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| Developing a Systematic Review | |
|  Interested in Writing a Systematic Review with CMSG? | |
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Please click here to see our list of priority areas for new systematic reviews. There are 4 main steps to writing a review: It is the policy of the Cochrane Musculoskeletal Group to ask for an outline of your proposed topic. For a complete information package to aid you to develop your topic and registering a title click here. The registration form can be downloaded here. The form can be sent to cmsg@uottawa.ca and will be reviewed by the editorial base at the University of Ottawa, Canada or Cabrini Hospital in Melbourne, Australia. When filling out the registration form, you will need to
To ensure that your area of interest/topic has not
already been reviewed, please view all of the titles currently registered
in the Cochrane Collaboration here through the Review Titles Manager.
The editorial base of a typical Cochrane collaborative review group consists of a
Coordinating Editor, a Review Group Coordinator (RGC) and a Trials Search Coordinator
(TSC).
All submitted protocols are peer
reviewed by at least two internal members of the editorial team
and at least two external peer referees. The bio-statistical editor and a
consumer also review all protocols prior to submission to the Cochrane Library. The peer
review process is conducted using a standard checklist designed by the editorial
team. In addition, the CMSG consumer members have developed a consumer version of
this checklist, which is currently being used for all protocols. The
coordinating office compiles the comments received from the various peer reviewers and
a summary is sent to the author. The final copy-editing prior to submission
to the Cochrane Library is done at the coordinating office. Once a
protocol is submitted the author has up to two years to submit a review, depending on
the extent of the review, and to whether the author is awaiting feedback regarding
publication in a paper-based journal. CMSG Search Strategy Access to specialized registers by authors A literature search should be conducted to identify the maximum number of trials relevant to your review. The first step is to search the Cochrane Controlled Trials Register (Central/CCTR) on the Cochrane Library. This is the major source of information for randomized controlled trials (RCTs). Remember when you search that not all records are indexed with MeSH terms (for more information on MeSH terms, see http://www.nlm.nih.gov/mesh/meshhome.html). Be sure to select appropriate MeSH terms but also include all relevant TEXTWORDS when doing your search. When choosing your textwords, think widely about what terms to use and include synonyms, alternative spellings, singular/plural forms etc. The CMSG Specialized Trials Register contains randomized and quasi-randomized trials that fall within the scope of the Group. These are found by conducting regular searches of CENTRAL on the Cochrane Library using a highly sensitive search strategy. The CMSGs specialized trials register is accessible to all authors. Additional search strategies Generally, the updated highly sensitive search strategies developed by members of the Cochrane Collaboration are recommended for use. These strategies can be found in the Cochrane Handbook. To ensure that as many relevant studies as possible are identified, authors need to conduct additional searches to those described for the specialized register. These strategies include personal contact with experts in the area, citation searches (using SCISEARCH or Science Citation Index), and use of other relevant bibliographic databases. It is recommended that EMBASE is searched because it is a major source of biomedical and pharmacological literature, much of which is not on MEDLINE. There are also a number of web sites that contain information about recent or ongoing trials such as the National Research Register in the UK and Current Controlled Trials in the USA. It is also important to follow up the references of relevant papers that you have found including those of any existing reviews. In addition you could contact the authors of papers and/or other experts in your particular field. Additional search strategies are described in the methods section. Dickersin K., Scherer R., Lefebvre C. Identifying relevant studies for systematic reviews. BMJ 1994; 309:1286-91. For a complete information package describing the process of writing a review click here . First Steps The primary contact person for the review should liaise with the managing editor while developing their review. The managing editor will be able to provide details of the support and resources available from the CMSG (such as access to CMSG's specialized register, technical help and methodological advice including the use of CMSG data collection checklists which describe the inclusion criteria for studies, quality issues, the collection of relevant data, etc). Study selection For all CMSG reviews 'a priori' peer reviewed protocols are produced prior to submission of the review to the Cochrane Library. The inclusion and exclusion criteria are established and at least two authors carry out the selection process for included studies. If consensus is not reached a third reviewer is assigned. Assessment of methodological quality The CMSG requires a quality assessment of included studies. Many reviewers
opted to use the validated tool by Jadad (1996) that assesses randomization,
blinding, and withdrawals and dropouts, supplemented by the allocation
concealment assessment of Schulz, et al (1995) or other assessment checklists or
scales. 1. Jadad A, Moore A, Carroll D. Assessing
the quality of randomized trials: Is blinding necessary? Control Clin Trial
1996;17:1-12. Grading of Evidence Methods for grading the scientific evidence have evolved over the past decade as evidence-based health care has become increasingly important in clinical practice. The CMSG editorial team decided in August 2003 to use a common system of grading throughout our systematic reviews and consumer synopses to rank the strength of scientific evidence for each therapeutic agent. This grading system was originally derived for and is described in more detail in the 2004 book Evidence-based Rheumatology by Tugwell P, Shea B, Boers M, Simons L, Strand V, Wells G published by BMJ books. The CMSG editorial team has now adopted the use of the
'Grading of Recommendation Assessment Development and Evaluation' (GRADE)
approach (GRADE Working Group 2004, Schunemann et all 2008) to summarize the
overall strength, or grading, of the evidence for each major outcome included in
a review. This grading system specifies four levels of quality: high, moderate,
low, and very low. The highest quality rating is for a body of evidence based on
randomized trials without important limitations.
Review authors can downgrade randomized trial evidence depending on the presence of five factors (study limitations, inconsistency of results, indirectness of evidence, imprecision and publication bias) and upgrade the quality of evidence of observational studies depending on three factors (large magnitude of effect, plausible confounding, which would reduce a demonstrated effect, and dose-response gradient). The GRADE approach is described in more detail in chapter 12 of The Cochrane Handbook. Summary of Findings Tables The CMSG editorial team now recommends the use of Summary of
Findings tables to present results in reviews. These replace clinical relevance
tables that were previously used. The summary of findings table provides key
information concerning the quality of evidence, the magnitude of effect of the
interventions examined, and the sum of available data on all important outcomes
for a given comparison. The absolute risk reduction and the relative risk
reduction should be provided and for those outcomes that are statistically
significant, the number needed to treat should calculated. A maximum of seven
important outcomes including benefit and harm outcomes should be identified
early in the review development process if possible during the protocol stage.
When review authors do not include information on these important outcomes in
the review they should say so.
CMSG summary of findings table guidelines are available at
the editorial office.
Data collection It is the Musculoskeletal Group's policy to recommend that at least two authors independently select the studies, assess the methodological quality and extract the data. Data collection forms should be used on all CMSG reviews. At the editorial office we have developed a number of data collection forms that can be modified for each of the reviews. Please send a request to cmsg@uottawa.ca for these forms. Analysis The CMSG also has statistical advisors who will work closely with all CMSG authors to provide ongoing statistical guidance for completion of their Cochrane reviews. For statistical guidelines used by the Musculoskeletal Group, please refer to the Cochrane Handbook or contact the editorial office. Reporting of reviews The CMSG editorial team is supportive of authors who wish to submit their review to a paper-based journal prior to or simultaneous to submission to the Cochrane Library. Please contact the managing editor if you plan to do this. Indeed, the CMSG has an agreement with the Journal of Rheumatology to submit Cochrane Reviews in paper based format at the same time as the release of our Cochrane Reviews. Agreements vary on the amount of modifications and timing for publication in those journals. The Cochrane Musculoskeletal Group has an agreement with the Journal of Rheumatology. For more information about the agreement, click here or contact Elizabeth Ghogomu (cmsg@uottawa.ca). Reviews and the Peer-review process All submitted reviews are peer reviewed by at least two internal members of the editorial team and at least two external peer referees. At least one external referee is a consumer. The peer review process is conducted using a standard checklist designed by the editorial team. In addition, the CMSG consumer members have developed a consumer version of this checklist, which is currently being used for all reviews. Again, the coordinating office compiles the comments received from the various peer reviewers and a summary is sent to the author. The final copy-editing prior to submission to the Cochrane Library is done at the coordinating office. Once a review is submitted the author has up to two years to submit an updated review, depending on the extent of the review. REVIEW PUBLICATION AND UPDATES For a complete information package describing the process of publishing and maintaining a review click here. Reviews should be ideally updated at least every two years and more frequently where possible. Failure to update a review can result in the review being assigned to a new author. The CMSG editorial team encourages all new authors who have not conducted a Cochrane review to be assigned to assist with updating a particular review. This gives new authors the opportunity to learn the process prior to taking on the task of completing a full Cochrane systematic review. For a complete information package describing the process of updating a review click here. Once the updated review has been submitted it will again go through the editorial process and copy-editing as outlined above.  | |