CONCEPTS OF

SYSTEMATIC REVIEW

DR SHARMISTA KARUNAKARAN
POST GRADUATE
09/16/2025 1
DEPARTMENT OF ORAL MEDICINE & RADIOLOGY
CONTENTS
INTRODUCTION

LITERATURE REVIEW

TYPES OF REVIEW

SYSTEMATIC REVIEW

STEPS INVOLVED

ADVANTAGES

CONCLUSION

REFERENCES
09/16/2025 2
INTRODUCTION
•A clinical research requires a systematic approach with diligent
planning, execution and sampling in order to obtain reliable and
validated results, as well as an understanding of each research
methodology is essential for researchers.

• Indeed, selecting an inappropriate study type, an error that cannot be

corrected after the beginning of a study, results in flawed methodology.

Sykora P, Marks R, Falsini B, Capodicasa N, Miertus S, Lorusso L, Dondossola D, Tartaglia G, Ergoren M, Dundar M, Michelini
09/16/2025 S. Methodology for clinical research. Journal of preventive medicine and hygiene. 2022 Jun 1;63(2 Suppl 3). 3
LITERATURE REVIEW
identifying what has been written on a subject or topic

determining the extent to which a specific research area

reveals any interpretable trends or patterns

aggregating empirical findings related to a narrow

research question to support evidence-based practice

generating new frameworks and theories

identifying topics or questions requiring more investigation

Paré G., Trudel M.-C., Jaana M., Kitsiou S. Synthesizing information systems knowledge: A typology of literature
09/16/2025reviews. Information & Management. 2015;52(2):183–199. 4
TYPES OF REVIEW

Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health information &
09/16/2025 libraries journal. 2009 Jun;26(2):91-108. 5
HIERARCHY OF
EVIDENCE

09/16/2025 6
SYSTEMATIC REVIEW

A rigorously performed SR identifies all empirical evidence that meets pre-specified eligibility
criteria to answer a specific clinical question using explicit, systematic methods to minimize bias
and provides reliable findings to inform evidence-based clinical care.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic
reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol
09/16/2025 2009;62:e1-34. 7
WHY SYSTEMATIC REVIEW?
CATEGORY UNDERLYING REASONS
SR as a type of synthetic research 1) to summarize and integrate original knowledge
2) to address a clearly formulated question
SR as the more informed and less biased review 3) to increase the external validity of findings
4) to increase the explanatory power of findings
5) to increase the precision of estimated values
6) to increase the statistical power to detect true
associations
7) to increase the internal validity or accuracy of findings
8) to increase the reliability of findings
SR as a scientific efficient method 9) to implement the current best evidence less costly
10) to implement the current best evidence more rapidly

Moosapour H, Saeidifard F, Aalaa M, Soltani A, Larijani B. The rationale behind systematic reviews in clinical medicine: a conceptual
09/16/2025 framework. Journal of Diabetes & Metabolic Disorders. 2021 Jun;20:919-29. 8
DIFFERENCE BETWEEN NR & SR

09/16/2025 9
STEPS IN SYSTEMATIC REVIEW
Formulating a Framing the
Protocol &
research eligibility
Registration
question criteria

Conducting the Study selection

Assessing the
Literature and Data
study quality
search Extraction

Data Analysis Manuscript

& Result writing &
interpretation Publication
09/16/2025 10
1. FORMULATING A RESEARCH QUESTION
• “The most successful research topics are
narrowly focused and carefully defined but
are important parts of a broad-ranging,
complex problem.”

A good Details the problem statement

RQ is an
asset as Further describes and refines the issue
it under study
Adds focus to the problem statement

Guides data collection and analysis

Sets context of research

09/16/2025 11
CONTINUE…

09/16/2025 12
 EXAMPLE

09/16/2025 13
CONTINUE…

SPIDER CRITERIA

FINER CRITERIA

09/16/2025 14
2. PROTOCOL & REGISTRATION
A protocol is a description of the proposed OPEN
systematic review, including methods, the SCIENCE
FRAMEWORK
rationale for the review, and steps which will
JOANNA
be taken to eliminate bias while conducting the INPLASY BRIGGS
review. INSTITUTE

PROSPERO Platforms protocols.io

The Declaration of Helsinki states that “[e]very research study involving human subjects must be registered in a publicly
accessible database before recruitment of the first subject”

09/16/2025 Pieper D, Rombey T. Where to prospectively register a systematic review. Systematic Reviews. 2022 Jan 8;11(1):8. 15
 PROSPERO REGISTRATION

09/16/2025 16
 PRISMA GUIDELINES

09/16/2025 17
09/16/2025 18
3. FRAMING THE ELIGIBILITY CRITERIA

09/16/2025 19
4. CONDUCTING THE LITERATURE SEARCH
• Formulating search strategies for each 1. PubMed

database is crucial due to their distinct 2. EMBASE

3. Cochrane
requirements.
4. Google Scholar
• In line with AMSTAR (A Measurement Tool 5. Web of Science
to Assess Systematic Reviews) guidelines, a 6. Science Direct

minimum of two databases should be 7. PsychINFO

8. ICTRP
explored in systematic reviews/meta-
9. Clinical Trials
analyses (SR/MA), but increasing this
10. LILACS
number improves the accuracy of the results.

Martinez EC, Valdés JR, Castillo JL, Castillo JV, Montecino RM, Jimenez JE, Escamilla DA, Diarte E. Ten steps to conduct a
09/16/2025 systematic review. Cureus. 2023 Dec;15(12). 20
09/16/2025 21
CONTINUE…
• Gray literature is defined as: “that which is produced on all
levels of government, academics, business and industry in
print and electronic formats, but which is not controlled by
commercial publishers.”

• 26% to 41% of the evidence found in some systematic

reviews is found in gray literature, with 33.6% of the findings
of one gray search consisting of randomized controlled trials.
Identify
Document Collect Adhere
and Record
09/16/2025 22
5. STUDY SELECTION & DATA EXTRACTION
TOOLS FOR SCREENING
1. Covidence
2. Rayyan
3. EPPI – Reviewer
4. CADIMA
5. DistillerSR

09/16/2025 23
09/16/2025 24
6. ASSESSING THE QUALITY
• Bias is a systematic error (or deviation from the truth) in results or
TOOLS TO ASSESS RISK OF BIAS
inferences. Biases can change the results of any study and lead to an
1. Cochrane RoB2 Tool
underestimation or overestimation of the true intervention effect.
2. AHQR
Selection Bias 3. AMSTAR 2
4. Newcastle-Ottawa Quality
Performance Bias
Assessment Scale case-control
Attrition Bias studies
5. GRADE
Detection Bias 6. ROBINS

Reporting Bias
09/16/2025 25
 SOURCE OF BIAS

09/16/2025 26
09/16/2025 27
09/16/2025 28
09/16/2025 29
7. DATA ANALYSIS & RESULT INTERPRETATION

• The final part of the systematic review is to combine the results to • Summarize findings

answer the research question. • Discuss limitations

• The final combination of results will be dependent on the nature • Contextualize results

of the question and the quality and homogeneity of the research. • Implications for practice and research

09/16/2025 30
8. MANUSCRIPT WRITING & PUBLICATION

09/16/2025 31
09/16/2025 32
ADVANTAGES OF SYSTEMATIC REVIEW
Provides focused answer

Avoids reporting bias

Addresses selection bias

Reproducible by anyone using similar methods

Transparent reporting of study quality, and confidence of the evidence (e.g., very low, low,
moderate, high) to inform clinical decision‑making
Combines evidence and provides precision associated with treatment effects

Minimises selection bias, enhances quality of review and reports overall evidence

Sriganesh K, Shanthanna H, Busse JW. A brief overview of systematic reviews and meta-analyses. Indian Journal of Anaesthesia.
09/16/2025 2016 Sep 1;60(9):689-94. 33
CONCLUSION

09/16/2025 34
REFERENCES
1. Sykora P, Marks R, Falsini B, Capodicasa N, Miertus S, Lorusso L, Dondossola D, Tartaglia G, Ergoren M,
Dundar M, Michelini S. Methodology for clinical research. Journal of preventive medicine and hygiene. 2022
Jun 1;63(2 Suppl 3).
2. Paré G., Trudel M.-C., Jaana M., Kitsiou S. Synthesizing information systems knowledge: A typology of
literature reviews. Information & Management. 2015;52(2):183–199.
3. Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies.
Health information & libraries journal. 2009 Jun;26(2):91-108.
4. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for
reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation
and elaboration. J Clin Epidemiol 2009;62:e1-34.
5. Moosapour H, Saeidifard F, Aalaa M, Soltani A, Larijani B. The rationale behind systematic reviews in
clinical medicine: a conceptual framework. Journal of Diabetes & Metabolic Disorders. 2021 Jun;20:919-29.
6. Pieper D, Rombey T. Where to prospectively register a systematic review. Systematic Reviews. 2022 Jan
8;11(1):8
09/16/2025 35
CONTINUE…
7. Ratan SK, Anand T, Ratan J. Formulation of research question–Stepwise approach. Journal of
Indian Association of Pediatric Surgeons. 2019 Jan 1;24(1):15-20.
8. Schmidt L, Mutlu AN, Elmore R, Olorisade BK, Thomas J, Higgins JP. Data extraction methods for
systematic review (semi) automation: Update of a living systematic review. F1000Research.
2021;10.
9. Hartling L, Hamm M, Milne A, et al. Validity and Inter-Rater Reliability Testing of Quality
Assessment Instruments [Internet]. Rockville (MD): Agency for Healthcare Research and Quality
(US); 2012 Mar. Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92281/

09/16/2025 36
09/16/2025 37