A systematic review is based on a pre-defined specific research question (Cochrane Handbook, 1.1). The first step in a systematic review is to determine its focus - you should clearly frame the question(s) the review seeks to answer (Cochrane Handbook, 2.1). It may take you a while to develop a good review question - it is an important step in your review. Well-formulated questions will guide many aspects of the review process, including determining eligibility criteria, searching for studies, collecting data from included studies, and presenting findings (Cochrane Handbook, 2.1).
The research question should be clear and focused - not too vague, too specific or too broad.
You may like to consider some of the techniques mentioned below to help you with this process. They can be useful but are not necessary for a good search strategy.
| P | I | C | O |
|---|---|---|---|
| Patient, Population | Intervention (or Exposure) | Comparison (or Control) if appropriate |
Outcome |
| Most important characteristics of patient (e.g. age, disease/condition, gender) | Main intervention (e.g. drug treatment, diagnostic/screening test) | Main alternative (e.g. placebo, standard therapy, no treatment, gold standard) | What you are trying to accomplish, measure, improve, affect (e.g. reduced mortality or morbidity, improved memory) |
We do not have access to this article at UTAS.
A variant of PICO is PICOS. S stands for Study designs. It establishes which study designs are appropriate for answering the question, e.g. randomised controlled trial (RCT). There is also PICOC (C for context) and PICOT (T for timeframe).
You may find this document on PICO / PIO / PEO useful:
| S | PI | D | E | R |
|---|---|---|---|---|
| Sample | Phenomenon of Interest | Design | Evaluation | Research type |
This article is only accessible for UTAS staff and students.
| S | P | I | C | E |
|---|---|---|---|---|
| Setting (where?) | Perspecitve (for whom?) | Intervention (what?) | Comparison (compared with what?) | Evaluation (with what result?) |
We do not have access to this article at UTAS.
| E | C | L | I | P | Se |
|---|---|---|---|---|---|
| Expectation (improvement or information or innovation) | Client group (at whom the service is aimed) | Location (where is the service located?) | Impact (outcomes) | Professionals (who is involved in providing/improving the service) | Service (for which service are you looking for information) |
This article is only accessible for UTAS staff and students.
There are many more techniques available. See the below guide from the CQUniversity Library for an extensive list:
This is the specific research question used in the example:
"Is animal-assisted therapy more effective than music therapy in managing aggressive behaviour in elderly people with dementia?"
Within this question are the four PICO concepts:
| P | elderly patients with dementia |
|---|---|
| I | animal-assisted therapy |
| C | music therapy |
| O | aggressive behaviour |
S - Study design
This is a therapy question. The best study design to answer a therapy question is a randomised controlled trial (RCT). You may decide to only include studies in the systematic review that were using a RCT, see Step 8.
