Six Steps to a Systematic Review

Finding What Works in Healthcare

Step 1: Initiate the process, organize the review team, develop a process for gathering user and stakeholder input, formulate the research question, and implement procedures for minimizing the impact of bias and conflict of interests (see standards in Chapter 2).

Step 2: Develop the review protocol, including the context and rationale for the review and the specific procedures for the search strategy, data collection and extraction, qualitative synthesis and quantitative data synthesis (if a meta-analysis is done), reporting, and peer review (see standards in Chapter 2).

Step 3: Systematically locate, screen, and select the studies for review (see standards in Chapter 3).

Step 4: Appraise the risk of bias in the individual studies and extract the data for analysis (see standards in Chapter 3).

Step 5: Synthesize the findings and assess the overall quality of the body of evidence (see standards in Chapter 4).

Step 6: Prepare a final report and have the report undergo peer review (see standards in Chapter 5)."

Reporting Standards


Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, the PRISMA-P Group. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 2015.349:g7647. doi: 10.1136/bmj.g7647

Systematic Reviews

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, et al. (2009) The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration. BMJ 2009;339:b2700, doi: 10.1136/bmj.b2700

The PRISMA Flow Diagram depicts the flow of information through the different phases of a systematic review. It maps out the number of records identified, included and excluded, and the reasons for exclusions.

The PRISMA Flow Generator online tool using an open source software to help create an image of the PRISMA Flow diagram. created by Toronto Health Economics and Technology Assessment Collaborative (THETA), University of Toronto.

PRISMA 2009 Flow Diagram

Prisma 2009 Flow Diagram

Flow Diagram IN: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. doi:10.1371/journal.pmed1000097

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