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Synthesising ‘best evidence in systematic reviews when randomised controlled trials are absent: three tips for authors to add value for clinician readers
  1. Clare L Ardern1,2,
  2. Marinus Winters3
  1. 1 Division of Physiotherapy, Linköping University, Linköping, Sweden
  2. 2 School of Allied Health, La Trobe University, Melbourne, Australia
  3. 3 Research Unit for General Practice, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  1. Correspondence to Dr Clare L Ardern, Division of Physiotherapy, Linköping University, 581 83 Linköping, SWEDEN; c.ardern{at}

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‘More research is needed’ is a most unhelpful conclusion for the clinician reader of a systematic review. Clinicians look to researchers for the ‘research evidence’ part of Professor Sackett’s ‘three circles’ of evidence-based practice.1 The clinician can not ignore the patient in front of him or her just because there is no evidence from systematic reviews or randomised controlled trials (RCTs): ‘Kindly forget about your shoulder problem, until we have better research to tell me what to do’? This will not do! In this editorial, we share three practical tips for authors synthesising lower level evidence in systematic reviews, when high-quality RCTs are absent. Our goal is to help authors help clinicians help patients.

Consider the patient who plays tennis and presents with shoulder pain. Right now, the clinician who is seeking RCT evidence on how to progress from impairment-focused tasks in neutral shoulder positions to high-level, sport-specific tasks will be disappointed. Being able to function in shoulder elevation positions above …

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  • Contributors CLA and MW contributed equally to the production of this editorial. CLA is a BJSM Deputy Editor responsible for systematic reviews. MW is a BJSM Senior Associate Editor responsible for systematic reviews.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.