Systematic Review Introduction.

Adopted December 2004

Occupational therapists are constantly required to make informed and rational clinical and policy decisions. Regardless of professional role as health care provider, consumer, researcher or policy maker, the occupational therapist is exposed to enormous amounts of information of varying quality and relevance.

The purpose of a systematic literature review is to rigorously evaluate and interpret all available research evidence relevant to a particular clinical question. It enables therapists who are unable to undertake primary research to critically analyse the research literature and evaluate the relevance to their particular clinical setting. Skills developed in critical analysis of literature can be integrated into everyday work practices. The results of a well-conducted Systematic Review can be disseminated to colleagues through publication in journals and conference presentations.

The primary aim of a systematic review is to summarise and understand the evidence without imposing values or preferences when answering the questions and make practical decisions about health care. They can be conducted in an effort to resolve conflicting evidence, to answer questions where the answer is uncertain or to explain variations in practice.

The conduct of a systematic review requires a concerted effort to identify all relevant primary research, appraise the quality of the studies using a systematic approach and then the studies of acceptable quality are rigorously and sometimes quantitatively synthesised. A systematic review is different from a traditional literature review in that attempts are made to identify all related studies that are then assessed for quality before synthesis.

The major advantages of this approach are that data from a number of smaller studies asking the same question can be combined to improve statistical power, and secondly, similar effects across a wide variety of settings and designs provide evidence of robustness and transferability of the results to other settings. These attributes can help the therapist to make clinical decisions with increased confidence. A disadvantage of Systematic Reviews is that along with the detection of smaller effects, biases and flaws can also be magnified. Therefore a rigorous process is required to identify and account for such flaws in any conclusion and resulting decision-making.

For a systematic review to be objective it is important that the parameters and methods to be used are established before the review process begins. This is especially important since the studies to be incorporated have usually been complete and reported, that is the data is retrospective. Therefore it is important to make the process as well defined and as rigorous as possible. A rigorous approach needs to be balanced with a practical perspective. While every effort should be made to comply to a predetermined protocol it is recognised that this is not always possible or appropriate. However, changes should not be made to the protocol on the basis of how they affect the results of the review. As a rule, changes to the protocol should be documented and reported, and ‘sensitivity analyses’ on the impact of the decisions on the results of the review should be made in the report.

Prospective applicants for a Occupational Therapist Registration Board of Western Australia grant to undertake a Systematic Review should prepare a Protocol aimed at resolving a question that addresses a practical problem therapists face when deciding about aspects of occupational therapy practice.

Applicants should submit the application form/s and attach a systematic review protocol using the following headings:

References

Cochrane Reviewers’ Handbook 4.2.2 (2004). Accessible at
http://www.cochrane.org/resources/handbook/index.htm  The Cochrane Collaboration.

Glaziou, P., Irwig, L., Bain, C. & Colditz, G. 2001. Systematic reviews in health care: a practical guide. Edinburgh: Cambridge University Press.

National Health and Medical Research Council (1998) A guide to the development, implementation and evaluation of clinical practice guidelines. Accessible at http://www.nhmrc.gov.au/research/general/access.htm