Article Text

Getting the systematic review basics right helps clinical practice: 4 common pitfalls for systematic review authors to avoid
  1. Lisa Bero
  1. Charles Perkins Centre and Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia
  1. Correspondence to Lisa Bero, University of Sydney, Sydney, NSW 2000, Australia; lisa.bero{at}

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As BJSM readers know, systematic reviews identify, critique and summarise evidence relevant to a specific question. Most importantly, systematic reviews should be transparent and follow a predefined protocol to reduce bias. Since many articles in the scientific literature mislabel systematic reviews,1 journals including BJSM are improving systematic review reporting by adhering to standards such as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines.2 This editorial provides practical tips for systematic review authors relevant to sports and exercise medicine: guidance on four common problems and suggestions on how to address these problems.

Key steps for quality systematic reviews

There are six keys steps that you should follow for a systematic review:

  1. State a clear question (specifying the Population studied, Intervention(s)or exposure(s), Comparisons (if any) and Outcomes—the PICO).

  2. Conduct a systematic, replicable search for evidence using a prespecified search strategy.

  3. Select studies for the review based on predefined inclusion and exclusion criteria.

  4. Assess the internal validity or ‘risk of bias’ of studies included.

  5. Extract data using predefined variables and coding forms.

  6. Synthesise the characteristics and findings of the included studies (using quantitative (meta-analysis) and/or qualitative methods).

Types of systematic reviews

The most straightforward type of systematic review has a focused question and combines summary data from randomised controlled trials that measure outcomes using the same metrics (eg, does the FIFA 11+ programme reduce lower extremity injuries in football?).3 The Cochrane Handbook for Systematic Reviews of Interventions provides guidance for every step of the systematic review process4 that you can apply to systematic reviews of randomised controlled trials studying the effects of exercise, surgery or training on injury prevention, recovery or fitness. More complex systematic reviews may address multiple questions with multiple interventions and outcomes reported in different ways and synthesise observational or qualitative studies (eg, what is …

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