Lewis College SRMA Initiative

Systematic Review & Meta-Analysis

Definition #1: It is a review of the evidence on a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant primary research studies, and to extract and analyze data from the studies included in the review. If a meta-analysis follows, the systematic review provides the data needed for the meta-analysis.

Definition #2: It is a rigorous review of the literature in which your goal is to find all studies conducted on a given research topic.

It is the use of statistical techniques to combine the results of quantitative research studies addressing the same question into a summary measure. If a meta-analysis is done, a systematic review has to precede it.
For clinicians, it can be used to determine the most effective course of treatment.

  • Systematic reviews with or without a meta-analysis are considered the best source of clinical evidence (See Sackett’s Levels of Evidence pyramid below.)
  • The Cochrane Collaboration is the single best database source for systematic reviews/meta-analyses on healthcare topics.saketts

 

 

 

 

 

 

 

 

For researchers, it can be used to:

  • Plan new studies
  • Justify these studies (e.g., in grant applications)
  • Put these studies in context (e.g., in the introductory section of a manuscript)
  • Get publications!!
The first (and hardest) step is coming up with the research question that you want to conduct your review on. For clinical questions, it is recommended that the question be in PICO format where:

P = patient type or population

I = intervention (a.k.a. treatment)

C = comparison (i.e., what is your control condition?)

O = outcomes (a.k.a. dependent variables)

The research question cannot be so novel that no research has ever been done on it. The bare minimum number of relevant studies for a systematic review/meta-analysis is around five. When the number of relevant studies gets into the 15 to 30 range, you can conduct a systematic review/meta-analysis that can lead to a nice publication. When you find more than 50 relevant studies, you should consider narrowing the scope of your research question.

After you have identified your research question, at least a preliminary one, you should contact Dr. Gordon Warren in the Lewis College SRMA Initiative to discuss the feasibility of conducting a systematic review/meta-analysis. His email address and phone number are gwarren@gsu.edu and (404) 413-1255, respectively. If the two of you think that a systematic review/meta-analysis is feasible, the SRMA Initiative will work with you throughout the review providing you with the technical expertise necessary to conduct the review. The workflow of the review is highlighted in the figure below. If it is your desired goal to generate a manuscript from the review, the SRMA Initiative will also help you with the systematic review/meta-analysis-specific parts of the manuscript preparation.
Though the Lewis College SRMA Initiative will provide you with the technical expertise necessary to conduct your systematic review/meta-analysis, it is important that you put together a team of content experts. The more your team knows about the area of research the better. This will make publishing your systematic review/meta-analysis easier. At the minimum, you and one other person are needed to conduct a systematic review/meta-analysis. A total of three to four persons would be better.
As a follow-up to our discussions about the CNHP systematic review/meta-analysis (SRMA) initiative at the unit faculty meetings last month, I would like to bring to everyone’s attention a possible means for you to get a systematic review/meta-analysis going sooner rather than later. This semester, our Doctor of Physical Therapy (DPT) students will take my PT 8500 (systematic review/meta-analysis) course. These students must complete a systematic review/meta-analysis by the time they graduate in 2 years. The hardest part for them is to come up with a good research question. I am hoping that you can help them. If you think you have a possible question for a systematic review/meta-analysis, let’s talk and flush out the idea. We can then present the question to the students and see if we have any takers. The question you propose doesn’t have to be PT related. I think a topic/question that crosses two or more clinical disciplines will be snapped up by the students. The advantage for you in going this route is that you will have 2-3 motivated (i.e., to graduate) students working on your project. After completing a systematic review/meta-analysis, the students must present the findings at two or more professional conferences or submit a manuscript for publication. And of course, you would be an author on these and will have a major say-so over whether you all go the conference presentation route or the manuscript route. If you pair up with a group of students, your (and maybe a colleague’s) main job will be to act as the content advisor (as well as overall advisor) for the project. The students and I will provide the technical expertise to carry out the project. The students will of course do most of the heavy lifting work as well.
Peer-reviewed publications (n=9):

Morelli, K.M., L.B. Brown, and G.L. Warren. NSAID impact on acute skeletal muscle injury: A systematic review and meta-analysis. Am. J. Sports Med. In press.

Warren, G.L., J.A. Call, A.K. Farthing, and B. Baadom-Piaro. Minimal evidence for a secondary loss of strength after an acute muscle injury: A systematic review and meta-analysis. Sports Med. Epub ahead of print. DOI: 10.1007/s40279-016-0528-7.

Morelli, K.M., M. Carrelli, M.A. Nunez, C. Smith, and G.L. Warren. Addition of hip exercises to treatment of patellofemoral pain syndrome: A meta-analysis. World J. Meta-Anal. 3: 118-124, 2015.

Novotny, S.A., G.L. Warren, and M.W. Hamrick. Aging and the muscle-bone relationship. Physiology. 30: 8-16, 2015.

Chen, Y.P., S. Pope, D. Tyler, and G.L. Warren. Effectiveness of constraint-induced movement therapy on upper-extremity function in children with cerebral palsy: A systematic review and meta-analysis of randomized controlled trials. Clin. Rehab. 10: 938-953, 2014.

Sawyer, A.M., S.K. Martinez, and G.L. Warren. Impact of yoga on low back pain and function: a systematic review and meta-analysis. J. Yoga Phys. Ther. 2:120, 2012. doi:10.4172/2157-7595.1000120.

Kressler, J., M. Millard-Stafford, and G.L. Warren. Quercetin improves endurance exercise capacity: a systematic review and meta-analysis. Med. Sci. Sports Exerc. 43: 2396-2404, 2011.

Warren, G.L., N.D. Park, R.D. Maresca, K.I. McKibans, and M.L. Millard-Stafford. Effect of caffeine ingestion on muscular strength and endurance: a meta-analysis. Med. Sci. Sports Exerc. 42: 1375-1387, 2010.

Greising, S.M., K.A. Baltgalvis, D.A. Lowe, and G.L. Warren. Hormone therapy and skeletal muscle strength: a meta‑analysis. J. Gerontol. A Biol. Sci. Med. Sci. 64: 1071-1081, 2009.

Presentations at professional conferences (n=22):

 

Hedrick, S., J. Sonderagard, D. Sams, J.P. Irwin, K.M. Morelli, and G.L. Warren. Effect of Kinesio tape on shoulder and knee pain with functional activity: a systematic review and meta-analysis. Annual meeting of the South Carolina Chapter of the American Physical Therapy Association, Charleston, SC, 2016.

Derr, P., S. Schwartz, K.M. Morelli, and G.L. Warren. The effectiveness of thoracic manipulation on shoulder pain. Annual meeting of the South Carolina Chapter of the American Physical Therapy Association, Charleston, SC, 2016.

Nguyen, T., O. Ece-Tufan, Y.P. Chen, and G.L. Warren. The effectiveness of the use of body weight support in treatment of children with cerebral palsy: a systematic review and meta-analysis. Annual meeting of the South Carolina Chapter of the American Physical Therapy Association, Charleston, SC, 2016.

Smelser, D.P., K.L. Robbins, P.M. Hopkins, G.L. Warren, and J.P. Irwin. Effectiveness of taping for reducing pain in patients with plantar fasciitis: A systematic review and meta-analysis. Annual meeting of the Southeast Chapter of the American College of Sports Medicine, 43rd annual meeting, Greenville, SC, 2016.

Dreyer, J., S. Shah, A.L. Lorio, and G.L. Warren. Enhancing outcomes for patients post-stroke: a meta-analysis comparing aquatic and land-based physical therapy. Fall meeting of the Physical Therapy Association of Georgia, Pine Mountain, GA, 2015.

Nguyen, T., O. Ece-Tufan, Y.P. Chen, and G.L. Warren. The effectiveness of the use of body weight support in treatment of children with cerebral palsy: a systematic review and meta-analysis. Fall meeting of the Physical Therapy Association of Georgia, Pine Mountain, GA, 2015.

Tsai, R., A. Farquharson, J.D. Garcia, and G.L. Warren. Effect of balance training in individuals with ankle instability: a systematic review and meta-analysis. Annual meeting of the American College of Sports Medicine, Orlando, FL, 2014.

Stewart, L.M., G.L. Warren, A.J. Butler, and L. Rogers. A systematic review and meta-analysis of the impact on urinary incontinence symptoms when abdominal muscles are trained concurrently with pelvic floor muscles. Annual meeting of the South Carolina Chapter of the American Physical Therapy Association, Myrtle Beach, SC, 2013.

Brown, L.B., B. Adler, K.M. Morelli, and G.L. Warren. Effect of NSAID use on muscle injury: a systematic review and meta-analysis. 2nd Annual Regenerative Rehabilitation Symposium, Pittsburgh, PA, 2012.

Van Winkle, K., M. Lasiy, S. Poblano, K.M. Morelli, and G.L. Warren. The effect of FES cycling on bone mineral density of patients with spinal cord injury: a meta-analysis. Fall meeting of the Physical Therapy Association of Georgia, Dahlonega, GA, 2012.

Adler, B., L.B. Brown, K.M. Morelli, and G.L. Warren. Effect of NSAID use on muscle injury: a systematic review and meta-analysis. Annual meeting of the American College of Sports Medicine, San Francisco, CA 2012.

Warren, G.L., A.K. Farthing, B.B. Piaro, S.R. Coley, C.W. Satterfield, C.D. Vlahos, and J.E. Lewis. Does a secondary loss of strength occur following induction of muscle injury? Annual meeting of the American College of Sports Medicine, San Francisco, CA 2012.

Capps, K., B. Espy, C. Hiers, and G. Warren. Is hospital length of stay different between unilateral and bilateral arthroplasty in the lower extremity? A systematic review and meta-analysis. Annual meeting of the South Carolina Chapter of the American Physical Therapy Association, Greenville, SC, 2012.

Brown, S., E. Dashiell, P. King and G. Warren. The restorative effects of MIRE (monochromatic near-infrared energy) therapy on lower extremity sensation in patients with diagnosed peripheral neuropathy: a systematic review and meta-analysis. Annual meeting of the South Carolina Chapter of the American Physical Therapy Association, Greenville, SC, 2012.

Fuller, N., C. Hobby, J.B. Williams, and G.L. Warren. Effects of proprioceptive neuromuscular facilitation on athletic performance: a systematic review and meta-analysis. Fall meeting of the Physical Therapy Association of Georgia, Dahlonega, GA, 2011.

Pope, S., D. Tyler, Y.P. Chen, and G.L. Warren. Efficacy of constraint-induced movement therapy (CIMT) on the pediatric population with cerebral palsy: a systematic review and meta-analysis. Fall meeting of the Physical Therapy Association of Georgia, Dahlonega, GA, 2011.

Cornell, B., M. Jackson, R. Canecchio, and G.L. Warren. Effect of thoracic manipulation on neck pain and function: a meta-analysis. Fall meeting of the Physical Therapy Association of Georgia, Dahlonega, GA, 2011.

Dukes, R.E., J.M. Kalmbach, R.R. Warren, G.L. Warren, Y.T. Wang, and J.E. Lewis. A comparison of barefoot running versus shod running on peak impact force and ankle excursion: a systematic review and meta-analysis. Fall meeting of the Physical Therapy Association of Georgia, Dahlonega, GA, 2011.

Sawyer, A., S. Martinez, and G.L. Warren. Impact of yoga on low back pain and function: a systematic review and meta-analysis. Fall meeting of the Physical Therapy Association of Georgia, Dahlonega, GA, 2011.

Morrison, S., S. Holness, C. Stinson, and G.L. Warren. Open kinetic chain vs. closed kinetic chain exercise in the treatment of patients with ACL injuries: a meta-analysis. Fall meeting of the Physical Therapy Association of Georgia, Dahlonega, GA, 2011.

Kressler, J., M. Millard-Stafford, and G.L. Warren. Quercetin improves aerobic capacity and endurance performance: a meta-analysis. Joint meeting of the American Physiological Society and the American College of Sports Medicine, Miami, FL, 2010.

McKibans, K., R. Maresca, N. Park, and G.L. Warren. Effect of caffeine on muscular performance: a meta‑analysis. Spring meeting of the Physical Therapy Association of Georgia, Savannah, GA, 2008.

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