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Systematic Reviews

Specialised advice for planning, researching and writing Systematic Reviews.

Define the question

Breaking down the question into discrete components can help formulate a good answerable question and also helps in the development of a search strategy.

Well-formulated systematic review (SR) questions use a structured format to improve the scientific rigor.

There are various models and frameworks that can be used depending on the nature of the systematic review.

Some of these models and frameworks are shown below:ethodology

Type of Study
Models
Disciplines
Clinical questions
PICO
Variants - PIO, PICOT, PICOS
Health
Quantitative

PICO & variants PIO, PICOT, PICOS
PIFT

Health; Social Sciences

Business & Policy; Environment; Ecology

Qualitative

PEO,  PICo
CLIP, ECLIPSE

Social Sciences
Management
Mixed Methods
(use for either qualitative
or quantitative)

SPICE
SPIDER
FINER

Health
Social Sciences

Methodology or theory

BeHEMoTH
SDMO

Health

 

Further reading:

Munn, Z., Stern, C., Aromataris, E., Lockwood, C., & Jordan, Z. (2018). What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. BMC Medical Research Methodology, 18, 5. http://doi.org/10.1186/s12874-017-0468-4

Models and frameworks

The PICO model is a tool widely used to develop answerable questions.

Population, Patient or Problem
Who are the people being studied or What is the problem being looked at?
What are their characteristics?
Intervention
What is the treatment or intervention being studied? (treat, diagnose, observe)
Comparison, Control or Comparator
What is the intervention compared to?
(e.g. other interventions, standard treatment, no treatment)
This can be optional if no comparison applies.
Outcome
What are the relevant outcomes and how are they measured?

Chapter 5 of the Cochrane Handbook for Systematic Reviews of Interventions has more information on the defining each element of the PICO acronym.

Variants of PICO

PIO

Use when there is no Comparison, Control or Comparator

PICOT

Includes Time from the intervention that outcomes are measured.

PICOS

Includes Study Design e.g. cohorts or randomized controlled trials.

Examples

Question:
 
Does the use of chlorhexidine mouthwash prevent gingivitis and aid in plaque control?
 
Question:
 
Do first year students who attend the library Orientation week sessions perform better on research assessment than non-attending students?
Patient, population or problem
gingivitis and plaque control  
Patient, population or problem
first year university students
Intervention
use of chlorhexidine mouthwash  
Intervention
attendance of library orientation sessions
Comparison
those who do not use chlorhexidine mouthwash  
Comparison
non-attending students
Outcome
decreased gingivitis and increased plaque control  
Outcome
good assessment results

Instructional Videos

Tutorial from the Cushing/Whitney Medical Library

 

Tutorial from QUT

 

SPICE, SPIDER and FINER are models that can be used for both qualitative and quantitative topics.

SPICE
SPIDER
Setting
Where is the study being undertaken?
Perspective
For whom? Who are the targets or participants of the study?
Intervention
What is the change or intervention being studied?
Comparison
What is the intervention being compared to?
Evaluation
With what result? How is the result being measured?
Sample
The group of people being looked at
Phenomenon of Interest
Looks at the reasons for behaviour and decisions, rather than an intervention.​
Design
The form of research used, such as interview or survey.​
Evaluation
The outcome measures.
Research type
Type of research. e.g. qualitative, quantitative or mixed method


 

Taken from:
Booth, A. (2006). Clear and present questions: Formulating questions for evidence based practice. Library Hi Tech, 24(3), 355-368. doi:10.1108/07378830610692127
Taken from:
Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qualitative Health Research, 22(10), 1435-1443. doi:10.1177/1049732312452938

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

FINER
 
Feasibility
What is the feasibility? Focuses on time, scope, resources, expertise, and funding    
Interesting
What is the intrinsic and extrinsic interest in answering a research question?    
Novel
How does it generate new evidence for the current empirical literature    
Ethical
What are the ethical implications?    
Relevant
What is the clinical relevance of a research question?    
Taken from:
Cummings, S. R., Browner, W. S., & Hulley, S. B. (1988) Conceiving the research question. In S. B. Hulley, & S. R. Cummings SR (Eds), Designing Clinical Research. (pp. 12 - 17). Baltimore, MD: Williams & Wilkins
 

The variants of PICO below are adapted to work better with qualitative studies.

PEO
 
PICo
Population and their problems

Who are the users, patients or community being affected? What are their symptoms, age, gender etc.

 
Population

What are the characteristics of the population or patient? What condition or disease are you interested in?
 

Exposure
Use for a specific exposure (this term is used loosely) such as “witnessed resuscitation” or “domestic violence”  
Interest

The phenomena of interest, related to a defined event, activity, experience or process
 

Outcomes or themes

Are you looking for improvements in pain, responsiveness to treatment, mobility, quality of life, daily living? Usually there will be an element of looking at patient’s experiences.

 
Context

The setting or distinct characteristics
 

 

Taken from:
Moola, S., Munn, Z., Sears, K., Sfetcu, R., Currie, M., Lisy, K., . . . Mu, P. (2015). Conducting systematic reviews of association (etiology): The Joanna Briggs Institute's approach. International Journal of Evidence-Based Healthcare, 13(3), 163-169. doi:10.1097/XEB.0000000000000064
 
Taken from:
Lockwood, C., Munn, Z., & Porritt, K. (2015). Qualitative research synthesis: Methodological guidance for systematic reviewers utilizing meta-aggregation. International Journal of Evidence-Based Healthcare, 13(3), 179-187. doi:10.1097/XEB.0000000000000062
 

CLIP & ECLIPSE are other types of question frameworks for qualitative studies

CLIP
 
ECLIPSE
Client group
At whom is the service aimed?  
Expectation
What do you want the information for (the original ‘I’s)?
Location
Where is the service sited?  
Client group
At whom is the service aimed?
Improvement or Information or
Innovation
What do you want to find out?  
Location
Where is the service sited?
Professionals
who is involved in providing/improving the service?  
Impact
What is the change in the service, if any, which is being looked for? What would constitute success? How is this being measured?
     
Professionals
Who is involved in providing/improving the service?
     
Service
Which service are you looking for information? For example, outpatient services, nurse‐led clinics, intermediate care.
Taken from:
Wildridge, V., & Bell, L. (2002). How CLIP became ECLIPSE: A mnemonic to assist in searching for health policy/management information. Health Information and Libraries Journal, 19(2), 113-115. doi:10.1046/j.1471-1842.2002.00378.x
PICO
 
PIFT
P
Population, Problem or Patient  
Product or Process
What is the product or process category being assessed?
I
Intervention  
Impacts
What are the impact(s) of interest?
C
Comparison, Control or Comparator  
Flows

What are the flow(s) or economic sectors contributing to the impact?
O

Outcome
 
 
Types

What are the types of Life Cycle Assessment of interest?
 
   
Taken from:
Zumsteg, J. M., Cooper, J. S., & Noon, M. S. (2012). Systematic review checklist: A standardized technique for assessing and reporting reviews of life cycle assessment data. Designing Journal of Industrial Ecology, 16 (S1), S12-S21. doi:10.1111/j.1530-9290.2012.00476.x
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