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Introduction to PRISMA 2020 and Implications for Research Synthesis Methodologists

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Title: Introduction to PRISMA 2020 and Implications for Research Synthesis Methodologists
Language: English
Authors: Page, Matthew J. (ORCID 0000-0002-4242-7526), Moher, David, McKenzie, Joanne E.
Source: Research Synthesis Methods. Mar 2022 13(2):156-163.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 8
Publication Date: 2022
Document Type: Journal Articles
Opinion Papers
Descriptors: Research Methodology, Literature Reviews, Best Practices
DOI: 10.1002/jrsm.1535
ISSN: 1759-2879
Abstract: Systematic reviews should be reported completely and accurately so that users can interpret and appraise the review findings appropriately. In this commentary, we describe key features of a major update of the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement--PRISMA 2020--and discuss its implications for research synthesis methodologists.
Abstractor: As Provided
Entry Date: 2022
Accession Number: EJ1328568
Database: ERIC
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  Value: <anid>AN0155656833;[bdct]01mar.22;2022Mar11.05:19;v2.2.500</anid> <title id="AN0155656833-1">Introduction to PRISMA 2020 and implications for research synthesis methodologists </title> <p>Systematic reviews should be reported completely and accurately so that users can interpret and appraise the review findings appropriately. In this commentary, we describe key features of a major update of the Preferred Reporting Items for Systematic reviews and Meta‐Analyses statement—PRISMA 2020—and discuss its implications for research synthesis methodologists.</p> <p>Keywords: checklist; meta‐analysis; reporting; systematic review; transparency</p> <hd id="AN0155656833-2">THE IMPORTANCE OF COMPLETE AND ACCURATE REPORTING OF SYSTEMATIC REVIEWS</hd> <p>If someone said they had undertaken a systematic review and found that a daily glass of alcohol "improved health dramatically", you might be wondering several things. For example, what types of studies were eligible for inclusion in the review? Was it likely that they located all the eligible studies? What type of alcohol was evaluated, where was it made, and what was its concentration? Which health outcomes were assessed? How large was the estimated effect of alcohol and how certain are you that it reflects the true effect? Answers to these types of questions, and others, should readily be found in a systematic review report, which should be reported completely and accurately so that users can interpret and appraise the review findings appropriately.</p> <p>The latest Preferred Reporting Items for Systematic reviews and Meta‐Analyses statement—PRISMA 20201–6—aims to help authors provide complete and accurate accounts of systematic reviews so that users are able to assess the trustworthiness and applicability of the review findings, use the findings in derivative products such as overviews of reviews and guidelines (thus leveraging on previous investment) and, if they wish, attempt to replicate the review to verify its findings.</p> <hd id="AN0155656833-3">REPORTING GUIDELINES FOR RESEARCH SYNTHESIS</hd> <p>The first PRISMA statement—PRISMA 2009—was focused on the reporting of systematic reviews of the effects of health interventions.7–13 The statement consisted of a 27‐item checklist, an explanation and elaboration document providing detailed guidance on what to report for each item, why to report each item and exemplars of each item,14–18 along with a template flow diagram for authors to illustrate the flow of studies from identification to inclusion. The 27‐item checklist has guided the reporting of thousands of reviews, and has been used by methodologists as a tool to evaluate the reporting quality of published systematic reviews in more than 50 studies.19</p> <p>In the years since PRISMA 2009 was disseminated, several other reporting guidelines for systematic reviews and other types of research synthesis have been published (Table 1). There are 13 extensions to PRISMA 2009,21–38 which provide reporting guidance for specific components of systematic reviews (such as the abstract24), stage of the review (such as the review protocol27,28), particular synthesis methods (such as network meta‐analysis25 and meta‐analysis of individual participant data26), and particular fields of research (such as traditional Chinese medicine35,36 and ecology and evolutionary biology38).</p> <p>1 TABLEScope of reporting guidelines for research synthesis published after preferred reporting items for systematic reviews and meta‐analyses (PRISMA) 2009 (adapted from Page et al. 19,20)</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Reporting guideline</th><th align="left">Year</th><th align="left">Primary discipline(s)</th><th align="left">Primary scope</th><th align="left">Included in reporting guideline</th></tr><tr><th align="left">Checklist</th><th align="left">E&E</th><th align="left">Exemplars</th></tr></thead><tbody valign="top"><tr><td>PRISMA and its extensions</td></tr><tr><td>PRISMA 20201,6</td><td>2021</td><td>Health</td><td>Systematic reviews of the effects of health interventions</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>PRISMA Equity<xref ref-type="fn" rid="tfn1" />21–23</td><td>2012</td><td>Health</td><td>Systematic reviews with a focus on health equity</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>PRISMA Abstracts<xref ref-type="fn" rid="tfn1" />24</td><td>2013</td><td>Health</td><td>Abstracts for systematic reviews of the effects of health interventions</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>PRISMA NMA<xref ref-type="fn" rid="tfn1" />25</td><td>2015</td><td>Health</td><td>Systematic reviews with network meta‐analysis</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>PRISMA IPD<xref ref-type="fn" rid="tfn1" />26</td><td>2015</td><td>Health</td><td>Systematic reviews and meta‐analyses of individual participant data</td><td>✓</td><td /><td>✓</td></tr><tr><td>PRISMA‐P<xref ref-type="fn" rid="tfn1" />27,28</td><td>2015</td><td>Health</td><td>Protocols for systematic reviews of the effects of health interventions</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>PRISMA Harms<xref ref-type="fn" rid="tfn1" />29</td><td>2016</td><td>Health</td><td>Systematic reviews assessing harms of interventions</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>PRISMA‐CI<xref ref-type="fn" rid="tfn1" />30,31</td><td>2017</td><td>Health</td><td>Systematic reviews of complex interventions</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>PRISMA DTA<xref ref-type="fn" rid="tfn1" />32,33</td><td>2018</td><td>Health</td><td>Systematic reviews of diagnostic test accuracy studies</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>PRISMA‐ScR<xref ref-type="fn" rid="tfn1" />34</td><td>2018</td><td>Health</td><td>Scoping reviews</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>PRISMA Acupuncture<xref ref-type="fn" rid="tfn1" />35</td><td>2019</td><td>Traditional Chinese Medicine</td><td>Systematic reviews of studies that evaluate the effects of acupuncture</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>PRISMA Moxibustion<xref ref-type="fn" rid="tfn1" />36</td><td>2020</td><td>Traditional Chinese Medicine</td><td>Systematic reviews of studies that evaluate the effects of moxibustion</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>PRISMA‐search<xref ref-type="fn" rid="tfn1" />37</td><td>2020</td><td>Health</td><td>Reporting of literature searches in systematic reviews</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>PRISMA‐EcoEvo<xref ref-type="fn" rid="tfn1" />38</td><td>2021</td><td>Ecology and evolutionary biology</td><td>Systematic reviews of research in ecology and evolutionary biology</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>Other reporting guidelines for research syntheses</td></tr><tr><td>IOM standards39</td><td>2011</td><td>Health</td><td>Systematic reviews of the effects of health interventions</td><td>✓</td><td>✓</td><td /></tr><tr><td>ENTREQ40</td><td>2012</td><td>Health</td><td>Syntheses of qualitative health research</td><td>✓</td><td /><td /></tr><tr><td>RAMESES realist syntheses41</td><td>2013</td><td>Health and social sciences</td><td>Realist syntheses of health and social interventions</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>RAMESES meta‐narrative reviews42</td><td>2013</td><td>Health and social sciences</td><td>Meta‐narrative reviews of health and social interventions</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>Atkinson43</td><td>2015</td><td>Not specified</td><td>Reporting of literature searches in systematic reviews</td><td>✓</td><td>✓</td><td /></tr><tr><td>MECCIR<xref ref-type="fn" rid="tfn2" />44</td><td>2017</td><td>Health and social sciences</td><td>New Campbell Collaboration systematic reviews of the effects of social interventions</td><td>✓</td><td>✓</td><td /></tr><tr><td>MARS45</td><td>2018</td><td>Psychology</td><td>Systematic reviews of quantitative research in psychology</td><td>✓</td><td /><td /></tr><tr><td>QMARS46</td><td>2018</td><td>Psychology</td><td>Systematic reviews of qualitative research in psychology</td><td>✓</td><td /><td /></tr><tr><td>Muller47</td><td>2018</td><td>Neuroscience</td><td>Systematic reviews of neuroimaging studies</td><td>✓</td><td>✓</td><td /></tr><tr><td>ROSES48</td><td>2018</td><td>Conservation and environmental management</td><td>Systematic reviews and maps of research in conservation and environmental management (and protocols of such reviews and maps)</td><td>✓</td><td /><td /></tr><tr><td>PRIO Harms49</td><td>2018</td><td>Health</td><td>Overviews of systematic reviews assessing harms of health interventions</td><td>✓</td><td /><td /></tr><tr><td>PRIO Abstracts50</td><td>2019</td><td>Health</td><td>Abstracts for overviews of systematic reviews of the effects of health interventions</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>MECIR<xref ref-type="fn" rid="tfn2" />51</td><td>2020</td><td>Health</td><td>New and updated Cochrane systematic reviews of the effects of health interventions (and protocols for such reviews)</td><td>✓</td><td>✓</td><td /></tr><tr><td>SWiM52</td><td>2020</td><td>Health and social sciences</td><td>Systematic reviews of the quantitative effects of interventions in which alternative synthesis methods to meta‐analysis are used</td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>MAER‐Net53</td><td>2020</td><td>Economics</td><td>Systematic reviews of empirical economics research</td><td>✓</td><td /><td /></tr><tr><td>NIRO‐SR54</td><td>2020</td><td>Psychology</td><td>Systematic reviews of non‐intervention studies (and protocols for such reviews)</td><td>✓</td><td>✓</td><td /></tr><tr><td>REGEMA55</td><td>2021</td><td>Psychology</td><td>Systematic reviews of reliability generalisation meta‐analyses, which intend to explain how measurement error varies from one test application to the next</td><td>✓</td><td>✓</td><td /></tr></tbody></table> </ephtml> </p> <p>1 a Extension of the PRISMA 2009 statement.</p> <ulist> <item>2 b Both MECIR and MECCIR provide, in addition to reporting guidance for systematic reviews, guidance on how to conduct Cochrane and Campbell reviews, respectively.</item> <item>3 Abbreviations: CI, complex interventions; DTA, diagnostic test accuracy; E&E, explanation and elaboration; EcoEvo, ecology and evolutionary biology; ENTREQ, enhancing transparency in reporting the synthesis of qualitative research; IOM, Institute of Medicine; IPD, individual participant data; MAER‐Net, Meta‐Analysis of Economics Research Network; MARS, Meta‐Analysis Reporting Standards; MECCIR, Methodological Expectations of Campbell Collaboration Intervention Reviews; MECIR, Methodological Expectations of Cochrane Intervention Reviews; NIRO‐SR, Non‐Intervention, Reproducible, and Open Systematic Reviews; NMA, network meta‐analysis; PRIO, Preferred Reporting Items for Overviews of systematic reviews; PRISMA, Preferred Reporting Items for Systematic reviews and Meta‐Analyses; QMARS, Qualitative Meta‐Analysis Reporting Standards; RAMESES, Realist And MEta‐narrative Evidence Syntheses: Evolving Standards; REGEMA, REliability GEneralization Meta‐Analysis; ROSES, RepOrting standards for Systematic Evidence Syntheses; ScR, scoping reviews; SWiM, Synthesis Without Meta‐analysis.</item> </ulist> <p>We are aware of 17 reporting guidelines for research synthesis developed outside of the PRISMA banner (Table 1), sourced from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network library and literature searches conducted to inform the update to PRISMA 2009.39–55 These 17 guidelines span the disciplines of health,39–42,44,49–52 social sciences,41,42,44,52 psychology,45,46,54,55 neuroscience,47 economics53 and conservation and environmental management.48 The content of some of these guidelines overlaps considerably with PRISMA 2009, while several provide guidance on topics not addressed in PRISMA 2009 or its extensions, including synthesis of qualitative data,40,46 realist synthesis,41 and synthesis of the quantitative effects of interventions using alternative methods to meta‐analysis.52 In addition to presenting a checklist of items, most (11/17) of these other reporting guidelines have adopted a structure similar to PRISMA 2009, by including an explanation and elaboration for each item, but few (4/17) include exemplars of reporting for each item. This is in contrast to the family of PRISMA guidelines, which all provide exemplars. Exemplars can help to solidify understanding and provide a guide to how the text for a particular item could be written.</p> <p>Many contributing factors have led to the number of available reporting guidelines for research synthesis. Reporting guidelines are researcher‐initiated endeavours, and those with specialist knowledge on a topic aptly see the need for improved reporting in their area. Furthermore, reporting guidelines developed for one discipline are not necessarily exchangeable to another, without modification. From our perspective, this is reasonable, so long as reporting guideline developers periodically consider whether the recommendations within their guideline are up‐to‐date and remain relevant to the systematic reviews for which they are designed.</p> <hd id="AN0155656833-4">METHODS FOR UPDATING PRISMA 2009</hd> <p>Examining the content of existing reporting guidelines for research synthesis was a crucial first step in our endeavour to update the PRISMA 2009 statement, as it helped us to generate ideas for possible modifications to the original statement.20 We followed this step by: surveying 110 systematic review methodologists and journal editors who shared their views on the possible modifications suggested; holding discussions on the content and wording of PRISMA 2020 at an in‐person meeting attended by 21 individuals with relevant expertise; and undergoing multiple rounds of drafting and revising the PRISMA 2020 statement, as informed by feedback from co‐authors and a convenience sample of 15 systematic reviewers (for an extensive description of the updating process, see Page et al.56).</p> <p>Our goals for the update of PRISMA 2009 were to accommodate reporting guidance relating to new or updated methods for systematic reviews (e.g. text mining for study identification,57 methods for assessing certainty of evidence58); enhance clarity for authors; facilitate replicability of systematic reviews59; ensure the items are aligned with tools for assessing the validity and applicability of systematic reviews60,61; ensure the items were applicable to systematic reviews wider than just those with meta‐analysis of the effects of health interventions; and to check for and remove redundancy across items.</p> <hd id="AN0155656833-5">PREFERRED REPORTING ITEMS FOR SYSTEMATIC REVIEWS AND META‐ANALYSES 2020</hd> <p>The PRISMA 2020 statement consists of a 27‐item main checklist, a checklist for abstracts, revised flow diagrams for original and updated reviews, and a detailed explanation and elaboration document with up to four exemplars per item.1,6 The explanation and elaboration document includes bullet points detailing reporting recommendations for each of the 27 items (which we refer to as elements), and an abridged version of these elements are collated into what we call an 'expanded checklist'. We believe this expanded checklist will facilitate uptake and implementation of PRISMA 2020. Authors should find PRISMA 2020 most suitable when drafting a systematic review of studies that evaluate the effects of health interventions, irrespective of the design of the included studies, or the statistical synthesis methods used (excluding network meta‐analysis and meta‐analysis of individual participant data).1 However, many items are applicable to other reviews, such as those evaluating non‐health‐related interventions (such as social or educational interventions), or those with objectives other than evaluating interventions (such as aetiology, prevalence or prognosis).</p> <p>The PRISMA 2020 checklist retains all items in the PRISMA 2009 checklist. However, the wording of all items has been revised, and some items have been reorganised for better flow and uptake. PRISMA 2020 covers aspects that received little or no emphasis in the PRISMA 2009 checklist and addresses aspects that are unique compared with other reporting guidelines for research synthesis. Specifically, it captures changes in expectations arising from the Open Science movement, through the inclusion of a new item on availability of data, analytic code and other review materials (item 27). It incorporates guidance on the use of automation tools throughout the review process (items 7, 8, 9 and 11), reflecting the development in this area. It includes a new item seeking the declaration of any competing interests of review authors (item 26), in line with the expectations of the International Committee of Medical Journal Editors.62 It includes two new items capturing the methods for, and the reporting of, assessments of the certainty of evidence (items 15 and 22), which were rarely reported prior to 2009. Finally, it broadens the focus beyond meta‐analysis, seeking the reporting of other statistical synthesis and presentation methods that may be used (item 13a–f).</p> <p>PRISMA 2020 has been developed cognisant of the array of methods that might be used at any stage of a systematic review (e.g. risk of reporting bias might be assessed by crosschecking study reports against their protocols, or generating contour‐enhanced funnel plots, or both63). In a departure from other explanation and elaboration documents, PRISMA 2020 separates explanations of why each item should be reported from recommendations on what to report, presenting the latter as bullet points to facilitate implementation.6 Such recommendations are classified as 'essential' or 'additional'. Essential elements are those which we believe should be reported so that users are able to assess the trustworthiness and applicability of a review's findings, or their reporting would aid in reproducing the findings. Additional elements are those which we believe are not essential, but may enhance the completeness and usability of systematic review reports.</p> <hd id="AN0155656833-6">METHODOLOGISTS' ROLE IN IMPROVING THE REPORTING OF SYSTEMATIC REVIEWS</hd> <p>Systematic review methodologists play a key role in planning, advising and applying the methods of a systematic review and interpreting the results. Because of this, they are integral to ensuring that the methods and results are accurately and completely reported. Careful input from the review team methodologist(s) will be particularly necessary to report items that cover methodologically more challenging concepts. For example, these may include:</p> <p></p> <ulist> <item> include item 7, 8, 9 and 11, which address both human and machine approaches to the search, selection, data collection and risk of bias assessment stages of the review;</item> <p></p> <item> item 10a on defining outcomes and selecting results for inclusion in the review, which addresses multiplicity of study results and various methods to deal with it;</item> <p></p> <item> items 13a‐13f on synthesis methods, which address methods required to prepare for synthesis, tabulation and graphical methods for displaying results, methods of meta‐analysis and alternative statistical synthesis methods, and subgroup and sensitivity analyses;</item> <p></p> <item> item 15 on methods for assessing certainty in the body of evidence for an outcome, which require consideration of multiple factors when interpreting findings (such as precision of the effect estimate, consistency of findings across studies).</item> </ulist> <hd id="AN0155656833-7">USING PRISMA 2020 IN METHODS RESEACH TO ASSESS THE COMPLETENESS OF REPORTING OF SYSTEMATIC RE...</hd> <p>The PRISMA 2009 statement has been used to evaluate the completeness of reporting of published systematic reviews in many methods studies.19 A limitation of such methods studies has been that few have articulated how they have dealt with multi‐component items in the PRISMA 2009 checklist, of which there are several (e.g. item 6 requires authors to "<emph>Specify study characteristics (e.g., PICOS, length of follow‐up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale</emph>").7 That is, it is not clear if 'complete reporting' requires at least one element of the item to be reported, a subset of elements or all elements. When conducting studies using PRISMA 2020 to evaluate systematic reviews, we recommend that the expanded checklist be used, and that completeness of reporting be assessed against each of the item's elements. Such a granular assessment will highlight the elements that are problematic, and therefore where re‐wording may be indicated or additional guidance developed. If limited resources prohibit such an extensive evaluation and the main PRISMA 2020 checklist is used, details of how each item was assessed should be reported; this is particularly important for multi‐component items.</p> <hd id="AN0155656833-8">CONCLUSIONS</hd> <p>We hope the modifications to the content and structure of the PRISMA 2020 statement will facilitate further uptake of the guideline and ultimately enhance the usability of systematic reviews of health interventions. However, recognising that passive strategies of disseminating guidelines in other contexts seldom bring about needed improvements,64,65 we plan to design active strategies to implement PRISMA 2020 and evaluate their effectiveness using randomised trials. Involvement of methodologists in the editorial process is one such active implementation strategy that has shown promise in the context of reviewing randomised trial reports,66 and so should be explored with journals handling systematic review submissions. Findings from these evaluations may inform guidance for development and dissemination of future reporting guidelines, regardless of their scope.</p> <hd id="AN0155656833-9">ACKNOWLEDGMENTS</hd> <p>We thank the following contributors who co‐authored the PRISMA 2020 statement with us: Elie A. Akl, Patrick M. Bossuyt, Isabelle Boutron, Sue E. Brennan, Roger Chou, Julie Glanville, Jeremy M. Grimshaw, Tammy C. Hoffmann, Asbjørn Hróbjartsson, Manoj M. Lalu, Tianjing Li, Elizabeth W. Loder, Evan Mayo‐Wilson, Steve McDonald, Luke A. McGuinness, Cynthia D. Mulrow, Larissa Shamseer, Lesley A. Stewart, Jennifer M. Tetzlaff, James Thomas, Andrea C. Tricco, Vivian A. Welch, and Penny Whiting.</p> <hd id="AN0155656833-10">CONFLICT OF INTEREST</hd> <p>MJP, DM and JEM co‐led the development of the PRISMA 2020 statement but have no commercial interest in the use of this reporting guideline. DM is chair of the EQUATOR Network, which advocates for the use of reporting guidelines to improve the quality of reporting in research articles.</p> <hd id="AN0155656833-11">AUTHOR CONTRIBUTIONS</hd> <p>All authors declare to meet the ICMJE conditions for authorship. Matthew J. Page wrote the first draft of the article. All authors contributed to revisions of the article. All authors approved the final version of the submitted article.</p> <hd id="AN0155656833-12">DATA AVAILABILITY STATEMENT</hd> <p>Data sharing is not applicable to this article as no new data were created or analysed in this study.</p> <ref id="AN0155656833-13"> <title> Footnotes </title> <blist> <bibl id="bib1" type="bt">1</bibl> <bibtext> Funding informationMJP is supported by an Australian Research Council Discovery Early Career Researcher Award (DE200101618). DM is supported in part by a University Research Chair, University of Ottawa. JEM is supported by an Australian National Health and Medical Research Council Career Development Fellowship (1143429). The funders had no role in the study design, decision to publish, or preparation of the manuscript.</bibtext> </blist> </ref> <ref id="AN0155656833-14"> <title> REFERENCES </title> <blist> <bibtext> Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 ; 372 : n71.</bibtext> </blist> <blist> <bibl id="bib2" type="bt">2</bibl> <bibtext> Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021 ; 10 (1): 89.</bibtext> </blist> <blist> <bibl id="bib3" type="bt">3</bibl> <bibtext> Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. PLoS Med. 2021 ; 18 (3): e1003583.</bibtext> </blist> <blist> <bibl id="bib4" type="bt">4</bibl> <bibtext> Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. J Clin Epidemiol. 2021 ; 134 : 178 ‐ 189.</bibtext> </blist> <blist> <bibl id="bib5" type="bt">5</bibl> <bibtext> Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. 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  Data: Systematic reviews should be reported completely and accurately so that users can interpret and appraise the review findings appropriately. In this commentary, we describe key features of a major update of the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement--PRISMA 2020--and discuss its implications for research synthesis methodologists.
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