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Watch this video from Cochrane Consumers and Communication to learn what systematic reviews are, how researchers prepare them, and why they’re an important part of making informed decisions about health - for everyone.
Cochrane evidence, including our systematic reviews, provides a powerful tool to enhance your healthcare knowledge and decision making. This video from Cochrane Sweden explains a bit about how we create health evidence and what Cochrane does.
A systematic review attempts to collate all empirical evidence that fits pre-specified eligibility criteria in order to answer a specific research question. It uses explicit, systematic methods that are selected with a view to minimizing bias, thus providing more reliable findings from which conclusions can be drawn and decisions made (Antman 1992, Oxman 1993) . The key characteristics of a systematic review are:
a clearly stated set of objectives with pre-defined eligibility criteria for studies;
an explicit, reproducible methodology;
a systematic search that attempts to identify all studies that would meet the eligibility criteria;
an assessment of the validity of the findings of the included studies, for example through the assessment of risk of bias; and
a systematic presentation, and synthesis, of the characteristics and findings of the included studies.
Many systematic reviews contain meta-analyses. Meta-analysis is the use of statistical methods to summarize the results of independent studies (Glass 1976). By combining information from all relevant studies, meta-analyses can provide more precise estimates of the effects of health care than those derived from the individual studies included within a review (see Chapter 9, Section 9.1.3 ). They also facilitate investigations of the consistency of evidence across studies, and the exploration of differences across studies.
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What is a systematic review.
A systematic review is an authoritative account of existing evidence using reliable, objective, thorough and reproducible research practices.
It is a method of making sense of large bodies of information and contributes to the answers to questions about what works and what doesn't.
Systematic reviews map areas of uncertainty and identify where little or no relevant research has been done, but where new studies are needed.
It is a good idea to familiarise yourself with the systematic review process before beginning your review. You can do this by searching for other systematic reviews to look at as examples, by reading a glossary of commonly used terms , and by learning how to distinguish between types of systematic review.
Some characteristics, or features, of systematic reviews are:
Watch this video from the Cochrane Library for more information about systematic reviews.
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Systematic reviews are a type of literature review of research that require equivalent standards of rigour to primary research. They have a clear, logical rationale that is reported to the reader of the review. They are used in research and policymaking to inform evidence-based decisions and practice. They differ from traditional literature reviews in the following elements of conduct and reporting.
Systematic reviews:
For example, systematic reviews (like all research) should have a clear research question, and the perspective of the authors in their approach to addressing the question is described. There are clearly described methods on how each study in a review was identified, how that study was appraised for quality and relevance and how it is combined with other studies in order to address the review question. A systematic review usually involves more than one person in order to increase the objectivity and trustworthiness of the reviews methods and findings.
Research protocols for systematic reviews may be peer-reviewed and published or registered in a suitable repository to help avoid duplication of reviews and for comparisons to be made with the final review and the planned review.
Should all literature reviews be 'systematic reviews', different methods for systematic reviews, reporting standards for systematic reviews.
Literature reviews provide a more complete picture of research knowledge than is possible from individual pieces of research. This can be used to: clarify what is known from research, provide new perspectives, build theory, test theory, identify research gaps or inform research agendas.
A systematic review requires a considerable amount of time and resources, and is one type of literature review.
If the purpose of a review is to make justifiable evidence claims, then it should be systematic, as a systematic review uses rigorous explicit methods. The methods used can depend on the purpose of the review, and the time and resources available.
A 'non-systematic review' might use some of the same methods as systematic reviews, such as systematic approaches to identify studies or quality appraise the literature. There may be times when this approach can be useful. In a student dissertation, for example, there may not be the time to be fully systematic in a review of the literature if this is only one small part of the thesis. In other types of research, there may also be a need to obtain a quick and not necessarily thorough overview of a literature to inform some other work (including a systematic review). Another example, is where policymakers, or other people using research findings, want to make quick decisions and there is no systematic review available to help them. They have a choice of gaining a rapid overview of the research literature or not having any research evidence to help their decision-making.
Just like any other piece of research, the methods used to undertake any literature review should be carefully planned to justify the conclusions made.
Finding out about different types of systematic reviews and the methods used for systematic reviews, and reading both systematic and other types of review will help to understand some of the differences.
Typically, a systematic review addresses a focussed, structured research question in order to inform understanding and decisions on an area. (see the Formulating a research question section for examples).
Sometimes systematic reviews ask a broad research question, and one strategy to achieve this is the use of several focussed sub-questions each addressed by sub-components of the review.
Another strategy is to develop a map to describe the type of research that has been undertaken in relation to a research question. Some maps even describe over 2,000 papers, while others are much smaller. One purpose of a map is to help choose a sub-set of studies to explore more fully in a synthesis. There are also other purposes of maps: see the box on systematic evidence maps for further information.
Reporting standards specify minimum elements that need to go into the reporting of a review. The reporting standards refer mainly to methodological issues but they are not as detailed or specific as critical appraisal for the methodological standards of conduct of a review.
A number of organisations have developed specific guidelines and standards for both the conducting and reporting on systematic reviews in different topic areas.
Systematic reviews: crd's guidance for undertaking reviews in health care.
Meta-analysis and research synthesis.
Literature reviews.
A "high-level overview of primary research on a focused question" utilizing high-quality research evidence through: Source: Kysh, Lynn (2013): Difference between a systematic review and a literature review. [figshare]. Available at:
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Depending on your learning style, please explore the resources in various formats on the tabs above.
For additional tutorials, visit the SR Workshop Videos from UNC at Chapel Hill outlining each stage of the systematic review process.
Know the difference! Systematic review vs. literature review
It is common to confuse systematic and literature reviews as both are used to provide a summary of the existent literature or research on a specific topic. Even with this common ground, both types vary significantly. Please review the following chart (and its corresponding poster linked below) for a detailed explanation of each as well as the differences between each type of review. Source: Kysh, L. (2013). What’s in a name? The difference between a systematic review and a literature review and why it matters. [Poster] Retrieved from . Check the website from UNC at Chapel Hill, |
Types of literature reviews along with associated methodologies
JBI Manual for Evidence Synthesis . Find definitions and methodological guidance.
- Systematic Reviews - Chapters 1-7
- Mixed Methods Systematic Reviews - Chapter 8
- Diagnostic Test Accuracy Systematic Reviews - Chapter 9
- Umbrella Reviews - Chapter 10
- Scoping Reviews - Chapter 11
- Systematic Reviews of Measurement Properties - Chapter 12
Systematic reviews vs scoping reviews -
Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information and Libraries Journal , 26 (2), 91–108. https://doi.org/10.1111/j.1471-1842.2009.00848.x
Gough, D., Thomas, J., & Oliver, S. (2012). Clarifying differences between review designs and methods. Systematic Reviews, 1 (28). htt p s://doi.org/ 10.1186/2046-4053-1-28
Munn, Z., Peters, M., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review ? Guidance for authors when choosing between a systematic or scoping review approach. BMC medical research methodology, 18 (1), 143. https://doi.org/10.1186/s12874-018-0611-x. Also, check out the Libguide from Weill Cornell Medicine for the differences between a systematic review and a scoping review and when to embark on either one of them.
Sutton, A., Clowes, M., Preston, L., & Booth, A. (2019). Meeting the review family: Exploring review types and associated information retrieval requirements . Health Information & Libraries Journal , 36 (3), 202–222. https://doi.org/10.1111/hir.12276
Temple University. Review Types . - This guide provides useful descriptions of some of the types of reviews listed in the above article.
UMD Health Sciences and Human Services Library. Review Types . - Guide describing Literature Reviews, Scoping Reviews, and Rapid Reviews.
Whittemore, R., Chao, A., Jang, M., Minges, K. E., & Park, C. (2014). Methods for knowledge synthesis: An overview. Heart & Lung: The Journal of Acute and Critical Care, 43 (5), 453–461. https://doi.org/10.1016/j.hrtlng.2014.05.014
Differences between a systematic review and other types of reviews
Armstrong, R., Hall, B. J., Doyle, J., & Waters, E. (2011). ‘ Scoping the scope ’ of a cochrane review. Journal of Public Health , 33 (1), 147–150. https://doi.org/10.1093/pubmed/fdr015
Kowalczyk, N., & Truluck, C. (2013). Literature reviews and systematic reviews: What is the difference? Radiologic Technology , 85 (2), 219–222.
White, H., Albers, B., Gaarder, M., Kornør, H., Littell, J., Marshall, Z., Matthew, C., Pigott, T., Snilstveit, B., Waddington, H., & Welch, V. (2020). Guidance for producing a Campbell evidence and gap map . Campbell Systematic Reviews, 16 (4), e1125. https://doi.org/10.1002/cl2.1125. Check also this comparison between evidence and gaps maps and systematic reviews.
Rapid Reviews Tutorials
Rapid Review Guidebook by the National Collaborating Centre of Methods and Tools (NCCMT)
Hamel, C., Michaud, A., Thuku, M., Skidmore, B., Stevens, A., Nussbaumer-Streit, B., & Garritty, C. (2021). Defining Rapid Reviews: a systematic scoping review and thematic analysis of definitions and defining characteristics of rapid reviews. Journal of clinical epidemiology , 129 , 74–85. https://doi.org/10.1016/j.jclinepi.2020.09.041
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Videos on systematic reviews
This video lecture explains in detail the steps necessary to conduct a systematic review (44 min.) | Here's a brief introduction to how to evaluate systematic reviews (16 min.) |
Systematic Reviews: What are they? Are they right for my research? - 47 min. video recording with a closed caption option.
More training videos on systematic reviews:
from Yale University (approximately 5-10 minutes each) | with Margaret Foster (approximately 55 min each) |
Books on Systematic Reviews
Books on Meta-analysis
Guidelines for a systematic review as part of the dissertation
Further readings on experiences of PhD students and doctoral programs with systematic reviews
Puljak, L., & Sapunar, D. (2017). Acceptance of a systematic review as a thesis: Survey of biomedical doctoral programs in Europe . Systematic Reviews , 6 (1), 253. https://doi.org/10.1186/s13643-017-0653-x
Perry, A., & Hammond, N. (2002). Systematic reviews: The experiences of a PhD Student . Psychology Learning & Teaching , 2 (1), 32–35. https://doi.org/10.2304/plat.2002.2.1.32
Daigneault, P.-M., Jacob, S., & Ouimet, M. (2014). Using systematic review methods within a Ph.D. dissertation in political science: Challenges and lessons learned from practice . International Journal of Social Research Methodology , 17 (3), 267–283. https://doi.org/10.1080/13645579.2012.730704
UMD Doctor of Philosophy Degree Policies
Before you embark on a systematic review research project, check the UMD PhD Policies to make sure you are on the right path. Systematic reviews require a team of at least two reviewers and an information specialist or a librarian. Discuss with your advisor the authorship roles of the involved team members. Keep in mind that the UMD Doctor of Philosophy Degree Policies (scroll down to the section, Inclusion of one's own previously published materials in a dissertation ) outline such cases, specifically the following:
" It is recognized that a graduate student may co-author work with faculty members and colleagues that should be included in a dissertation . In such an event, a letter should be sent to the Dean of the Graduate School certifying that the student's examining committee has determined that the student made a substantial contribution to that work. This letter should also note that the inclusion of the work has the approval of the dissertation advisor and the program chair or Graduate Director. The letter should be included with the dissertation at the time of submission. The format of such inclusions must conform to the standard dissertation format. A foreword to the dissertation, as approved by the Dissertation Committee, must state that the student made substantial contributions to the relevant aspects of the jointly authored work included in the dissertation."
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Collaboration for Environmental Evidence. 2018. Guidelines and Standards for Evidence synthesis in Environmental Management. Version 5.0 (AS Pullin, GK Frampton, B Livoreil & G Petrokofsky, Eds) www.environmentalevidence.org/information-for-authors .
Pullin, A. S., & Stewart, G. B. (2006). Guidelines for systematic review in conservation and environmental management. Conservation Biology, 20 (6), 1647–1656. https://doi.org/10.1111/j.1523-1739.2006.00485.x
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A high-quality systematic review is described as the most reliable source of evidence to guide clinical practice. The purpose of a systematic review is to deliver a meticulous summary of all the available primary research in response to a research question. A systematic review uses all the existing research and is sometime called ‘secondary research’ (research on research). They are often required by research funders to establish the state of existing knowledge and are frequently used in guideline development. Systematic review findings are often used within the …
Competing interests None.
Volume 70, 2019, review article, how to do a systematic review: a best practice guide for conducting and reporting narrative reviews, meta-analyses, and meta-syntheses.
Systematic reviews are characterized by a methodical and replicable methodology and presentation. They involve a comprehensive search to locate all relevant published and unpublished work on a subject; a systematic integration of search results; and a critique of the extent, nature, and quality of evidence in relation to a particular research question. The best reviews synthesize studies to draw broad theoretical conclusions about what a literature means, linking theory to evidence and evidence to theory. This guide describes how to plan, conduct, organize, and present a systematic review of quantitative (meta-analysis) or qualitative (narrative review, meta-synthesis) information. We outline core standards and principles and describe commonly encountered problems. Although this guide targets psychological scientists, its high level of abstraction makes it potentially relevant to any subject area or discipline. We argue that systematic reviews are a key methodology for clarifying whether and how research findings replicate and for explaining possible inconsistencies, and we call for researchers to conduct systematic reviews to help elucidate whether there is a replication crisis.
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Describes what is involved with conducting a systematic review of the literature for evidence-based public health and how the librarian is a partner in the process.
Several CDC librarians have special training in conducting literature searches for systematic reviews. Literature searches for systematic reviews can take a few weeks to several months from planning to delivery.
Fill out a search request form here or contact the Stephen B. Thacker CDC Library by email [email protected] or telephone 404-639-1717.
Campbell Collaboration
Cochrane Collaboration
Eppi Centre
Joanna Briggs Institute
McMaster University
PRISMA Statement
Systematic Reviews – CRD’s Guide
Systematic Reviews of Health Promotion and Public Health Interventions
The Guide to Community Preventive Services
Look for systematic reviews that have already been published.
Look in PROSPERO for registered systematic reviews.
Search Cochrane and CRD-York for systematic reviews.
Search filter for finding systematic reviews in PubMed
Other search filters to locate systematic reviews
A systematic review attempts to collect and analyze all evidence that answers a specific question. The question must be clearly defined and have inclusion and exclusion criteria. A broad and thorough search of the literature is performed and a critical analysis of the search results is reported and ultimately provides a current evidence-based answer to the specific question.
Time: According to Cochrane , it takes 18 months on average to complete a Systematic Review.
The average systematic review from beginning to end requires 18 months of work. “…to find out about a healthcare intervention it is worth searching research literature thoroughly to see if the answer is already known. This may require considerable work over many months…” ( Cochrane Collaboration )
Review Team: Team Members at minimum…
“Expert searchers are an important part of the systematic review team, crucial throughout the review process-from the development of the proposal and research question to publication.” ( McGowan & Sampson, 2005 )
*Ask your librarian to write a methods section regarding the search methods and to give them co-authorship. You may also want to consider providing a copy of one or all of the search strategies used in an appendix.
The Question to Be Answered: A clearly defined and specific question or questions with inclusion and exclusion criteria.
Written Protocol: Outline the study method, rationale, key questions, inclusion and exclusion criteria, literature searches, data abstraction and data management, analysis of quality of the individual studies, synthesis of data, and grading of the evidience for each key question.
Literature Searches: Search for any systematic reviews that may already answer the key question(s). Next, choose appropriate databases and conduct very broad, comprehensive searches. Search strategies must be documented so that they can be duplicated. The librarian is integral to this step of the process. Before your librarian creates a search strategy and starts searching in earnest you should write a detailed PICO question , determine the inclusion and exclusion criteria for your study, run a preliminary search, and have 2-4 articles that already fit the criteria for your review.
What is searched depends on the topic of the review but should include…
Citation Management: EndNote is a bibliographic management tools that assist researchers in managing citations. The Stephen B. Thacker CDC Library oversees the site license for EndNote.
To request installation: The library provides EndNote to CDC staff under a site-wide license. Please use the ITSO Software Request Tool (SRT) and submit a request for the latest version (or upgraded version) of EndNote. Please be sure to include the computer name for the workstation where you would like to have the software installed.
EndNote Training: CDC Library offers training on EndNote on a regular basis – both a basic and advanced course. To view the course descriptions and upcoming training dates, please visit the CDC Library training page .
For assistance with EndNote software, please contact [email protected]
Vendor Support and Services: EndNote – Support and Services (Thomson Reuters) EndNote – Tutorials and Live Online Classes (Thomson Reuters)
Getting Articles:
Articles can be obtained using DocExpress or by searching the electronic journals at the Stephen B. Thacker CDC Library.
IOM Standards for Systematic Reviews: Standard 3.1: Conduct a comprehensive systematic search for evidence
The goal of a systematic review search is to maximize recall and precision while keeping results manageable. Recall (sensitivity) is defined as the number of relevant reports identified divided by the total number of relevant reports in existence. Precision (specificity) is defined as the number of relevant reports identified divided by the total number of reports identified.
Issues to consider when creating a systematic review search:
A step-by-step guide to systematically identify all relevant animal studies
Materials listed in these guides are selected to provide awareness of quality public health literature and resources. A material’s inclusion does not necessarily represent the views of the U.S. Department of Health and Human Services (HHS), the Public Health Service (PHS), or the Centers for Disease Control and Prevention (CDC), nor does it imply endorsement of the material’s methods or findings. HHS, PHS, and CDC assume no responsibility for the factual accuracy of the items presented. The selection, omission, or content of items does not imply any endorsement or other position taken by HHS, PHS, and CDC. Opinion, findings, and conclusions expressed by the original authors of items included in these materials, or persons quoted therein, are strictly their own and are in no way meant to represent the opinion or views of HHS, PHS, or CDC. References to publications, news sources, and non-CDC Websites are provided solely for informational purposes and do not imply endorsement by HHS, PHS, or CDC.
In the health-related professions, systematic reviews are considered the most reliable resources. They are studies that make up the top level of the evidence-based information pyramid, and as a result, they are the most sought after information for questions about health. Systematic reviews are not quite the same as literature reviews. Literature reviews, also known as narrative reviews, attempt to find all published materials on a subject, whereas systematic reviews try to find everything that focuses on answering a specific question. Since systematic reviews are generally associated with health related fields, their main objective is to ensure the results of the review provide accurate evidence that answers relevant questions. If you are looking for information about literature reviews, please check the library's guide on the topic here .
When looking for answers to health questions, systematic reviews are considered the best resources to use for evidence-based information. The predefined protocols, the amount of information reviewed, the evaluation process involved, and the efforts to eliminate bias are all a part of what makes health professionals consider systematic reviews to be the highest level of evidence based information available. As a part of the process, systematic reviews tend to look at and evaluate all the randomized controlled trials, or all the cohort studies, for their specific topic. By looking at and evaluating a vast amount of comparable studies, a systematic review is able to provide answers that have a much stronger level of evidence than any individual study.
These reviews collect large amounts of information that fit within the predetermined parameters, so performing a systematic review is an excellent way to develop expertise on a topic. Setting up the criteria, searching for the information, and evaluating the information found, gives the reviewer an extremely strong understanding of the process needed to create a review as well as how to evaluate its various elements. Creating a systematic review gives the reviewer an opportunity to further the discussion on a topic. In the health fields, performing and then publishing these reviews provides more evidence on topics that can be used for making decisions in a clinical environment.
There are a number of databases that focus on health related resources, and most of them search through journals that include systematic reviews. In these cases, you can include the words “systematic review” and the results will include entries that have the words “systematic review” in them somewhere. Many of these results will be systematic reviews; however, some of the results may include these words, but are not systematic reviews. A few databases that are used by researchers have added in limitation features that make it easier to find systematic reviews, and ensure a specific article/document/publication type are found. Here are three examples of databases and how to limit their search results to systematic reviews:
These are a few of the various types of systematic reviews.
Critical review
Critical reviews are often thought to be the same as a literature review. They involve a comprehensive review of a topic that involves a high level of analysis that seeks to identify the most important aspects of a subject.
The overview is a look at the literature available on the topic. They may or may not have an analytical component that provides a synthesis of the information found, but this depends on how systematic the review has been.
Qualitative systematic review
This type of study looks at as many qualitative studies and tries to find themes among these studies that lie across the range of reviews. The information is then organized into a narrative that is frequently accompanied by a conceptual model.
Rapid review
The number of studies included in a rapid review are dictated by time constraints. Most often these reviews are conducted to determine what is known about policies or practices, and then determine how much these are based on evidence.
Scoping review
These reviews are intended to quickly assess the availability of research on a specific topic, and then determine whether the evidence provided in these research articles is sufficient and appropriate,
Umbrella review
Umbrella reviews research broad topic, and look at a wide range of reviews that have been done for a number of potential interventions. It then triest to establish the pros and cons of each treatment and what the potential results would be.
Assessing the certainty of the evidence in systematic reviews: importance, process, and use.
Romina Brignardello-Petersen, Gordon H Guyatt, Assessing the Certainty of the Evidence in Systematic Reviews: Importance, Process, and Use, American Journal of Epidemiology , 2024;, kwae332, https://doi.org/10.1093/aje/kwae332
When interpreting results and drawing conclusions, authors of systematic reviews should consider the limitations of the evidence included in their review. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach provides a framework for the explicit consideration of the limitations of the evidence included in a systematic review, and for incorporating this assessment into the conclusions. Assessments of certainty of evidence are a methodological expectation of systematic reviews. The certainty of the evidence is specific to each outcome in a systematic review, and can be rated as high, moderate, low, or very low. Because it will have an important impact, before conducting certainty of evidence, reviewers must clarify the intent of their question: are they interested in causation or association. Serious concerns regarding limitations in the study design, inconsistency, imprecision, indirectness, and publication bias can decrease the certainty of the evidence. Using an example, this article describes and illustrates the importance and the steps for assessing the certainty of evidence and drawing accurate conclusions in a systematic review.
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Systematic reviews and other types of literature reviews are more prevalent in clinical medicine than in other fields. The recurring need for improvement and updates in these disciplines has led to the Living Systematic Review (LSR) concept to enhance the effectiveness of scientific synthesis efforts. While LSR was introduced in 2014, its adoption outside clinical medicine has been limited, with one exception. However, it is anticipated that this will change in the future, prompting a detailed exploration of four key dimensions for LSR development, regardless of the scientific domain. These dimensions include (a) compliance with FAIR principles, (b) interactivity to facilitate easier access to scientific knowledge, (c) public participation for a more comprehensive review, and (d) extending the scope beyond mere updates to living systematic reviews. Each field needs to establish clear guidelines for drafting literature reviews as independent studies, with discussions centring around the central theme of the Living Systematic Review.
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Paré, G. and Kitsiou, S. (2017) 'Methods for Literature Reviews' , in: Lau, F. and Kuziemsky, C. (eds.) Handbook of eHealth evaluation: an evidence-based approach . Victoria (BC): University of Victoria.
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Prabhakar veginadu.
1 Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo Victoria, Australia
2 Lincoln International Institute for Rural Health, University of Lincoln, Brayford Pool, Lincoln UK
3 Department of Orthodontics, Saveetha Dental College, Chennai Tamil Nadu, India
Associated data.
APPENDIX B: List of excluded studies with detailed reasons for exclusion
APPENDIX C: Quality assessment of included reviews using AMSTAR 2
The aim of this overview is to identify and collate evidence from existing published systematic review (SR) articles evaluating various methodological approaches used at each stage of an SR.
The search was conducted in five electronic databases from inception to November 2020 and updated in February 2022: MEDLINE, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and APA PsycINFO. Title and abstract screening were performed in two stages by one reviewer, supported by a second reviewer. Full‐text screening, data extraction, and quality appraisal were performed by two reviewers independently. The quality of the included SRs was assessed using the AMSTAR 2 checklist.
The search retrieved 41,556 unique citations, of which 9 SRs were deemed eligible for inclusion in final synthesis. Included SRs evaluated 24 unique methodological approaches used for defining the review scope and eligibility, literature search, screening, data extraction, and quality appraisal in the SR process. Limited evidence supports the following (a) searching multiple resources (electronic databases, handsearching, and reference lists) to identify relevant literature; (b) excluding non‐English, gray, and unpublished literature, and (c) use of text‐mining approaches during title and abstract screening.
The overview identified limited SR‐level evidence on various methodological approaches currently employed during five of the seven fundamental steps in the SR process, as well as some methodological modifications currently used in expedited SRs. Overall, findings of this overview highlight the dearth of published SRs focused on SR methodologies and this warrants future work in this area.
Evidence synthesis is a prerequisite for knowledge translation. 1 A well conducted systematic review (SR), often in conjunction with meta‐analyses (MA) when appropriate, is considered the “gold standard” of methods for synthesizing evidence related to a topic of interest. 2 The central strength of an SR is the transparency of the methods used to systematically search, appraise, and synthesize the available evidence. 3 Several guidelines, developed by various organizations, are available for the conduct of an SR; 4 , 5 , 6 , 7 among these, Cochrane is considered a pioneer in developing rigorous and highly structured methodology for the conduct of SRs. 8 The guidelines developed by these organizations outline seven fundamental steps required in SR process: defining the scope of the review and eligibility criteria, literature searching and retrieval, selecting eligible studies, extracting relevant data, assessing risk of bias (RoB) in included studies, synthesizing results, and assessing certainty of evidence (CoE) and presenting findings. 4 , 5 , 6 , 7
The methodological rigor involved in an SR can require a significant amount of time and resource, which may not always be available. 9 As a result, there has been a proliferation of modifications made to the traditional SR process, such as refining, shortening, bypassing, or omitting one or more steps, 10 , 11 for example, limits on the number and type of databases searched, limits on publication date, language, and types of studies included, and limiting to one reviewer for screening and selection of studies, as opposed to two or more reviewers. 10 , 11 These methodological modifications are made to accommodate the needs of and resource constraints of the reviewers and stakeholders (e.g., organizations, policymakers, health care professionals, and other knowledge users). While such modifications are considered time and resource efficient, they may introduce bias in the review process reducing their usefulness. 5
Substantial research has been conducted examining various approaches used in the standardized SR methodology and their impact on the validity of SR results. There are a number of published reviews examining the approaches or modifications corresponding to single 12 , 13 or multiple steps 14 involved in an SR. However, there is yet to be a comprehensive summary of the SR‐level evidence for all the seven fundamental steps in an SR. Such a holistic evidence synthesis will provide an empirical basis to confirm the validity of current accepted practices in the conduct of SRs. Furthermore, sometimes there is a balance that needs to be achieved between the resource availability and the need to synthesize the evidence in the best way possible, given the constraints. This evidence base will also inform the choice of modifications to be made to the SR methods, as well as the potential impact of these modifications on the SR results. An overview is considered the choice of approach for summarizing existing evidence on a broad topic, directing the reader to evidence, or highlighting the gaps in evidence, where the evidence is derived exclusively from SRs. 15 Therefore, for this review, an overview approach was used to (a) identify and collate evidence from existing published SR articles evaluating various methodological approaches employed in each of the seven fundamental steps of an SR and (b) highlight both the gaps in the current research and the potential areas for future research on the methods employed in SRs.
An a priori protocol was developed for this overview but was not registered with the International Prospective Register of Systematic Reviews (PROSPERO), as the review was primarily methodological in nature and did not meet PROSPERO eligibility criteria for registration. The protocol is available from the corresponding author upon reasonable request. This overview was conducted based on the guidelines for the conduct of overviews as outlined in The Cochrane Handbook. 15 Reporting followed the Preferred Reporting Items for Systematic reviews and Meta‐analyses (PRISMA) statement. 3
Only published SRs, with or without associated MA, were included in this overview. We adopted the defining characteristics of SRs from The Cochrane Handbook. 5 According to The Cochrane Handbook, a review was considered systematic if it satisfied the following criteria: (a) clearly states the objectives and eligibility criteria for study inclusion; (b) provides reproducible methodology; (c) includes a systematic search to identify all eligible studies; (d) reports assessment of validity of findings of included studies (e.g., RoB assessment of the included studies); (e) systematically presents all the characteristics or findings of the included studies. 5 Reviews that did not meet all of the above criteria were not considered a SR for this study and were excluded. MA‐only articles were included if it was mentioned that the MA was based on an SR.
SRs and/or MA of primary studies evaluating methodological approaches used in defining review scope and study eligibility, literature search, study selection, data extraction, RoB assessment, data synthesis, and CoE assessment and reporting were included. The methodological approaches examined in these SRs and/or MA can also be related to the substeps or elements of these steps; for example, applying limits on date or type of publication are the elements of literature search. Included SRs examined or compared various aspects of a method or methods, and the associated factors, including but not limited to: precision or effectiveness; accuracy or reliability; impact on the SR and/or MA results; reproducibility of an SR steps or bias occurred; time and/or resource efficiency. SRs assessing the methodological quality of SRs (e.g., adherence to reporting guidelines), evaluating techniques for building search strategies or the use of specific database filters (e.g., use of Boolean operators or search filters for randomized controlled trials), examining various tools used for RoB or CoE assessment (e.g., ROBINS vs. Cochrane RoB tool), or evaluating statistical techniques used in meta‐analyses were excluded. 14
The search for published SRs was performed on the following scientific databases initially from inception to third week of November 2020 and updated in the last week of February 2022: MEDLINE (via Ovid), Embase (via Ovid), Web of Science Core Collection, Cochrane Database of Systematic Reviews, and American Psychological Association (APA) PsycINFO. Search was restricted to English language publications. Following the objectives of this study, study design filters within databases were used to restrict the search to SRs and MA, where available. The reference lists of included SRs were also searched for potentially relevant publications.
The search terms included keywords, truncations, and subject headings for the key concepts in the review question: SRs and/or MA, methods, and evaluation. Some of the terms were adopted from the search strategy used in a previous review by Robson et al., which reviewed primary studies on methodological approaches used in study selection, data extraction, and quality appraisal steps of SR process. 14 Individual search strategies were developed for respective databases by combining the search terms using appropriate proximity and Boolean operators, along with the related subject headings in order to identify SRs and/or MA. 16 , 17 A senior librarian was consulted in the design of the search terms and strategy. Appendix A presents the detailed search strategies for all five databases.
Title and abstract screening of references were performed in three steps. First, one reviewer (PV) screened all the titles and excluded obviously irrelevant citations, for example, articles on topics not related to SRs, non‐SR publications (such as randomized controlled trials, observational studies, scoping reviews, etc.). Next, from the remaining citations, a random sample of 200 titles and abstracts were screened against the predefined eligibility criteria by two reviewers (PV and MM), independently, in duplicate. Discrepancies were discussed and resolved by consensus. This step ensured that the responses of the two reviewers were calibrated for consistency in the application of the eligibility criteria in the screening process. Finally, all the remaining titles and abstracts were reviewed by a single “calibrated” reviewer (PV) to identify potential full‐text records. Full‐text screening was performed by at least two authors independently (PV screened all the records, and duplicate assessment was conducted by MM, HC, or MG), with discrepancies resolved via discussions or by consulting a third reviewer.
Data related to review characteristics, results, key findings, and conclusions were extracted by at least two reviewers independently (PV performed data extraction for all the reviews and duplicate extraction was performed by AP, HC, or MG).
The quality assessment of the included SRs was performed using the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). The tool consists of a 16‐item checklist addressing critical and noncritical domains. 18 For the purpose of this study, the domain related to MA was reclassified from critical to noncritical, as SRs with and without MA were included. The other six critical domains were used according to the tool guidelines. 18 Two reviewers (PV and AP) independently responded to each of the 16 items in the checklist with either “yes,” “partial yes,” or “no.” Based on the interpretations of the critical and noncritical domains, the overall quality of the review was rated as high, moderate, low, or critically low. 18 Disagreements were resolved through discussion or by consulting a third reviewer.
To provide an understandable summary of existing evidence syntheses, characteristics of the methods evaluated in the included SRs were examined and key findings were categorized and presented based on the corresponding step in the SR process. The categories of key elements within each step were discussed and agreed by the authors. Results of the included reviews were tabulated and summarized descriptively, along with a discussion on any overlap in the primary studies. 15 No quantitative analyses of the data were performed.
From 41,556 unique citations identified through literature search, 50 full‐text records were reviewed, and nine systematic reviews 14 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 were deemed eligible for inclusion. The flow of studies through the screening process is presented in Figure 1 . A list of excluded studies with reasons can be found in Appendix B .
Study selection flowchart
Table 1 summarizes the characteristics of included SRs. The majority of the included reviews (six of nine) were published after 2010. 14 , 22 , 23 , 24 , 25 , 26 Four of the nine included SRs were Cochrane reviews. 20 , 21 , 22 , 23 The number of databases searched in the reviews ranged from 2 to 14, 2 reviews searched gray literature sources, 24 , 25 and 7 reviews included a supplementary search strategy to identify relevant literature. 14 , 19 , 20 , 21 , 22 , 23 , 26 Three of the included SRs (all Cochrane reviews) included an integrated MA. 20 , 21 , 23
Characteristics of included studies
Author, year | Search strategy (year last searched; no. databases; supplementary searches) | SR design (type of review; no. of studies included) | Topic; subject area | SR objectives | SR authors’ comments on study quality |
---|---|---|---|---|---|
Crumley, 2005 | 2004; Seven databases; four journals handsearched, reference lists and contacting authors | SR; = 64 | RCTs and CCTs; not specified | To identify and quantitatively review studies comparing two or more different resources (e.g., databases, Internet, handsearching) used to identify RCTs and CCTs for systematic reviews. | Most of the studies adequately described reproducible search methods, expected search yield. Poor quality in studies was mainly due to lack of rigor in reporting selection methodology. Majority of the studies did not indicate the number of people involved in independently screening the searches or applying eligibility criteria to identify potentially relevant studies. |
Hopewell, 2007 | 2002; eight databases; selected journals and published abstracts handsearched, and contacting authors | SR and MA; = 34 (34 in quantitative analysis) | RCTs; health care | To review systematically empirical studies, which have compared the results of handsearching with the results of searching one or more electronic databases to identify reports of randomized trials. | The electronic search was designed and carried out appropriately in majority of the studies, while the appropriateness of handsearching was unclear in half the studies because of limited information. The screening studies methods used in both groups were comparable in most of the studies. |
Hopewell, 2007 | 2005; two databases; selected journals and published abstracts handsearched, reference lists, citations and contacting authors | SR and MA; = 5 (5 in quantitative analysis) | RCTs; health care | To review systematically research studies, which have investigated the impact of gray literature in meta‐analyses of randomized trials of health care interventions. | In majority of the studies, electronic searches were designed and conducted appropriately, and the selection of studies for eligibility was similar for handsearching and database searching. Insufficient data for most studies to assess the appropriateness of handsearching and investigator agreeability on the eligibility of the trial reports. |
Horsley, 2011 | 2008; three databases; reference lists, citations and contacting authors | SR; = 12 | Any topic or study area | To investigate the effectiveness of checking reference lists for the identification of additional, relevant studies for systematic reviews. Effectiveness is defined as the proportion of relevant studies identified by review authors solely by checking reference lists. | Interpretability and generalizability of included studies was difficult. Extensive heterogeneity among the studies in the number and type of databases used. Lack of control in majority of the studies related to the quality and comprehensiveness of searching. |
Morrison, 2012 | 2011; six databases and gray literature | SR; = 5 | RCTs; conventional medicine | To examine the impact of English language restriction on systematic review‐based meta‐analyses | The included studies were assessed to have good reporting quality and validity of results. Methodological issues were mainly noted in the areas of sample power calculation and distribution of confounders. |
Robson, 2019 | 2016; three databases; reference lists and contacting authors | SR; = 37 | N/R | To identify and summarize studies assessing methodologies for study selection, data abstraction, or quality appraisal in systematic reviews. | The quality of the included studies was generally low. Only one study was assessed as having low RoB across all four domains. Majority of the studies were assessed to having unclear RoB across one or more domains. |
Schmucker, 2017 | 2016; four databases; reference lists | SR; = 10 | Study data; medicine | To assess whether the inclusion of data that were not published at all and/or published only in the gray literature influences pooled effect estimates in meta‐analyses and leads to different interpretation. | Majority of the included studies could not be judged on the adequacy of matching or adjusting for confounders of the gray/unpublished data in comparison to published data. |
Also, generalizability of results was low or unclear in four research projects | |||||
Morissette, 2011 | 2009; five databases; reference lists and contacting authors | SR and MA; = 6 (5 included in quantitative analysis) | N/R | To determine whether blinded versus unblinded assessments of risk of bias result in similar or systematically different assessments in studies included in a systematic review. | Four studies had unclear risk of bias, while two studies had high risk of bias. |
O'Mara‐Eves, 2015 | 2013; 14 databases and gray literature | SR; = 44 | N/R | To gather and present the available research evidence on existing methods for text mining related to the title and abstract screening stage in a systematic review, including the performance metrics used to evaluate these technologies. | Quality appraised based on two criteria‐sampling of test cases and adequacy of methods description for replication. No study was excluded based on the quality (author contact). |
SR = systematic review; MA = meta‐analysis; RCT = randomized controlled trial; CCT = controlled clinical trial; N/R = not reported.
The included SRs evaluated 24 unique methodological approaches (26 in total) used across five steps in the SR process; 8 SRs evaluated 6 approaches, 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 while 1 review evaluated 18 approaches. 14 Exclusion of gray or unpublished literature 21 , 26 and blinding of reviewers for RoB assessment 14 , 23 were evaluated in two reviews each. Included SRs evaluated methods used in five different steps in the SR process, including methods used in defining the scope of review ( n = 3), literature search ( n = 3), study selection ( n = 2), data extraction ( n = 1), and RoB assessment ( n = 2) (Table 2 ).
Summary of findings from review evaluating systematic review methods
Key elements | Author, year | Method assessed | Evaluations/outcomes (P—primary; S—secondary) | Summary of SR authors’ conclusions | Quality of review |
---|---|---|---|---|---|
Excluding study data based on publication status | Hopewell, 2007 | Gray vs. published literature | Pooled effect estimate | Published trials are usually larger and show an overall greater treatment effect than gray trials. Excluding trials reported in gray literature from SRs and MAs may exaggerate the results. | Moderate |
Schmucker, 2017 | Gray and/or unpublished vs. published literature | P: Pooled effect estimate | Excluding unpublished trials had no or only a small effect on the pooled estimates of treatment effects. Insufficient evidence to conclude the impact of including unpublished or gray study data on MA conclusions. | Moderate | |
S: Impact on interpretation of MA | |||||
Excluding study data based on language of publication | Morrison, 2012 | English language vs. non‐English language publications | P: Bias in summary treatment effects | No evidence of a systematic bias from the use of English language restrictions in systematic review‐based meta‐analyses in conventional medicine. Conflicting results on the methodological and reporting quality of English and non‐English language RCTs. Further research required. | Low |
S: number of included studies and patients, methodological quality and statistical heterogeneity | |||||
Resources searching | Crumley, 2005 | Two or more resources searching vs. resource‐specific searching | Recall and precision | Multiple‐source comprehensive searches are necessary to identify all RCTs for a systematic review. For electronic databases, using the Cochrane HSS or complex search strategy in consultation with a librarian is recommended. | Critically low |
Supplementary searching | Hopewell, 2007 | Handsearching only vs. one or more electronic database(s) searching | Number of identified randomized trials | Handsearching is important for identifying trial reports for inclusion in systematic reviews of health care interventions published in nonindexed journals. Where time and resources are limited, majority of the full English‐language trial reports can be identified using a complex search or the Cochrane HSS. | Moderate |
Horsley, 2011 | Checking reference list (no comparison) | P: additional yield of checking reference lists | There is some evidence to support the use of checking reference lists to complement literature search in systematic reviews. | Low | |
S: additional yield by publication type, study design or both and data pertaining to costs | |||||
Reviewer characteristics | Robson, 2019 | Single vs. double reviewer screening | P: Accuracy, reliability, or efficiency of a method | Using two reviewers for screening is recommended. If resources are limited, one reviewer can screen, and other reviewer can verify the list of excluded studies. | Low |
S: factors affecting accuracy or reliability of a method | |||||
Experienced vs. inexperienced reviewers for screening | Screening must be performed by experienced reviewers | ||||
Screening by blinded vs. unblinded reviewers | Authors do not recommend blinding of reviewers during screening as the blinding process was time‐consuming and had little impact on the results of MA | ||||
Use of technology for study selection | Robson, 2019 | Use of dual computer monitors vs. nonuse of dual monitors for screening | P: Accuracy, reliability, or efficiency of a method | There are no significant differences in the time spent on abstract or full‐text screening with the use and nonuse of dual monitors | Low |
S: factors affecting accuracy or reliability of a method | |||||
Use of Google translate to translate non‐English citations to facilitate screening | Use of Google translate to screen German language citations | ||||
O'Mara‐Eves, 2015 | Use of text mining for title and abstract screening | Any evaluation concerning workload reduction | Text mining approaches can be used to reduce the number of studies to be screened, increase the rate of screening, improve the workflow with screening prioritization, and replace the second reviewer. The evaluated approaches reported saving a workload of between 30% and 70% | Critically low | |
Order of screening | Robson, 2019 | Title‐first screening vs. title‐and‐abstract simultaneous screening | P: Accuracy, reliability, or efficiency of a method | Title‐first screening showed no substantial gain in time when compared to simultaneous title and abstract screening. | Low |
S: factors affecting accuracy or reliability of a method | |||||
Reviewer characteristics | Robson, 2019 | Single vs. double reviewer data extraction | P: Accuracy, reliability, or efficiency of a method | Use two reviewers for data extraction. Single reviewer data extraction followed by the verification of outcome data by a second reviewer (where statistical analysis is planned), if resources preclude | Low |
S: factors affecting accuracy or reliability of a method | |||||
Experienced vs. inexperienced reviewers for data extraction | Experienced reviewers must be used for extracting continuous outcomes data | ||||
Data extraction by blinded vs. unblinded reviewers | Authors do not recommend blinding of reviewers during data extraction as it had no impact on the results of MA | ||||
Use of technology for data extraction | Use of dual computer monitors vs. nonuse of dual monitors for data extraction | Using two computer monitors may improve the efficiency of data extraction | |||
Data extraction by two English reviewers using Google translate vs. data extraction by two reviewers fluent in respective languages | Google translate provides limited accuracy for data extraction | ||||
Computer‐assisted vs. double reviewer extraction of graphical data | Use of computer‐assisted programs to extract graphical data | ||||
Obtaining additional data | Contacting study authors for additional data | Recommend contacting authors for obtaining additional relevant data | |||
Reviewer characteristics | Robson, 2019 | Quality appraisal by blinded vs. unblinded reviewers | P: Accuracy, reliability, or efficiency of a method | Inconsistent results on RoB assessments performed by blinded and unblinded reviewers. Blinding reviewers for quality appraisal not recommended | Low |
S: factors affecting accuracy or reliability of a method | |||||
Morissette, 2011 | Risk of bias (RoB) assessment by blinded vs. unblinded reviewers | P: Mean difference and 95% confidence interval between RoB assessment scores | Findings related to the difference between blinded and unblinded RoB assessments are inconsistent from the studies. Pooled effects show no differences in RoB assessments for assessments completed in a blinded or unblinded manner. | Moderate | |
S: qualitative level of agreement, mean RoB scores and measures of variance for the results of the RoB assessments, and inter‐rater reliability between blinded and unblinded reviewers | |||||
Robson, 2019 | Experienced vs. inexperienced reviewers for quality appraisal | P: Accuracy, reliability, or efficiency of a method | Reviewers performing quality appraisal must be trained. Quality assessment tool must be pilot tested. | Low | |
S: factors affecting accuracy or reliability of a method | |||||
Use of additional guidance vs. nonuse of additional guidance for quality appraisal | Providing guidance and decision rules for quality appraisal improved the inter‐rater reliability in RoB assessments. | ||||
Obtaining additional data | Contacting study authors for obtaining additional information/use of supplementary information available in the published trials vs. no additional information for quality appraisal | Additional data related to study quality obtained by contacting study authors improved the quality assessment. | |||
RoB assessment of qualitative studies | Structured vs. unstructured appraisal of qualitative research studies | Use of structured tool if qualitative and quantitative studies designs are included in the review. For qualitative reviews, either structured or unstructured quality appraisal tool can be used. |
There was some overlap in the primary studies evaluated in the included SRs on the same topics: Schmucker et al. 26 and Hopewell et al. 21 ( n = 4), Hopewell et al. 20 and Crumley et al. 19 ( n = 30), and Robson et al. 14 and Morissette et al. 23 ( n = 4). There were no conflicting results between any of the identified SRs on the same topic.
Overall, the quality of the included reviews was assessed as moderate at best (Table 2 ). The most common critical weakness in the reviews was failure to provide justification for excluding individual studies (four reviews). Detailed quality assessment is provided in Appendix C .
3.3.1. methods for defining review scope and eligibility.
Two SRs investigated the effect of excluding data obtained from gray or unpublished sources on the pooled effect estimates of MA. 21 , 26 Hopewell et al. 21 reviewed five studies that compared the impact of gray literature on the results of a cohort of MA of RCTs in health care interventions. Gray literature was defined as information published in “print or electronic sources not controlled by commercial or academic publishers.” Findings showed an overall greater treatment effect for published trials than trials reported in gray literature. In a more recent review, Schmucker et al. 26 addressed similar objectives, by investigating gray and unpublished data in medicine. In addition to gray literature, defined similar to the previous review by Hopewell et al., the authors also evaluated unpublished data—defined as “supplemental unpublished data related to published trials, data obtained from the Food and Drug Administration or other regulatory websites or postmarketing analyses hidden from the public.” The review found that in majority of the MA, excluding gray literature had little or no effect on the pooled effect estimates. The evidence was limited to conclude if the data from gray and unpublished literature had an impact on the conclusions of MA. 26
Morrison et al. 24 examined five studies measuring the effect of excluding non‐English language RCTs on the summary treatment effects of SR‐based MA in various fields of conventional medicine. Although none of the included studies reported major difference in the treatment effect estimates between English only and non‐English inclusive MA, the review found inconsistent evidence regarding the methodological and reporting quality of English and non‐English trials. 24 As such, there might be a risk of introducing “language bias” when excluding non‐English language RCTs. The authors also noted that the numbers of non‐English trials vary across medical specialties, as does the impact of these trials on MA results. Based on these findings, Morrison et al. 24 conclude that literature searches must include non‐English studies when resources and time are available to minimize the risk of introducing “language bias.”
Crumley et al. 19 analyzed recall (also referred to as “sensitivity” by some researchers; defined as “percentage of relevant studies identified by the search”) and precision (defined as “percentage of studies identified by the search that were relevant”) when searching a single resource to identify randomized controlled trials and controlled clinical trials, as opposed to searching multiple resources. The studies included in their review frequently compared a MEDLINE only search with the search involving a combination of other resources. The review found low median recall estimates (median values between 24% and 92%) and very low median precisions (median values between 0% and 49%) for most of the electronic databases when searched singularly. 19 A between‐database comparison, based on the type of search strategy used, showed better recall and precision for complex and Cochrane Highly Sensitive search strategies (CHSSS). In conclusion, the authors emphasize that literature searches for trials in SRs must include multiple sources. 19
In an SR comparing handsearching and electronic database searching, Hopewell et al. 20 found that handsearching retrieved more relevant RCTs (retrieval rate of 92%−100%) than searching in a single electronic database (retrieval rates of 67% for PsycINFO/PsycLIT, 55% for MEDLINE, and 49% for Embase). The retrieval rates varied depending on the quality of handsearching, type of electronic search strategy used (e.g., simple, complex or CHSSS), and type of trial reports searched (e.g., full reports, conference abstracts, etc.). The authors concluded that handsearching was particularly important in identifying full trials published in nonindexed journals and in languages other than English, as well as those published as abstracts and letters. 20
The effectiveness of checking reference lists to retrieve additional relevant studies for an SR was investigated by Horsley et al. 22 The review reported that checking reference lists yielded 2.5%–40% more studies depending on the quality and comprehensiveness of the electronic search used. The authors conclude that there is some evidence, although from poor quality studies, to support use of checking reference lists to supplement database searching. 22
Three approaches relevant to reviewer characteristics, including number, experience, and blinding of reviewers involved in the screening process were highlighted in an SR by Robson et al. 14 Based on the retrieved evidence, the authors recommended that two independent, experienced, and unblinded reviewers be involved in study selection. 14 A modified approach has also been suggested by the review authors, where one reviewer screens and the other reviewer verifies the list of excluded studies, when the resources are limited. It should be noted however this suggestion is likely based on the authors’ opinion, as there was no evidence related to this from the studies included in the review.
Robson et al. 14 also reported two methods describing the use of technology for screening studies: use of Google Translate for translating languages (for example, German language articles to English) to facilitate screening was considered a viable method, while using two computer monitors for screening did not increase the screening efficiency in SR. Title‐first screening was found to be more efficient than simultaneous screening of titles and abstracts, although the gain in time with the former method was lesser than the latter. Therefore, considering that the search results are routinely exported as titles and abstracts, Robson et al. 14 recommend screening titles and abstracts simultaneously. However, the authors note that these conclusions were based on very limited number (in most instances one study per method) of low‐quality studies. 14
Robson et al. 14 examined three approaches for data extraction relevant to reviewer characteristics, including number, experience, and blinding of reviewers (similar to the study selection step). Although based on limited evidence from a small number of studies, the authors recommended use of two experienced and unblinded reviewers for data extraction. The experience of the reviewers was suggested to be especially important when extracting continuous outcomes (or quantitative) data. However, when the resources are limited, data extraction by one reviewer and a verification of the outcomes data by a second reviewer was recommended.
As for the methods involving use of technology, Robson et al. 14 identified limited evidence on the use of two monitors to improve the data extraction efficiency and computer‐assisted programs for graphical data extraction. However, use of Google Translate for data extraction in non‐English articles was not considered to be viable. 14 In the same review, Robson et al. 14 identified evidence supporting contacting authors for obtaining additional relevant data.
Two SRs examined the impact of blinding of reviewers for RoB assessments. 14 , 23 Morissette et al. 23 investigated the mean differences between the blinded and unblinded RoB assessment scores and found inconsistent differences among the included studies providing no definitive conclusions. Similar conclusions were drawn in a more recent review by Robson et al., 14 which included four studies on reviewer blinding for RoB assessment that completely overlapped with Morissette et al. 23
Use of experienced reviewers and provision of additional guidance for RoB assessment were examined by Robson et al. 14 The review concluded that providing intensive training and guidance on assessing studies reporting insufficient data to the reviewers improves RoB assessments. 14 Obtaining additional data related to quality assessment by contacting study authors was also found to help the RoB assessments, although based on limited evidence. When assessing the qualitative or mixed method reviews, Robson et al. 14 recommends the use of a structured RoB tool as opposed to an unstructured tool. No SRs were identified on data synthesis and CoE assessment and reporting steps.
4.1. summary of findings.
Nine SRs examining 24 unique methods used across five steps in the SR process were identified in this overview. The collective evidence supports some current traditional and modified SR practices, while challenging other approaches. However, the quality of the included reviews was assessed to be moderate at best and in the majority of the included SRs, evidence related to the evaluated methods was obtained from very limited numbers of primary studies. As such, the interpretations from these SRs should be made cautiously.
The evidence gathered from the included SRs corroborate a few current SR approaches. 5 For example, it is important to search multiple resources for identifying relevant trials (RCTs and/or CCTs). The resources must include a combination of electronic database searching, handsearching, and reference lists of retrieved articles. 5 However, no SRs have been identified that evaluated the impact of the number of electronic databases searched. A recent study by Halladay et al. 27 found that articles on therapeutic intervention, retrieved by searching databases other than PubMed (including Embase), contributed only a small amount of information to the MA and also had a minimal impact on the MA results. The authors concluded that when the resources are limited and when large number of studies are expected to be retrieved for the SR or MA, PubMed‐only search can yield reliable results. 27
Findings from the included SRs also reiterate some methodological modifications currently employed to “expedite” the SR process. 10 , 11 For example, excluding non‐English language trials and gray/unpublished trials from MA have been shown to have minimal or no impact on the results of MA. 24 , 26 However, the efficiency of these SR methods, in terms of time and the resources used, have not been evaluated in the included SRs. 24 , 26 Of the SRs included, only two have focused on the aspect of efficiency 14 , 25 ; O'Mara‐Eves et al. 25 report some evidence to support the use of text‐mining approaches for title and abstract screening in order to increase the rate of screening. Moreover, only one included SR 14 considered primary studies that evaluated reliability (inter‐ or intra‐reviewer consistency) and accuracy (validity when compared against a “gold standard” method) of the SR methods. This can be attributed to the limited number of primary studies that evaluated these outcomes when evaluating the SR methods. 14 Lack of outcome measures related to reliability, accuracy, and efficiency precludes making definitive recommendations on the use of these methods/modifications. Future research studies must focus on these outcomes.
Some evaluated methods may be relevant to multiple steps; for example, exclusions based on publication status (gray/unpublished literature) and language of publication (non‐English language studies) can be outlined in the a priori eligibility criteria or can be incorporated as search limits in the search strategy. SRs included in this overview focused on the effect of study exclusions on pooled treatment effect estimates or MA conclusions. Excluding studies from the search results, after conducting a comprehensive search, based on different eligibility criteria may yield different results when compared to the results obtained when limiting the search itself. 28 Further studies are required to examine this aspect.
Although we acknowledge the lack of standardized quality assessment tools for methodological study designs, we adhered to the Cochrane criteria for identifying SRs in this overview. This was done to ensure consistency in the quality of the included evidence. As a result, we excluded three reviews that did not provide any form of discussion on the quality of the included studies. The methods investigated in these reviews concern supplementary search, 29 data extraction, 12 and screening. 13 However, methods reported in two of these three reviews, by Mathes et al. 12 and Waffenschmidt et al., 13 have also been examined in the SR by Robson et al., 14 which was included in this overview; in most instances (with the exception of one study included in Mathes et al. 12 and Waffenschmidt et al. 13 each), the studies examined in these excluded reviews overlapped with those in the SR by Robson et al. 14
One of the key gaps in the knowledge observed in this overview was the dearth of SRs on the methods used in the data synthesis component of SR. Narrative and quantitative syntheses are the two most commonly used approaches for synthesizing data in evidence synthesis. 5 There are some published studies on the proposed indications and implications of these two approaches. 30 , 31 These studies found that both data synthesis methods produced comparable results and have their own advantages, suggesting that the choice of the method must be based on the purpose of the review. 31 With increasing number of “expedited” SR approaches (so called “rapid reviews”) avoiding MA, 10 , 11 further research studies are warranted in this area to determine the impact of the type of data synthesis on the results of the SR.
The findings of this overview highlight several areas of paucity in primary research and evidence synthesis on SR methods. First, no SRs were identified on methods used in two important components of the SR process, including data synthesis and CoE and reporting. As for the included SRs, a limited number of evaluation studies have been identified for several methods. This indicates that further research is required to corroborate many of the methods recommended in current SR guidelines. 4 , 5 , 6 , 7 Second, some SRs evaluated the impact of methods on the results of quantitative synthesis and MA conclusions. Future research studies must also focus on the interpretations of SR results. 28 , 32 Finally, most of the included SRs were conducted on specific topics related to the field of health care, limiting the generalizability of the findings to other areas. It is important that future research studies evaluating evidence syntheses broaden the objectives and include studies on different topics within the field of health care.
To our knowledge, this is the first overview summarizing current evidence from SRs and MA on different methodological approaches used in several fundamental steps in SR conduct. The overview methodology followed well established guidelines and strict criteria defined for the inclusion of SRs.
There are several limitations related to the nature of the included reviews. Evidence for most of the methods investigated in the included reviews was derived from a limited number of primary studies. Also, the majority of the included SRs may be considered outdated as they were published (or last updated) more than 5 years ago 33 ; only three of the nine SRs have been published in the last 5 years. 14 , 25 , 26 Therefore, important and recent evidence related to these topics may not have been included. Substantial numbers of included SRs were conducted in the field of health, which may limit the generalizability of the findings. Some method evaluations in the included SRs focused on quantitative analyses components and MA conclusions only. As such, the applicability of these findings to SR more broadly is still unclear. 28 Considering the methodological nature of our overview, limiting the inclusion of SRs according to the Cochrane criteria might have resulted in missing some relevant evidence from those reviews without a quality assessment component. 12 , 13 , 29 Although the included SRs performed some form of quality appraisal of the included studies, most of them did not use a standardized RoB tool, which may impact the confidence in their conclusions. Due to the type of outcome measures used for the method evaluations in the primary studies and the included SRs, some of the identified methods have not been validated against a reference standard.
Some limitations in the overview process must be noted. While our literature search was exhaustive covering five bibliographic databases and supplementary search of reference lists, no gray sources or other evidence resources were searched. Also, the search was primarily conducted in health databases, which might have resulted in missing SRs published in other fields. Moreover, only English language SRs were included for feasibility. As the literature search retrieved large number of citations (i.e., 41,556), the title and abstract screening was performed by a single reviewer, calibrated for consistency in the screening process by another reviewer, owing to time and resource limitations. These might have potentially resulted in some errors when retrieving and selecting relevant SRs. The SR methods were grouped based on key elements of each recommended SR step, as agreed by the authors. This categorization pertains to the identified set of methods and should be considered subjective.
This overview identified limited SR‐level evidence on various methodological approaches currently employed during five of the seven fundamental steps in the SR process. Limited evidence was also identified on some methodological modifications currently used to expedite the SR process. Overall, findings highlight the dearth of SRs on SR methodologies, warranting further work to confirm several current recommendations on conventional and expedited SR processes.
The authors declare no conflicts of interest.
APPENDIX A: Detailed search strategies
The first author is supported by a La Trobe University Full Fee Research Scholarship and a Graduate Research Scholarship.
Open Access Funding provided by La Trobe University.
Veginadu P, Calache H, Gussy M, Pandian A, Masood M. An overview of methodological approaches in systematic reviews . J Evid Based Med . 2022; 15 :39–54. 10.1111/jebm.12468 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
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A systematic review is a type of review that uses repeatable methods to find, select, and synthesize all available evidence. It answers a clearly formulated research question and explicitly states the methods used to arrive at the answer. Example: Systematic review. In 2008, Dr. Robert Boyle and his colleagues published a systematic review in ...
Topic selection and planning. In recent years, there has been an explosion in the number of systematic reviews conducted and published (Chalmers & Fox 2016, Fontelo & Liu 2018, Page et al 2015) - although a systematic review may be an inappropriate or unnecessary research methodology for answering many research questions.Systematic reviews can be inadvisable for a variety of reasons.
A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. [1] A systematic review extracts and interprets data from published studies on the topic (in the scientific literature), then analyzes, describes, critically appraises and summarizes interpretations into a refined evidence-based ...
It is easy to confuse systematic reviews and meta-analyses. A systematic review is an objective, reproducible method to find answers to a certain research question, by collecting all available studies related to that question and reviewing and analyzing their results. A meta-analysis differs from a systematic review in that it uses statistical ...
an explicit, reproducible methodology. a systematic search that attempts to identify all studies that would meet the eligibility criteria. an assessment of the validity of the findings of the included studies, for example through the assessment of the risk of bias. a systematic presentation, and synthesis, of the characteristics and findings of ...
Systematic reviews are characterized by a methodical and replicable methodology and presentation. They involve a comprehensive search to locate all relevant published and unpublished work on a subject; a systematic integration of search results; and a critique of the extent, nature, and quality of evidence in relation to a particular research question.
A systematic review is a type of review that uses repeatable methods to find, select, and synthesise all available evidence. It answers a clearly formulated research question and explicitly states the methods used to arrive at the answer. Example: Systematic review. In 2008, Dr Robert Boyle and his colleagues published a systematic review in ...
Systematic reviews involve the application of scientific methods to reduce bias in review of literature. The key components of a systematic review are a well-defined research question, comprehensive literature search to identify all studies that potentially address the question, systematic assembly of the studies that answer the question, critical appraisal of the methodological quality of the ...
A systematic review identifies and synthesizes all relevant studies that fit prespecified criteria to answer a research question (Lasserson et al. 2019; IOM 2011).What sets a systematic review apart from a narrative review is that it follows consistent, rigorous, and transparent methods established in a protocol in order to minimize bias and errors.
A systematic review is guided filtering and synthesis of all available evidence addressing a specific, focused research question, generally about a specific intervention or exposure. The use of standardized, systematic methods and pre-selected eligibility criteria reduce the risk of bias in identifying, selecting and analyzing relevant studies.
Watch on. Cochrane evidence, including our systematic reviews, provides a powerful tool to enhance your healthcare knowledge and decision making. This video from Cochrane Sweden explains a bit about how we create health evidence and what Cochrane does. About Cochrane.
In recent years, there has been an explosion in the number of systematic reviews conducted and published (Chalmers & Fox 2016, Fontelo & Liu 2018, Page et al 2015) - although a systematic review may be an inappropriate or unnecessary research methodology for answering many research questions.Systematic reviews can be inadvisable for a variety of reasons.
A systematic review attempts to collate all empirical evidence that fits pre-specified eligibility criteria in order to answer a specific research question. It uses explicit, systematic methods that are selected with a view to minimizing bias, thus providing more reliable findings from which conclusions can be drawn and decisions made (Antman ...
A systematic review is an authoritative account of existing evidence using reliable, objective, thorough and reproducible research practices. It is a method of making sense of large bodies of information and contributes to the answers to questions about what works and what doesn't. Systematic reviews map areas of uncertainty and identify where ...
Sometimes systematic reviews ask a broad research question, and one strategy to achieve this is the use of several focussed sub-questions each addressed by sub-components of the review. Another strategy is to develop a map to describe the type of research that has been undertaken in relation to a research question. Some maps even describe over ...
Systematic Reviews in the Social Sciences by Roberts, H., & Petticrew, M. Such diverse thinkers as Lao-Tze, Confucius, and U.S. Defense Secretary Donald Rumsfeld have all pointed out that we need to be able to tell the difference between real and assumed knowledge. The systematic review is a scientific tool that can help with this difficult task.
A high-quality systematic review is described as the most reliable source of evidence to guide clinical practice. The purpose of a systematic review is to deliver a meticulous summary of all the available primary research in response to a research question. A systematic review uses all the existing research and is sometime called 'secondary research' (research on research).
Systematic reviews are characterized by a methodical and replicable methodology and presentation. They involve a comprehensive search to locate all relevant published and unpublished work on a subject; a systematic integration of search results; and a critique of the extent, nature, and quality of evidence in relation to a particular research question. The best reviews synthesize studies to ...
Systematic review and meta-analysis is a way of summarizing research evidence, which is generally the best form of evidence, and hence positioned at the top of the hierarchy of evidence. Systematic reviews can be very useful decision-making tools for primary care/family physicians.
Systematic Reviews. Describes what is involved with conducting a systematic review of the literature for evidence-based public health and how the librarian is a partner in the process.
Literature reviews, also known as narrative reviews, attempt to find all published materials on a subject, whereas systematic reviews try to find everything that focuses on answering a specific question. Since systematic reviews are generally associated with health related fields, their main objective is to ensure the results of the review ...
The certainty of the evidence is specific to each outcome in a systematic review, and can be rated as high, moderate, low, or very low. Because it will have an important impact, before conducting certainty of evidence, reviewers must clarify the intent of their question: are they interested in causation or association.
Systematic reviews and other types of literature reviews are more prevalent in clinical medicine than in other fields. The recurring need for improvement and updates in these disciplines has led to the Living Systematic Review (LSR) concept to enhance the effectiveness of scientific synthesis efforts. While LSR was introduced in 2014, its adoption outside clinical medicine has been limited ...
Integrative Reviews: Similar to systematic reviews, but they aim to generate new knowledge by integrating findings from different studies to develop new theories or frameworks. Importance of Literature Reviews. Foundation for Research: They provide a solid background for new research projects, helping to justify the research question and ...
Funding: This systematic review and network meta-analysis was funded by the National Institute for Health and Care Research (NIHR) through a Research for Patient Benefit grant to Dr Robert Boyle (NIHR201993) and a Systematic Review Programme Grant to Cochrane Skin at the Centre of Evidence Based Dermatology. The views expressed are those of the authors and not necessarily those of the NIHR or ...
This new systematic review of human observational studies is based on a much larger data set compared to what the IARC examined in 2011. It includes more recent and more comprehensive studies.
Study designs: Part 7 - Systematic reviews. In this series on research study designs, we have so far looked at different types of primary research designs which attempt to answer a specific question. In this segment, we discuss systematic review, which is a study design used to summarize the results of several primary research studies.
The aim of this systematic review is to investigate the causes and effects of decision fatigue from the existing literature that can be generalized across different organizational domains. A comprehensive literature search in three databases identified 589 articles on decision fatigue.
Objective:There are significant temporal and financial barriers for individuals with personality disorders (PD) receiving evidence-based psychological treatments. Emerging research indicates Group Schema Therapy (GST) may be an accessible, efficient, and cost-effective PD intervention, however, there has been no synthesis of the available evidence to date. This review therefore aimed to ...
1. INTRODUCTION. Evidence synthesis is a prerequisite for knowledge translation. 1 A well conducted systematic review (SR), often in conjunction with meta‐analyses (MA) when appropriate, is considered the "gold standard" of methods for synthesizing evidence related to a topic of interest. 2 The central strength of an SR is the transparency of the methods used to systematically search ...