The Methodology of Conducting Systematic Reviews David Scalzitti, PT, PhD, OCS Lunch and Learn October 15, 2014

Key Points Identify the uses of systematic reviews Differentiate systematic reviews, meta- analyses, and clinical practice guidelines Identify/perform valid methods for a systematic review

Relative Hierarchy of Intervention Evidence based on Systematic reviews of RCTs Randomized controlled trials or an observational study with dramatic effect Cohort study Case-control study or Case series Mechanism-based reasoning

Systematic Review A summary of the medical literature that uses EXPLICIT methods to perform a thorough literature search AND critical appraisal of individual studies AND that uses appropriate techniques to combine these valid studies.

Meta-Analysis A systematic review that incorporates a quantitative strategy for combining the results of several studies into a single pooled or summary estimate. All MA should be based on a SR. All SR do not include a MA.

Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. All clinical practice guidelines should include a systematic review of the literature PLUS a recommendation. Clinical Practice Guideline

How I got involved

PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) ▫27 item checklist ▫Flow diagram

PRISMA

Define a Clinical Question - PICOTS P - Participants I - Interventions C - Comparisons O - Outcomes (T – Timing) (S – Setting or Study Design)

Assemble a Team

Develop the Protocol for the SR Set inclusion/exclusion criteria Define evaluation method Draft evidence tables ▫Good resource: Mlika-Cabanne N, Harbour R, de Beer H, Laurence M, Cook R, Twaddle S; Guidelines International Network (GIN) Working Group on Evidence Tables. Sharing hard labour: developing a standard template for data summaries in guideline development. BMJ Qual Saf Feb;20(2):141-5.

Develop the Search Strategy Select keywords Identify databases ▫PubMed ▫Scopus ▫CINAHL ▫SPORTDiscus ▫Cochrane Controlled Trial Registry ((“Anterior cruciate ligament” [TW] OR “posterior cruciate ligament” [TW] OR “medial collateral ligament” [TW] OR “lateral collateral ligament” [TW] OR “tibial collateral ligament” [TW] OR “fibular collateral ligament” [TW] OR “posterolateral corner” [TW] OR “arcuate complex” [TW] OR “posteromedial corner” [TW]) OR ((knee joint [MH]) AND (ligaments, articular [MH] OR ACL [TW] OR PCL [TW] OR MCL [TW] OR LCL [TW] OR TCL [TW] OR FCL [TW]))) AND (physical therapy modalities [MH] OR recovery of function [MH] OR rehabilitation [MH] OR therapeutics [MH] OR “physical therapy” [TW] OR physiother* [TW] OR recovery [TW] OR restoration [TW] OR re-education [TW] OR early ambulation [MH] OR strengthening [TW] OR resistance training [MH] OR “resistance methods” [TW] OR exercise therapy [MH] OR biofeedback, psychology [MH] OR “neuromuscular electrical stimulation” [TW] OR pain management [MH] OR pain measurement [MH] OR mobilization* [TW] OR “continuous passive motion” [TW] OR manipulation, spinal [MH] OR ultrasonography [TW] OR ultrasound [TW] OR acupuncture [TW] OR laser* [TW] OR patient education as topic [MH] OR electrical stimulation [MH] OR electrical stimulation therapy [MH] OR Transcutaneous electric nerve stimulation [MH] OR taping [TW] OR bracing [TW] OR orthotic* [TW] OR weight-bearing [MH] OR Range of motion [MH] OR Treatment Outcome [MH] OR Exercise [MH] OR “physical therapy treatments” [TW] OR “training program” [TW])

ANY QUESTIONS? To be continued - November 5, 2014… Systematic Reviews Part 2 Translating Evidence to Practice and Policy