Systematic Review

Developing your research question

Formulating a clearly defined systematic review question is the foundation of your review. This step is not an easy process. Coming up with a question that is not only answerable but relevant can take a considerable amount of time.

Seek the perspectives of colleagues, experts on the topic of interest and stakeholders, for example; patients and families who may be impacted by the disease or intervention, as their input can be valuable in shaping the question and the direction of the review.

According to the Australian NHMRC guide, How to review the evidence: systematic identification and review of the scientific literature (2000) there are six types of questions that can be answered by undertaking a systematic review.

  • Investigating the effect of an intervention
  • Investigating the frequency or rate of a condition or disease
  • Establishing the performance of a diagnostic test and the impact on the patient
  • Understanding aetiology and risk factors
  • Attempting to predict patients at risk and identify patient prognosis
  • Identifying the economic impact of treatments and procedures.

 

PICO search framework

Richardson et al (1995) developed the PICO Framework, to facilitate the creation of a well-phrased question. The PICO Framework not only assists in developing your question; it enables the identification of keywords that can help in the development of your search strategy later on.

PICO is the framework most used by health researchers when formulating their clinical questions.

Population or Problem
  • Which problem, disease or condition are you looking at?
  • How is your population defined? (age, gender, ethnic group …)
Intervention
  • How is the problem being treated?
Comparison
  • Which alternative method are you comparing this with? (It’s ok to leave this one blank if you are not doing a comparison)
Outcome
  • Which result are you focusing on or measuring?

 

Other variables that can be added to this PICO framework are:

Timeframe
  • What is the duration of the intervention?
  • What is the follow up schedule?
Type of study
or
Study design
  • Which type of study will you be using? (e.g. Randomised Control Trials, Treatment Outcome Studies)
Setting
  • Where is your intervention of interest taking place?

 

The PICo variation is useful for for qualitative studies

Population or Problem
  • Which problem, disease or condition are you looking at?
  • How is your population defined? (age, gender, ethnic group …)
Interest
  • Which experience, activity, process or event are you interesting in focusing on?
Context
  • Where is this happening? (Geographical location, e.g. Australia / Service location, e.g. hospital)

Other Search Frameworks

The PICO Framework may not fit the type of issue or topic you may want to research, therefore, here are some other frameworks that may assist in building a research question.

 

ECLIPSE – can facilitate the building of a review question looking at health policy and management. The aim of ECLIPSE is to focus on terms that differ to those used in the medical profession.

Expectation
  • What is the information you find going to be used to support?
Client group
  • Who is the service for?
Location
  • Where is the service run from? E.g. community centre or hospital
Impact
  • What is the desired change to service, is any?
  • How are you defining success?
  • How will you measure success?
Professionals
  • Who is providing the service?
  • Who will be involved in improving the service?
SErvice
  • Which service are you searching for information on?

 

SPIDER – has been designed to enable researchers to develop a research question and search strategy that is focused on qualitative and mixed methods primary research.

Sample
  • Who are your participants?
Phenomenon of
Interest
  • What are their attitudes and experiences in relation the issue you are focussing on?
Design
  • What type of study are you doing?
Evaluation
  • Which result are you focussing on?
  • How are you measuring it?
Research type
  • Is it qualitative, quantitative or a mixture of both?

 

SPICE – was formulated to assist in the development of research questions and search strategies looking to evaluate the outcomes of a specific intervention.

Setting
  • Where is this taking place?
Perspective
  • Who are the patients?
  • How are you defining this population?
Intervention
  • How is this issue being dealt with?
Comparison
  • What alternative method are you comparing this with?
Evaluation
  • How was success measured in the studies you used?
  • What do you need to measure?