Systematic Reviews and Clinical Practice Guidelines
Systematic Review
Systematic review is the summation and assessment of research studies found in the literature based on a clearly focused question that uses systematic and explicit methods to identify, select, critically appraise, and analyze relevant data from the selected studies to summarize the findings in a focused area.
Meta-Analysis
A review of studies using statistical methods
Statistically analyzes and integrates the results of many studies
Provides level I evidence, the highest level of evidence
Integrative Review
Critically appraises the literature in an area, but without a statistical analysis
Broadest category of review
Systematic Review
Summary of the quantitative research literature that used similar designs based on a focused clinical question
Brings together all the studies concerning a focused clinical question and, using rigorous inclusion and exclusion criteria, assesses the strength and quality of the evidence provided by the chosen studies in relation to:
Sampling issues
Internal validity (bias) threats
External validity
Data analysis
EFFECT OF SIZE
Effect sizes are calculated using the difference in the averages scores between the intervention and control groups from each study.
Thus, the effect size is an estimate of how large of a difference there is between intervention and control groups in the summarized studies.
Cochrane Collaboration
Largest repository of meta-analyses
Cochrane Collaboration is an international organization that prepares and maintains a body of systematic reviews that focus on health care interventions.
Clinical Practice Guidelines
Systematically developed statements or recommendations that link research and practice and serve as a guide for practitioners.
Guidelines are developed by professional organizations, government agencies, institutions, or convened expert panels.
Guidelines provide clinicians with an algorithm for clinical management, or decision making for specific diseases.
Evidence-based practice guidelines are developed using a scientific process.
Expert-based guidelines: agreement of a group of nationally known experts in the field who meet and solely use opinions of experts along with whatever research evidence is developed to date
Appraising the Evidence: Systematic Reviews and Clinical Guidelines
Does the PICO question used as the basis of the review match the studies included in the review?
Are the review methods clearly stated and comprehensive?
Are the dates of the review’s inclusion clear and relevant to the area reviewed?
Are the inclusion and exclusion criteria for studies in the review clear and comprehensive?
What criteria were used to assess each of the studies in the review for quality and scientific merit?
If studies were analyzed individually were the data clear?
Were the methods of study combination clear and appropriate?
If the studies were reviewed collectively, how large was the effect?
Are the clinical conclusions drawn from the studies relevant and supported by the review?
Is the date of publication or release current?
Are the authors of the guideline clear and appropriate to the guideline?
Is there a clinical problem and purpose clear in terms of what the guideline covers and patient groups for which it was designed?
What types of evidence (research, nonresearched) were used in formulating the guideline and were they appropriate to the topic?
Is there a description of the methods used to grade the evidence?
Were the search terms and retrieval methods used to acquire research and non-research evidence used in the guideline clear and relevant?
Is the guideline well referenced and comprehensive?
Are the recommendations in the guideline sourced according to the level of evidence for its basis?
Has the guideline been reviewed by experts in the area?
Who funded the guideline development?
SUMMARY
Systematic reviews vs. clinical guidelines
Benefits of systematic reviews
Where to find: Cochrane Collaboration