Developing Research Proposal Systematic Review

Mohammed TA, Omar Ph.D. PT

Rehabilitation Health Science

What is a systematic Review ?

• A systematic review is defined as “a review of the evidence on a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant primary research, and to extract and synthesis, analyze data from the studies that are included in the review.”

3

Why ? The problems are that …

• Too much information, too little time

• Many too poorly done or insufficiently relevant to be clinically useful

• Many have conflicting results

• On top of these, high quality information is often not easy to find

Why do systematic reviews?

• Support Evidence Based Practice

• Research

• Inform clinical policy

• Publication

• Personal professional development

Systematic reviews are the same as narrative reviews

Narrative vs systematic review

Types of Systematic Review

Intervention

• To assess the evidence about the effects of a healthcare intervention.

Prognostics

• To assess the evidence about the effects of a healthcare intervention

Measurement

• To assess the properties of health-status instruments or tools

Stages of Systematic Review

Formulate research / policy conclusions

Search bibliographic

databases

Identify possible papers from

titles/abstractsRetrieve papers

Extract data

Further selection of primary studies using

inclusion criteria

Synthesi

s

Formulate research question

Design search strategy/plan

Quality

appraisal

Formulate Research Question

PICO

• What types of Participants?

• What types of Interventions?

• What types of Comparison?

• What types of Outcomes?

• The first and most important decision in preparing a review is to determine its focus

• This is best done by asking clearly framed questions.

Formulation of a intervention question

• Does low level laser therapy effective in treatment of diabetic foot ulcer?

In patients with Chronic Diabetic Foot Ulcer (DFU), does low level laser therapy lead to higher rates of healing as compared to standardized wound care?

Design Research Strategy/Plan Your development plan should include:1. Your clinical question2. Criteria for the literature search

Key words Databases Dates to include (how far back do you go?)

3. Inclusion and exclusion criteria Types of studies design Types of participants Types of intervention Type of outcome measurements

4. A timeline for your project

Key Words

• Key Text words for the condition, e.g.,

• ‘Foot ulcer' , 'diabetic foot ulcer' , 'diabetic wound', 'diabetic complications'

• Key Text words for the intervention, e.g.,

• Low level Laser Therapy

• Low Power Laser

• Low Energy Laser

• Laser Bio-stimulation  Dates to include (how far back do you go?)

Time of the fist review (if possible) No systematic review before

( back for 10 years)

12

Data sources for a systematic review

• Electronic databases

• MEDLINE and EMBASE• Specialized or local databases (CINAHL, CENTRAL, AMED,…)

• Hand searching

• “Grey literature” ( thesis, Internal reports, pharmaceutical industry files)

• Checking reference lists

• Unpublished sources known to experts in the specialty (seek by personal communication)

• Raw data from published trials

Criteria

Stu

dy d

esi

gn

s • RCT• Case

control • Cohort

study

Part

icip

an

ts • sex

• Age • Condition

s

Inte

rventi

on

• Parameters

• Comparison to other intervention

• Placebo• Sham

Outc

om

es • Primary

• Secondary

Exercises:

As group carful read the following paper and selected the following

• Research questions

• Keywords

• Date of search

• Language of search

• Types of data base

• Criteria of search

Study TimelineProject Tasks Timeline

1. Project Development Plan

2. Perform Literature Search

3. Inclusion/exclusion of Articles

4. Table of Evidence/Data Extraction

5. Table of Evidence Review

6. First Draft of Review

7. Committee Review

8. External Review

Synthesis and Critical Appraisal

• Data Extraction (draw diagram )

• Create Tables of Evidence

• Methodological Quality

Data extraction flow chart

Create Tables of Evidence

Most common approaches to classification and grading of the evidence

• Sackett 's 5 levels of evidence

• Oxford Centre for Evidence-Based Medicine levels of evidence

Methodological Quality: Jadad Scale JADAD SCAL Criteria Score

1a. Was the study described as randomized? +1

1b. Was the method of randomization described and appropriate to conceal allocation?

+1

1c. If described and inappropriate, describe: -1

2a. Was the study described as double blinded? +1

2b. Was the method of double-blinding described andappropriate to maintain a double-blinding?

=1

2c. Was the method of blinding inappropriate? -1

3. Was there a description of withdrawals and drop outs?

+1

Total (0-5) 5

Methodological Quality: PEDroScale

Methodological Quality: Van Tulder

Systematic Review to User Product

Using the synthesis of evidence resulting from you review

What would you take as a next step for each of the following audiences

• CLINICIANS

• RESEARCHERS

• CONSUMERS