Tip: Look for these icons for guidance on which technique is required
Systematic Review
Integrative Review
Rapid Review
Scoping Review
Traditional Literature Review
The first stage in a review is formulating the research question. The research question accurately and succinctly sums up the review's line of inquiry. This page outlines approaches to developing a research question that can be used as the basis for a review.
It can be useful to use a framework to aid in the development of a research question. Frameworks can help you identify searchable parts of a question and focus your search on relevant results
A technique often used in research for formulating a clinical research question is the PICO model. Slightly different versions of this concept are used to search for quantitative and qualitative reviews.
The PICO/ PECO framework is an adaptable approach to help you focus your research question and guide you in developing search terms. The framework prompts you to consider your question in terms of these four elements:
P: Patient/ Population/ Problem
I/E: Intervention/ Indicator/ Exposure/ Event
C: Comparison/ Control
O: Outcome
For more detail, there are also the PICOT and PICOS additions:
PICOT - adds Time
PICOS - adds Study design
Consider this scenario:
Current guidelines indicate that nicotine replacement therapies (NRTs) should not be used as an intervention in young smokers. Counselling is generally the recommended best practice for young smokers, however youth who are at high risk for smoking often live in regional or remote communities with limited access to counselling services. You have been funded to review the evidence for the effectiveness of NRTs for smoking cessation in Australian youths to update the guidelines.
The research question stemming from this scenario could be phrased in this way:
In (P) adolescent smokers, how does (I) nicotine replacement therapy compared with (C) counselling affect (O) smoking cessation rates?
PICO element | Definition | Scenario |
---|---|---|
P (patient/population/problem) | Describe your patient, population, or problem | adolescent smokers |
I (intervention/indicator | Describe your intervention or indicator | Nicotine Replacement Therapy (NRT) |
C (comparison/control) | What is your comparison or control? | counselling |
O (outcome) | What outcome are you looking for? | smoking cessation / risk of continued nicotine dependency |
PICO is one of the most frequently used frameworks, but there are several other frameworks available to use, depending on your question.
Try PIC or SPIDER:
Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qualitative health research, 22(10), 1435-1443.
Try PEO:
Moola, Sandeep; Munn, Zachary; Sears, Kim; Sfetcu, Ralucac; Currie, Marian; Lisy, Karolina; Tufanaru, Catalin; Qureshi, Rubab; Mattis, Patrick; Mu, Peifanf. Conducting systematic reviews of association (etiology), International Journal of Evidence-Based Healthcare: September 2015 - Volume 13 - Issue 3 - p 163-169.
Try SPICE:
Booth, A. (2006), "Clear and present questions: formulating questions for evidence based practice", Library Hi Tech, Vol. 24 No. 3, pp. 355-368. https://doi-org.ezproxy-b.deakin.edu.au/10.1108/07378830610692127
Try ECLIPSE:
Wildridge, V., & Bell, L. (2002). How CLIP became ECLIPSE: a mnemonic to assist in searching for health policy/management information. Health Information & Libraries Journal, 19(2), 113-115.
Try CoCoPop:
Munn, Z., Moola, S., Lisy, K., Riitano, D., & Tufanaru, C. (2015). Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. International journal of evidence-based healthcare, 13(3), 147-153.
Try PFO:
Try PICOC:
Petticrew, M., & Roberts, H. (2006). Systematic reviews in the social sciences: a practical guide. Blackwell Pub.
JBI recommends the PCC (Population (or Participants), Concept, and Context) search framework to develop the research question of a scoping review. In some instances, just the concept and context are used in the search.
The University of Notre Dame Australia provides information on some different frameworks available to help structure the research question.
Booth A, Noyes J, Flemming K, et al, Formulating questions to explore complex interventions within qualitative evidence synthesis. BMJ Global Health 2019;4:e001107.
This paper explores the importance of focused, relevant questions in qualitative evidence syntheses to address complexity and context in interventions.
Kim, K. W., Lee, J., Choi, S. H., Huh, J., & Park, S. H. (2015). Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: a practical review for clinical researchers-part I. General guidance and tips. Korean journal of radiology, 16(6), 1175-1187.
As the use of systematic reviews and meta-analyses is increasing in the field of diagnostic test accuracy (DTA), this first of a two-part article provides a practical guide on how to conduct, report, and critically appraise studies of DTA.
Methley, A. M., Campbell, S., Chew-Graham, C., McNally, R., & Cheraghi-Sohi, S. (2014). PICO, PICOS and SPIDER: A comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Services Research, 14(1), 579.
In this article the ‘SPIDER’ search framework, developed for more effective searching of qualitative research, was evaluated against PICO and PICOD.
Munn, Z., Stern, C., Aromataris, E., Lockwood, C., & Jordan, Z. (2018). What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. BMC medical research methodology, 18(1), 5. https://doi.org/10.1186/s12874-017-0468-4
This article aligns review types to question development frameworks.
Before you start searching, find out whether any systematic reviews have been conducted recently on your topic. This is because similar systematic reviews could help with identifying your search terms, and information on your topic. It is also helpful to know if there is already a systematic review on your topic as it may mean you need to change your question.
Cochrane Library and Joanna Briggs Institute publish systematic reviews. You can also search for the term "systematic review" in any of the subject databases. You can also search PROSPERO, an international register of systematic reviews, to see if there are any related reviews underway but not yet published; there are additional review registers detailed below.
Watch this video to find out how to search for published systematic reviews
It is recommended that authors consult relevant guidelines and create a protocol for their review.
Protocols provide a clear plan for how the review will be conducted, including what will and will not be included in the final review. Protocols are widely recommended for any systematic review and are increasingly a requirement for publication of a completed systematic review.
Guidelines provide specific information on how to perform a review in your field of study. A completed review may be evaluated against the relevant guidelines by peer reviewers or readers, so it makes sense to follow the guidelines as best you can.
Click the headings below to learn more about the importance of protocols and guidelines.
Your protocol (or plan for conducting your review) should include the rationale, objectives, hypothesis, and planned methods used in searching, screening and analysing identified studies used in the review. The rationale should clearly state what will be included and excluded from the review. The aim is to minimise any bias by having pre-defined eligibility criteria.
Base the protocol on the relevant guidelines for the review that you are conducting. PRISMA-P was developed for reporting and development of protocols for systematic reviews. Their Explanation and Elaboration paper includes examples of what to write in your protocol. York's CRD has also created a document on how to submit a protocol to PROSPERO.
There are several registers of protocols, often associated with the organisation publishing the review. Cochrane and Joanna Briggs Institute both have their own protocol registries, and PROSPERO is a wide-reaching registry covering protocols for Cochrane, non-Cochrane and non-JBI reviews on a range of health, social care, education, justice, and international development topics.
Before beginning your protocol, search within protocol registries such as those listed above, or Open Science Framework or Research Registry, or journals such as Systematic Reviews and BMJ Open. This is a useful step to see if a protocol has already been submitted on your review topic and to find examples of protocols in similar areas of research.
While a protocol will contain details of the intended search strategy, a protocol should be registered before the search strategy is finalised and run, so that you can show that your intention for the review has remained true and to limit duplication of in progress reviews.
A protocol should typically address points that define the kind of studies to be included and the kind of data required to ensure the systematic review is focused on the appropriate studies for the topic. Some points to think about are:
PLoS Medicine Editors. (2011). Best practice in systematic reviews: the importance of protocols and registration. PLoS medicine, 8(2), e1001009.
The Cochrane handbook of systematic reviews of interventions is a world-renowned resource for information on designing systematic reviews of intervention.
Many other guidelines have been developed from these extensive guidelines.
General systematic reviews
Meta-analyses
Surgical systematic reviews
Nursing/Allied Health systematic reviews
Joanna Briggs Institute Manual for Evidence Synthesis a comprehensive guide to conducting JBI systematic and similar reviews
Nutrition systematic reviews
Occupational therapy
Education/Law/ Sociology systematic reviews
Other
Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy
COSMIN Guideline for Systematic Reviews of Outcome Measurement Instruments – This was developed for patient reported outcomes (PROMs) but has since been adapted for use with other types of outcome measurements in systematic reviews.
Prinsen, C.A.C., Mokkink, L.B., Bouter, L.M. et al. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res 27, 1147–1157 (2018). https://doi.org/10.1007/s11136-018-1798-3
HuGENet™ Handbook of systematic reviews – particularly useful for describing population-based data and human genetic variants.
AHRQ: Methods Guide for Effectiveness and Comparative Effectiveness Reviews - from the US Department of Health and Human Services, guidelines on conducting systematic reviews of existing research on the effectiveness, comparative effectiveness, and harms of different health care interventions.
Mariano, D. C., Leite, C., Santos, L. H., Rocha, R. E., & de Melo-Minardi, R. C. (2017). A guide to performing systematic literature reviews in bioinformatics. arXiv preprint arXiv:1707.05813.
Integrative reviews may incorporate experimental and non-experimental data, as well as theoretical information. They differ from systematic reviews in the diversity of the study methodologies included.
Guidelines:
Rapid reviews differ from systematic reviews in the shorter timeframe taken and reduced comprehensiveness of the search.
Cochrane has a methods group to inform the conduct of rapid reviews with a bibliography of relevant publications.
A modified approach to systematic review guidelines can be used for rapid reviews, but guidelines are beginning to appear:
Crawford C, Boyd C, Jain S, Khorsan R and Jonas W (2015), Rapid Evidence Assessment of the Literature (REAL©): streamlining the systematic review process and creating utility for evidence-based health care. BMC Res Notes 8:631 DOI 10.1186/s13104-015-1604-z
Philip Moons, Eva Goossens, David R. Thompson, Rapid reviews: the pros and cons of an accelerated review process, European Journal of Cardiovascular Nursing, Volume 20, Issue 5, June 2021, Pages 515–519, https://doi.org/10.1093/eurjcn/zvab041
Rapid Review Guidebook: Steps for conducting a rapid review National Collaborating Centre for Methods and Tools (McMaster University and Public Health Agency Canada) 2017
Tricco AC, Langlois EV, Straus SE, editors (2017) Rapid reviews to strengthen health policy and systems: a practical guide (World Health Organization). This guide is particularly aimed towards developing rapid reviews to inform health policy.
Scoping reviews can be used to map an area, or to determine the need for a subsequent systematic review. Scoping reviews tend to have a broader focus than many other types of reviews, however, still require a focused question.
Guidelines:
Scoping reviews: what they are and how you can do them - Series of Cochrane Training videos presented by Dr. Andrea C. Tricco and Kafayat Oboirien
Martin, G. P., Jenkins, D. A., Bull, L., Sisk, R., Lin, L., Hulme, W., ... & Group, P. H. A. (2020). Toward a framework for the design, implementation, and reporting of methodology scoping reviews. Journal of Clinical Epidemiology, 127, 191-197.
Khalil, H., McInerney, P., Pollock, D., Alexander, L., Munn, Z., Tricco, A. C., ... & Peters, M. D. (2021). Practical guide to undertaking scoping reviews for pharmacy clinicians, researchers and policymakers. Journal of clinical pharmacy and therapeutics.
Colquhoun, H (2016) Current best practices for the conduct of scoping reviews (presentation)
Arksey H & O'Malley L (2005) Scoping studies: towards a methodological framework, International Journal of Social Research Methodology, 8:1, 19-32, DOI: 10.1080/1364557032000119616
Noyes, J., Booth, A., Cargo, M., Flemming, K., Garside, R., Hannes, K., ... & Thomas, J. (2018). Cochrane Qualitative and Implementation Methods Group guidance series—paper 1: introduction. Journal of clinical epidemiology, 97, 35-38.
Harris, J. L., Booth, A., Cargo, M., Hannes, K., Harden, A., Flemming, K., ... & Noyes, J. (2018). Cochrane Qualitative and Implementation Methods Group guidance series—paper 2: methods for question formulation, searching, and protocol development for qualitative evidence synthesis. Journal of clinical epidemiology, 97, 39-48.
Noyes, J., Booth, A., Flemming, K., Garside, R., Harden, A., Lewin, S., ... & Thomas, J. (2018). Cochrane Qualitative and Implementation Methods Group guidance series—paper 3: methods for assessing methodological limitations, data extraction and synthesis, and confidence in synthesized qualitative findings. Journal of clinical epidemiology, 97, 49-58.
Cargo, M., Harris, J., Pantoja, T., Booth, A., Harden, A., Hannes, K., ... & Noyes, J. (2018). Cochrane Qualitative and Implementation Methods Group guidance series—paper 4: methods for assessing evidence on intervention implementation. Journal of clinical epidemiology, 97, 59-69.
Harden, A., Thomas, J., Cargo, M., Harris, J., Pantoja, T., Flemming, K., ... & Noyes, J. (2018). Cochrane Qualitative and Implementation Methods Group guidance series—paper 5: methods for integrating qualitative and implementation evidence within intervention effectiveness reviews. Journal of clinical epidemiology, 97, 70-78.
Flemming, K., Booth, A., Hannes, K., Cargo, M., & Noyes, J. (2018). Cochrane Qualitative and Implementation Methods Group guidance series—Paper 6: Reporting guidelines for qualitative, implementation, and process evaluation evidence syntheses. Journal of Clinical Epidemiology, 97, 79-85.
Walsh, D. and Downe, S. (2005), Meta-synthesis method for qualitative research: a literature review. Journal of Advanced Nursing, 50: 204–211. doi:10.1111/j.1365-2648.2005.03380.x
The RAMESES Projects - Includes information on publication, quality, and reporting standards, as well as training materials for realist reviews, meta-narrative reviews, and realist evaluation.
Rycroft-Malone, J., McCormack, B., Hutchinson, A. M., DeCorby, K., Bucknall, T. K., Kent, B., ... & Wilson, V. (2012). Realist synthesis: illustrating the method for implementation research. Implementation Science, 7(1), 1-10.
Wong, G., Westhorp, G., Manzano, A. et al. RAMESES II reporting standards for realist evaluations. BMC Med 14, 96 (2016). https://doi.org/10.1186/s12916-016-0643-1
Wong, G., Greenhalgh, T., Westhorp, G., Buckingham, J., & Pawson, R. (2013). RAMESES publication standards: realist syntheses. BMC medicine, 11, 21. https://doi.org/10.1186/1741-7015-11-21
Wong, G., Greenhalgh, T., Westhorp, G., Buckingham, J., & Pawson, R. (2013). RAMESES publication standards: realist syntheses. BMC medicine, 11(1), 1-14. https://doi.org/10.1186/1741-7015-11-21
Social sciences
Uttley, L., Montgomery, P. The influence of the team in conducting a systematic review. Syst Rev 6, 149 (2017). https://doi.org/10.1186/s13643-017-0548-x