Systematic Review and Network Analysis Process Diagram
Welcome to the interactive process map.
This tool was developed by the St. Michael’s hospital KT program. We have a defined and rigorous process for all our systematic reviews.
This process map takes you through the steps to conduct a systematic review. Click on the individual steps for more information about each step.

Develop Research Question using PICOST
• Population of interest
• Intervention to examine
• Comparator(s)
• Outcome of interest
• Study design(s)
• Time limitations
Additional Resources
Popping the (PICO) question in research and evidence- based practice. Stone PW. 2002. Appl Nurs Res.
Formulating questions and locating primary studies for inclusion in systematic reviews. Counsell C. 1997. Ann Intern Med.
Determine Eligibility Criteria
• Develop a research question based on PICOST
Additional Resources
Plan Literature Search
• Ask a librarian to develop the search to ensure relevant keywords and search strategies are used for a comprehensive search; peer-review by another librarian
Additional Resources
Cochrane Handbook Section 2.6.4: Designing search strategies
Perform Literature Search
• Search at least two databases, difficult to locate or “grey” literature, hand search key journals, ask experts, and scan reference lists
Additional Resources
Cochrane Handbook Section 2.6.2: Sources to search
CADTH: Grey matters: a practical search tool for evidence-based medicine
Starting a Systematic Review
• Identify knowledge gap and research question with knowledge users
• Involve key stakeholders during the review process (i.e. integrated knowledge translation)
Additional Resources
Cochrane Handbook Section 1.2.1: The need for systematic reviews
Cochrane Handbook Section 1.2.2: What is a systematic review
Centre for Reviews and Dissemination: 1.1.1 Is a review required?
CIHR Guide to Knowledge Translation
The art and science of knowledge synthesis. Tricco AC et al. 2011. J Clin Epidemiol.
Systematic reviews from astronomy to zoology: myths and misconceptions. Petticrew M. 2001. BMJ.
Level 1 Screening: Titles and Abstracts
• Pilot test to assess accuracy and usability of eligibility criteria developed for the Level 1 screening process with a small sample of studies
• Screening of all titles and abstracts by two independent reviewers. Conflicts usually resolved by discussion
Additional Resources
Cochrane Handbook Section 2.7.2: Selecting studies
Centre for Reviews and Dissemination: 1.3.2 Study Selection
Identifying relevant studies for systematic reviews. Dickersin et al. 1994. BMJ.
Oxman AD, Guyatt GH. The science of reviewing research. 1993. Ann N Y Acad Sci.
Level 2 Screening: Full Text Articles
• Pilot test to assess accuracy and usability of eligibility criteria developed for the Level 2 screening process with a small sample of studies
• Screening of all full text articles by two independent reviewers. Conflicts usually resolved by discussion
Additional Resources
Develop Data Abstraction Form
• Pilot test the form on a small sample of studies to ensure it captures all relevant information from the studies. Revise forms as necessary
Additional Resources
Cochrane Handbook Section 2.7.3: What data to collect
Cochrane Handbook Section 2.7.5: Data collection forms
Centre for Reviews and Dissemination: 1.3.3 Data extraction
Abstract Data
• Two reviewers abstract data independently and assess study quality. Conflicts usually resolved by discussion
Additional Resources
Cochrane Handbook Section 2.7.6: Extracting data from reports
Cochrane Handbook Section 2.7.7: Extracting study results and converting to the desired format
Cochrane Handbook: Part 2, Chapter 7, Sections 7.3-7.9: Collecting data
Critical Appraisal and Assessment
• Critical appraisal is the assessment of evidence by systematically reviewing its relevance, validity, and results.
Additional Resources
Cochrane Handbook Section 2.12.2: Assessing the quality of a body of evidence
Cochrane Handbook Section 2.8: Assessing risk of bias in included studies
Centre for Reviews and Dissemination: 1.3.4 Quality Assessment
Critical Appraisals Skills Programme (CASP)
Summarize Study and Patient Characteristics
• Use tables and text to describe study and patient characteristics
Additional Resources
Cochrane Handbook Section 2.11.2.2: Characteristics of included studies tables
Synthesize the Results
• Based on your research question and the available data, choose the appropriate method to synthesize your findings
• This may include:
- Meta-analysis
- Network meta-analysis (NMA)
- Individual patient data NMA
- Qualitative synthesis methods
Additional Resources
Cochrane Handbook Section 2.9: Analysing data and undertaking meta-analysis
Cochrane Handbook Section 3.16.6: Indirect comparisons and multiple-treatments meta-analysis
Cochrane Handbook Section 3.20: Qualitative research and Cochrane reviews
Centre for Reviews and Dissemination: 1.3.5 Data Synthesis Module 12.4
The statistical basis of meta-analysis. Fleiss JL. 1993. Stat Methods Med Res.
Meta-analysis: formulating, evaluating, combining, and reporting. S-L. Normand. 1999. Stat Med.
Bias in meta-analytic research. Felson DT. 1992. J Clin Epidemiol.
Presentation of Results
Additional Resources
Cochrane Handbook Section 2.11: Presenting results and ‘Summary of findings’ tables
Cochrane Handbook: Part 2, Chapter 12: Interpreting results and drawing conclusions file
Centre for Reviews and Dissemination: 1.3.6.3 Formulating the discussion file
Centre for Reviews and Dissemination: 1.3.6.4 Conclusions, implications, recommendations file
How can we improve the interpretation of systematic reviews? Tricco et al. 2011. BMC Med.
Prepare Manuscript
• Include background, methods, results, and discussion; may involve key stakeholders/audience
Additional Resources
Cochrane Handbook Section 2.11: Presenting results and ‘Summary of findings’ tables
Cochrane Handbook Section 2.12: Interpreting results and drawing conclusions
End-of-Review Knowledge Translation
• For example: Conference presentations, Key opinion meetings, Peer-reviewed publications
Additional Resources
CIHR Guide to Knowledge Translation
Moving knowledge to action through dissemination and exchange. Gagnon ML. 2011. J Clin Epidemiol.
Systematic Review Protocol Development
Systematic Review Protocol Development based on the PRISMA statement
Additional Resources
Cochrane Handbook Section 2.1: Rationale for protocols
Cochrane Handbook Section 2.2.2 Outline of a protocol for a Cochrane review