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What is a systematic review?

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Terry Hanley at The University of Manchester
Terry Hanley
Laura Anne Winter at The University of Manchester
Laura Anne Winter
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Abstract

Content & Focus: This Special Edition of Counselling Psychology Review is focused on systematic reviews. Whilst considering the topic for the editorial to begin this Special Edition, we considered one overarching question to be of fundamental importance to attempt to tackle: What is a systematic review? We decided to have this as the focus of the editorial in part as a result of discussions with colleagues (both trainee and qualified psychologists) whose awareness of the answers to the following questions proved limited: What is a systematic review?; Why are they conducted?; and What does one look like? Following a brief introduction focused on the history and context surrounding the systematic review, we have, therefore, aimed to address each of these questions in turn. To end this initial section of the editorial, we provide readers with a check list of possible sections contained within a systematic review. The aim of this is to hopefully elaborate on the definitions and the discussions already considered, in order to help the reader more clearly understand what a systematic review really is. Following this we provide an overview of the seven papers incorporated into this Special Edition. Five of these provide very practical examples of the factors noted below in action while two provide further methodological reflections around the use of such research designs.
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Editorial
What is a systematic review?
Terry Hanley & Laura Cutts
Counselling Psychology Review, Vol. 28, No. 4, December 2013 3
© The British Psychological Society – ISSN 0269-6975
Content & Focus: This Special Edition of Counselling Psychology Review is focused on systematic reviews.
Whilst considering the topic for the editorial to begin this Special Edition, we considered one overarching
question to be of fundamental importance to attempt to tackle: What is a systematic review? We decided to
have this as the focus of the editorial in part as a result of discussions with colleagues (both trainee and
qualified psychologists) whose awareness of the answers to the following questions proved limited: What is a
systematic review?; Why are they conducted?; and What does one look like? Following a brief introduction
focused on the history and context surrounding the systematic review, we have, therefore, aimed to address
each of these questions in turn. To end this initial section of the editorial, we provide readers with a check
list of possible sections contained within a systematic review. The aim of this is to hopefully elaborate on the
definitions and the discussions already considered, in order to help the reader more clearly understand what
a systematic review really is. Following this we provide an overview of the seven papers incorporated into this
Special Edition. Five of these provide very practical examples of the factors noted below in action while two
provide further methodological reflections around the use of such research designs.
Keywords: Systematic review; applied psychology; check list.
Background
ROFESSOR Archie Cochrane is cited as
the ‘architect’ of systematic reviews; in
1979 he put forward the idea that,
within the medical profession, critical
summaries of research trials should be
produced (Bower, 2010, p.2). Since the
1970s, systematic reviews have become very
influential in the health care professions.
For example, they play an important role in
the development of the clinical guidelines
set out by the National Institute of Health
and Clinical Excellence (NICE). In the
process of developing their guidelines for
specific problems, NICE adopt a grading
scheme which details how the quality of
evidence is rated. This grading scheme
places systematic reviews of randomised
controlled trials at the top of the pile
(www.nice.org.uk). NICE guidelines in turn
have a large influence on what services are
commissioned. Therefore, as a research
methodology, systematic reviews hold a large
amount of political power and influence
(Hanley et al., 2013).
What is a systematic review, and why
would I want to do one?
Imagine a scenario where, for example, you
wanted to know what research has to say
about the effectiveness of psychological
therapy. In this case you might want to
conduct a review of the literature, because a
review of the literature would bring together
research conducted in this specific area, and
help you answer your question. However, this
approach (or methodology) is potentially
limited. For example, you might only review
studies that you already know have been
conducted (such as pieces of research which
colleagues have conducted, or told you
about), or ones which confirm your hypoth-
esis or argument, whilst neglecting to review
those which disprove your position. There-
fore, a literature review can be criticised for
not being rigorous enough (Bower, 2010).
Alternatively, you might think about
conducting a systematic review, because a
systematic review is designed to overcome this
bias and is a more rigorous, and systematic,
way of reviewing research in a specific area.
P
4Counselling Psychology Review, Vol. 28, No. 4, December 2013
At its core a systematic review is a
‘method of critically appraising,
summarising, and attempting to reconcile
the evidence’ (Petticrew & Roberts, 2006,
p.15). Dempster (2011, p.15) defines a
systematic review as:
‘a comprehensive review of literature
which differs from a traditional literature
review in that it is conducted in a
methodical (or systematic) manner,
according to a pre-specified protocol to
minimise bias, with the aim of synthesising
the retrieved information.’
So a systematic review is what it says on the
tin – a review of the literature which is system-
atic. Historically, qualitative research was
excluded from systematic reviews (Dixon-
Woods, Fitzpatrick & Roberts, 2001).
However, in recent years there has been a
move towards including diverse types of
evidence within systematic reviews (Dixon-
Woods & Fitzpatrick, 2001), and the guid-
ance on undertaking systematic reviews
published by the NHS Centre for Reviews
and Dissemination specifically considers the
inclusion of qualitative research evidence
(Centre for Reviews and Dissemination,
2009). Methodological papers have, there-
fore, considered both the procedures for the
synthesis of qualitative research evidence
(Timulak, 2009) and how to combine both
quantitative and qualitative research within a
single systematic review (Dixon-Woods et al.,
2005; Harden & Thomas, 2005).
What does a systematic review look like?
Whether conducting a systematic review of
solely quantitative research, qualitative
research, or a combination of both, there is
generally a protocol of steps to follow. Within
the Cochrane Handbook for Systematic Reviews of
Interventions it is stated that a systematic
review has the following characteristics:
l‘a clearly stated set of objectives with pre-
defined eligibility criteria for studies;
lan explicit, reproducible methodology;
la systematic search that attempts to
identify all studies that would meet the
eligibility criteria;
lan assessment of the validity of the
findings of the included studies, for
example, through the assessment of risk
of bias; and
la systematic presentation, and synthesis,
of the characteristics and findings of the
included studies.’
(Higgins & Green, 2008, p.6).
This gives a flavour of what elements might be
contained within a systematic review. Within
this section we take this further and reflect on
what sections you might expect to see within a
systematic review paper. Following this we
have provided readers with a check list which
brings together some of these thoughts and
can hopefully act as a useful tool for those
individuals who are considering producing a
systematic review paper.
Within the introduction to a systematic
review paper two things are required: a brief
discussion of the literature in the area, and a
clear statement of the study aim and
research question considered. Following
this, the methodology section should detail
the process undertaken in the systematic
review. Given the requirement for the
systematic review to have an ‘explicit, repro-
ducible methodology’ (Higgins & Green,
2008, p.6), the methodology section will
often be very detailed. Within this, you
would expect to see a number of important
sections. Firstly, the author(s) should outline
the search procedures used, specifying
where and when they have conducted their
searches, and what search terms they have
used. Eligibility criteria also need to be
discussed: the criteria against which the
author(s) decided whether or not a citation
was relevant to the research. The author(s)
will also commonly discuss data extraction:
what data they extracted from the citation
and how. Quality criteria will outline how the
author(s) have assessed the quality of the
citations, and whether or not any papers
were excluded on the basis of quality (this
section is sometimes combined with eligi-
bility criteria). The procedures of data
synthesis need to been described, and finally,
ethical considerations may be discussed.
Terry Hanley & Laura Cutts
Counselling Psychology Review, Vol. 28, No. 4, December 2013 5
Within the findings section of a systematic
review, typically the study flow is represented
(often diagrammatically). This will outline
how many citations were found at different
levels of the search, and how many were
included/excluded. Following this, the char-
acteristics of the included studies will be
described, and the author(s) will typically
report on the outcome of the quality assess-
ment described above. Finally, the findings
resulting from the synthesis of the data will
be reported. In the final section of the
systematic review paper, readers should
expect to see authors discuss the findings of
the research in relation to their initial
research question and the previous litera-
ture. Limitations of the review and sugges-
tions for further research will typically be
considered, in addition to the implications
or recommendations resulting from the
study. The paper should end on the conclu-
sions drawn from the research.
What is a systematic review?
Background
Brief contextual literature review
Research question or study aim
Methodology
Search procedures
Eligibility criteria: inclusion and exclusion criteria
Data extraction
Quality criteria and assessment
Data synthesis
Ethical considerations
Results/Findings
Study flow
Characteristics of included studies
Quality of included studies
Synthesis of data
Discussion
Revisiting the research question
Discussion in relation to previous research
Limitations of the review
Future research
Implications/recommendations
Conclusion
Table 1: Check list for systematic review papers.
Overview of the present edition
This Special Edition provides a wide scope to
reflect upon. However, each of these papers
fits into two distinct categories, notably
either as a research paper or a methodo-
logical paper. In relation to the former we
list the titles and authors below:
lWhere do counselling psychologists based
in the UK disseminate their research?
A systematic review.
(Ruth Gordon & Terry Hanley)
lPost-traumatic growth following bereave-
ment: A systematic review of the literature.
(Christina Michael & Mick Cooper)
6Counselling Psychology Review, Vol. 28, No. 4, December 2013
lPsychological treatments for eating
disorders: What is the importance of the
quality of the therapeutic alliance for
outcomes?
(Pavlina Antoniou & Mick Cooper)
lA systematic review of qualitative studies
on shame, guilt and eating disorders.
(Tammy Oluyori)
lThe relationship between children’s
outcomes in counselling and psycho-
therapy and attachment styles.
(Birgit Innerhofer)
The titles of these papers speak for them-
selves and thus need little more reflection.
Additionally, and in line with the purpose of
this Special Edition, each paper demon-
strates how the boxes noted above (outlining
what a systematic review is) might be ticked
off. The second category gets a bit more
methodological with the inclusion of the
following papers:
lHealth Technology Assessment method-
ology: An overview and example of its
potential use in the field of Primary Care
Psychological Therapies in the NH.S
(Rebecca Southall)
lExperiences of conducting qualitative
meta-analysis.
(Ladislav Timulak & Mary Creaner)
In these we explicitly enter into the method-
ological complexities of such work. Hope-
fully these papers will support the
development of understanding and lead to
further reflections upon the process
conducting a systematic review.
To end, the ‘Dialogues and Debates’
section once again provides much more
food for thought. Thank you for reading and
we hope you enjoy this Special Edition.
About the Authors
Terry Hanley is Programme Director of the
Doctorate in Counselling Psychology at the
University of Manchester and Editor of
Counselling Psychology Review.
Laura Cutts is a Lecturer in Counselling
Psychology at the University of Manchester.
Correspondence
Email: terry.hanley@manchester.ac.uk
References
Bower, P. (2010). Undertaking systematic reviews in
counselling and psychotherapy. Lutterworth: British
Association for Counselling & Psychotherapy
(BACP).
Centre for Reviews and Dissemination (2008).
Systematic reviews. CRD’s guidance for undertaking
reviews in health care. York: CRD. Retrieved
8 October 2013, from:
http://www.york.ac.uk/inst/crd/pdf/
Systematic_Reviews.pdf
Dempster, M. (2011). A research guide for health and
clinical psychology. Hampshire: Palgrave Macmillan.
Dixon-Woods, M., Agarwal, S., Jones, D., Young, B. &
Sutton, A. (2005). Synthesising qualitative and
quantitative evidence: A review of possible
methods. Journal of Health Services Research & Policy,
10(1), 45–55.
Dixon-Woods, M. & Fitzpatrick, R. (2001). Qualitative
research in systematic reviews. British Medical
Journal, 323, 765–766.
Dixon-Woods, M., Fitzpatrick, R. & Roberts, K. (2001).
Including qualitative research in systematic
reviews: opportunities and problems. Journal of
Evaluation in Clinical Practice, 7(2), 125–133.
Hanley, T., Cutts, L., Gordon, R. & Scott, A. (2013).
A research informed approach to counselling
psychology. In G. Davey (Ed.), Applied psychology.
London: BPS Wiley-Blackwell.
Harden, A. & Thomas, J. (2005). Methodological
issues in combining diverse study types in
systematic reviews. International Journal of Social
Research Methodology, 8(3), 257–271.
Higgins, Julian, P.T. & Green, S. (2008). Cochrane
Handbook for Systematic Reviews of Interventions.
Chichester, West Sussex: The Cochrane
Collaboration and John Wiley & Sons Ltd.
Petticrew, M. & Roberts, H. (2006). Systematic reviews
in the social sciences. A practical guide. Oxford:
Blackwell Publishing.
Timulak, L. (2009). Meta-analysis of qualitative
studies: A tool for reviewing qualitative research
findings in psychotherapy. Psychotherapy Research,
19(4), 591–600.
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alkla ilişkiler alanında sosyal medyanın yoğun olarak kullanılması, halkla ilişkiler araştırmacılarının sosyal medyanın değeri hakkında bilgi edinme isteği son zamanlarda halkla ilişkiler ve sosyal medya konularında yayınlanan akademik çalışmaların artmasını sağlamıştır. Bu çalışmada Türkiye’de halkla ilişkiler ve sosyal medya konusunda yayımlanan çalışmaların 2012-2022 yılları arasında nasıl bir gelişim gösterdiğinin ve bu makalelerin nasıl bir temel eğilim sergilediğinin ortaya konulması amaçlanmıştır. Bu amaç doğrultusunda Web of Science’da taranan Türkçe akademik hakemli dergilerde 2012-2022 yılları arasında yayımlanmış 85 makaleye ulaşılmış ve bu makalelere sistematik analiz uygulanmıştır. Bu çalışma, son zamanlarda sosyal medyanın halkla ilişkilerdeki rolünü anlamak için çerçeve sağlayan sistematik bir incelemeye dayanmaktadır. Çalışmada dikkat çeken bulgulardan biri, halkla ilişkiler araştırmalarında sosyal medyanın stratejik olarak kullanılmasıdır. Makalelerde kriz iletişimi, itibar yönetimi, diyalogsal iletişim gibi halkla ilişkilerin uygulama alanlarıyla sosyal medyanın ilişkisini ortaya koyan konular ele alınmıştır. Ayrıca makalelerde sosyal medyayı bir bütün olarak almak yerine sosyal medya platformlarına odaklanılmıştır. Makalelerde en fazla araştırılan sosyal medya platformunun Twitter olduğu belirlenmiştir. Bu çalışma halkla ilişkiler alanındaki sosyal medya araştırmalarının daha iyi anlaşılabilmesi için önem arz eden bulgular sunmakta ve bu doğrultuda birtakım önerilerle son bulmaktadır.
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Synthesising Qualitative and Quantitative Evidence: A Review of Possible Methods
Article
Full-text available
  • Feb 2005
The limitations of traditional forms of systematic review in making optimal use of all forms of evidence are increasingly evident, especially for policy-makers and practitioners. There is an urgent need for robust ways of incorporating qualitative evidence into systematic reviews. In this paper we provide a brief overview and critique of a selection of strategies for synthesising qualitative and quantitative evidence, ranging from techniques that are largely qualitative and interpretive through to techniques that are largely quantitative and integrative. A range of methods is available for synthesising diverse forms of evidence. These include narrative summary, thematic analysis, grounded theory, meta-ethnography, meta-study, realist synthesis, Miles and Huberman's data analysis techniques, content analysis, case survey, qualitative comparative analysis and Bayesian meta-analysis. Methods vary in their strengths and weaknesses, ability to deal with qualitative and quantitative forms of evidence, and type of question for which they are most suitable. We identify a number of procedural, conceptual and theoretical issues that need to be addressed in moving forward with this area, and emphasise the need for existing techniques to be evaluated and modified, rather than inventing new approaches.
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Systematic Reviews in the Social Sciences: A Practical Guide
Book
  • Jan 2006
Such diverse thinkers as Lao-Tze, Confucius, and U.S. Defense Secretary Donald Rumsfeld have all pointed out that we need to be able to tell the difference between real and assumed knowledge. The systematic review is a scientific tool that can help with this difficult task. It can help, for example, with appraising, summarising, and communicating the results and implications of otherwise unmanageable quantities of data. This book, written by two highly-respected social scientists, provides an overview of systematic literature review methods: Outlining the rationale and methods of systematic reviews; Giving worked examples from social science and other fields; Applying the practice to all social science disciplines; It requires no previous knowledge, but takes the reader through the process stage by stage; Drawing on examples from such diverse fields as psychology, criminology, education, transport, social welfare, public health, and housing and urban policy, among others. Including detailed sections on assessing the quality of both quantitative, and qualitative research; searching for evidence in the social sciences; meta-analytic and other methods of evidence synthesis; publication bias; heterogeneity; and approaches to dissemination.
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Methodological Issues in Combining Diverse Study Types in Systematic Reviews
Article
  • Jul 2005
In this paper we discuss mixing methods at the level of reviews of research, combining the findings of multiple, already existing, studies that are labelled broadly as using either ‘qualitative’ or ‘quantitative’ methods. We define systematic reviews and outline the ‘mixed methods’ we have developed for combining diverse study types within them. Traditional systematic reviews usually answer a single question, use one type of study and, hence, only require one method of synthesis to combine the findings of studies. Our methods involve conducting three types of synthesis: (1) a statistical meta‐analysis to pool trials of interventions tackling a particular health, social or educational problem; (2) a synthesis of studies examining people’s perspectives or experiences of that problem using qualitative analysis; and (3) a mixed methods synthesis bringing the products of (1) and (2) together. We discuss the strengths of these mixed methods at the review level, reflect on their lessons for the concept of ‘triangulation’ and raise questions about the utility of the terms ‘qualitative’ and ‘quantitative’ and ‘mixed methods’ for classifying different types of research.
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Cochrane Handbook for Systematic Reviews of Interventions
Book
  • Jan 2009
The Cochrane Handbook for Systematic Reviews of Interventions (the Handbook) has undergone a substantial update, and Version 5 of the Handbook is now available online at www.cochrane-handbook.org and in RevMan 5. In addition, for the first time, the Handbook will soon be available as a printed volume, published by Wiley-Blackwell. We are anticipating release of this at the Colloquium in Freiburg. Version 5 of the Handbook describes the new methods available in RevMan 5, as well as containing extensive guidance on all aspects of Cochrane review methodology. It has a new structure, with 22 chapters divided into three parts. Part 1, relevant to all reviews, introduces Cochrane reviews, covering their planning and preparation, and their maintenance and updating, and ends with a guide to the contents of a Cochrane protocol and review. Part 2, relevant to all reviews, provides general methodological guidance on preparing reviews, covering question development, eligibility criteria, searching, collecting data, within-study bias (including completion of the Risk of Bias table), analysing data, reporting bias, presenting and interpreting results (including Summary of Findings tables). Part 3 addresses special topics that will be relevant to some, but not all, reviews, including particular considerations in addressing adverse effects, meta-analysis with non-standard study designs and using individual participant data. This part has new chapters on incorporating economic evaluations, non-randomized studies, qualitative research, patient-reported outcomes in reviews, prospective meta-analysis, reviews in health promotion and public health, and the new review type of overviews of reviews.
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Meta-analysis of qualitative studies: A tool for reviewing qualitative research findings in psychotherapy
Article
This article focuses on the presentation of qualitative meta-analysis as a method for reviewing qualitative studies. Qualitative meta-analysis is an attempt to conduct a rigorous secondary qualitative analysis of primary qualitative findings. Its purpose*to provide a more comprehensive description of a phenomenon and an assessment of the influence of the method of investigation on findings*is discussed. The distinctive features of conducting meta-analysis approaches are presented. Several considerations important for conducting qualitative meta-analysis are also discussed. The author uses examples of the first experiences attempted with qualitative meta-analysis in the field of psychotherapy research.
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Including qualitative research in systematic reviews: Opportunities and problems
Article
  • Jun 2001
Qualitative research has been increasingly recognized in recent years as having a distinctive and important contribution to make to health care research. It is capable of being used as a methodologically sufficient approach in its own right, as a precursor to quantitative studies, during or after trials to explain processes and outcomes, and as a means of enhancing the link between evidence and practice. However, qualitative research has been little used as an evidence resource for systematic reviews. We argue that formal synthesis of both qualitative and quantitative forms of research is essential, and we discuss some of the problems that need to be overcome in carrying out such syntheses. These include methodological prejudice, problems in searching for qualitative evidence, and issues in synthesizing qualitative data. We call for progress to be made on the science and methods of including qualitative research in the evidence base of medicine.
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Undertaking systematic reviews in counselling and psychotherapy
  • Jan 2010
  • P Bower
Bower, P. (2010). Undertaking systematic reviews in counselling and psychotherapy. Lutterworth: British Association for Counselling & Psychotherapy (BACP).
Systematic reviews. CRD's guidance for undertaking reviews in health care. York: CrD. retrieved 8 october 2013 A research guide for health and clinical psychology
  • Jan 2008
  • Centre
  • Reviews
  • M Dissemination
Centre for reviews and Dissemination (2008). Systematic reviews. CRD's guidance for undertaking reviews in health care. York: CrD. retrieved 8 october 2013, from: http://www.york.ac.uk/inst/crd/pdf/ systematic_reviews.pdf Dempster, M. (2011). A research guide for health and clinical psychology. Hampshire: Palgrave Macmillan.