The Methodology of Conducting
Systematic Reviews
David Scalzitti, PT, PhD, OCS
scalzitt@gwu.edu
Lunch and Learn
October 15, 2014
Key Points
• Identify the uses of systematic reviews
• Differentiate systematic reviews, metaanalyses, and clinical practice guidelines
• Identify/perform valid methods for a
systematic review
Relative Hierarchy of Intervention Evidence
based on www.cebm.net
• Systematic reviews of RCTs
• Randomized controlled trials or an
observational study with dramatic effect
• Cohort study
• Case-control study or Case series
• Mechanism-based reasoning
Systematic Review
A summary of the medical literature that uses
EXPLICIT methods to perform a thorough literature
search AND critical appraisal of individual studies
AND that uses appropriate techniques to combine
these valid studies.
Meta-Analysis
A systematic review that incorporates a
quantitative strategy for combining the results of
several studies into a single pooled or summary
estimate.
All MA should be based on a SR.
All SR do not include a MA.
Clinical Practice Guideline
Systematically developed statements to assist
practitioner and patient decisions about appropriate
health care for specific clinical circumstances.
All clinical practice guidelines should include a
systematic review of the literature PLUS a
recommendation.
How I got involved
PRISMA
• Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA)
• www.prisma-statement.org
▫ 27 item checklist
▫ Flow diagram
PRISMA
Define a Clinical Question - PICOTS
•
•
•
•
•
•
P - Participants
I - Interventions
C - Comparisons
O - Outcomes
(T – Timing)
(S – Setting or Study Design)
Assemble a Team
Develop the Protocol for the SR
• Set inclusion/exclusion criteria
• Define evaluation method
• Draft evidence tables
▫ Good resource: Mlika-Cabanne N, Harbour R, de
Beer H, Laurence M, Cook R, Twaddle S;
Guidelines International Network (GIN) Working
Group on Evidence Tables. Sharing hard labour:
developing a standard template for data
summaries in guideline development. BMJ Qual
Saf. 2011 Feb;20(2):141-5.
Develop the Search Strategy
• Select keywords
• Identify databases
▫ PubMed
▫ Scopus
▫ CINAHL
▫ SPORTDiscus
▫ Cochrane
Controlled Trial
Registry
((“Anterior cruciate ligament” [TW] OR “posterior cruciate
ligament” [TW] OR “medial collateral ligament” [TW] OR
“lateral collateral ligament” [TW] OR “tibial collateral
ligament” [TW] OR “fibular collateral ligament” [TW] OR
“posterolateral corner” [TW] OR “arcuate complex” [TW]
OR “posteromedial corner” [TW]) OR ((knee joint [MH])
AND (ligaments, articular [MH] OR ACL [TW] OR PCL
[TW] OR MCL [TW] OR LCL [TW] OR TCL [TW] OR FCL
[TW]))) AND (physical therapy modalities [MH] OR
recovery of function [MH] OR rehabilitation [MH] OR
therapeutics [MH] OR “physical therapy” [TW] OR
physiother* [TW] OR recovery [TW] OR restoration [TW]
OR re-education [TW] OR early ambulation [MH] OR
strengthening [TW] OR resistance training [MH] OR
“resistance methods” [TW] OR exercise therapy [MH] OR
biofeedback, psychology [MH] OR “neuromuscular electrical
stimulation” [TW] OR pain management [MH] OR pain
measurement [MH] OR mobilization* [TW] OR “continuous
passive motion” [TW] OR manipulation, spinal [MH] OR
ultrasonography [TW] OR ultrasound [TW] OR acupuncture
[TW] OR laser* [TW] OR patient education as topic [MH]
OR electrical stimulation [MH] OR electrical stimulation
therapy [MH] OR Transcutaneous electric nerve stimulation
[MH] OR taping [TW] OR bracing [TW] OR orthotic* [TW]
OR weight-bearing [MH] OR Range of motion [MH] OR
Treatment Outcome [MH] OR Exercise [MH] OR “physical
therapy treatments” [TW] OR “training program” [TW])
ANY QUESTIONS?
scalzitt@gwu.edu
To be continued - November 5, 2014…
Systematic Reviews Part 2
Translating Evidence to Practice and Policy