Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Dec 21:12:102532.
doi: 10.1016/j.mex.2023.102532. eCollection 2024 Jun.

Systematic review of clinical practice guidelines and systematic reviews: A method for conducting comprehensive analysis

Stefano Mancin  1   2 , Marco Sguanci  3 , Desirèe Andreoli  4 , Fanny Soekeland  5 , Giuliano Anastasi  6 , Michela Piredda  3 , Maria Grazia De Marinis  3   7
Affiliations
Review

Systematic review of clinical practice guidelines and systematic reviews: A method for conducting comprehensive analysis

Stefano Mancin et al. MethodsX. .

Abstract

A systematic review (SR) is a research method for synthesizing evidence on a specific topic. Among the various types of systematic reviews, there are SRs of guidelines (CPGs) and SRs of SRs. Traditionally, they are limited to just one type of secondary evidence. This paper introduces an innovative SR methodology that combines CPGs and SRs to improve evidence synthesis and overcome the limitations of isolated use. Essential steps that should always precede the actual research process include registering the research protocol, formulating research questions and setting inclusion/exclusion criteria. Using the PRISMA protocol for comprehensive database searches, it's crucial to combine keywords with boolean operators and remove duplicates. The eligibility of studies should be assessed by selecting potentially relevant articles through an initial screening of titles and abstracts, followed by a meticulous analysis of the full-texts. Rigorous evidence evaluation tools, such as AGREE II for CPGs and AMSTAR 2 for SRs, and the double reviewer approach ensure high-quality selections. Additionally, converting summarized results into percentages and applying statistical analyses facilitate interpretation and improve the reliability of rater assessments. A further characteristic of this methodology is its adaptability to the evolution of healthcare research.

Keywords: Clinical practice guidelines; Evidence-based medicine; Meta-analysis; Methodology; Systematic review of clinical practice guidelines and systematic reviews; Systematic reviews.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image, graphical abstract
Graphical abstract
Fig 1
Fig. 1
Main Elements of PICOR Framework. Legend: Methodology and phases of the PICOR (Patient/Population, Intervention, Comparator, Outcome, and Recommendations).
Fig 2
Fig. 2
Search Strategy methodology. Legend: PICOR: patient/population, intervention, comparison, outcomes; R: Characteristics of the recommendations; CPG: Clinical Practice Guideline.
Fig 3
Fig. 3
Calculation of the AGREE II standardized score. Legend: Obtained Score is the sum of the scores of all the items within the specific domain. Minimum Possible Score represents the minimum score obtainable for the domain. This is calculated as the number of items in the domain multiplied by the minimum item score (typically 1, since the scoring ranges from 1 to 7). Maximum Possible Score is the maximum score obtainable for the domain. It is calculated as the number of items in the domain multiplied by the maximum item score (typically 7). DSi represents the Domain Score for the i th domain.
Fig 4
Fig. 4
Main Elements of AGREE II. Legend: Methodology and characteristics of the AGREE II methodology (Appraisal of Guidelines for Research and Evaluation).
Fig 5
Fig. 5
Calculation of the AMSTAR 2 score. Legend: The “Sum of Scores from Questions” refers to the total sum of scores assigned to all answered questions; The “Maximum Number of Applicable Questions” is 16 by default but can be reduced if certain questions are not applicable (e.g., when a meta-analysis is not conducted); The “Maximum Score per Question” is 1.
Fig 6
Fig. 6
Methodology for integrating a meta-analysis. Legend: Methodology for integrating a meta-analysis into a systematic review.
See this image and copyright information in PMC

References

    1. Bramer W.M., Rethlefsen M.L., Kleijnen J., et al. Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst. Rev. 2017;6:245. doi: 10.1186/s13643-017-0644-y. - DOI - PMC - PubMed
    1. Demner-Fushman D., Hauser S., Thoma G. The role of title, metadata and abstract in identifying clinically relevant journal articles. AMIA Annu. Symp. Proc. 2005:191–195. - PMC - PubMed
    1. Godin K., Stapleton J., Kirkpatrick S.I., et al. Applying systematic review search methods to the grey literature: a case study examining guidelines for school-based breakfast programs in Canada. Syst. Rev. 2015;4:138. doi: 10.1186/s13643-015-0125-0. - DOI - PMC - PubMed
    1. Paez A. Grey literature: an important resource in systematic reviews. J. Evid. Based Med. 2017;10(3):233–240. doi: 10.1111/jebm.12266. - DOI - PubMed
    1. El-Khayat Y.M., Forbes C.S., Coghill J.G. Guideline.gov: a database of clinical specialty guidelines. Med. Ref. Serv. Q. 2017;36(1):62–72. doi: 10.1080/02763869.2017.1259914. - DOI - PubMed