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Systematic Reviews: First steps

What are the steps in a systematic review protocol

  1. Identify the team members- A systematic review requires at least 2 people as well as a nominated third person where there is disagreement  between the two.
  2. Check existing reviews/protocols – Decide whether to abort the review or amend the question.
  3. Formulate a specific question – Use a known framework (PICO for quantitative reviews) – Check alternative frameworks for a qualitative reviews.
  4. Inclusion criteria – Decide on the specific criteria (population, intervention or comparison, outcome, study design, language, publication).
  5. Exclusion criteria - Decide on the specific criteria for not including certain studies (specific populations, language, setting).
  6. Search strategy – Document an explicit and reproducible search strategy (include grey literature).
  7. Critical appraisal – Assess risk of bias in individual studies.
  8. Synthesis of results - Interpret/analyse results-determining the applicability of results.
  9. Report –Write a comprehensive report on all steps of the systematic review and presents results.

The PICO framework

A clear and  comprehensive search strategy is a critical step in planning a systematic review. Searching frameworks are commonly used to ensure the essential concepts related to the research question have been identified. PICO (Population, Intervention,Comparison,Outcome) is the most commonly used framework (see Other relevant  frameworks on this page for information on alternative frameworks). Additionally in some cases identifying the study design most relevant to the research question and using this in your search strategy can create a more efficient search reducing the number of irrelevant results.






  Population, Patient or Problem

Intervention, Interest or Exposure

Comparison, Context or Condition





  Controlled trials  >  Cross-sectional studies


  RCTs  >  Prospective cohort studies


  Cohort studies  > Case control > Case series


  RCT > Cohort > Case control > Case series


  RCT > Cohort studies >Case control > Case series




  Economic analysis



Other relevant frameworks

Some research disciplines prefer different frameworks to PICO particularly qualitative researchers. Examples of these alternative frameworks include SPICE: Setting, Perspective, Interest, Comparison, Evaluation and SPIDER: Sample, Phenomena of Interest, Design, Evaluation, Research Type.

S Setting S Sample
P Perspective PI Phenomenon of Interest
I Interest D Design
C Comparison E Evaluation
E Evaluation R Research Type

Writing up your review:Reportable items

PRISMA is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses. PRISMA focuses on the reporting reviews evaluating randomized trials, but can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions.The PRISMA web page holds a number of resources to support researchers conducting systematic reviews including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement.

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Finding systematic reviews and registering a protocol

Ensure that a recently completed or ongoing systematic review in your area has not already been registered by searching relevant databases on your topic area before commencing a systematic review. The most common databases for systematic reviews are listed below.

Cochrane Library (John Wiley & Sons, Ltd.)  The Campbell Collaboration
PubMed Clinical Queries (U.S. National Library of Medicine) Joanna Briggs Institute EBP (Ovid)
Bandolier: Evidence based thinking about health care OT Seeker
PEDro: Physiotherapy Evidence Database Prospero

Registering your own protocol

A protocol documents the key points of your systematic review. It  specifies the objectives, methods, and outcomes of primary interest of the systematic review. Registering a protocol promotes transparency of methods, allowing your peers to review how you will extract information to quantitatively summarize your outcome data promotes potential communication with interested researchers and reduces the risk of multiple reviews addressing the same question.


Systematic Review/Protocol registries

- PROSPERO – international prospective register of systematic reviews.

- Campbell Collaboration – produces systematic reviews of the effects of social interventions.

- Cochrane Collaboration – international organization, produces and disseminates systematic reviews of health care interventions.

- Open Science Framework (OSF) -  is a free, open source tool provided by the Center for Open Science. It can be used to share all or part of a project for example register a protocol for either a systematic or scoping review.

Source: National Institute of Health Systematic Reviews guide

Getting help


School Librarians are available to explain the processes related to systematic searching for systematic reviews. School Librarians are also able to supply training in regard to specific searching techniques relevant to systematic searching.

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