There are different types of reviews, such as systematic and scoping reviews.
Systematic reviews play a pivotal role when it comes to making evidence-based decisions in health, social sciences, and many other fields. By collating and summarising the findings of individual studies, systematic reviews help stakeholders make informed decisions. This guide discusses how to conduct a systematic review.
A systematic review is a rigorous and systematic synthesis of research studies on a specific topic or question. The primary goal of a systematic review is to evaluate and summarise all available evidence related to a particular research question, in a manner that is comprehensive, transparent, and minimises bias. Systematic reviews are essential in evidence-based practice, as they provide a high level of evidence on the effectiveness of interventions or treatments.
Key components of a systematic review include:
The review starts with a clearly formulated research question, often framed in terms of the Population, Intervention, Comparison, and Outcome (PICO) framework.
Before starting the review, a protocol is developed that details the specific methods that will be used. This protocol ensures transparency and can be registered on platforms like PROSPERO.
A comprehensive and systematic search of multiple databases (e.g., PubMed, Cochrane Library, Embase) is conducted to identify all relevant studies. Search terms and strategies are meticulously designed to capture as much relevant literature as possible.
Using predefined inclusion and exclusion criteria, studies are selected for inclusion in the review. This process is typically done by at least two reviewers independently to minimise bias.
Relevant data are extracted from the included studies using standardised forms or software. This can include details on study design, population, interventions, outcomes, and results.
The individual studies’ quality or risk of bias is assessed using standardised tools. This helps in determining the overall strength of the evidence.
The data from individual studies are synthesised. If studies are sufficiently homogenous in terms of design and outcomes, a meta-analysis may be conducted to statistically pool results.
The findings are interpreted in the context of the overall evidence, and conclusions are drawn about the research question.
The review is reported following guidelines such as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to ensure transparent and complete reporting.
Systematic reviews are a type of research meta synthesis that plays a crucial role in evidence-based practice and decision-making in various fields, especially in healthcare. Here are some reasons why systematic reviews are important:
Systematic reviews comprehensively summarise the available evidence on a particular topic or question. By aggregating results from multiple studies, they offer a more complete picture than individual studies can provide.
The systematic approach involves a structured and predefined methodology, which helps minimise biases that can occur in traditional narrative reviews. This includes the explicit selection criteria, comprehensive literature search, and standardised evidence appraisal.
Because of the rigorous methodology, the findings of systematic reviews are often considered more reliable than other types of reviews. They can help identify the consistency or variability in research findings.
Systematic reviews can highlight areas where evidence is lacking or inconsistent, guiding future research endeavours.
Policymakers, clinicians, and other stakeholders can use systematic reviews to make informed decisions, as they present a synthesised view of the best available evidence.
Given that systematic reviews summarise vast amounts of research, they can save time for practitioners and researchers trying to understand the state of knowledge on a particular topic.
By pooling data from various studies, systematic reviews can provide insights that are more generalisable across different populations and settings than individual studies.
When systematic reviews include a meta-analysis, they combine quantitative results from multiple studies, which can increase the statistical power to detect effects that might be missed in individual studies.
They play a pivotal role in the development of clinical guidelines and consensus statements, ensuring that recommendations are grounded in a thorough review of the evidence.
Beyond healthcare, systematic reviews can influence public policy decisions by providing consolidated evidence on the effectiveness and implications of interventions and policies.
For students and trainees in various fields, systematic reviews can serve as educational resources, giving a distilled overview of what is known and not known about a topic.
Systematic reviews are a rigorous and transparent form of literature review designed to answer a specific research question. They provide a complete, exhaustive summary of current literature relevant to a research question. Here is a comprehensive guide to conducting a systematic review:
Your research question should be clear and specific. Consider the PICO format:
Before you start your search, develop a protocol that outlines your planned methods. This should include:
Begin a comprehensive search using electronic databases like PubMed, Scopus, Web of Science, and specialised databases relevant to your field. Employ controlled vocabulary and free-text terms. Document all search strategies to ensure transparency.
After retrieving studies, eliminate duplicates. Screen titles and abstracts for relevance, followed by full-text reviews. Document reasons for exclusion to ensure transparency and reproducibility.
For each included study, extract relevant data using standardised forms. This may include:
Evaluate the quality or risk of bias in each study. Tools like the Cochrane Risk of Bias tool or the Newcastle-Ottawa Scale can be employed depending on the study design.
Combine and summarise the findings. If the studies are sufficiently homogeneous, consider a meta-analysis. This statistical method combines results from multiple studies to derive an overall effect size. If a meta-analysis isn’t feasible, provide a narrative synthesis.
Discuss the findings in context, consider the strengths and limitations of the included studies, and draw conclusions. Remember to:
Submit the systematic review to a relevant journal for peer review. Feedback from experts can greatly enhance the quality and validity of your findings.
Systematic reviews are essential for summarising the best available evidence on a particular topic, guiding clinical decisions, and identifying gaps in current research. However, conducting systematic reviews is a complex process that can encounter multiple challenges. Some of these challenges include:
It is crucial to develop a comprehensive and unbiased search strategy. Missing relevant studies or including irrelevant ones can skew results.
Positive or significant findings are more likely to be published than negative or non-significant findings. This bias can lead to an overestimation of an intervention’s effect.
Extracting data from studies can be laborious and sometimes challenging if the data are presented in a non-standardised way or if necessary details are missing.
Differences between studies in terms of their populations, interventions, outcomes, and methodologies can make combining data problematic.
Deciding how to evaluate the quality and risk of bias in the included studies can be challenging.
Deciding whether to conduct a meta-analysis or a qualitative synthesis can be difficult, depending on the heterogeneity of the studies.
Authors might not always report all outcomes, or selectively report only the positive findings.
The literature on a given topic continuously evolves, making it challenging to keep systematic reviews up-to-date.
Systematic reviews require a significant amount of time, managing sources, and expertise, making them expensive and sometimes prohibitive for some researchers.
Sometimes, full-text articles may be behind paywalls or not available online at all, making it challenging to assess and extract data.
Important studies may be published in languages other than English or in regional databases that are not commonly searched, which could lead to inadvertent exclusions.
Different studies may measure outcomes differently or use different scales, complicating synthesis efforts.
This includes non-peer-reviewed articles, reports, theses, etc. Searching, appraising, and incorporating grey literature can be challenging but essential to reduce publication bias.
Involving all relevant stakeholders can be time-consuming, but is crucial for ensuring the review is comprehensive and relevant.
Results from systematic reviews may not always be directly applicable to all populations or settings due to variability in the included studies.
Especially when primary data are used or when patient-sensitive data are involved.
Here are some tips to ensure the success of a systematic review:
Using established tools like the Cochrane Collaboration’s risk of bias tool or the Newcastle-Ottawa Scale can help in evaluating the quality of included studies.
Engage clinicians, patients, or policymakers to ensure the review remains relevant to its intended audience.
Developing a research strategy is continuously evolving. Depending on the topic, you may need to update the review periodically.
Before finalising, get input from experts or peers who haven’t been involved in the review process.
Tailor the message as different audiences (clinicians, patients, policymakers) require different presentations of the findings.
A systematic review is a rigorous synthesis of research studies on a specific topic. Researchers follow a structured process to identify, appraise, and summarise all available evidence on a question. This helps to provide a comprehensive understanding and ensures conclusions are based on the best available evidence, minimising biases.
Example: A systematic review on the efficacy of face masks in preventing respiratory virus transmission. Researchers search databases for studies comparing mask usage to non-usage. After screening, relevant studies are analysed. Findings might suggest that wearing masks significantly reduces the risk of viral spread, with implications for public health recommendations.
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