Systematic reviews and meta-analyses reside at the top of the evidentiary hierarchy scale for effectiveness questions.

Both of these approaches can be used to synthesize results of a research question, by including a wide variety of studies which are assessed based on their internal and external validity prior to inclusion in the review.

These methods combine contrasting results that have been reported in previous research studies; these results can better predict general outcomes of a specific intervention, policy, or program.

Practitioners can save time when searching for evidence-based research; instead of individually searching for studies, practitioners can utilize these methods which review multiple studies and provide a general consensus of results, based on previously conducted research.

External validity is high when the study and findings are replicated within different contexts, meaning that the outcomes of the study is more-likely applicable to a greater population.

Each singular study has its own flaws and limitations; when multiple studies are included, confidence in results increases.

Check if the systematic review is sponsored and consider who conducted the review. Are the findings and methodology biased in any way?

Check if the systematic review has specific exclusion and inclusion criteria.

Check the methodology of the review; recognize that a systematic review including mostly randomized controlled trials (RCTs) excludes high-quality quasi-experimental research, which could be crucial evidence.

Consider participants and whether the findings of the review can be applied to your clients; how are the participants similar to or different from my clients?

Check whether researchers provided information about the limitations/flaws of specific studies included.

Consider whether researchers critically appraised studies they included in the review.

Check for comprehensiveness in search methods; did the researcher(s) use both published and unpublished research? Were studies in multiple languages included?

Consider the quality of the studies included.

Consider possible bias during selection of studies to include.

Ensure that the research question is focused.

Consider the methodology of the analysis.

Do not assume that findings are relevant to clinical practice.

Does it specify a sufficiently narrow and well-defined question?

Is it transparent regarding the following questions?

Were its search procedures and inclusion criteria sufficiently comprehensive?

Were its exclusion criteria too restrictive?

Did those who sponsored, funded, or conducted the review have vested interests at stake in its conclusions? (Review authors should report whether any of them were involved in any studies included in the review and whether they have any sort of affiliation with or financial stake in any of the concerns being reviewed.)

Does it critically appraise the quality of included studies? 7

Does it sort the evidence according to study quality?

Does it sort the evidence according to client characteristics? If so, do its conclusions seem to apply to your clients?

Does it inappropriately lump together clinically meaningful outcome indicators and clinically insignificant ones?

Did it use at least two independent review authors to assess the quality of the studies and extract findings from the studies?

If yes to question 10, was there agreement between the assessments and findings of the review authors? If there were disagreements, how were they resolved?

Were strategies for dealing with missing data described?

Were steps taken to prevent bias in the review process?

Were clear and practical implications for practice articulated?