Term 3 EBP 2 week 1

Question 1

Systematic review (SR) is a secondary analysis of original ________ research studies.

Answer 1

individual

Question 2

Types of Review Studies are …

Answer 2

1. Narrative (or literature) review or “traditional
   narrative literature review”
2. Systematic reviews without statistical
   analysis
3. Meta-analysis (= systematic reviews with
   statistical analysis)
4. Scoping reviews
   (2 and 3 are involved in clinical practice guidelines)

Question 3

Systematic reviews

Answer 3

✓Focused question
✓Summary of findings from
selected individual studies
that meet eligibility criteria
✓Rigorous search and
selection methods
established ahead of time
✓Extensive critical analysis of
individual studies included in
review
✓Stronger evidence sources
for EBP

Question 4

Narrative or Lit Review

Answer 4

✓Often broad/general in topic
✓Summary of findings from
individual studies
✓Typically does NOT have
established search and
selection methods
✓Limited to NO critical analysis
of individual studies included in
review
✓A good source for background
information

Question 5

Definition of Systematic Reviews (SR)

Answer 5

• “a summary of the medical literature that uses explicit
  methods to systematically search, critically appraise, and
  synthesize the world literature on a specific issue”
  Sackett et al. Evidence-Based Medicine: How to Practice and Teach
  EBM. 2000
• “a review of a clearly formulated question that uses
  systematic and explicit methods to identify, select, and
  critically appraise relevant research, and to collect and
  analyze data from the studies that are included in the
  review.”

Question 6

Scoping Reviews (ScRs)

Answer 6

• Systematic reviews typically address very specific clinical questions.
  Yet, not every topic in healthcare is appropriate for a SR. For example,
• background clinical questions on more general topics, and
• foreground clinical questions with a paucity of supporting evidence
• A scoping review plays a different role, mapping the body of
  knowledge on a topic for which the body of literature has not been
  comprehensively reviewed.
• It is an exploratory method that is especially useful when an area of
  inquiry exhibits a complex or heterogeneous nature that would
  preclude a formal SR.
• Scoping reviews summarize evidence on a topic
  ✓to describe consistencies or inconsistencies in current practice,
  ✓to identify gaps in the literature, clarify concepts, and
  ✓can serve as a precursor to systematic reviews.
• Methods
• Systematic search
• More expansive selection criteria for study designs
• Do not involve appraisal of methodologic quality of included studies

Question 7

Purpose of systematic reviews (SR’s)

Answer 7

Any single study, even if well-designed, is essentially a
form of tentative evidence, which needs confirmation
by additional research. Therefore, researchers and
practitioners benefit from syntheses of literature that
summarize and critique published studies.
* To appropriately report on the state of knowledge
and research results
* To guide clinical practice by aggregating evidence
* To provide clinicians a broader view of evidence than
any single study can do
* To draw conclusions based upon a larger sample size!
* Are most commonly focused on the effectiveness
of interventions but can also be used to address
✓the accuracy of diagnostic and measurement
tools,
✓to identify prognostic or risk factors, and
✓to develop recommendations for clinical practice
guidelines (CPG).
* To be the ultimate use of evidence
* Top of “Evidence hierarchy”

Question 8

Types of Research Questions: Which types of SRs?

Answer 8

• Spinal manipulative therapy (SMT)
  is a common treatment option for
  patients with acute low back pain.
  However, results of RCTs have not
  provided consistent findings about
  the effectiveness of SMT. Paige et
  al. did a SR to evaluate the
  effectiveness and harms of SMT
  compared with sham or usual care
  to reduce pain in patients with
  acute (≤ 6 weeks) low back pain.
• Ankle decision rules have been
  developed to reduce the number
  of radiographs of the ankle and
  foot. Although 3 SRs have
  examined the accuracy of the
  Ottawa Ankle & Foot Rules, none
  had yet compared several available
  tests. Barelds et al. did a SR to
  compare the accuracy of 6 clinical
  decision rules intended to exclude
  ankle fractures in the emergency
  department.

Question 9

Characteristics and Process of SRs

Answer 9

• Include larger sample sizes
• A specific clinical question to be addressed
• Explicit rules of inclusion/exclusion criteria for selection
  of studies* (see next slide for more information)
• Document search strategies
• Standardized review protocols conducted by two
  independent reviewers
• Formal ratings of study quality!!! (e.g., PEDro scale,
  Cochrane Risk of Bias)

Question 10

Criteria for studies selected for SR….

Answer 10

*Require patient, intervention(s) &
outcomes of individual studies be the
same or similar (homogeneity)
✓This applies to both types of SRs, but
extremely critical for a meta-analysis