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Systematic Reviews - Research Guide
- Defining your review question
- Starting a Systematic Review
- Developing your search strategy
- Where to search
- Appraising Your Results
- Documenting Your Review
- Find Systematic Reviews
- Software and Tools for Systematic Reviews
- Guidance for conducting systematic reviews by discipline
- Library Support
Review question
A systematic review aims to answer a clear and focused clinical question. The question guides the rest of the systematic review process. This includes determining inclusion and exclusion criteria, developing the search strategy, collecting data and presenting findings. Therefore, developing a clear, focused and well-formulated question is critical to successfully undertaking a systematic review.
A good review question:
- allows you to find information quickly
- allows you to find relevant information (applicable to the patient) and valid (accurately measures stated objectives)
- provides a checklist for the main concepts to be included in your search strategy.
How to define your systematic review question and create your protocol
- Starting the process
- Defining the question
- Creating a protocol
Types of clinical questions
- PICO/PICo framework
- Other frameworks
Research topic vs review question
A research topic is the area of study you are researching, and the review question is the straightforward, focused question that your systematic review will attempt to answer.
Developing a suitable review question from a research topic can take some time. You should:
- perform some scoping searches
- use a framework such as PICO
- consider the FINER criteria; review questions should be F easible, I nteresting, N ovel, E thical and R elevant
- check for existing or prospective systematic reviews.
When considering the feasibility of a potential review question, there should be enough evidence to answer the question whilst ensuring that the quantity of information retrieved remains manageable. A scoping search will aid in defining the boundaries of the question and determining feasibility.
For more information on FINER criteria in systematic review questions, read Section 2.1 of the Cochrane Handbook .
Check for existing or prospective systematic reviews
Before finalising your review question, you should determine if any other systematic review is in progress or has been completed on your intended question (i.e. consider if the review is N ovel).
To find systematic reviews you might search specialist resources such as the Cochrane Library , Joanna Briggs Institute EBP Database or the Campbell Collaboration . "Systematic review" can also be used as a search term or limit when searching the recommended databases .
You should appraise any systematic reviews you find to assess their quality. An article may include ‘systematic review’ in its title without correctly following the systematic review methodology. Checklists, including those developed by AMSTAR and JBI , are useful tools for appraisal.
You may undertake a review on a similar question if that posed by a previously published review had issues with its methodology such as not having a comprehensive search strategy, for example. You may choose to narrow the parameters of a previously conducted search or to update the review if it was published some years ago.
Searching a register of prospective systematic reviews such as PROSPERO will allow you to check that you are not duplicating research already underway.
Once you have performed scoping searches and checked for other systematic reviews on your topic, you can focus and refine your review question. Any PICO elements identified during the initial development of the review question from the research topic should now be further refined.
The review question should always be:
- unambiguous
- structured.
| Work through the first section of the to define your review question |
Review questions may be broad or narrow in focus; however, you should consider the FINER criteria when determining the breadth of the PICO elements of your review question.
A question that is too broad may present difficulty with searching, data collection, analysis, and writing, as the number of studies retrieved would be unwieldy. A broad review question could be more suited to another type of review .
A question that is too narrow may not have enough evidence to allow you to answer your review question. Table 2.3.a in the Cochrane Handbook summarises the advantages and disadvantages of broad versus narrow reviews and provides examples of how you could broaden or narrow different PICO elements.
It is essential to formulate your research question with care to avoid missing relevant studies or collecting a potentially biased result set.
A systematic review protocol is a document that describes the rationale, question, and planned methods of a systematic review. Creating a protocol is an essential part of the systematic review process, ensuring careful planning and detailed documentation of what is planned before undertaking the review.
The Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) checklist outlines recommended items to address in a systematic review protocol, including:
- review question, with PICO elements defined
- eligibility criteria
- information sources (e.g. planned databases, trial registers, grey literature sources, etc.)
- draft search strategy.
| The has been designed to help you create your systematic review protocol |
Systematic reviews must have pre-specified criteria for including and excluding studies in the review. The Cochrane Handbook states that "predefined, unambiguous eligibility criteria are a fundamental prerequisite for a systematic review."
The first step in developing a protocol is determining the PICO elements of the review question and how the intervention produces the expected outcomes in the specified population. You should then specify the types of studies that will provide the evidence to answer your review question. Then outline the inclusion and exclusion criteria based on these PICO elements.
For more information on defining eligibility criteria, see Chapter 3 of the Cochrane Handbook .
A key purpose of a protocol is to make plans to minimise bias in the findings of the review; where possible, changes should not be made to the eligibility criteria of a published protocol. Where such changes are made, they must be justified and documented in the review. Appropriate time and consideration should be given to creating the protocol.
You may wish to register your protocol in a publicly accessible way. This will help prevent other people from completing a review on your topic.
If you intend to publish a systematic review in the health sciences, it should conform to the IOM Standards for Reporting Systematic Reviews .
If you intend to publish a systematic review in the Cochrane Database of Systematic Reviews , it should conform to the Methodological Expectations in Cochrane Intervention Review s (MECIR).
A clinical question needs to be directly relevant to the patient or problem and phrased to facilitate the search for an answer. A clear and focused question is more likely to lead to a credible and useful answer, whereas a poorly formulated question can lead to an uncertain answer and create confusion.
The population and intervention should be specific, but if any or both are described too narrowly, it may not be easy to find relevant studies or sufficient data to demonstrate a reliable answer.
| Question type | Explanation | Evidence types required to answer the question |
|---|---|---|
| Diagnosis | Questions about the ability of a test or procedure to differentiate between those with and without a disease or condition | Randomised controlled trial (RCT) or cohort study |
| Etiology (causation) | Questions about the harmful effect of an intervention or exposure on a patient | Cohort study |
| Meaning | Questions about patients' experiences and concerns | Qualitative study |
| Prevention | Questions about the effectiveness of an intervention or exposure in preventing morbidity and mortality. Questions are similar to treatment questions. When assessing preventive measures, it is essential to evaluate potential harms as well as benefits | Randomised controlled trial (RCT) or prospective study |
| Prognosis (forecast) | Questions about the probable cause of a patient's disease or the likelihood that they will develop an illness | Cohort study and/or case-control series |
| Therapy (treatment) | Questions about the effectiveness of interventions in improving outcomes in patients suffering from an illness, disease or condition. This is the most frequently asked type of clinical question. Treatments may include medications, surgical procedures, exercise and counselling about lifestyles changes | Randomised controlled trial (RCT) |
PICO is a framework for developing a focused clinical question.
Slightly different versions of this concept are used to search for quantitative and qualitative reviews, examples are given below:
PICO for quantitative studies
| What are the characteristics of the opulation or atient?
| How do you wish to ntervene? What do you want to do with this patient - treat, diagnose, observe, etc.? | What is the omparison or alternative to the intervention - placebo, different drug or therapy, surgery, etc.? | What are the possible utcomes - morbidity, death, complications, etc.? |
Here is an example of a clinical question that outlines the PICO components:
PICo for qualitative studies
| P | I | Co |
|---|---|---|
| What are the characteristics of the opulation or atient?
| nterest relates to a defined event, activity, experience or process | ntext is the setting or distinct characteristics |
Here is an example of a clinical question that outlines the PICo components:
Two other mnemonics may be used to frame questions for qualitative and quantitative studies - SPIDER and SPICE .
SPIDER for qualitative or quantitative studies
SPIDER can be used for both qualitative and quantitative studies:
| ample size may vary in quantitative and qualitative studies | henomena of nterest include behaviours, experiences and interventions | esign influences the strength of the study analysis and findings | valuation outcomes may include more subjective outcomes such as views, attitudes, etc. | esearch types include qualitative, quantitative, or mixed-method studies |
Within social sciences research, SPICE may be more appropriate for formulating research questions:
| etting is the context for the question - | erspective is the users, potential users or stakeholders of the service - | ntervention is the action taken for the users, potential users or stakeholders - | omparison is the alternative actions or outcomes - | valuation is the result or measurement that will determine the success of the intervention - or |
More question frameworks
For more question frameworks, see the following:
- Table 1 Types of reviews , from ' What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. '
- Framing your research question , CQ University
- Asking focused questions - Centre for Evidence Based Medicine Tips and examples for formulating focused questions
- Cochrane Handbook, Chapter 2: Determining the scope of the review and the questions it will address Discusses the formulation of review questions in detail
- PICO for Evidence-Based Veterinary Medicine EBVM Toolkit from the RCVS
- PICO worksheet
- PICo worksheet
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- Last Updated: Jul 4, 2024 1:14 PM
- URL: https://libguides.murdoch.edu.au/systematic
Systematic Reviews
- Introduction to Systematic Reviews
- Systematic review
- Systematic literature review
- Scoping review
- Rapid evidence assessment / review
- Evidence and gap mapping exercise
- Meta-analysis
- Systematic Reviews in Science and Engineering
- Timescales and processes
- Question frameworks (e.g PICO)
- Inclusion and exclusion criteria
- Using grey literature
- Search Strategy This link opens in a new window
- Subject heading searching (e.g MeSH)
- Database video & help guides This link opens in a new window
- Documenting your search and results
- Data management
- How the library can help
- Systematic reviews A to Z
Using a framework to structure your research question
Your systematic review or systematic literature review will be defined by your research question. A well formulated question will help:
- Frame your entire research process
- Determine the scope of your review
- Provide a focus for your searches
- Help you identify key concepts
- Guide the selection of your papers
There are different models you can use to structure help structure a question, which will help with searching.
Selecting a framework
- What if my topic doesn't fit a framework?
A model commonly used for clinical and healthcare related questions, often, although not exclusively, used for searching for quantitively designed studies.
Example question: Does handwashing reduce hospital acquired infections in elderly people?
| opulation | Any characteristic that define your patient or population group. | Elderly people | |
| ntervention | What do you want to do with the patient or population? | Handwashing | |
| omparison (if relevant) | What are the alternatives to the main intervention? | No handwashing | |
| utcome | Any specific outcomes or effects of your intervention. | Reduced infection |
Richardson, W.S., Wilson, M.C, Nishikawa, J. and Hayward, R.S.A. (1995) 'The well-built clinical question: a key to evidence-based decisions.' ACP Journal Club , 123(3) pp. A12
PEO is useful for qualitative research questions.
Example question: How does substance dependence addiction play a role in homelessness?
| Who are the users - patients, family, practitioners or community being affected? What are the symptoms, condition, health status, age, gender, ethnicity? What is the setting e.g. acute care, community, mental health? | homeless persons | |
| Exposure to a condition or illness, a risk factor (e.g. smoking), screening, rehabilitation, service etc. | drug and alcohol addiction services | |
| Experiences, attitudes, feelings, improvement in condition, mobility, responsiveness to treatment, care, quality of life or daily living. | reduced homelessness |
Moola S, Munn Z, Sears K, Sfetcu R, Currie M, Lisy K, Tufanaru C, Qureshi R, Mattis P & Mu P. (2015) 'Conducting systematic reviews of association (etiology): The Joanna Briggs Institute's approach'. International Journal of Evidence - Based Healthcare, 13(3), pp. 163-9. Available at: 10.1097/XEB.0000000000000064.
PCC is useful for both qualitative and quantitative (mixed methods) topics, and is commonly used in scoping reviews.
Example question: “What patient-led models of care are used to manage chronic disease in high income countries?"
| Population | "Important characteristics of participants, including age and other qualifying criteria. You may not need to include this element unless your question focuses on a specific condition or cohort." | N/A. As our example considers chronic diseases broadly, not a specific condition/population - such as women with chronic obstructive pulmonary disorder. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Concept |
Chronic disease Patient-led care models Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis, JBI, 2020. Available from https://synthesismanual.jbi.global . https://doi.org/10.46658/JBIMES-20-12 A model useful for qualitative and mixed method type research questions. Example question: What are young parents’ experiences of attending antenatal education? (Cooke et al., 2012)
Cooke, A., Smith, D. and Booth, A. (2012) 'Beyond PICO: the SPIDER tool for qualitative evidence synthesis.' Qualitative Health Research , 22(10) pp. 1435-1443 A model useful for qualitative and mixed method type research questions. Example question: How effective is mindfulness used as a cognitive therapy in a counseling service in improving the attitudes of patients diagnosed with cancer?
Example question taken from: Tate, KJ., Newbury-Birch, D., and McGeechan, GJ. (2018) ‘A systematic review of qualitative evidence of cancer patients’ attitudes to mindfulness.’ European Journal of Cancer Care , 27(2) pp. 1 – 10. A model useful for qualitative and mixed method type research questions, especially for question examining particular services or professions. Example question: Cross service communication in supporting adults with learning difficulties
You might find that your topic does not always fall into one of the models listed on this page. You can always modify a model to make it work for your topic, and either remove or incorporate additional elements. The important thing is to ensure that you have a high quality question that can be separated into its component parts.
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