The Difference Between a Systematic Review and Methodology

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• Open Access
• Published: xix November 2018

Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach

• Micah D. J. Peters¹,
• Cindy Stern¹,
• Catalin Tufanaru¹,
• Alexa McArthur^ane &
• Edoardo Aromataris^ane

BMC Medical Research Methodology volume eighteen, Article number:143 (2018) Cite this article

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Abstract

Background

Scoping reviews are a relatively new approach to testify synthesis and currently there exists piddling guidance regarding the decision to choose between a systematic review or scoping review approach when synthesising show. The purpose of this article is to clearly describe the differences in indications between scoping reviews and systematic reviews and to provide guidance for when a scoping review is (and is not) appropriate.

Results

Researchers may conduct scoping reviews instead of systematic reviews where the purpose of the review is to identify knowledge gaps, scope a trunk of literature, analyze concepts or to investigate enquiry deport. While useful in their own right, scoping reviews may also exist helpful precursors to systematic reviews and can be used to confirm the relevance of inclusion criteria and potential questions.

Conclusions

Scoping reviews are a useful tool in the ever increasing armory of evidence synthesis approaches. Although conducted for dissimilar purposes compared to systematic reviews, scoping reviews withal require rigorous and transparent methods in their behave to ensure that the results are trustworthy. Our hope is that with clear guidance available regarding whether to conduct a scoping review or a systematic review, in that location volition be less scoping reviews being performed for inappropriate indications better served by a systematic review, and vice-versa.

Peer Review reports

Groundwork

Systematic reviews in healthcare began to appear in publication in the 1970s and 1980s [ane, 2]. With the emergence of groups such as Cochrane and the Joanna Briggs Institute (JBI) in the 1990s [iii], reviews have exploded in popularity both in terms of the number conducted [1], and their uptake to inform policy and practice. Today, systematic reviews are conducted for a wide range of purposes across diverse fields of inquiry, different evidence types and for different questions [4]. More recently, the field of evidence synthesis has seen the emergence of scoping reviews, which are similar to systematic reviews in that they follow a structured process, however they are performed for dissimilar reasons and have some key methodological differences [v,half dozen,7,8]. Scoping reviews are now seen as a valid approach in those circumstances where systematic reviews are unable to meet the necessary objectives or requirements of cognition users. There at present exists articulate guidance regarding the definition of scoping reviews, how to behave scoping reviews and the steps involved in the scoping review process [6, viii]. Withal, the guidance regarding the key indications or reasons why reviewers may cull to follow a scoping review approach is not as straightforward, with scoping reviews often conducted for purposes that exercise not marshal with the original indications equally proposed by Arksey and O'Malley [5,6,seven,8,ix,10]. As editors and peer reviewers for various journals we have noticed that there is inconsistency and confusion regarding the indications for scoping reviews and a lack of clarity for authors regarding when a scoping review should be performed as opposed to a systematic review. The purpose of this commodity is to provide applied guidance for reviewers on when to perform a systematic review or a scoping review, supported with some key examples.

Indications for systematic reviews

Systematic reviews can be broadly defined as a type of research synthesis that are conducted by review groups with specialized skills, who ready out to place and retrieve international evidence that is relevant to a particular question or questions and to appraise and synthesize the results of this search to inform practice, policy and in some cases, further research [11,12,13]. According to the Cochrane handbook, a systematic review 'uses explicit, systematic methods that are selected with a view to minimizing bias, thus providing more than reliable findings from which conclusions can be fatigued and decisions made.' [14] Systematic reviews follow a structured and pre-defined process that requires rigorous methods to ensure that the results are both reliable and meaningful to stop users. These reviews may be considered the colonnade of show-based healthcare [15] and are widely used to inform the development of trustworthy clinical guidelines [11, 16, 17].

A systematic review may be undertaken to ostend or refute whether or not current practice is based on relevant evidence, to establish the quality of that evidence, and to accost any incertitude or variation in practice that may be occurring. Such variations in exercise may be due to conflicting testify and undertaking a systematic review should (hopefully) resolve such conflicts. Conducting a systematic review may also identify gaps, deficiencies, and trends in the current evidence and tin help underpin and inform time to come research in the area. Systematic reviews can be used to produce statements to guide clinical decision-making, the delivery of care, every bit well as policy evolution [12]. Broadly, indications for systematic reviews are equally follows [4]:

1. 1.

   Uncover the international show

2. 2.

   Confirm electric current practice/ address any variation/ identify new practices

3. 3.

   Place and inform areas for future research

4. 4.

   Identify and investigate alien results

5. 5.

   Produce statements to guide decision-making

Despite the utility of systematic reviews to accost the to a higher place indications, at that place are cases where systematic reviews are unable to run into the necessary objectives or requirements of noesis users or where a methodologically robust and structured preliminary searching and scoping activity may be useful to inform the conduct of the systematic reviews. As such, scoping reviews (which are also sometimes called scoping exercises/scoping studies) [8] have emerged as a valid approach with rather different indications to those for systematic reviews. It is important to note hither that other approaches to evidence synthesis have besides emerged, including realist reviews, mixed methods reviews, concept analyses and others [four, 18,xix,20]. This commodity focuses specifically on the selection between a systematic review or scoping review approach.

Indications for scoping reviews

True to their name, scoping reviews are an ideal tool to determine the scope or coverage of a torso of literature on a given topic and requite clear indication of the volume of literature and studies available equally well as an overview (broad or detailed) of its focus. Scoping reviews are useful for examining emerging evidence when information technology is even so unclear what other, more specific questions can be posed and valuably addressed by a more precise systematic review [21]. They can report on the types of evidence that address and inform do in the field and the way the inquiry has been conducted.

The general purpose for conducting scoping reviews is to place and map the available bear witness [five, 22]. Arskey and O'Malley, authors of the seminal paper describing a framework for scoping reviews, provided iv specific reasons why a scoping review may exist conducted [5,half dozen,vii, 22]. Soon after, Levac, Colquhoun and O'Brien further clarified and extended this original framework [7]. These authors acknowledged that at the time, there was no universally recognized definition of scoping reviews nor a unremarkably acknowledged purpose or indication for conducting them. In 2015, a methodological working group of the JBI produced formal guidance for conducting scoping reviews [6]. Nevertheless, we have not previously addressed and expanded upon the indications for scoping reviews. Below, we build upon previously described indications and propose the following purposes for conducting a scoping review:

• To identify the types of available testify in a given field

• To clarify key concepts/ definitions in the literature

• To examine how research is conducted on a certain topic or field

• To identify cardinal characteristics or factors related to a concept

• As a forerunner to a systematic review

• To identify and analyse knowledge gaps

Deciding between a systematic review and a scoping review approach

Authors deciding betwixt the systematic review or scoping review approach should carefully consider the indications discussed above for each synthesis type and determine exactly what question they are asking and what purpose they are trying to achieve with their review. We propose that the most important consideration is whether or not the authors wish to apply the results of their review to reply a clinically meaningful question or provide evidence to inform practise. If the authors have a question addressing the feasibility, appropriateness, meaningfulness or effectiveness of a certain handling or practice, and so a systematic review is likely the most valid approach [11, 23]. Still, authors do non ever wish to ask such single or precise questions, and may be more than interested in the identification of certain characteristics/concepts in papers or studies, and in the mapping, reporting or word of these characteristics/concepts. In these cases, a scoping review is the meliorate option.

As scoping reviews do not aim to produce a critically appraised and synthesised result/reply to a particular question, and rather aim to provide an overview or map of the evidence. Due to this, an assessment of methodological limitations or gamble of bias of the testify included within a scoping review is generally not performed (unless there is a specific requirement due to the nature of the scoping review aim) [6]. Given this assessment of bias is not conducted, the implications for practise (from a clinical or policy making point of view) that arise from a scoping review are quite unlike compared to those of a systematic review. In some cases, there may exist no demand or impetus to make implications for practice and if there is a need to do so, these implications may be significantly limited in terms of providing concrete guidance from a clinical or policy making point of view. Conversely, when we compare this to systematic reviews, the provision of implications for practise is a key characteristic of systematic reviews and is recommended in reporting guidelines for systematic reviews [13].

Exemplars for different scoping review indications

In the following section, we elaborate on each of the indications listed for scoping reviews and provide a number of examples for authors considering a scoping review approach.

To identify the types of available prove in a given field

Scoping reviews that seek to identify the types of evidence in a given field share similarities with evidence mapping activities as explained past Bragge and colleagues in a newspaper on conducting scoping enquiry in wide topic areas [24]. Chambers and colleagues [25] conducted a scoping review in lodge to identify electric current cognition translation resources (and whatever evaluations of them) that use, suit and present findings from systematic reviews to adapt the needs of policy makers. Post-obit a comprehensive search across a range of databases, organizational websites and briefing abstract repositories based upon predetermined inclusion criteria, the authors identified 20 knowledge translation resources which they classified into three different types (overviews, summaries and policy briefs) every bit well equally seven published and unpublished evaluations. The authors concluded that evidence synthesists produce a range of resource to aid policy makers to transfer and apply the findings of systematic reviews and that focussed summaries are the well-nigh mutual. Similarly, a scoping review was conducted past Challen and colleagues [26] in order to decide the types of available evidence identifying the source and quality of publications and grey literature for emergency planning. A comprehensive set of databases and websites were investigated and 1603 relevant sources of bear witness were identified mainly addressing emergency planning and response with fewer sources concerned with hazard analysis, mitigation and capability assessment. Based on the results of the review, the authors concluded that while in that location is a large body of evidence in the field, issues with its generalizability and validity are as even so largely unknown and that the verbal type and course of testify that would be valuable to cognition users in the field is not all the same understood.

To clarify key concepts/definitions in the literature

Scoping reviews are often performed to examine and clarify definitions that are used in the literature. A scoping review by Schaink and colleagues²⁷ was performed to investigate how the notion of "patient complexity" had been defined, classified, and understood in the existing literature. A systematic search of healthcare databases was conducted. Manufactures were assessed to decide whether they met the inclusion criteria and the findings of included articles were grouped into five health dimensions. An overview of how complication has been described was presented, including the varying definitions and interpretations of the term. The results of the scoping review enabled the authors to then develop a complexity framework or model to assist in defining and understanding patient complication [27].

Hines et al. [28] provide a farther case where a scoping review has been conducted to define a concept, in this case the condition bronchopulmonary dysplasia. The authors revealed meaning variation in how the status was defined across the literature, prompting the authors to call for a 'comprehensive and evidence-based definition'. [28]

To examine how inquiry is conducted on a certain topic

Scoping reviews can be useful tools to investigate the design and bear of enquiry on a particular topic. A scoping review by Callary and colleagues²⁹ investigated the methodological design of studies assessing clothing of a certain type of hip replacement (highly crosslinked polyethylene acetabular components) [29]. The aim of the scoping review was to survey the literature to make up one's mind how data pertinent to the measurement of hip replacement wear had been reported in chief studies and whether the methods were like enough to allow for comparison beyond studies. The scoping review revealed that the methods to appraise wear (radiostereometric analysis) varied significantly with many dissimilar approaches being employed among the investigators. The results of the scoping review led to the authors recommending enhanced standardization in measurements and methods for futurity research in this field [29].

At that place are other examples of scoping reviews investigating research methodology, with perhaps the nearly pertinent examples beingness two recent scoping reviews of scoping review methods [nine, 10]. Both of these scoping reviews investigated how scoping reviews had been reported and conducted, with both advocating for a demand for clear guidance to improve standardization of methods [9, 10]. Similarly, a scoping review investigating methodology was conducted by Tricco and colleagues^xxx on rapid review methods that have been evaluated, compared, used or described in the literature. A diverseness of rapid review approaches were identified with many instances of poor reporting identified. The authors called for prospective studies to compare results presented by rapid reviews versus systematic reviews.

To identify key characteristics or factors related to a concept

Scoping reviews tin be conducted to place and examine characteristics or factors related to a particular concept. Harfield and colleagues (2015) conducted a scoping review to identify the characteristics of indigenous primary healthcare service delivery models [30,31,32]. A systematic search was conducted, followed past screening and study selection. Once relevant studies had been identified, a process of data extraction commenced to extract characteristics referred to in the included papers. Over k findings were eventually grouped into eight key factors (attainable health services, community participation, culturally appropriate and skilled workforce, civilization, continuous quality improvement, flexible approaches to care, holistic health care, self-determination and empowerment). The results of this scoping review have been able to inform a best do model for indigenous primary healthcare services.

As a precursor to a systematic review

Scoping reviews conducted equally precursors to systematic reviews may enable authors to identify the nature of a broad field of prove and so that ensuing reviews can be bodacious of locating adequate numbers of relevant studies for inclusion. They also enable the relevant outcomes and target grouping or population for example for a particular intervention to be identified. This tin have particular practical benefits for review teams undertaking reviews on less familiar topics and tin can assist the team to avoid undertaking an "empty" review [33]. Scoping reviews of this kind may help reviewers to develop and confirm their a priori inclusion criteria and ensure that the questions to be posed by their subsequent systematic review are able to exist answered by available, relevant evidence. In this way, systematic reviews are able to be underpinned by a preliminary and evidence-based scoping stage.

A scoping review deputed by the United Kingdom Department for International Development was undertaken to decide the scope and nature of literature on people's experiences of microfinance. The results of this scoping review were used to inform the development of targeted systematic review questions that focussed upon areas of particular interest [34].

In their recent scoping review on the behave and reporting of scoping reviews, Tricco and colleagues¹⁰ reveal only 12% of scoping reviews independent recommendations for the development of ensuing systematic reviews, suggesting that the bulk of scoping review authors practise not acquit scoping reviews equally a precursor to future systematic reviews.

To identify and analyze gaps in the cognition base

Scoping reviews are rarely solely conducted to simply identify and clarify gaps present in a given cognition base of operations, as examination and presentation of what hasn't been investigated or reported by and large requires exhaustive examination of all of what is available. In whatever case, because scoping reviews tend to be a useful approach for reviewing show chop-chop in emerging fields or topics, identification and analysis of cognition gaps is a common and valuable indication for conducting a scoping review. A scoping review was recently conducted to review electric current inquiry and place knowledge gaps on the topic of "occupational residue", or the balance of piece of work, remainder, sleep, and play [35]. Following a systematic search across a range of relevant databases, included studies were selected and in line with predetermined inclusion criteria, were described and mapped to provide both an overall motion picture of the current land of the prove in the field and to place and highlight cognition gaps in the area. The results of the scoping review immune the authors to illustrate several inquiry 'gaps', including the absenteeism of studies conducted exterior of western societies, the lack of knowledge around peoples' levels of occupational balance, likewise as a dearth of testify regarding how occupational balance may be enhanced. Equally with other scoping reviews focussed upon identifying and analyzing noesis gaps, results such equally these let for the identification of future inquiry initiatives.

Discussion

Scoping reviews are now seen as a valid review approach for certain indications. A key difference between scoping reviews and systematic reviews is that in terms of a review question, a scoping review volition have a broader "scope" than traditional systematic reviews with correspondingly more expansive inclusion criteria. In addition, scoping reviews differ from systematic reviews in their overriding purpose. We accept previously recommended the employ of the PCC mnemonic (Population, Concept and Context) to guide question development [36]. The importance of clearly defining the cardinal questions and objectives of a scoping review has been discussed previously by one of the authors, as a lack of clarity tin can result in difficulties encountered later on in the review procedure [36].

Because their differences from systematic reviews, scoping reviews should still not be dislocated with traditional literature reviews. Traditional literature reviews have been used equally a means to summarise various publications or enquiry on a detail topic for many years. In these traditional reviews, authors examine research reports in addition to conceptual or theoretical literature that focuses on the history, importance, and commonage thinking around a topic, consequence or concept. These types of reviews can be considered subjective, due to their substantial reliance on the author's pre-exiting knowledge and experience and as they do not normally present an unbiased, exhaustive and systematic summary of a topic [12]. Regardless of some of these limitations, traditional literature reviews may still take some employ in terms of providing an overview of a topic or issue. Scoping reviews provide a useful culling to literature reviews when clarification around a concept or theory is required. If traditional literature reviews are contrasted with scoping reviews, the latter [vi]:

• Are informed by an a priori protocol

• Are systematic and often include exhaustive searching for information

• Aim to be transparent and reproducible

• Include steps to reduce error and increase reliability (such as the inclusion of multiple reviewers)

• Ensure data is extracted and presented in a structured mode

Another approach to evidence synthesis that has emerged recently is the production of testify maps [37]. The purpose of these evidence maps is similar to scoping reviews to place and analyse gaps in the knowledge base [37, 38]. In fact, most bear witness mapping articles cite seminal scoping review guidance for their methods [38]. The two approaches therefore accept many similarities, with maybe the most prominent difference being the product of a visual database or schematic (i.eastward. map) which assists the user in interpreting where bear witness exists and where in that location are gaps [38]. As Miake-Lye states, at this stage 'it is difficult to make up one's mind where one method ends and the other begins.' [38] Both approaches may be valid when the indication is for determining the extent of evidence on a item topic, especially when highlighting gaps in the enquiry.

A further popular method to define and scope concepts, particularly in nursing, is through the behave of a concept assay [39,40,41,42]. Formal concept analysis is 'a process whereby concepts are logically and systematically investigated to grade clear and rigorously constructed conceptual definitions,' [42] which is like to scoping reviews where the indication is to clarify concepts in the literature. There is limited methodological guidance on how to bear a concept analysis and recently they take been critiqued for having no impact on do [39]. In our opinion, scoping reviews (where the purpose is to systematically investigate a concept in the literature) offer a methodologically rigorous alternative to concept analysis with their results perhaps being more than useful to inform practice.

Comparing and contrasting the characteristics of traditional literature reviews, scoping reviews and systematic reviews may help clarify the true essence of these different types of reviews (see Tabular array 1).

Table 1 Defining characteristics of traditional literature reviews, scoping reviews and systematic reviews

Total size table

Rapid reviews are another emerging type of prove synthesis and a substantial corporeality of literature have addressed these types of reviews [43,44,45,46,47]. There are various definitions for rapid reviews, and for simplification purposes, nosotros define these review types as 'systematic reviews with shortcuts.' In this newspaper, we have not discussed the choice betwixt a rapid or systematic review arroyo every bit we are of the opinion that perhaps the major consideration for conducting a rapid review (as compared to a systematic or scoping review) is not the purpose/question itself, simply the feasibility of conducting a total review given financial/resources limitations and fourth dimension pressures. As such, a rapid review could potentially be conducted for whatever of the indications listed above for the scoping or systematic review, whilst shortening or skipping entirely some steps in the standard systematic or scoping review procedure.

At that place is some overlap across the half-dozen listed purposes for conducting a scoping review described in this newspaper. For example, it is logical to presume that if a review grouping were aiming to place the types of available evidence in a field they would likewise be interested in identifying and analysing gaps in the knowledge base. Other combinations of purposes for scoping reviews would likewise make sense for certain questions/aims. However, we have chosen to listing them equally discrete reasons in this paper in an effort to provide some much needed clarity on the advisable purposes for conducting scoping reviews. As such, scoping review authors should not interpret our list of indications as a discrete list where simply ane purpose can be identified.

It is important to mention some potential abuses of scoping reviews. Reviewers may conduct a scoping review as an culling to a systematic review in order to avoid the critical appraisement phase of the review and expedite the procedure, thinking that a scoping review may exist easier than a systematic review to acquit. Other reviewers may conduct a scoping review in order to 'map' the literature when there is no obvious need for 'mapping' in this item subject area. Others may conduct a scoping review with very broad questions as an alternative to investing the time and effort required to craft the necessary specific questions required for undertaking a systematic review. In these cases, scoping reviews are non appropriate and authors should refer to our guidance regarding whether they should exist conducting a systematic review instead.

This article provides some clarification on when to conduct a scoping review every bit compared to a systematic review and clear guidance on the purposes for conducting a scoping review. We hope that this newspaper volition provide a useful improver to this evolving methodology and encourage others to review, modify and build upon these indications every bit the approach matures. Further work in scoping review methods is required, with perhaps the most important advocacy being the recent development of an extension to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for scoping reviews [48] and the development of software and preparation programs to back up these reviews [49, l]. As the methodology advances, guidance for scoping reviews (such every bit that included in the Joanna Briggs Institute Reviewer'south Transmission) volition crave revision, refining and updating.

Decision

Scoping reviews are a useful tool in the ever increasing arsenal of evidence synthesis approaches. Researchers may preference the behave of a scoping review over a systematic review where the purpose of the review is to identify knowledge gaps, scope a body of literature, clarify concepts, investigate research comport, or to inform a systematic review. Although conducted for different purposes compared to systematic reviews, scoping reviews however require rigorous and transparent methods in their conduct to ensure that the results are trustworthy. Our promise is that with articulate guidance bachelor regarding whether to conduct a scoping review or a systematic review, there will exist less scoping reviews being performed for inappropriate indications meliorate served by a systematic review, and vice-versa.

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1. The Joanna Briggs Institute, The University of Adelaide, 55 Rex William Road, North Adelaide, 5005, Due south Commonwealth of australia

   Zachary Munn, Micah D. J. Peters, Cindy Stern, Catalin Tufanaru, Alexa McArthur & Edoardo Aromataris

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ZM: Led the development of this paper and conceptualised the thought for a newspaper on indications for scoping reviews. Provided final approving for submission. MP: Contributed conceptually to the newspaper and wrote sections of the newspaper. Provided final approving for submission. CS: Contributed conceptually to the paper and wrote sections of the paper. Provided final approval for submission. CT: Contributed conceptually to the newspaper and wrote sections of the paper. Provided concluding blessing for submission. AM: Contributed conceptually to the paper and reviewed and provided feedback on all drafts. Provided terminal approving for submission. EA: Contributed conceptually to the newspaper and reviewed and provided feedback on all drafts. Provided approval and encouragement for the piece of work to proceed. Provided final approval for submission.

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Correspondence to Zachary Munn.

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All the authors are members of the Joanna Briggs Institute, an evidence-based healthcare research institute which provides formal guidance regarding evidence synthesis, transfer and implementation. Zachary Munn is a member of the editorial lath of this journal. The authors have no other competing interests to declare.

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Munn, Z., Peters, M.D.J., Stern, C. et al. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol 18, 143 (2018). https://doi.org/10.1186/s12874-018-0611-x

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• Received: 21 February 2018

• Accustomed: 06 Nov 2018

• Published: 19 November 2018

• DOI : https://doi.org/x.1186/s12874-018-0611-ten

Keywords

• Systematic review
• Scoping review
• Evidence-based healthcare

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Source: https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-018-0611-x

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