Complementary medicine mention and recommendations are limited across hypertension guidelines: A systematic review

ObjectiveThe purpose of this study was to determine the quantity of complementary medicine (CM) recommendations and their quality across clinical practice guidelines (CPGs) for the treatment and/or management of hypertension.Design/SettingA systematic review was conducted to identify hypertension CPGs. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018, alongside the Guidelines International Network and the National Centre for Complementary and Integrative Health websites. Eligible articles were assessed with the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument.Outcome/ResultsFrom 1445 unique search results, 18 CPGs for the treatment and/or management of hypertension published in 2008 or later were eligible for review, though only 1 contained CM recommendations. This CPG was published by the European Society of Cardiology and the European Society of Hypertension, and made a recommendation regarding the Mediterranean diet. The scaled domain percentages of this CPG overall scored significantly better than the CM section across every domain, and were as follows: (overall, CM): scope and purpose (88.9 %, 66.7 %), clarity-of-presentation (88.9 %, 0.0 %), stakeholder involvement (66.7 %, 16.7 %), applicability (60.4 %, 0.0 %), rigor-of-development (35.4 %, 15.6 %), and editorial independence (4.2 %, 0.0 %).ConclusionA lack of CM treatment recommendations exists in CPGs for the treatment and/or management of hypertension. Given that it is known that a high proportion of patients with hypertension seek CM, current hypertension guidelines’ lack of CM treatment and/or management recommendations reflects a large gap in guidance for both clinicians and patients.     

The efficacy of acupuncture for attention deficit hyperactivity disorder (ADHD): An overview of systematic reviews and meta-analyses

BackgroundAttention deficit hyperactivity disorder (ADHD) is one of the most common neurological and mental developmental disorders in children. Published systematic reviews (SRs) and meta-analyses (MAs) concerning the use of acupuncture for ADHD have compared the efficacy of acupuncture treatment to that of drug therapies. However, the quality of these articles has not been evaluated and the evidence varies widely.ObjectiveTo summarize and assess the efficacy of acupuncture for ADHD based on existing SRs and MAs.MethodsA systematic search of the literature was conducted from inception until September 16 2021, using seven electronic databases. The AMSTAR-2 tool was used to evaluate the quality of SRs and MAs, and the GRADE system was used to assess the quality of evidence.ResultsThere are a total of five SRs and MAs included in this overview. Using the AMSTAR-2, three articles were rated as having ‘Low’ quality, while two were rated as having of ‘Critically Low’ quality. The GRADE system was used to measure the quality of evidence for ten outcomes (five response rate outcomes, three Conners’ Index of Hyperactivity (CIH) score outcomes, one Conners’ rating scale score outcome, and one Chinese medicine syndrome outcome) across the five included MAs. Four of the ten outcomes demonstrated ‘moderate’ quality, four demonstrated ‘low’ quality, and two demonstrated ‘very low’ quality. The risk of bias and inconsistency accounted for most downgrading factors in the included reviews.ConclusionIt is still debatable whether acupuncture is efficacious in improving the CIH score and the Response rate. Considering the heterogeneity of clinical trials and the fact that this study did not search and evaluate the relevant data of each randomized controlled trial, large-sample and high-quality randomized controlled trials are still needed to draw reliable conclusions regarding acupuncture's role in treating ADHD. Due to the poor quality of existing available evidence, little inference can be drawn from the included studies.     

Effect of acupuncture in eczema: An overview of systematic reviews

BackgroundEczema is a common chronic relapsing inflammatory skin disease, which is characterized by intense itching. Acupuncture can be effective for eczema, and it is thus regarded as a common complementary treatment.ObjectiveThe intention of this overview is to methodically appraise and synthesize evidence about systematic reviews/meta-analyses (SRs/MAs) on acupuncture in eczema.MethodsWe searched for SRs/MAs of acupuncture with eczema in eight databases. We evaluated the methodological quality by Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the reporting quality with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020 Checkist), and the evidence quality according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.ResultsA total of 7 SRs/MAs were included. According to AMSTAR-2, all the SRs/MAs included were categorized as critically low-quality. According to the PRISMA 2020 checklist, none of the reviews completed all the 27 items, thus their compliance was relatively weak. On the base of GRADE system, 2 of the 12 outcomes were rated as moderate, and 5 outcomes were rated as low-quality, while the others were regarded as very low-quality.ConclusionCompared with the control group, the included reviews of the acupuncture group were more effective and safer; however, the conclusion should be treated cautiously because the quality of evidence was not high enough to support it. In order to improve the quality, more rigorous, standardized, and comprehensive SRs/MAs need designing in the future.     

Variable methodological quality and use found in systematic reviews referenced in STEMI clinical practice guidelines

Background

The objective of this study was to assess the methodological quality and clarity of reporting of the systematic reviews (SRs) supporting clinical practice guideline (CPG) recommendations in the management of ST-elevation myocardial infarction (STEMI) across international CPGs.

Adherence to guideline creation recommendations for suicide prevention in the emergency department: A systematic review

ObjectivesSuicide rates in the United States rose 35.2% from 1999-2018. As emergency department (ED) providers often have limited training in management of suicidal patients and minimal access to mental health experts, clinical practice guidelines (CPGs) may improve care for these patients. However, clinical practice guidelines that do not adhere to quality standards for development may be harmful both to patients, if they promote practices based on flawed evidence, and to ED providers, if used in malpractice claims. In 2011, the Institute of Medicine created standards to determine the trustworthiness of CPGs. This review assessed the adherence of suicide prevention CPGs, intended for the ED, to these standards. Secondary objectives were to assess the association of adherence both with first author/organization specialty (ED vs non-ED) and with inclusion of recommendations on substance use, a potent risk factor for suicide.MethodsThis is a systematic review of available suicide-prevention CPGs for the ED in both peer-reviewed and gray literature. This review followed the PRISMA standards for reporting systematic reviews.ResultsOf 22 included CPGs, the 7 ED-sponsored CPGs had higher adherence to quality standards (3.1 vs 2.4) and included the highest-rated CPG (ICAR²E) identified by this review. Regardless of specialty, nearly all CPGs included some mention of identifying or managing substance use.ConclusionsMost suicide prevention CPGs intended for the ED are written by non-ED first authors or organizations and have low adherence to quality standards. Future CPGs should be developed with more scientific rigor, include a multidisciplinary writing group, and be created by authors working in the practice environment to which the CPG applies.     

Acupuncture for treatment of insomnia: An overview of systematic reviews

PurposeTo evaluate the reliability of the methodological quality and outcome measures of systematic review (SR) /meta-analysis (MA) of acupuncture for insomnia.MethodsWe conducted a comprehensive literature search for SRs with MAs in seven international and Chinese databases. Two reviewers independently extracted data and assessed the methodological quality of the reviews according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the quality of evidence.ResultsThirty-four reviews were included. The AMSTAR-2 score showed that most of the included studies were of low methodological quality and included only two high-quality literatures. The lowest score were the item 10 (all the studies didn't report on the sources of funding for the studies included in the review), item 7(32 studies didn't provide a list of excluded studies and justify the exclusions) and item 3 (27 studies didn't explain their selection of the study designs for inclusion in the review).ConclusionMost of the reviews included suggested that the acupuncture group was more effective than the control group in the treatment of insomnia, but the methodological quality of most of the studies and the quality of evidence were low.     

A critical appraisal of the quality of critical care pharmacotherapy clinical practice guidelines and their strength of recommendations

Objective  

Clinical practice guideline (CPG) quality assessment is important before applying their recommendations. Determining whether recommendation strength is consistent with supporting quality of evidence is also essential. We aimed to determine quality of critical care pharmacotherapy CPGs and to assess whether high quality evidence supports strong pharmacotherapy recommendations.     

Acupuncture for treatment of anxiety,an overview of systematic reviews

PurposeTo evaluate the methodological quality and summarize evidence of important outcomes of systematic reviews (SRs)/Meta analyses (MAs) of acupuncture for anxiety.MethodsWe conducted a comprehensive literature search for SRs/MAs in PubMed, EMBASE, Cochrane library, Chinese Biomedical Databases (CBM), Wanfang database and China National Knowledge Infrastructure (CNKI) until November 30, 2018. Three reviewers independently extracted data and assessed the methodological quality of the reviews according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the quality of evidence. In the pre-experiment, we used the intra-class correlation coefficient (ICC) to assess reviewer agreement, the ICC value for overall score was 0.978.ResultsTen reviews were included. The assessment results of AMSTAR-2 showed that the methodological quality of all included studies was critically low. The lowest score were item “provide a list of excluded studies and justify the exclusions” and item “report sources of funding for the included studies”, none of studies provided information about the above two items, followed by the “providing a priori design” item with only two (20%) studies conforming to this item. For GRADE, of the 7 outcomes, high quality evidence was provided in only 1 (14.3%), moderate in 2 (28.6.7%), and low in 4 (57.1%).ConclusionAlthough most of the included reviews indicated that acupuncture group was more effective than control group in the treatment of anxiety, more importantly, the methodological quality of the included reviews and the quality of evidence were low. More high-quality evidence is needed to determine whether acupuncture is more effective than other treatments.     

A scoping review of clinical practice guidelines for the diagnosis of primary spontaneous pneumothorax

Introduction/BackgroundPrimary spontaneous pneumothorax (PSP) is characterised by the onset of pneumothorax with no evidence of trauma or associated co-morbidities. Several clinical practice guidelines (CPGs) have been published regarding the management of PSP. Inconsistency in imaging protocols across clinics globally may indicate variability in the recommendations within these guidelines. We aimed to support clinical decision making with an assessment of CPGs regarding PSP diagnosis.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was utilised. A systematic search of databases Medline, Embase, and Scopus was conducted. Manual searches of the grey literature and guideline-focused databases was undertaken Inclusion criteria included English-language CPGs pertaining to the management of PSP. Publications were independently extracted and critically appraised by two reviewers using the AGREE-II tool. Recommendations were assessed and tabulated.ResultsEight CPGs met the eligibility criteria. 16 recommendations were identified relating to assessment of medical history, physical examination, assessment of clinical stability, posterior-anterior chest X-ray (CXR) on held inspiration, computed tomography following inconclusive CXR, and ultrasound to complement other imaging modalities.ConclusionThere is universal agreement on the exclusion of expiratory and lateral images in the conventional radiographic series, suggesting that these clinical behaviours may be influenced by local preferences or inhibitors to knowledge translation. This scoping review has summarised the key recommendations of CPGs regarding PSP diagnosis and assessed the methodological quality of the current evidence-base.     

The effectiveness and safety of acupuncture for depression: An overview of meta-analyses

PurposeTo provide an overview of existing meta-analysis (MAs) on the efficacy and safety of acupuncture for depression, and assess the methodological quality and the strength of evidence of the included MAs.MethodsWe searched MAs of randomized trials that have evaluated the effects of acupuncture on depression in three international and three Chinese databases from their inception until August 2019. The methodological quality of included MAs was evaluated with the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), and the strength of evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). We used the intra-class correlation coefficient (ICC) to assess reviewer agreement in the pre-experiment.ResultsWe included 31 MAs and 59 RCTs. The results of included MAs were conflicting, our meta-analyses found that acupuncture may confer small benefit in reducing the severity of depression by end of treatment than no treatment/wait list/treatment as usual(SMD -0.74, 95% CI -1.06 to -0.41, eight trials, 624 participants), control acupuncture (invasive, non-invasive sham controls) (SMD 0.27, 95% CI -0.51 to -0.04, 20 trials, 1055 participants), antidepressants(Selective serotonin reuptake inhibitors (SSRI)/ Tetracyclic antidepressants(TCAs)) (SMD -0.28, 95% CI -0.46 to -0.10, 30 trials, 3068 participants), acupuncture plus antidepressants versus antidepressants(SSRI/TCAs) (SMD -0.99, 95% CI -1.37 to -0.61, 17 trials, 1110 participants). Subgroup analyses showed that there was no difference between electro-acupuncture and invasive control (P = 0.37), electro-acupuncture and non-invasive control (P = 0.90), manual acupuncture and Tetracyclic antidepressants (P = 0.57), electro-acupuncture and Tetracyclic antidepressants (P = 0.07). Six MAs concluded that acupuncture reduced the incidence of adverse events compared with antidepressants. The evaluation with AMSTAR-2 showed that the quality of included MAs was low or critically low. The results of the GRADE evaluation showed that the strength of evidence was low to very low for most outcomes.ConclusionsAlthough acupuncture appears to be more effective and safer than no treatment, control acupuncture and antidepressants, the quality of the available evidence was very low. Further methodologically rigorous and adequately powered primary studies are needed to confirm the effectiveness of acupuncture for depression.     

How do we know if a clinical practice guideline is good? A response to Djulbegovic and colleagues' use of fast‐and‐frugal decision trees to improve clinical care strategies

Clinical practice guidelines (CPGs) and clinical pathways have become important tools for improving the uptake of evidence‐based care. Where CPGs are good, adherence to the recommendations within is thought to result in improved patient outcomes. However, the usefulness of such tools for improving patient important outcomes depends both on adherence to the guideline and whether or not the CPG in question is good. This begs the question of what it is that makes a CPG good? In this issue of the Journal, Djulbegovic and colleagues offer a theory to help guide the development of CPGs. The “fast‐and‐frugal tree” (FFT) heuristic theory is purported to provide the theoretical structure needed to quantitatively assess clinical guidelines in practice, something that the lack of theory to guide CPG development has precluded. In this paper, I examine the role of FFTs in providing an adequate theoretical framework for developing CPGs. In my view, positioning guideline development within the FFT framework may help with problems related to adherence. However, I believe that FTTs fall short in providing panel members with the theoretical basis needed to justify which factors should be considered when developing a CPG, how information on those factors derived from research studies should be interpreted, and how those factors should be integrated into the recommendation.     

Barriers and facilitators of nurses’ use of clinical practice guidelines: An integrative review

BackgroundPreventable harm continues to be one of the leading causes of patient death. Each year about 400,000 patients die from sepsis, hospital acquired infections, venous thromboembolism, and pulmonary embolism. However, as shown in the recent reduction in hospital acquired infections, the number of deaths could be reduced if healthcare providers used evidence-based therapies, which are often included in clinical practice guidelines (CPGs).PurposeThe purpose of this integrative review is to appraise and synthesize the current literature on barriers to and facilitators in the use of clinical practice guidelines (CPGs) by registered nurses.DesignWhittemore and Knafl integrative review methodology was used. Primary quantitative and qualitative studies about the nurses’ use of CPGs and published in peer-reviewed journals between January 2000 and August 2015 were included.MethodsThe Critical Skills Appraisal Program (CASP) was used to critically appraise the quality of sixteen selected quantitative and qualitative studies.ResultsInternal factors were attitudes, perceptions, and knowledge whereas format and usability of CPGs, resources, leadership, and organizational culture were external factors influencing CPG use.ConclusionGiven each barrier and facilitator, interventions and policies can be designed to increase nurses’ use of CPGs to deliver more evidence based therapy. In order to improve the use of CPGs and to ensure high quality care for all patients, nurses must actively participate in development, implementation, and maintenance of CPGs.     

Effectiveness of nonpharmacological interventions to prevent adverse events in the intensive care unit: A review of systematic reviews

BackgroundDifferent types of interventions have been assessed for the prevention of adverse events. However, determining which patient-safety practice is most effective can be challenging when there is no systematised evidence synthesis. An overview following the best methodological standards can provide the best reliable integrative evidence.ObjectivesThe objective of this study was to provide an overview of effectiveness nonpharmacological interventions aimed at preventing adverse events in the intensive care unit.MethodsA review of systematic reviews (SRs) was conducted according to the Cochrane Handbook and PRISMA recommendations. PubMed, CINAHL, and Cochrane Library were searched for SRs published until March 2022. Two reviewers independently assessed the study’s quality, using AMSTAR-2, and extracted data on intervention characteristics and effect on prevention of adverse events.ResultsThirty-seven SRs were included, and 27 nonpharmacological interventions were identified to prevent 11 adverse events. Most of the reviews had critically low methodological quality. Among all the identified interventions, subglottic secretion drainage, semirecumbent position, and kinetic bed therapy were effective in preventing ventilator-associated pneumonia; the use of earplugs, early mobilisation, family participation, and music in reducing delirium; physical rehabilitation in improving muscle strength; use of respiratory support in preventing reintubation; the use of a computerised physician order entry system in reducing risk of medication errors; and the use of heated water humidifier was effective in reducing artificial airway occlusion.ConclusionsSome nonpharmacological interventions reduced adverse events in the intensive care setting. These findings should be interpreted carefully due to the low methodological quality. SRs on preventing adverse events in the intensive care unit should adhere to quality assessment tools so that best evidence can be used in decision-making.     

Multiple sclerosis clinical practice guidelines provide few complementary and alternative medicine recommendations: A systematic review

ObjectiveComplementary and alternative medicine (CAM) use is prevalent among individuals with multiple sclerosis (MS), yet the quantity and quality of CAM recommendations in MS clinical practice guidelines (CPGs) has not been assessed. The objective of this study was to determine the mention of CAM in MS CPGs and assess the quality of CAM recommendations.Design/SettingA systematic review was conducted to identify MS CPGs. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health (NCCIH) websites were also searched. Eligible CPGs containing CAM recommendations published by non-profit agencies on the treatment of MS for adults were assessed for quality and reporting using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument.Outcome/ResultsFrom 204 unique search results, six CPGs mentioned CAM and four made CAM recommendations. Scaled domain percentages from highest to lowest were clarity of presentation (90.3 % Overall, 83.3 % CAM), scope and purpose (87.5 % Overall, 86.8 % CAM), rigour of development (80.0 % Overall, 61.7 % CAM), applicability (55.2 % Overall, 44.3 % CAM), editorial independence (49.0 % Overall, 47.9 % CAM), and stakeholder involvement (55.6 % Overall, 39.6 % CAM). Quality varied within and across CPGs. Three of the four CPGs were recommended by both appraisers; one was recommended as "No" or "Yes with modifications".ConclusionCAM recommendations were only present in one third of all eligible CPGs. CPGs that scored highly can be used by patients and healthcare professionals as the basis for discussion about the use of CAM therapies for MS treatment/management. Although many people living with MS (PwMS) seek CAM therapies, few CPGs are available to provide guidance for clinicians and patients.     

Mass colorectal cancer screening: methodological quality of practice guidelines is not related to their content validity

ObjectivesIt is not clear if good methodological quality in developing practice guidelines (GLs) necessarily leads to valid recommendations that, when implemented, are more likely to improve the balance between benefits and harms/costs. We assessed whether or not there is a link between methodological quality and recommendation validity in GLs for the use of fecal occult blood test (FOBT) as a screening test for colorectal cancer (CRC) in the average-risk population.MethodsWe systematically searched for such practice GLs published in English or in French within the last 7 years. Our inclusion criteria limited the initial 36 GLs to 12. Scores for methodological quality based on the AGREE criteria were attributed to each of these 12 GLs. Likewise, we searched for meta-analysis and other systematic reviews (SRs) addressing the issue, and we selected for inclusion 8 SRs that met basic quality criteria according to the Critical Appraisal Skills Programme (CASP) of the National Health Service of the United Kingdom (NHS). We used the results and conclusions of these 8 SRs to establish the validity of recommendations made in the 12 included GLs.ResultsRegarding methodological quality, the GLs were labeled either “strongly recommend” (n = 3), “recommend with provisos or alterations" (n = 3), “would not recommend" (n = 2), or “unsure” (n = 4). The nine GLs recommending for, as well as the three GLs recommending against, mass-screening are equally valid, because the former base their recommendation on the fact that this can decrease CRC-mortality, whereas the latter base their recommendation on the facts that: (1) this procedure would be too expensive and/or not adapted to their local organization of care, and (2) to a lesser extent, the balance between benefits and harms is not crystal-clear from an individual patient perspective.ConclusionThe fact that the 12 GLs fell short of basic quality criteria confirms many previous observations in various areas of medicine. Because the 12 GLs were found to be equally valid regarding their FOBT-related recommendations, no relation could be found between their methodological quality and their content validity.     

Ginger for health care: An overview of systematic reviews

ObjectivesTo summarize the evidence from systematic reviews (SRs) and meta-analyses that evaluated the efficacy of ginger in treating any conditions and critically assess the quality of these evidence.MethodsA systematic search of the literature was conducted from inception until February 28, 2019 using the PubMed, EMBASE, Web of science, Cochrane library, and four Chinese databases. Literature selection and data extraction were conducted by two independent reviewers. The quality of SRs was evaluated using the AMSTAR-2 tool. The GRADE system was used to assess the quality of evidence.ResultsTwenty-seven SRs were included. The number of included studies were various, range from 3 to 27. The condition with the most included SRs was nausea and vomiting (n = 12, 44.4%). Many SRs showed a promising efficacy of ginger, including nausea and vomiting, metabolic syndrome and pain, while the effect of ginger for platelet aggregation failed to draw a certain conclusion. The quality of SRs was heterogeneous. All of included SRs well complied with the Item 1 (“research questions included the components of PICO”) and Item 3 (“explained selection of the study designs for inclusion”). Twenty review failed to provide registration information. Only one SR reported the sources of funding for studies included.ConclusionsIn our overview, most of SRs suggest ginger is a promising herbal medicine for health care, which is beneficial for nausea and vomiting, metabolic syndrome and pain. However, considering the limited quality of included evidence and heterogeneity of different clinical trials, more well-design studies are required to confirm the conclusion further.     

The Effectiveness of Tai Chi in Patients With Breast Cancer: An Overview of Systematic Reviews and Meta-Analyses

BackgroundAs a mind-body exercise, Tai Chi (TC) may have a positive impact on physical function and psychological well-being in patients with breast cancer (BC). The aim of this current overview of systematic reviews (SRs) and meta-analyses (MAs) was to identify and summarize the existing evidence regarding the effectiveness of TC in patients with BC.MethodsA computerized search of electronic databases was performed to identify relevant SRs/MAs of TC related to BC from inception to June 2020. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklists were used to assess the methodological quality and reporting quality of SRs and MAs, respectively. The Grades of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the evidence quality of outcome measures.ResultsSix SRs/MAs in which quantitative synthesis was used to assess various outcomes of TC related to BC were included in this overview. The quality of the SRs/MAs and the evidence quality of the outcome measures were generally unsatisfactory. The limitations of the past SRs/MAs were the lack of a protocol and registration, a list of excluded studies, or inadequately reported computational details of meta-analyses. The critical problems were that the qualitative data synthesis relied on the trials with small sample sizes and of critical low quality.ConclusionsTC is possibly beneficial to BC treatment. However, further rigorous and comprehensive studies are required to provide robust evidence for definitive conclusions.     

Cognitive interventions for mild cognitive impairment and dementia: An overview of systematic reviews

PurposeConducting an overview of systematic reviews (SRs)/Meta analyses (MAs) to assess the effectiveness of cognitive interventions on participants with mild cognitive impairment (MCI) or dementia and evaluate the methodological quality of SRs/MAs.MethodsPubMed, EMBASE, Cochrane library, Web of science, China National Knowledge Infrastructure (CNKI) and Chinese Biomedical Databases (CBM) were systematically searched from inception to January 1, 2019 to identify SRs/MAs. Three reviewers independently screened the articles, extracted data and assessed the quality of the included studies according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Grading of Recommendations Assessment Development and Evaluation (GRADE) was used to evaluate the quality of evidence.ResultsA total of 22 reviews were included. New meta-analyses (36 RCTs) showed that cognitive interventions were more effective than routine therapies for the alleviation of MCI and dementia symptoms (SMD: 0.62; 95%CI: 0.47, 0.78; I² = 53.9%). The results of AMSTAR-2 showed that the methodological quality of most included studies was critically low, and two reviews were low quality. The lowest score was item 10, none of reviews reported on the sources of funding for the included studies. Followed by the “provide a list of excluded studies and justify the exclusions” item with only one (4.5%) reviews conforming to this item. Results of GRADE manifested that moderate quality evidence was provided in 11 reviews (39.3%), 12 (42.9%) were low quality and 5 (17.8%) were very low.ConclusionThe present SRs/MAs indicated that persons with MCI or dementia could benefit from cognitive interventions. Future trial designs should focus on measuring changes in individual specific cognitive functions. More high-quality evidence is needed to further determine the effectiveness of cognitive interventions.