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Chapter 30 Systematic Reviews of Research Evidence

Question #1

Tell whether the following statement is true or false:

Evidence-based practice relies on rigorous integration of research evidence on a topic through systematic reviews.

Answer to Question #1

True

Evidence-based practice relies on rigorous integration of research evidence on a topic through systematic reviews. A systematic review methodically integrates research evidence about a specific research question using carefully developed sampling and data collection procedures that are spelled out in advance in a protocol.

Research Integration and Synthesis

Systematic review

Integrates research evidence about research question

Carefully developed

Sampling

Data collection procedures

Spelled out in advance in a protocol

Question #2

Tell whether the following statement is true or false:

Systematic reviews of qualitative studies often involve statistical integration of findings through meta-analysis.

Answer to Question #2

False

Systematic reviews of quantitative studies often involve statistical integration of findings through meta-analysis, a procedure whose advantages include objectivity, enhanced power, and precision; meta-analysis is not appropriate, however, for broad questions or when there is substantial inconsistency of findings.

Types of Systematic Reviews #1

Systemic reviews

Metasyntheses

Qualitative evidence syntheses (QESs)

Mixed studies reviews

Types of Systematic Reviews #2

Meta-analysis

Objectivity

Enhanced power

Precision

Types of Systematic Reviews #3

Special types of review

Scoping reviews

Rapid reviews

Overview of reviews (umbrella review)

Living systemic reviews

Next-generation systematic reviews

Individual patient-level meta-analysis

Network meta-analysis (NMA)

Planning a Systematic Review #1

Broad steps in a systems review

Formulate the questions

Define eligibility criteria for the primary studies

Prepare a protocol for the review

Search for and retrieve primary studies

Select studies for inclusion in the review

Assess the quality of the selected primary studies

Extract data from the studies

Analyze and synthesize the data

Evaluate the degree of confidence in the results

Present the findings in a systematic review report

Planning a Systematic Review #2

Prepare to conduct a systematic review

Preliminary groundwork

PROSPERO

The review team

The review auspices

Computer software

Schedule for a systematic review

Question #3

Tell whether the following statement is true or false:

The steps in both quantitative and qualitative integration are similar.

Answer to Question #3

True

The steps in both quantitative and qualitative integration are similar and involve formulating the problem, designing the study, searching the literature for a sample of primary studies, evaluating study quality, extracting and encoding data for analysis, analyzing the data, and reporting the findings.

Systematic Reviews of Quantitative Research #1

Formulating the review question

Defining eligibility criteria

Study participants

Intervention/influence

Study design

Other criteria

Searching the literature for a sample of primary studies

Evaluating study quality

Extracting and encoding data for analysis

Analyzing the data

Reporting the findings

Systematic Reviews of Quantitative Research #2

Preparing a review protocol

The title of the review

Members of the review team

Proposed schedule, with start and end dates

The research questions

Background/argument for the review

Eligibility criteria for studies in the review

Search strategy

Review methods

Assessment of confidence in the findings

Question #4

Tell whether the following statement is true or false:

There is consensus on systematic reviews should include the grey literature.

Answer to Question #4

False

There is no consensus on whether systematic reviews should include the grey literature—that is, unpublished reports.

Systematic Reviews of Quantitative Research #3

Searching for and screening primary studies

PICO

MEDLINE, CINAHL, EMBASE

Grey literature

Publication bias

Dissemination bias

Handsearching

Systematic Reviews of Quantitative Research #4

Evaluating study quality and risk of bias

Cochrane Collaboration’s tool

Selection bias

Performance bias

Attrition bias

Reporting bias

Other bias

Extracting and encoding data for analysis

Systematic Reviews of Quantitative Research #5

Analyzing and synthesizing the data

Criteria for using meta-analysis in a systematic review

Calculating effects in a meta-analysis

Analyzing data in a meta-analysis

Inverse variance method

Statistical heterogeneity

Forest plots

Random effects

Sensitivity analysis

Systematic Reviews of Quantitative Research #6

Examining factors affecting heterogeneity

Methodologic heterogeneity

Subgroup analysis

Meta-regression

Systematic Reviews of Quantitative Research #7

Addressing study quality

Set a quality threshold

Perform sensitivity analyses

Test indicators of bias

Weight studies according to quality criteria

Graphic output from a meta-analysis

Systematic Reviews of Quantitative Research #8

Interpreting results and assessing degree of confidence: GRADE

Risk of bias

Inconsistent results

Indirectness of evidence

Imprecision

Publication bias

Large effect

Dose-response gradient

Implausible confounders

Systematic Reviews of Quantitative Research #9

Interpreting results and assessing degree of confidence: GRADE (continued)

Evidence profile

Summary of findings

Systematic Reviews of Quantitative Research #10

Writing a quantitative systematic review

The final step in a systematic review project is to prepare a report to disseminate the results.

PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) is useful for writing up a systematic review of RCTs.

MOOSE (Meta-analysis of Observational Studies in Epidemiology) guides reporting of meta-analyses of observational studies.

Qualitative Systematic Reviews #1

Aggregative and interpretive qualitative reviews

Aggregative qualitative reviews

Pooling of findings

Fairly structured

Fairly focused

Exhaustive searching is expected

Quality of primary studies is essential

Minimal subjectively or bias

Provide direct and usable guidance for action

Qualitative Systematic Reviews #2

Aggregative and interpretive qualitative reviews

Interpretive qualitative reviews

Not highly structured

Fairly focused

Purposive sampling

Quality of primary studies is not essential

Interpreters’ insights are valued

Provide enlightenment through new ways of understanding

Qualitative Systematic Reviews #3

Metasynthesis

Meta-ethnography

Megastudy

Metasummary

Question #5

Tell whether the following statement is true or false:

Metasyntheses are more than just summaries of prior quantitative findings; they involve a discovery of essential features of a body of findings and, typically, a transformation that yields new insights and interpretations.

Answer to Question #5

False

Metasyntheses are more than just summaries of prior qualitative findings; they involve a discovery of essential features of a body of findings and, typically, a transformation that yields new insights and interpretations.

Qualitative Systematic Reviews #4

Preliminary steps in a metasynthesis

Formulating the question

Designing a metasynthesis

Searching the literature for data

Appraising study quality

Extracting data for analysis

Qualitative Systematic Reviews #5

Synthesizing and interpreting the data

Meta-ethnography

Deciding on the phenomenon

Deciding on relevant studies

Reading and rereading each study

Deciding how studies are related

Translating qualitative studies

Synthesizing translations

Qualitative Systematic Reviews #6

Analyzing and interpreting data

Noblit and Hare approach

Paterson and colleagues approach

Sandelowski and Barroso approach

Qualitative Systematic Reviews #7

Paterson

Metadata analysis: the study of results in a specific substantive area through analysis of the processed data

Metamethod: the study of the studies’ methodologic rigor

Metatheory: the analysis of the theoretical underpinnings on which the studies are grounded

Qualitative Systematic Reviews #8

Sandelowski and Barroso

Metasummary

Summaries: descriptive synopses

Syntheses: interpretative explanations of the data

Manifest effect sizes

Frequency effect size

Intensity effect size

Qualitative Systematic Reviews #9

Writing a metasynthesis report

PRISMA

ENTREO

Meta-aggregation

The JBI meta-aggregation method

Preliminary steps in a JBI qualitative evidence synthesis

Analysis through meta-aggregation

Assessment of confidence

Writing a meta-aggregation report

Systematic Mixed Studies Reviews

Rationale for mixed studies reviews

Conducting mixed studies reviews

Research questions for MSRs

Designs for mixed studies reviews

Segregated design

Integrated design

Contingent design

Approaches to analysis and integration

Realist reviews