Steps in the undertaking of a systematic review in orthopaedic surgery

Abstract

In the last decades of the twentieth century it became obvious that modern medical care is replete with data and information, but in need of reliable evidence. This has led to an increased effort to systematically synthesise medical research and make it more useful for practitioners. Systematic reviews use an approach to research synthesis that minimises the risk of misinterpreting a body of evidence due to incomprehensive search or subjective opinion. Carrying out a systematic review is a rigorous procedure which corresponds to standard methodological steps in primary research studies. It involves posing a well-defined question, developing a robust search strategy, screening for relevant primary studies, critical appraisal of included studies, data extraction and processing, analysis and interpretation of results. In some, but not all systematic reviews it is appropriate to conduct a meta-analysis, which is a statistical procedure that integrates the results of several independent studies. Results of meta-analysis are graphically presented in forest plots, with pooled point estimate and its confidence interval represented as a rhombus, usually called a "diamond". Methodological quality of systematic reviews should not be judged by the quality of primary studies included, but by a distinct set of criteria specified in assessment tools such as AMSTAR. Systematic reviews and meta-analyses should be reported according to the PRISMA checklist. A major contribution to the development of methodological standards has been given by The Cochrane Collaboration, whose Handbook of Systematic Reviews of Interventions is the primary reference for all authors and referees of systematic reviews in health care.

Current paediatric orthopaedic practice in hereditary multiple osteochondromas of the forearm: a systematic review

“…Narrative/traditional reviews are usually biased and subjective in contrast to systematic reviews which are often unbiased and objective [ 52 ]. The reliability and accuracy of systematic review recommendations should not be determined by methodologic quality of the primary studies included, but rather by the degree of methodological integrity implemented by researchers [ 52 ]. In this systematic review we formulated focused research questions that require specific answers.…”

Sustavni pregled – podloga medicini utemeljenoj na znanstvenim spoznajama

“…levels of evidence), odnosno hijerarhija snage dostupnih dokaza vezuju se uz vrstu kliničke studije, odnosno istraživanja. Randomizirana kontrolirana klinička istraživanja smatraju se izvorom najveće dokazne snage u hijerarhiji dokaza koji se upotrebljavaju u prosudbi djelotvornosti neke intervencije ili terapijske metode 5 . Ta hijerarhija dokaza najprije je opisana u izvješću Canadian Task Force on the Periodic Health Examination iz 1979. godine 6 .…”

Setting standards for medical writing in orthopaedics

“…Review papers are usually the most heavily cited manuscripts, but they are difficult to publish. Helpful steps for writing a systematic review are described by Sambujak et al [5]. Case reports are challenging to publish, as they are rarely quoted in subsequent papers, and the space attributed to them in journals is limited.…”