Systematic Review Systematic Review

What is a Systematic Review

  • Systematic Reviews (SR’s) focus on systematically summarizing evidence on a specific question, typically through quantitative means, and aim to provide a clear, objective answer based on the best available evidence.
  • They are necessary when there are no existing SR’s and the evidence base is either overwhelming/contradictory or both.  

Systematic Review

Systematic Reviews (SRs) focus on systematically summarising evidence on a specific question, typically through quantitative means, and aim to provide a clear, objective answer based on the best available evidence. They are necessary when there are no existing SRs and the evidence base is either overwhelming, contradictory or both.  

Check Cochrane https://www.cochranelibrary.com/ and PROSPERO https://www.crd.york.ac.uk/PROSPERO/ databases for any existing and proposed SRs respectively. It is a requirement of NIHR funding that proposed systematic reviews are pre-registered in the PROSPERO database.

Purpose:

  • To Synthesise Evidence: The primary aim is to systematically collect, evaluate, and synthesise research evidence on a specific research question or topic.
  • To Provide Comprehensive Answers: To offer a comprehensive and objective summary of the existing evidence, often to inform practice, policy, or further research.

Characteristics:

  • Structured Methodology: Follows a predefined, rigorous methodology, including a systematic search strategy, inclusion and exclusion criteria, and standardised data extraction procedures.
  • Comprehensive Search: Involves a thorough search of multiple databases and sources to identify all relevant studies, minimising the risk of missing important evidence.
  • Quality Assessment: Includes an assessment of the quality and risk of bias of included studies, often using standardised tools.
  • Data Synthesis: May include statistical techniques like meta-analysis to combine quantitative data from different studies to produce pooled estimates of effect.
  • Transparency and Reproducibility: The process is transparent, with detailed reporting of methods and findings to ensure reproducibility. Adheres to guidelines such as PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).
  • Focus: Typically focused on answering specific clinical or research questions with quantitative data, though qualitative data can also be included.

Timescale:

  • 6 to 12 months: Systematic reviews usually take between 6 to 12 months to complete, although the duration can extend depending on the complexity of the topic, the volume of literature, and the resources available. The Cochrane guidance suggests that literature searching be only as comprehensive as time and resources allow.

Qualitative Systematic Review (Qualitative Evidence Synthesis)

Qualitative systematic reviews have similar aims to the quantitative systematic review but additionally has the following purpose and characteristics

Purpose:

  • To synthesise qualitative research to provide insights into phenomena, experiences, processes, attitudes or beliefs.
  • To develop or refine theories by identifying patterns, themes, and relationships within the qualitative evidence
  • To inform practice, policy-making, and further research by providing a nuanced understanding of how and why certain outcomes occur.

Characteristics:

  • Involves extracting qualitative data (e.g., themes, concepts) and synthesising it through methods like thematic synthesis, meta-ethnography, or narrative synthesis.
  • Focus on subjective experiences, emphasising understanding the meanings, perspectives and experiences of participants as reported in the original qualitative studies.
  • Includes a rigorous appraisal of the quality and credibility of the included studies, often using specific criteria tailored to qualitative research.
  • Pays close attention to the context in which the original studies were conducted, ensuring that the synthesis reflects the diversity and richness of the qualitative data.

Example: Systematic Review on Nicotine Replacement Therapy for Smoking Cessation

This review is a prime example of how systematic reviews can be used to summarise evidence from multiple studies to inform healthcare practice and policy.

Title: Nicotine replacement therapy for smoking cessation

Authors: Silagy, C., Lancaster, T., Stead, L., Mant, D., & Fowler, G.

Published In: Cochrane Database of Systematic Reviews, 2004

Purpose: The primary aim of this systematic review was to evaluate the effectiveness of various forms of nicotine replacement therapy (NRT), such as patches, gum, lozenges, inhalers, and nasal sprays, in helping people quit smoking.

Key Characteristics of the Review:
  1. Comprehensive Literature Search: The review included a detailed and systematic search of multiple databases to identify randomised controlled trials (RCTs) that evaluated the effectiveness of NRT for smoking cessation. The search strategy was designed to be exhaustive to ensure all relevant studies were included.
  2. Inclusion and Exclusion Criteria: Clear criteria were established for including studies in the review. Only RCTs that compared NRT to placebo or no treatment and reported on smoking cessation outcomes were included.
  3. Quality Assessment: Each included study was assessed for quality and risk of bias using standardised criteria. This ensured that the findings of the review were based on high-quality evidence.
  4. Data Extraction and Synthesis: Data from the included studies were systematically extracted and synthesised. The review used meta-analysis to combine data from multiple studies, providing a pooled estimate of the effectiveness of NRT.
  5. Statistical Analysis: The review conducted meta-analyses using fixed-effect or random-effect models, depending on the level of heterogeneity among the studies. It also assessed publication bias and conducted sensitivity analyses.
Key Findings:
  • The review found that all forms of NRT (patch, gum, lozenges, inhalers, and nasal sprays) significantly increased the likelihood of quitting smoking compared to placebo or no treatment.
  • The pooled analysis showed that the use of NRT doubled the chances of successful smoking cessation.
  • The effectiveness of NRT was consistent across different forms and doses, and it was effective regardless of the level of additional behavioural support provided.
Impact:

This systematic review provided robust evidence supporting the use of NRT for smoking cessation. It has informed clinical guidelines and public health policies worldwide, promoting the widespread use of NRT as a first-line treatment for people attempting to quit smoking.

Summary:

This Cochrane systematic review is a classic example of how systematic reviews can be used to rigorously evaluate the effectiveness of healthcare interventions. By combining evidence from multiple high-quality studies, the review provided clear and reliable conclusions about the benefits of NRT for smoking cessation, which have had a significant impact on clinical practice and policy.

 

NIHR example:

Recent systematic review and meta analysis (from NIHR Journals library database 30/7/2024)

Caldwell DM, Davies SR, Thorn JC, Palmer JC, Caro P, Hetrick SE, et al. School-based interventions to prevent anxiety, depression and conduct disorder in children and young people: a systematic review and network meta-analysis. Public Health Res 2021;9(8)

Funding: Public Health Research programme (Public Health Research Volume: 9, Issue: 8, Published in August 2021) https://doi.org/10.3310/phr09080 https://www.journalslibrary.nihr.ac.uk/phr/phr09080/#/abstract

  • Cochrane's "What are Systematic Reviews?" This video from Cochrane provides an in-depth explanation of systematic reviews, focusing on how they help in making informed healthcare decisions by synthesising empirical evidence. It’s especially useful for those in health-related fields. (Cochrane 3:23 minutes)
  • What are systematic reviews? A collection of videos relating to systematic reviews, including methodology, approaches and tips. (5 videos from Joanna Briggs Institute totalling 36 minutes)
  • "What is a Systematic Review?" This video is a concise introduction to systematic reviews, explaining their purpose, methodology, and importance in research. It’s ideal for beginners who want a clear overview. (Research Masterminds 4:38 minutes)

Protocols

PRISMA-P

Reporting guideline

Equator network
This contains links to particular designs of systematic review (SR’s) (64 different guidelines!)

  • For SR’s that include a meta analysis of observational studies see the MOOSE guideline
  • For population health and policy interventions see TIDieR-PHP