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Background: The role of evidence-based medicine in sports medicine and orthopaedic surgery is rapidly growing. Systematic reviews and meta-analyses are also proliferating in the medical literature.

Purpose: To provide the outline necessary for a practitioner to properly understand and/or conduct a systematic review for publication in a sports medicine journal. Study Design: Review.

Methods: The steps of a successful systematic review include the following: identification of an unanswered answerable question; explicit definitions of the investigation’s participant(s), intervention(s), comparison(s), and outcome(s); utilization of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and PROSPERO registration; thorough systematic data extraction; and appropriate grading of the evidence and strength of the recommendations.

Results: An outline to understand and conduct a systematic review is provided, and the difference between meta-analyses and systematic reviews is described. The steps necessary to perform a systematic review are fully explained, including the study purpose, search methodology, data extraction, reporting of results, identification of bias, and reporting of the study’s main findings.

Conclusion: Systematic reviews or meta-analyses critically appraise and formally synthesize the best existing evidence to provide a statement of conclusion that answers specific clinical questions. Readers and reviewers, however, must recognize that the quality and strength of recommendations in a review are only as strong as the quality of studies that it analyzes. Thus, great care must be used in the interpretation of bias and extrapolation of the review’s findings to translation to clinical practice. Without advanced education on the topic, the reader may follow the steps discussed herein to perform a systematic review.

• The quality of the individual studies determines the quality of the systematic review
• Differences between a meta-analysis and systematic review
  • systematic review: a priori questions
  • meta-analysis: statistical methods ΓÇô> forest plot; “mathematical assimilation of studies”
  • QUORUM (Quality of Reporting of Meta-analyses) → PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)
  • EQUATOR (Enhancing the Quality and Transparency of Health Care Research)

1. Check registries to avoid duplication: e.g. PROSPERO
   • What does this review answer that previous ones did not?
2. Answer an answerable question - important, underreported
   • balance between too broad and too narrow - use PICOS criteria (Participants, intervention, comparisons, outcomes, study design)
   • may need to adjust criteria e.g. hip replacement outcomes

1. Critical evaluation of eligible studies for “best available evidence”
   • Level 1 studies of course great, but not always available or possible e.g. compartment syndrome
2. primary study outcomes determined a priori

1. Search methodology and documenting it in a PRISMA flowchart
   • Besides MEDLINE/PubMed; EMbase, PEDro, Cochrane, CENTRAL, SciVerse SCopus, CINAHL, SPORTDIscus, Google Scholar
2. Review lists
3. Extract data from studies using checklists: CEBM, Cochrane collaboration ΓÇô> Excel

1. Data analysis:
   • beware heterogeneity
   • “eyeball test”; Cochrane Q test, index test or T2 test.
2. Grade evidence and strength of recomendations (SORT - Strength of Recommendation Taxonomy, GRADE: Grading of Recommendations Assessment, Development and Evaluation)
3. AMSTAR (to grade systematic reviews); MECIR (Methodological Expectations of Cochrane Intervention Reviews)
4. Summarize the take home message well

1. 2020 PRISMA statement described in BMJ
2. EQUATOR provides a lot of resources for research including a checklist for case reportsCARE

Harris, J. D., Quatman, C. E., Manring, M. M., Siston, R. A., & Flanigan, D. C. (2014). How to Write a Systematic Review. The American Journal of Sports Medicine, 42(11), 2761ΓÇô2768. https://doi.org/10.1177/0363546513497567

• Author: Alphonsus Chong
• Created: 2021-07-20 Tue 20:51

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