparency of decisions made by the researcher for including or excluding certain studies, which may subsequently introduce biases in the overall measure of effect. [6] It subsequently became a required element in a number of medical and life science journals when submitting review papers. [3]

In 2009, the QUOROM was updated to address several conceptual and practical advances in the science of systematic reviews, and was renamed PRISMA (Preferred Reporting Items of Systematic reviews and Meta-Analyses). [3] This was when updated by the PRISMA 2020 which includes new reporting guidance. [7] [8]

In 2021, a 'PRISMA for Searching' (PRISMA-S) guidance was added [9] and published, [10] to improve the literature searches of systematic reviews, which are accentuated to "underlie the foundations of systematic review".

PRISMA components

The PRISMA checklist

The checklist includes 27 items pertaining to the content of a systematic review and meta-analysis, which include the title, abstract, methods, results, discussion and funding.

The PRISMA flow diagram

The following is an example of a PRISMA flow diagram:

A completed PRISMA flow diagram from a published systematic review Vitamin D CAP meta-analysis WikiJournal Fig 1.jpg
A completed PRISMA flow diagram from a published systematic review

Impact of PRISMA

The use of checklists like PRISMA is likely to improve the reporting quality of a systematic review and provides substantial transparency in the selection process of papers in a systematic review. The PRISMA Statement has been published in several journals. [12] [13] [14] [15] [16]

Many journals publishing health research refer to PRISMA in their Instructions to Authors and some require authors to adhere to them. The PRISMA Group advised that PRISMA should replace QUOROM for those journals that endorsed QUOROM in the past.[ citation needed ]

Recent surveys of leading medical journals evaluated the extent to which the PRISMA Statement has been incorporated into their Instructions to Authors. In a sample of 146 journals publishing systematic reviews, the PRISMA Statement was referred to in the instructions to authors for 27% of journals; more often in general and internal medicine journals (50%) than in specialty medicine journals (25%). [17] These results showed that the uptake of PRISMA guidelines by journals is still inadequate although there has been some improvement over time.[ citation needed ]

Approximately 174 journals in the health sciences endorse the PRISMA Statement for the reporting of systematic reviews and meta-analysis published in their collections. [18] PRISMA has been also included as one of the tools for assessing the reporting of research within the EQUATOR Network (Enhancing the Quality and Transparency of Health Care Research), an international initiative that seeks to enhance reliability and value of medical research literature by promoting transparent and accurate reporting of research studies.[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Meta-analysis</span> Statistical method that summarizes data from multiple sources

A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting measurements that are expected to have some degree of error. The aim then is to use approaches from statistics to derive a pooled estimate closest to the unknown common truth based on how this error is perceived. It is thus a basic methodology of Metascience. Meta-analytic results are considered the most trustworthy source of evidence by the evidence-based medicine literature.

<span class="mw-page-title-main">Randomized controlled trial</span> Form of scientific experiment

A randomized controlled trial is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical techniques, medical devices, diagnostic procedures or other medical treatments.

<span class="mw-page-title-main">Cochrane (organisation)</span> British nonprofit for reviews of medical research (formed 1993)

The Cochrane Collaboration is a British international charitable organisation formed to synthesise medical research findings to facilitate evidence-based choices about health interventions involving health professionals, patients and policy makers. It includes 53 review groups that are based at research institutions worldwide. Cochrane has approximately 30,000 volunteer experts from around the world.

In published academic research, publication bias occurs when the outcome of an experiment or research study biases the decision to publish or otherwise distribute it. Publishing only results that show a significant finding disturbs the balance of findings in favor of positive results. The study of publication bias is an important topic in metascience.

<span class="mw-page-title-main">Systematic review</span> Comprehensive review of research literature using systematic methods

A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on the topic, then analyzes, describes, critically appraises and summarizes interpretations into a refined evidence-based conclusion. For example, a systematic review of randomized controlled trials is a way of summarizing and implementing evidence-based medicine.

In statistics, (between-) study heterogeneity is a phenomenon that commonly occurs when attempting to undertake a meta-analysis. In a simplistic scenario, studies whose results are to be combined in the meta-analysis would all be undertaken in the same way and to the same experimental protocols. Differences between outcomes would only be due to measurement error. Study heterogeneity denotes the variability in outcomes that goes beyond what would be expected due to measurement error alone.

In medicine, a case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel occurrence. Some case reports also contain a literature review of other reported cases. Case reports are professional narratives that provide feedback on clinical practice guidelines and offer a framework for early signals of effectiveness, adverse events, and cost. They can be shared for medical, scientific, or educational purposes.

Consolidated Standards of Reporting Trials (CONSORT) encompasses various initiatives developed by the CONSORT Group to alleviate the problems arising from inadequate reporting of randomized controlled trials. It is part of the larger EQUATOR Network initiative to enhance the transparency and accuracy of reporting in research.

The STROBE(STrengthening the Reporting of OBservational studies in Epidemiology) Statement is a reporting guideline including a checklist of 22 items that are considered essential for good reporting of observational studies. It was published simultaneously in several leading biomedical journals in October and November 2007 and comprises both the checklist and an explanation and elaboration article which gives examples of good reporting and provides authors with more guidance on good reporting. It is also referred to in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals established by the International Committee of Medical Journal Editors and is endorsed by hundreds of biomedical journals.

The Jadad scale, sometimes known as Jadad scoring or the Oxford quality scoring system, is a procedure to assess the methodological quality of a clinical trial by objective criteria. It is named after Canadian-Colombian physician Alex Jadad who in 1996 described a system for allocating such trials a score of between zero and five (rigorous). It is the most widely used such assessment in the world, and as of 2022, its seminal paper has been cited in over 23,000 scientific works.

<span class="mw-page-title-main">John Ioannidis</span> American scientist (born 1965)

John P. A. Ioannidis is a Greek-American physician-scientist, writer and Stanford University professor who has made contributions to evidence-based medicine, epidemiology, and clinical research. Ioannidis studies scientific research itself, meta-research primarily in clinical medicine and the social sciences.

Critical appraisal in evidence based medicine, is the use of explicit, transparent methods to assess the data in published research, applying the rules of evidence to factors such as internal validity, adherence to reporting standards, conclusions, generalizability and risk-of-bias. Critical appraisal methods form a central part of the systematic review process. They are used in evidence synthesis to assist clinical decision-making, and are increasingly used in evidence-based social care and education provision.

The Enhancing the Quality and Transparency of health research Network is an international initiative aimed at promoting transparent and accurate reporting of health research studies to enhance the value and reliability of medical research literature. The EQUATOR Network was established with the goals of raising awareness of the importance of good reporting of research, assisting in the development, dissemination and implementation of reporting guidelines for different types of study designs, monitoring the status of the quality of reporting of research studies in the health sciences literature, and conducting research relating to issues that impact the quality of reporting of health research studies. The Network acts as an "umbrella" organisation, bringing together developers of reporting guidelines, medical journal editors and peer reviewers, research funding bodies, and other key stakeholders with a mutual interest in improving the quality of research publications and research itself. The EQUATOR Network comprises four centres at the University of Oxford, Bond University, Paris Descartes University, and Ottawa Hospital Research Institute.

Alessandro Liberati was an Italian healthcare researcher and clinical epidemiologist, and founder of the Italian Cochrane Centre.

Lesley Ann Stewart is a Scottish academic whose research interests are in the development and application of evidence synthesis methods, particularly systematic reviews and individual participant data meta-analysis. She is head of department for the Centre for Reviews and Dissemination at the University of York and director for the NIHR Evidence Synthesis Programme. She was one of the founders of the Cochrane Collaboration in 1993. Stewart served as president of the Society for Research Synthesis Methodology (2013-2016) and was a founding co-editor in chief of the academic journal Systematic Reviews (2010–2021).

<span class="mw-page-title-main">Cynthia Mulrow</span> American physician (born 1953)

Cynthia Mulrow is an American physician and scholar from Edinburg, Texas. She has regularly contributed academic research on many topics to the medical community. Her academic work mainly focuses on systematic reviews and evidence reports, research methodology, and chronic medical conditions.

<span class="mw-page-title-main">Allegiance bias</span>

Allegiance bias in behavioral sciences is a bias resulted from the investigator's or researcher's allegiance to a specific school of thought. Researchers/investigators have been exposed to many types of branches of psychology or schools of thought. Naturally they adopt a school or branch that fits with their paradigm of thinking. More specifically, allegiance bias is when this leads therapists, researchers, etc. believing that their school of thought or treatment is superior to others. Their superior belief to these certain schools of thought can bias their research in effective treatments trials or investigative situations leading to allegiance bias. Reason being is that they may have devoted their thinking to certain treatments they have seen work in their past experiences. This can lead to a fundamental errors to the results of their research they are conducting. Their “pledge” to stay within their own paradigm of thinking may affect their ability to find more effective treatments to help the patient or situation they are investigating.

The International Prospective Register of Systematic Reviews, better known as PROSPERO, is an open access online database of systematic review protocols on a wide range of topics. While it was initially restricted to medicine, as of 2021, it also accepts protocols in criminology, social care, education and international development, as long as there is a health-related outcome. Researchers can choose to have their reviews prospectively registered with PROSPERO. The database is produced by the Centre for Reviews and Dissemination at the University of York in England, and it is funded by the National Institute for Health Research. Registration of systematic reviews in the database has been supported by PLoS Medicine, BioMed Central, the EQUATOR Network, and BMJ editor-in-chief Fiona Godlee, among others.

Virginia M. Barbour is a professor at Queensland University of Technology in Brisbane, Australia, and serves as the Director of the Australasian Open Access Strategy Group. She is best known for being one of the three founding editors of PLOS Medicine, and her various roles in championing the open access movement.

A non-pharmaceutical intervention or non-pharmacological intervention (NPI) is any type of health intervention which is not primarily based on medication. Some examples include exercise, sleep improvement, or dietary habits.

References

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