Experiences and Lessons from Conducting a Mixed Studies Systematic Review Presenter: Dale Forsdyke Supervisor: Professor Andy Smith

Background and Context Provisional PhD title - Experiences of sports injury rehabilitation in elite women's soccer Systematic Review title - The role of psychosocial responses to sports injury on rehabilitation outcomes in competitive athletes– a mixed method systemic review PROSPERO registration: CRD Ethics reference: DF/08/09/2014/01 Crux of the debate isn't whether a literature review should be undertaken it is when and how (Dunne, 2011) Rationale for (adapted from Dunne, 2011): Create rationale inc. justifying a specific research approach Highlight pertinent lacunae in existing knowledge Improve contextual awareness and how studied to date Help avoid methodological and conceptual pitfalls Aware of rather than numb to possible unhelpful preconceptions ‘In the context of your thesis rationalise why you are undertaking a systematic review’

Quali research designs not included or justified AND Mixed methods studies taken as quant despite dominant quali approach ‘A systematic review is purely a function of its inclusion criteria’

‘Don’t reinvent the wheel - there are some robust quality guidelines for conducting systematic reviews’ Framework: Q- question E - eligibility S - search I - identify S – selection A – appraisal S – synthesis (Pace et al. 2013)

Synthesising research from different paradigms (qual, quant, MM) in the same systematic review- are you bonkers? Yes Unique and distinctive? Seems philosophically ‘right’ Slightly messy Presents a challenge Evaluate contribution of ALL empirical study types methodological Topic area

‘Getting started is a bit like playing cat and mouse’ ‘being transparent and auditable are key traits of a robust systematic review’

Search strategy (terms, methods, databases) Title screening Abstract screening Full text screening Final study appraisal Dale, have you also thought about this? Dale, why has this been included and this not? ‘Never work in isolation’ ‘There are ethical decisions to be made when conducting a systematic review’ – ethics has moved over time

12/2/14 n=328 17/2/14 n=324 Where and how did I lose 4 studies – arghhhh! =

‘All search strategies should ideally follow same data extraction protocol’

Pluye et al. (2011) mixed methods appraisal tool for systematic mixed studies reviews ‘The real critical instrument is you NOT the appraisal tool’

Core ThemeSub-setsStudies* Successful vs. unsuccessful rehabilitationDirect comparison4,9,16,21 Emotion Mood (TMD, TNM) Injury anxieties Emotional integrity 2,3,4, 5, 6, 7, 8,9, 10, 11, 13,15,16, 17, 18, 21,22,23 Injury related cognition Restoring the self Basic needs fulfilment Personal growth and development 1,3,4,5, 6, 7, 8, 10,11, 13, 14, 18, 19, 20, 22, 23 Injury related behaviourCoping Social interaction 3,4, 6, 12,13,15,17,19,22,23 *where studies have multiple findings spanning a number of constructs these have been replicated across the core themes ( e.g. qualitative papers that infer both emotion and cognition factors having an effect on sports rehabilitation outcomes) ‘You need to rationalise your data analysis strategy’ e.g. qualifying purely quantitative work is incongruent and not the best ‘fit’ For this review convergent qualitative thematic analysis was undertaken

Questions? Are systematic reviews simply regressing our topic understanding to the mean?

References Dunne, C. (2011) The place of the literature review in grounded theory research. International Journal of Social Research Methodology; 14(2): Pluye, P., Gagnon, M.P., Griffiths, F. & Johnson-Lafleur, J. (2009). A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantitative and mixed methods primary studies in Mixed Studies Reviews. International Journal of Nursing Studies; 46(4), Pluye, P., Robert, E., Cargo, M., Bartlett, G., O’Cathain, A., Griffiths, F., Boardman, F., Gagnon, M.P., & Rousseau, M.C. (2011). Proposal: A mixed methods appraisal tool for systematic mixed studies reviews. Retrieved on [17/10/14] from Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e doi: /journal.pmed [accessed 29/10/14]