1. Developing Research Proposal Systematic Review Mohammed TA, Omar Ph.D. PT Rehabilitation Health Science

2. What is a systematic Review ? A systematic review is defined as “a review of the evidence on a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant primary research, and to extract and synthesis, analyze data from the studies that are included in the review.”

3. Why ? The problems are that … Too much information, too little time Many too poorly done or insufficiently relevant to be clinically useful Many have conflicting results On top of these, high quality information is often not easy to find 3

4. Why do systematic reviews? Support Evidence Based Practice Research Inform clinical policy Publication Personal professional development

5. Systematic reviews are the same as narrative reviews

6. Types of Systematic Review Intervention To assess the evidence about the effects of a healthcare intervention. Prognostics To assess the evidence about the effects of a healthcare intervention Measurement To assess the properties of health-status instruments or tools

7. Stages of Systematic Review Formulate research / policy conclusions Search bibliographic databases Identify possible papers from titles/abstracts Retrieve papers Extract data Further selection of primary studies using inclusion criteria Synthesis Formulate research question Design search strategy/plan Quality appraisal

8. Formulate Research Question PICO What types of P articipants? What types of I nterventions? What types of C omparison? What types of O utcomes? The first and most important decision in preparing a review is to determine its focus This is best done by asking clearly framed questions.

9. Formulation of a intervention question Does low level laser therapy effective in treatment of diabetic foot ulcer? In patients with Chronic Diabetic Foot Ulcer (DFU), does low level laser therapy lead to higher rates of healing as compared to standardized wound care?

10. Design Research Strategy/Plan Your development plan should include: 1.Your clinical question 2.Criteria for the literature search Key words Databases Dates to include (how far back do you go?) 3.Inclusion and exclusion criteria Types of studies design Types of participants Types of intervention Type of outcome measurements 4. A timeline for your project

11. Key Words Key Text words for the condition, e.g., ‘Foot ulcer', 'diabetic foot ulcer', 'diabetic wound', 'diabetic complications' Key Text words for the intervention, e.g., Low level Laser Therapy Low Power Laser Low Energy Laser Laser Bio-stimulation Dates to include (how far back do you go?)  Time of the fist review (if possible)  No systematic review before ( back for 10 years)

12. Data sources for a systematic review Electronic databases MEDLINE and EMBASE Specialized or local databases (CINAHL, CENTRAL, AMED,…) Hand searching “Grey literature” ( thesis, Internal reports, pharmaceutical industry files) Checking reference lists Unpublished sources known to experts in the specialty (seek by personal communication) Raw data from published trials 12

13. Criteria Study designs RCT Case control Cohort study Participants sex Age Conditions Intervention Parameters Comparison to other intervention Placebo Sham Outcomes Primary Secondary

14. Exercises: As group carful read the following paper and selected the following Research questions Keywords Date of search Language of search Types of data base Criteria of search

15. Study Timeline Project TasksTimeline 1.Project Development Plan 2. Perform Literature Search 3.Inclusion/exclusion of Articles 4.Table of Evidence/Data Extraction 5.Table of Evidence Review 6.First Draft of Review 7.Committee Review 8.External Review

16. Synthesis and Critical Appraisal Data Extraction (draw diagram ) Create Tables of Evidence Methodological Quality

17. Data extraction flow chart

18. Create Tables of Evidence Most common approaches to classification and grading of the evidence Sackett 's 5 levels of evidence Oxford Centre for Evidence-Based Medicine levels of evidence

19. Methodological Quality: Jadad Scale JADAD SCAL Criteria Score 1a. Was the study described as randomized? +1 1b. Was the method of randomization described and appropriate to conceal allocation? +1 1c. If described and inappropriate, describe: 2a. Was the study described as double blinded? +1 2b. Was the method of double-blinding described and appropriate to maintain a double-blinding? =1 2c. Was the method of blinding inappropriate? 3. Was there a description of withdrawals and drop outs? +1 Total (0-5) 5

20. Methodological Quality: PEDroScale

21. Methodological Quality: Van Tulder

22. Systematic Review to User Product Using the synthesis of evidence resulting from you review What would you take as a next step for each of the following audiences CLINICIANS RESEARCHERS CONSUMERS