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Systematic Reviews: The steps of a systematic review

An introduction to systematic reviews and the steps involved in undertaking a systematic review

Steps 1-3

The eight steps of a systematic review

  1. Establish a team
  2. Formulate the research question
  3. Develop a protocol and register it
  4. Formulate the search strategy
  5. Screen the results
  6. Extract the data
  7. Assess the risk of bias
  8. Analyse and Report

This guide will cover some steps in detail and signpost resources that will help you with others.

Step 1. Establish a team

At least two people and preferably three+

  • Researcher/s
  • Screener/s
  • Statistician/s
  • (Librarian/s)

Step 2. Formulate the research question

Developing a protocol (plan) for a systematic review underpins many of the individual processes that need to be undertaken within the review process.

There are several available frameworks for developing questions, including:

  • PICO  = Population, Intervention, Comparison, Outcome (Intervention questions)
  • PECO = Population, Exposure, Comparison, Outcome (Risk questions)
  • PIRT   = Population, Index Test, Reference Test, Target Condition (Diagnostic questions)
  • SPIDER = Sample, Phenomenon of Interest, Design, Evaluation, Research Type (Experiential/qualitative questions)

i) Define inclusion and exclusion criteria  - used to further focus the research question and select studies and helps to develop the search strategy

ii) Has the topic already been reviewed?

iii) Is your topic (the FINER criteria):

  • Feasible - i.e. is the question one that the team is capable of addressing using the available evidence

  • Interesting - authors need enough commitment to see the work through

  • Novel - is there a genuine gap in knowledge

  • Ethical - implication of results

  • Relevant - translation of finds to inform decisions

Further reading:

Richardson, W. S., Wilson, M. C., Nishikawa, J., & Hayward, R. S. (1995). The well-built clinical question: a key to evidence-based decisions [Editorial]. ACP Journal Club, 123(3), A12-13. https://www.acpjournals.org/doi/10.7326/ACPJC-1995-123-3-A12

Counsell, C. (1997, Sep). Formulating questions and locating primary studies for inclusion in systematic reviews. Annals of Internal Medicine, 127(5), 380-387. https://doi.org/10.7326/0003-4819-127-5-199709010-00008

Samson, D., & Schoelles, K. M. (2012, Jun). Chapter 2: Medical Tests Guidance (2) Developing the Topic and Structuring Systematic Reviews of Medical Tests: Utility of PICOTS, Analytic Frameworks, Decision Trees, and Other Frameworks. Journal of General Internal Medicine, 27, S11-S19. https://doi.org/10.1007/s11606-012-2007-7

Booth, A., Noyes, J., Flemming, K., Moore, G., Tuncalp, O., & Shakibazadeh, E. (2019, Jan). Formulating questions to explore complex interventions within qualitative evidence synthesis. BMJ Glob Health, 4, Article e001107. https://doi.org/10.1136/bmjgh-2018-001107

Step 3. Develop and register your protocol

Once you have formulated your question, you will need to start developing a protocol to guide the conduct of your review. This will cover inclusion/exclusion criteria, screening methods, risk of bias and data analysis.

It is good practice to prospectively register your protocol and, in many cases, is a requirement for future publication of the review.

There are a number of places where you can register your protocol, for example:

Protocols from Otago staff and students can be deposited in the institutional repository, but this is not the same as registration.

Further reading:

Stewart, L., Moher, D., & Shekelle, P. (2012). Why prospective registration of systematic reviews makes sense [Editorial]. Systematic Reviews, 1(1), Article 7. https://doi.org/10.1186/2046-4053-1-7

Booth, A., Clarke, M., Dooley, G., Ghersi, D., Moher, D., Petticrew, M., & Stewart, L. (2012). The nuts and bolts of PROSPERO: An international prospective register of systematic reviews [Article]. Systematic Reviews, 1(1), Article 2. https://doi.org/10.1186/2046-4053-1-2

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