Box 81 The six steps of undertaking a systematic review

• Asking a clearly focused question

• An explicit and thorough search of the literature

• Data extraction

• Critical appraisal of the quality of the primary studies

• Quantitative pooling of the data if appropriate

• Interpretation of the data, including implications for clinical practice and further research

Not all systematic reviews and meta-analyses are equal. A systematic review should be conducted in a manner that will include all the relevant trials, minimise the introduction of bias, and synthesise the results to be as truthful and useful to clinicians as possible. A systematic review can only be as good as the clinical trials that it includes. The criteria to critically appraise systematic reviews and meta-analyses are shown in Box 8.2. In general, these criteria are similar to those used to appraise the individual studies that make up the systematic review. Detailed explanations of each criterion are available.1,7

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