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Systematic and Systematic-Style Reviews

Analysing results

Levels of evidence

The levels of evidence pyramid is important to consider when undertaking a systematic or systematic-style review because it provides a framework for assessing the quality of the studies included in your review. As you move up the pyramid the amount of available literature decreases, but increases in its relevance to the clinical setting.

Systematic reviews and meta-analyses of Randomized Controlled Trials (RCTs) are considered the gold standard of evidence, particularly in the clinical setting, while expert opinion and editorials sit at the bottom of the pyramid and are considered the weakest form of evidence.

Click on the question mark hotspots below to learn more:

Critical appraisal 

Critical appraisal tools 

Critical appraisal tools are used in systematic reviews to assess the quality and risk of bias of studies included in the review. The best tool to use will depend on the nature of your specific research question, and the kind of evidence you are synthesising. 

Here are some of the most commonly used critical appraisal tools for conducting systematic reviews:

Screening tools

When reviewing the final search results from your chosen databases (and other sources if relevant), you and the other reviewers will make decisions on which articles to include and exclude based on the criteria specified in your protocol in the following sequence. The first stage of this is usually based on titles and abstracts, then a full-text analysis follows before data extraction.

  • Pre-screening:  Record the numbers of results from each database or source recorded before screening commences.
  • Remove duplicates:  Covidence automates this process, but you can also choose to de-duplicate references within EndNote. In addition, you can also utilise the Deduplicator (Systematic Review Accelerator) tool. 
  • Title/abstract screening:  Reviewers scan titles and abstracts to see if they match the criteria or have some value to the systematic review.  This may be done by a single reviewer, but independent screening by multiple reviewers and the comparison of results reduces the likelihood of bias.
  • Full-text screening:  Multiple reviewers individually read the full-text of included articles to fine-tune the final collection of articles that will be included in the review.

Access the deduplication tools below: