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Systematic Reviews

Information about systematic and integrative reviews for the health sciences

What is a Systematic Review?

A systematic literature review (SLRs; also known as systematic review or as systematic overview, evidence summary, integrative review, or research synthesis) is a summary of the research literature that is focused on a single question.

The systematic review process has been developed to minimize bias and ensure transparency. Methods should be adequately documented so that they can be replicated.

Key components of a systematic review include:

  • systematic and extensive searches to identify all the relevant published and unpublished literature
  • study selection according to predefined eligibility criteria
  • assessment of the risk of bias for included studies
  • presentation of the findings in an independent and impartial manner
  • discussion of the limitations of the evidence and of the review.

What is the average time commitment for a systematic review?

Conducting a systematic or integrative review is a team endeavor and if well-designed, is a time intensive research project that may take a year or more to complete. Total time will vary depending on the scope of the review and the size and availability of the team. The Cochrane Handbook for Systematic Reviews of Interventions provides the following  table showing estimated times for each task:

Timeline for a Cochrane Review

Table used with permission. Green S, Higgins JPT (editors). Chapter 2: Preparing a Cochrane review. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from http://handbook.cochrane.org

What is included in the systematic review life cycle?

Functions and Process of Systematic or Integrative Review
 FUNCTION  TOOL(S)  REFERENCE  NOTES
Identify existing systematic reviews (if any)      
Explicit statement of PICO question(s)   PRISMA-P  
Describe information sources (databases, websites, grey literature, hand searching, etc.) and date ranges   PRISMA-P  
Identify literature limits (if any)   PRISMA-P  
Identify "gold standard" articles [GSA] (3-10 minimum)      
Subject heading frequency analysis of GSA http://mesh.med.yale.edu/    
Term harvesting      
Testing search terms      
Finalize reproducible search string in database 1      
Test search string 1 against GSA      
PI approval of search string 1      
Translate search string to remaining database(s)      
Peer review of search strategies   PRESS + Copy editing
+ Methodologic assessment
Conduct search of grey literature (if necessary)      
Conduct hand-searching (if necessary)      
Conduct reference list searching (if necessary)      
Contact other authors (if necessary)      
Document reproducible search strings      
Export literature search results   Cochrane Handbook
Section 6.5.2
 
Import and organize literature search results EndNote    
Deduplicate search results EndNote Bramer method  
Export deduplicated results into selection software https://rayyan.qcri.org/    
Populate screening software with inclusion/exclusion criteria https://rayyan.qcri.org/    
Perform title/abstract [tiab] screening using minimum of two independent reviewers https://rayyan.qcri.org/    
Export chosen citations after tiab screening      
Obtain full text for tiab selected articles      
Screen full text articles (two independent reviewers minimum)      
Export chosen citations after full text screening      
DATA EXTRACTION      
STATISTICAL ANALYSIS      
Submit protocol to PROSPERO      
Update search strings      
Supply figures for PRISMA flow diagram   PRISMA flow diagram PDF Example
Complete PRISMA flow diagram   PRISMA flow diagram Word Template
Write structured abstract   PRISMA-A  
Write methods section of abstract      
Present full reproducible search strategy for at least one database   PRISMA checklist  

Organization Tools

Types of Reviews

In 2019, Sutton et al. compiled a comprehensive update of review types:
Sutton A, Clowes M, Preston L, Booth A. Meeting the review family: exploring review types and associated information retrieval requirements. Health Info Libr J. 2019;36(3):202–222. doi:10.1111/hir.12276

Information from a 2009 article by Grant and Booth is reproduced below.
Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J. 2009 Jun;26(2):91-108. doi: 10.1111/j.1471-1842.2009.00848.x. Review. PubMed PMID: 19490148.

Label

Description

Search

Appraisal

Synthesis

Analysis

Critical review

Aims to demonstrate writer has extensively researched literature and critically evaluated its quality. Goes beyond mere description to include degree of analysis and conceptual innovation. Typically results in hypothesis or model.

Seeks to identify significant items in the field.

No formal quality assessment. Attempts to evaluate according to contribution.

Typically narrative, perhaps conceptual or chronological.

Significant component: seeks to identify conceptual contribution to embody existing or derive new theory.

Literature review

Generic term: published materials that provide examination of recent or current literature. Can cover wide range of subjects at various levels of completeness and comprehensiveness. May include research findings.

May or may not include comprehensive searching.

May or may not include quality assessment.

Typically narrative.

Analysis may be chronological, conceptual, thematic, etc.

Mapping review/systematic map

Map out and categorize existing literature from which to commission further reviews and/or primary research by identifying gaps in research literature.

Completeness of searching determined by time/scope constraints.

No formal quality assessment.

May be graphical and tabular.

Characterizes quantity and quality of literature, perhaps by study design and other key features. May identify need for primary or secondary research.

Meta-analysis

Technique that statistically combines the results of quantitative studies to provide a more precise effect of the results.

Aims for exhaustive searching. May use funnel plot to assess completeness.

Quality assessment may determine inclusion/exclusion and/or sensitivity analyses.

Graphical and tabular with narrative commentary.

Numerical analysis of measures of effect assuming absence of heterogeneity.

Mixed studies review/mixed methods review

Refers to any combination of methods where one significant component is a literature review (usually systematic). Within a review context it refers to a combination of review approaches for example combining quantitative with qualitative research or outcome with process studies.

Requires either very sensitive search to retrieve all studies or separately conceived quantitative and qualitative strategies.

Requires either a generic appraisal instrument or separate appraisal processes with corresponding checklists.

Typically both components will be presented as narrative and in tables. May also employ graphical means of integrating quantitative and qualitative studies.

Analysis may characterize both literatures and look for correlations between characteristics or use gap analysis to identify aspects absent in one literature but missing in the other.

Overview

Generic term: summary of the [medical] literature that attempts to survey the literature and describe its characteristics.

May or may not include comprehensive searching (depends whether systematic overview or not).

May or may not include quality assessment (depends whether systematic overview or not).

Synthesis depends on whether systematic or not. Typically narrative but may include tabular features.

Analysis may be chronological, conceptual, thematic, etc.

Qualitative systematic review/qualitative evidence synthesis

Method for integrating or comparing the findings from qualitative studies. It looks for ‘themes’ or ‘constructs’ that lie in or across individual qualitative studies.

May employ selective or purposive sampling.

Quality assessment typically used to mediate messages not for inclusion/exclusion.

Qualitative, narrative synthesis.

Thematic analysis, may include conceptual models.

Rapid review

Assessment of what is already known about a policy or practice issue, by using systematic review methods to search and critically appraise existing research.

Completeness of searching determined by time constraints.

Time-limited formal quality assessment.

Typically narrative and tabular.

Quantities of literature and overall quality/direction of effect of literature.

Scoping review

Preliminary assessment of potential size and scope of available research literature. Aims to identify nature and extent of research evidence (usually including ongoing research).

Completeness of searching determined by time/scope constraints. May include research in progress.

No formal quality assessment.

Typically tabular with some narrative commentary.

Characterizes quantity and quality of literature, perhaps by study design and other key features. Attempts to specify a viable review.

State-of-the-art review

Tend to address more current matters in contrast to other combined retrospective and current approaches. May offer new perspectives on issue or point out area for further research.

Aims for comprehensive searching of current literature.

No formal quality assessment.

Typically narrative, may have tabular accompaniment.

Current state of knowledge and priorities for future investigation and research.

Systematic review

Seeks to systematically search for, appraise and synthesize research evidence, often adhering to guidelines on the conduct of a review.

Aims for exhaustive, comprehensive searching.

Quality assessment may determine inclusion/exclusion.

Typically narrative with tabular accompaniment.

What is known; recommendations for practice. What remains unknown; uncertainty around findings, recommendations for future research.

Systematic search and review

Combines strengths of critical review with a comprehensive search process. Typically addresses broad questions to produce ‘best evidence synthesis’.

Aims for exhaustive, comprehensive searching.

May or may not include quality assessment.

Minimal narrative, tabular summary of studies.

What is known; recommendations for practice. Limitations.

Systematized review

Attempt to include elements of systematic review process while stopping short of systematic review. Typically conducted as postgraduate student assignment.

May or may not include comprehensive searching.

May or may not include quality assessment.

Typically narrative with tabular accompaniment.

What is known; uncertainty around findings; limitations of methodology.

Umbrella review

Specifically refers to review compiling evidence from multiple reviews into one accessible and usable document. Focuses on broad condition or problem for which there are competing interventions and highlights reviews that address these interventions and their results.

Identification of component reviews, but no search for primary studies.

Quality assessment of studies within component reviews and/or of reviews themselves.

Graphical and tabular with narrative commentary.

What is known; recommendations for practice. What remains unknown; recommendations for future research.

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