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It is important to beware that systematic review methods need to be tailored to your question and the type of data you are synthesising. There are many decisions you need to take to develop a sensible and safe review question and analysis. You can not simply use the same methods repeatedly for all questions and expect them to always work and output safe advice. This is why it is essential you use the most up to date methods and analysis advice to plan, protocol and conduct your review. You can use the analysis advisor on this website, to get instant initial guidance on your analysis decision process. You may also want to arrange for a systematic review methods expert to consult with or join your review team.
Guides are continuously updated by space medicine systematic review experts. You should read through all the stages briefly as part of planning so you aware of what is coming up. All stages should factor into protocol planning.
STage one - planning
Start your review process here. Begin by defining your question. Use the overarching methods handbook to help you determine if your review will be quantitative, qualitative or an integrative (mixed methods) topic that combines both. You should pre-scope the evidence base to help you make your decisions. You can also use the analysis advisor on this website to help you refine the nature of review question(s).
Stage two - protocol Development
It is really important to make a protocol that outlines exactly how your review will be conducted. You need to define the populations, interventions, control/comparisons, outcome measures and study types you will include in your review and use these to create a systematic search strategy. You also need to explain the quality scoring tools and analysis you will run. Do not rush this step, it is easier to solve methods problems at protocol than mid-review. A protocol can also reduce bias if it is registered online so others can compare your final report with your original protocol. Please use the search advisor on this website to help you refine your full search strategy and the analysis advisor to select the safest analysis method.
STage three - quality Assessment tools
It is essential to rate the quality of the evidence you include in your systematic review. This enables comments on the state and quality of the current evidence base and ensures your final report is completely transparent regarding the quality of the data on which it is based. It is expected that all reviews will at least rate the risk of bias of included articles.
In space medicine reviews it is often not possible to use real astronaut data due to lack of controlled trials, minimal data, difficulty accessing data etc. Therefore ground based simulation studies are often used, such as bed rest, parabolic flight, isolation studies, suspension studies etc. Should you include data from ground based simulations it is important that you assess how well data from these is expected to transfer to astronauts and operational space medicine. Several of the tools here will help you do this step, but we have not yet got tools for all environments, or animal models as these still need to be developed.
Stage Four - Extraction & Anaysis
Run your search and screen results, ideally with two blinded screeners. You can use software or online tools such as Rayyan to make this process easier. Rayyan is cloud based and can aid collaboration with remote reviewers. Data is then extracted as needed for all your analyses and statistical or thematic analysis is performed to provide summary information. The analysis summarises the evidence from all the included studies. For full meta analysis you need to have controlled trials. Basic effect size analysis can be performed with within participant data. Significance vote counting might be considered with caution if better data is unavailable. There is a spreadsheet in this section ("data extraction and analysis") to help you manage you extraction and perform basic analysis, along with additional analysis tools that might be useful depending on your question and protocol.
STage five - publish your report
All completed reviews should be published in a peer reviewed scientific journal. This enables independent scrutiny of the peer reviewer. It also provides a record of your review to the global community so others can check, repeat and update the review. Publishing also provides the auditable trail from independent data sources through to space medicine operational decisions that is essential for evidence based practice.
You should write up your report to conform to 'The Preferered Reporting Items for Systematic Reviews and Meta-Analyses' (PRISMA) standards. Most journals require PRISMA standards to be followed for publication.
You should also consider any Space to Earth benefits from your review, that could be reported in your discussion.
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