Applying Appraisal Tools in Aphasia Systematic Reviews: A Tutorial

A systematic review (SR) represents a rigorous process of identifying and summarizing current research to answer specific clinical questions. Not all SRs present high-quality information, because they do not adhere to established standards of conduct or reporting. This tutorial aims to (a) describe two tools developed in epidemiology for reporting (PRISMA 2020; Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and appraising (AMSTAR 2; A MeaSurement Tool to Assess Systematic Reviews) SRs and (b) exemplify the use of AMSTAR 2. First, we describe the intents of PRISMA 2020 and AMSTAR 2 and compare the items on each checklist. Next, we apply the AMSTAR 2 list of domains to critically appraise methodological quality in two randomly selected SRs, which describe aphasia treatment. Appraisal results are reported, including the AMSTAR 2 ratings for overall confidence in the results of each review. For each SR, the overall rating was critically low, indicating that within the seven critical domains of AMSTAR 2, the SR had more than one critical weakness.

While PRISMA 2020 is a tool to guide preparation of SRs, to examine SR quality, the AMSTAR 2 is the tool of choice. Applied to two current aphasia treatment SRs, the AMSTAR 2 demonstrates that although both SRs were thorough, thoughtful summaries of a body of aphasia treatment literature, they did not achieve high ratings for methodological quality. Clinicians reading SRs are advised to familiarize themselves with quality assessment tools to assure that an SR meets expected criteria to document internal and external validity of the SR process, so resulting findings can be confidently applied for patients with aphasia.