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Rapid Review Protocol

What is a rapid review, step 1: form/refine question, step 2: define parameters, step 3: identify biases, step 4: plan & execute search, step 5: screen & select, step 6: quality appraisal, step 7: evidence synthesis, rapid review workbook.

For articles that will be included in your review, keep track of your findings with a review matrix. Click on the image below to view a sample review matrix:

You can also download this template as a Microsoft Excel file .

How can the Health Sciences Library Help?

Health Sciences librarians can assist you with:

• Expert literature searches
• Finding protocols
• Citation management assistance
• Organizing your rapid review findings

If your database search results in too many or too few citations, please contact us! We are trained on how to craft efficient searches.

Contact your liaison librarian to schedule a consultation.

Additional Resources

• Bibliography References cited in this research guide.
• Supplemental Resources Other resources that can assist with your rapid review.

A rapid review (or rapid evidence assessment) is a variation of a systematic review   that balances time constraints with considerations in bias.

Consider your research question. Is it focused and well-defined?

After taking into account basic considerations such as the biology and physiology of the problem, its epidemiology, and the unsatisfactory clinical performance and patient outcomes that lead to interest in the topic, Haynes 3 suggests the following to further develop a research topic:

• What is the appropriate stage for evaluation?
• Can internal validity be achieved?
• To what extent is external validity achievable?
• What will your circumstances permit?
• What can you afford?
• What is the best balance between "idea" and "feasibility"?

Alternatively, Farrugia 4  summarizes two frameworks for refining research questions, FINER and PICOT.

Determine the parameters of your literature search by answering the following questions:

What resources will you search?

Databases commonly searched at VCU include PubMed , CINAHL , Web of Science , and  PsycInfo . Embase is another good resource for institutions with access to it. Popular "grey literature" resources include  clinicaltrials.gov , NIH RePORTER ,  Dissertations and Theses , and professional associations' conference proceedings. Check our  research guides for additional resources.

What will be your inclusion/exclusion criteria?

Some criteria to consider include: time period, language,  location,  age range, animal or human studies, type of published materials (e.g. randomized-control trials, cohort studies, etc.)

What will be your screening protocol?

Things to consider include:

How many reviewers will you have and who will they be? ( The  IOM  recommends a team of 2+ reviewers for systematic reviews.) 5

If you use multiple reviewers, how will disagreements between them be settled (e.g. consensus, third-party)?

The Cochrane Handbook  (7.2.3) lists specific steps to take in the screening and selection process  that could be adapted for a rapid review. 2

How will you appraise the quality of selected studies? What  tool/rubric will you use?

Many reviews employ a system similar to that developed by the Cochrane Handbook for assessing bias in interventional studies ( Section 8.5, Table 8.5a ). 2

Many recent studies also analyze and suggest more efficient and reliable ways to assess the quality of quantitative, qualitative, and mixed methods studies.   See supplemental resources .

Critical appraisal worksheets may be useful  for a small number of studies. Some examples of these can be found on the Oxford Centre for Evidence-Based Medicine's (CEBM) website , and Duke's EBP research guide . Note whether you decide to modify these worksheets in order to save time; this may create some bias in your conclusions.

As a result of your choices in Step 2 , what biases will be introduced into your protocol? Are these biases acceptable given your time constraints?

Plan your search.

• Consult with a health sciences librarian . Some studies have shown that librarian involvement can improve the quality of reported systematic review and meta-analysis search strategies. 9,10
• Determine the best method for documenting your search (e.g. spreadsheet, etc.). 
• Select a citation management tool to use. VCU librarians can provide instruction and troubleshooting for Mendeley and Zotero, which are free to the VCU community.

Execute your search and store your citations.

Screen search results based on the criteria defined in Step 2 .

A table or worksheet is often used to keep track of the screening and review process. Sample screening worksheets: 1 , 2 , 3 .

Apply appraisal tool/rubric selected in Step 2 to identify high quality studies that  will be included in your evidence synthesis. The simplest way to track the final quality judgment will vary by tool, e.g.  1 , 2 .

Evidence summary tables are used to track important characteristics of appraised studies, including the reference, study design, sample size, and quality score. Examples of tables used to present the studies included in a review differ by the aspects listed above as well as other, e.g. 1 , 2 , 3 .  Consider creating your own review matrix (sample Excel file)   to take notes on papers that will be included in your study.

A narrative synthesis of studies that made it through the screening and quality appraisal phases is a simple, efficient way to set the stage for your own work. At a minimum, the synthesis should include:

• Study problem / purpose
• Why is the research important?
• Has it been done before?
• How will the study benefit patients, increase knowledge, or influence policy?
• What methods are most commonly used in previous studies?
• What are the most common outcomes analyzed?
• Is there a significant patient population that is not well - studied?
• What limitations were present in the existing body of research?
• What sources of bias could have been introduced in your review of literature?
• Last Updated: Nov 9, 2023 2:15 PM
• URL: https://guides.library.vcu.edu/rapidreview

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Updated recommendations for the Cochrane rapid review methods guidance for rapid reviews of effectiveness

• Related content
• Peer review
• Chantelle Garritty , adjunct professor and manager 1 2 ,
• Candyce Hamel , adjunct professor and senior epidemiologist 1 3 ,
• Marialena Trivella , research associate, senior methodologist, and assistant professor 4 5 6 ,
• Gerald Gartlehner , professor and senior health research analyst 4 7 ,
• Barbara Nussbaumer-Streit , co-director 4 ,
• Declan Devane , professor 8 ,
• Chris Kamel , director 9 ,
• Ursula Griebler , senior research associate 4 ,
• Valerie J King , professor 10
• on behalf of the Cochrane Rapid Reviews Methods Group
• 1 School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1G 5Z3, Canada
• 2 Global Health and Guidelines Division, Public Health Agency of Canada, Ottawa, ON, Canada
• 3 Canadian Association of Radiologists, Ottawa, ON, Canada
• 4 Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
• 5 Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
• 6 Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
• 7 Research Triangle Institute (RTI) International, Research Triangle Park, NC, USA
• 8 Cochrane Ireland and Evidence Synthesis Ireland, School of Nursing and Midwifery, University of Galway, Galway, Ireland
• 9 Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, ON, Canada
• 10 Center for Evidence-based Policy, Department of Family Medicine, Oregon Health and Science University (OHSU), Portland, OR, USA
• Correspondence to: C Garritty chantelle.garritty{at}uottawa.ca (or @cgarritty on Twitter)
• Accepted 2 January 2023

This article provides updated guidance on methods for conducting rapid reviews of effectiveness, targeted at Cochrane and other stakeholders interested in the methodology of rapid reviews. The guidance, developed by the Cochrane Rapid Reviews Methods Group, builds upon previous interim guidance, and incorporates changes based on an evaluation of its application, a scope of the literature on rapid review methodology, and input from a diverse group of experts in rapid review methods. The guidance consists of 24 specific recommendations supporting the conduct of rapid reviews, applicable both within and outside Cochrane. It underscores the importance of considering the appropriateness of undertaking rapid reviews and advocates for a tailored, iterative approach to each review. Key defining features of rapid reviews, such as restricted methods, how the dimension of timelines factors into rapid reviews, and the involvement of knowledge users (eg, patient and public partners, healthcare providers, policy makers), are outlined. The paper presents a definition of a Cochrane rapid review and additional considerations for rapid reviews of effectiveness to enhance the efficiency of the review process. In conclusion, the Cochrane Rapid Review Methods Group’s updated guidance, complemented by examples, seeks to guide methodological decisions in the design and conduct of rapid reviews, facilitating timely decision making in healthcare.

Summary points

This article updates the Cochrane rapid review methods guidance published in 2020 to support rapid reviews of effectiveness in the context of urgent and high priority health questions

The updated guidance incorporates new knowledge and feedback from users of the interim guidance, with input from a broader group of methodologists specialising in rapid reviews, and it is both evidence informed and user informed and widely applicable to anyone conducting a rapid review

The update clarifies key concepts underpinning rapid reviews, provides a refined list of 24 recommendations, offers supporting examples, and provides best practice considerations and practical tips for teams to increase efficiencies

The Cochrane Rapid Reviews Methods Group will continue to promote research, monitor published literature, and update recommendations to facilitate timely, evidence based decision making in healthcare

Introduction

In recent years, the Cochrane Collaboration, a global leader in producing high quality systematic reviews and methodological guidance, has taken steps to support rapid reviews. In 2020, the Cochrane Rapid Review Methods Group published interim guidance on the conduct of rapid reviews of effectiveness produced within Cochrane and beyond. 1 Guidance was developed to focus on rapid reviews of health interventions to address urgent and high priority questions. The original guidance was informed by a suite of research, including a scoping review of the underlying evidence, 2 a proposed definition of a rapid review, 3 primary meta-epidemiological studies, 4 5 and a survey of Cochrane community members who prioritised the appropriateness of rapid review methods across stages during the conduct of reviews. 1 The original guidance offered 26 recommendations, with accompanying rationales on the steps and considerations for accelerating each part of the review process. Completion of the guidance coincided with the onset of the covid-19 pandemic, which was the catalyst for the increased number of Cochrane and non-Cochrane rapid reviews conducted and published since 2020. 6 The pandemic showed the importance of expedited systematically produced evidence synthesis to address many clinical, public health, and health policy and systems related questions.

In this article, we present an update on the interim Cochrane rapid review methods guidance, integrating new knowledge on the conduct of the reviews and feedback from users of the interim guidance. We clarify key concepts underpinning rapid reviews, include a refined list of recommendations, and provide some accompanying examples, supporting information, and links to additional resources to guide methods for those interested in the methodology of rapid reviews. The decision to update the interim guidance on Cochrane rapid review methods at this juncture was driven by several critical factors. The original guidance was expedited for release during the onset of the covid-19 pandemic, ensuring timely access for Cochrane’s network of reviewers and the broader research community grappling with urgent needs for evidence synthesis. Consequently, refinement of the recommendations was temporarily halted. As stated in our interim guidance, the increase in published rapid reviews, combined with our commitment to ongoing quality improvement efforts, underscored the need to align the guidance now with the evolving landscape of rapid review methodology after the pandemic. In addition, insights gleaned from an evaluation assessing the guidance’s real world use have pinpointed areas requiring enhancement, particularly in terms of user friendliness and practicality for authors of rapid reviews with varying levels of experience. 7

This update of the Cochrane rapid review methods guidance builds upon previously published interim guidance. 1 We have also integrated findings from a formal evaluation conducted to assess authors’ adherence to and understanding of the interim Cochrane guidance and the guidance’s comprehensibility, usability, and usefulness. A complete description of the evaluation is available elsewhere. 7 This evaluation included the text analysis of 128 rapid reviews (17 Cochrane and 111 non-Cochrane) and 20 in-depth qualitative interviews. Main findings suggested that many authors did not follow certain recommendations, such as the stepwise approach to study inclusion or peer review of search strategies. However, some recommendations, such as dual independent screening of abstracts or full texts, were exceeded. Common reasons for not adhering to the guidance included time constraints, unclear recommended approaches, or inapplicability to specific rapid reviews. Overall, the guidance was considered user friendly, but it was perceived as challenging to apply without experience of conducting systematic reviews. On this basis, we identified the need to change the wording of some recommendations and to clarify others, further keeping in mind that the guidance might be used by investigators with varied experience of systematic review and rapid review methods. 7 As such, this updated guidance clarifies some defining features of rapid reviews and additional aspects to consider for Cochrane rapid reviews.

We also scanned the literature for publications related to rapid review methodology published since the initial scoping review that underpinned our interim guidance in 2020. 2 To identify potentially relevant studies, we used the option for similar articles in PubMed for every article included in the initial scoping review. We also searched PubMed using a general keyword search based on our original scoping review search strategy. We limited searches from February 2019 (the previous search) to August 2022. A total of 841 citations were then screened and 87 articles assessed for relevancy in accordance with an initial scoping review of rapid review methods 2 (see subsection w1 in the supplementary file for list of studies). Although none met the original eligibility criteria, five studies provided further insights to the search recommendations. 8 9 10 11 12

Furthermore, we assembled a broader collaborative of rapid review methodologists beyond the coauthor group, who provided specific input on proposed modifications to the guidance. Led by the Cochrane Rapid Review Methods Group, this group of experts, including a patient and public partner, has produced a multipart series to further guide methods decisions in each step of the process for rapid reviews. 13 14 15 16 The series expands on and explains in further detail what this updated methods guidance recommends.

Cochrane methods guidance considerations

Cochrane defines a systematic review as using systematic and explicit methods to identify, select, critically appraise, extract, and analyse data from all relevant research. 17 Rapid reviews also use systematic and explicit methods to appraise, extract, and analyse data. By comparison, however, specific components of the systematic review process are either restricted or omitted or the scope is narrowed for rapid reviews, to provide an evidence synthesis product more quickly. Therefore, as rapid reviews might not include all relevant studies, they may be less comprehensive. As a result, the appropriateness of undertaking a rapid review needs to be considered carefully, with a strong justification provided for using this approach instead of a systematic review, including the rationale for using restricted methods. 18 General distinctions between systematic reviews and rapid reviews have been published previously. 19 20

In updating the interim guidance, it is also important to emphasise that Cochrane rapid reviews should be driven by the need for timely evidence for decision making purposes, including addressing urgent and emergent health issues and questions deemed high priority. Additionally, when conducting a rapid review, multiple methodological paths can be taken, and no “one size fits all” approaches can be applied. Rapid reviews are tailored and therefore can vary in scope and methodology depending on time and resources available, restricted methods used (or a combination of restrictions), and the types and levels of evidence included. Although this guidance is intended as best practice advice to determine the methodological way forward when conducting a Cochrane rapid review, not every restricted method that is recommended needs to be implemented. Teams may use stricter methods, if time and resources allow, and still call it a rapid review, as discussed below.

For this update we have clarified key defining features of rapid reviews relative to systematic reviews:

Restricted methods —To accelerate the review process, it is typical for rapid reviews to introduce methodological restrictions (shortcuts or abbreviated methods). Therefore, the reviews should be well reported, highlighting the restricted methods taken to accelerate the review, the potential biases these methods may have introduced, and other limitations of the evidence base.

Dimension of time —Despite the term “rapid” being used for these reviews, time is not the sole defining feature—although rapid reviews should be conducted in a short timeline. Timelines across the reviews vary, however, depending on several factors, including the complexity of the topic or the urgency of the decision making to meet timelines, which are often short out of necessity. Importantly, the notion that rapid reviews are simply systematic reviews done faster is misleading. A rapidly conducted systematic review would still be a systematic review if authors followed stringent systematic review methodology, such as methods proposed by Cochrane. 17 Consistent with our interim guidance, we continue to endorse that Cochrane rapid reviews should take no longer than six months.

Knowledge user involvement —As decision makers typically commission rapid reviews to address specific and pressing health questions, it is common for them to be involved in the process, given the urgent nature of these inquiries. However, other important knowledge users (eg, patient and public partners, healthcare providers, and policy makers) may also be involved in shaping the rapid review. In collaboration with funders and other knowledge users, the scope of the review should be narrowed down to answer a focused question.

Cochrane rapid reviews

We recommend the following definition for a Cochrane rapid review: “A rapid review is a type of evidence synthesis that brings together and summarises information from different research studies to produce evidence for people such as the public, healthcare providers, researchers, policy makers, and funders in a systematic, resource efficient manner. This is done by speeding up the ways we plan, do, and/or share the results of conventional structured (systematic) reviews, by simplifying or omitting a variety of methods that should be clearly defined by the authors.” This definition builds upon the original definition endorsed in the interim guidance, 16 and it was modified following the input of patient and public partners as part of a recent collaborative Priority Setting Partnership on rapid reviews. 3

Additional aspects also need to be considered when applying this guidance:

Guidance for rapid reviews of effectiveness —Importantly, this guidance was developed within the context of Cochrane and focuses on rapid reviews concerning the effectiveness of health interventions, albeit it may be used for non-Cochrane reviews of effectiveness. This guidance has not yet been adapted beyond interventions of effectiveness to other question types relevant to rapid reviews (eg, rapid reviews of diagnostic test accuracy or screening, or rapid qualitative evidence synthesis) since specific review question types may pose unique methodological challenges. 21 Examples of other review question types and methodological considerations for rapid reviews can be found at https://methods.cochrane.org/rapidreviews/rr-methods-guidance/additional-methodological-considerations .

Experience of systematic reviews —Rapid review teams should include expertise from information specialists and have access to clinical experts and individuals with expert knowledge of systematic review methods, ideally available throughout the rapid review process to guide and advise on the strengths and limitations of abbreviated methods to minimise compromising validity.

Access to electronic databases and software —Rapid review teams must have adequate resources before embarking on the review. Required resources include access to electronic databases most relevant to the topic of rapid reviews (eg, Medline, CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, PsycInfo), reference management software (eg, Endnote, Zotero, RefWorks), screening software (eg, Rayyan, Covidence, DistillerSR), a virtual meeting platform (eg, Google meet, Zoom, MS Teams), and possibly other messaging applications used to facilitate timely communications and project management across the rapid review team (eg, Slack). We recommend that teams use live document platforms, as these enable real time collaboration, version control, and efficient information sharing, ultimately streamlining the review process. Some of these resources are freely available, whereas others require access through a library or academic institution or a paid user licence.

Cochrane rapid review recommendations

The Cochrane Rapid Review Methods Group has issued an updated list of 24 recommendations for Cochrane rapid reviews as outlined in table 1 , with rationales and examples to support the recommendations provided in subsection w2 of the supplementary file. Rapid review teams may apply all or some of the methodological restrictions proposed in the recommendations, depending on the topic, timeframe, and resources.

Updated guidance on methods used in Cochrane rapid reviews of effectiveness

• View inline

Topic refinement—setting the research question

Recommendation 1: Involve knowledge users to set and refine the review question, eligibility criteria, and outcomes of interest, with consultation at various stages of the review

Knowledge users are individuals or groups responsible for, or affected by, health and healthcare related decisions that rapid reviews can inform. 22 23 The term knowledge user includes but is not limited to healthcare providers and their professional associations, policy makers, patients, caregivers, patient groups, government agencies, and the public. 24 By their very nature, rapid reviews often necessitate close and intensive collaboration between researchers and decision makers, including the organisations that commissioned them. 25 However, the involvement of key knowledge users (eg, patient and public partners, healthcare providers, and policy makers) is often limited, omitted, or not reported. 26 Although meaningful involvement requires time, resources, and advanced planning given the shortened timelines of rapid reviews, involving key knowledge users when possible can enhance the relevance and applicability of the review and should be encouraged. 27 28 The STARR (SelecTing Approaches for Rapid Reviews) tool aids authors in planning approaches to rapid reviews and obtaining structured input from users through targeted questions. 29 A recent publication provides further insight on ways to involve knowledge users in the co-development of rapid reviews (eg, planning, performance, and knowledge translation of the reviews). 13 Authors of Cochrane rapid reviews should be aware of Cochrane’s new framework for consumer (patient, carer, and public) engagement and involvement 30 and should leverage the Cochrane Consumer Network to identify potential patients, carers, and the public as knowledge users. 31

Recommendation 2: Develop a protocol that includes the review questions, description of the population, interventions, comparators, outcomes, and methods of conducting the review

As you would for a systematic review, it is important to develop a protocol for the rapid review that supports the principles of transparency and reproducibility. Protocols should include the review question or questions, using a question framework such as PICOs (population-intervention-comparator-outcomes), and detail the eligibility criteria and methods that will be used for searches, study selection, data extraction, risk of bias, and synthesis. The authors of Cochrane rapid reviews must submit a completed protocol to the Cochrane central editorial service ( [email protected] ), which will undergo editorial and methodological checks. Cochrane has a streamlined workflow and protocol template to accommodate rapid reviews across priority topics (see https://covidreviews.cochrane.org/resources ) . Non-Cochrane rapid reviews may use this template as a guide. If this template is not used, protocols should be reported to the extent possible following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). 32 If the time for peer review is limited, protocols should, at a minimum, be reviewed internally for consistency and accuracy. For transparency, authors should ensure public availability of their protocol through open access platforms (eg, PROSPERO, Open Science Framework).

Recommendation 3: Clearly define the eligibility criteria, including any restrictions or limits

To ensure rapid reviews are manageable and timely, various restrictions can be applied to eligibility criteria (eg, PICOs, timing, settings, date) (see recommendations 3.1 to 3.6). Such restrictions must be considered through discussions with the rapid review team and knowledge users.

Recommendation 3.1: Limit the number of interventions and comparators —So the review is focused and manageable, the number of interventions and comparators should be limited. Any such restrictions should not impact the decision making ability of knowledge users.

Recommendation 3.2: Limit the number of outcomes, focusing on those most important for decision making —When developing the protocol, focus on outcomes that are relevant for knowledge users and important for decision making. The recommendation is to rate outcomes by importance, with seven as a maximum 33 (although fewer may be better for a rapid review, depending on available time and resources). The list of outcomes may be restricted at any point throughout the conduct of the rapid review in consultation with knowledge users. Ideally, a core set of outcome measures would be available to inform decisions on outcome selection (eg, from the Core Outcome Measures in Effectiveness Trials (COMET) Initiative 34 ). Outcomes will depend on the needs of knowledge users and should include outcomes for both potential benefits and potential harms.

Recommendation 3.3: Consider restricting the search date of the evidence base, with clinical or methodological justification provided —Although setting a date restriction is a pragmatic decision in some cases, this needs to be carefully considered for each topic. When conducting a rapid review, authors should consider the trade-offs (ie, the potential for less accuracy with the loss of studies versus workload) by different limits of a search date. 11 35 To make the right decision, authors should also assess each case individually because of variation in topics. When it is deemed important to avoid date restrictions, other approaches described in this guidance may be needed to deal with the potentially high number of search results. Regardless, rapid review teams should provide an appropriate justification if instituting date restrictions (see subsection w2 in the supplementary file). Besides, close communication with information specialists and clinical experts will help to set informed date limits. Other knowledge users may also provide insight on whether date limits are appropriate for each topic.

Recommendation 3.4: Limit the setting, with clinical or methodological justification provided —Limitations on the setting may be related to geographical areas or regions (eg, studies in the UK, low income and middle income countries, rural settings) and where the study is conducted, such as in the community or in a hospital. Any restrictions in the setting should be justified and relevant (see subsection w2 in the supplementary file) and should not impact the decision making ability of knowledge users.

Recommendation 3.5: Limit the publication language to English at study selection, with other languages added when relevant —Language restrictions during the initial search process are discouraged; we advise applying these restrictions during the study selection phase. Research suggests that excluding non-English publications from systematic reviews on clinical interventions has a minimal effect on overall conclusions and can be a viable methodological shortcut for rapid reviews. 4 We do not, however, recommend restricting to English only publications if previous knowledge suggests that studies relevant to the chosen rapid review topic may be published in languages other than English. Suppose, for example, rapid reviews are related to complementary and alternative medicine treatments. In that case, relevant studies in languages other than English would be expected, and studies published in these languages should be included in the rapid review. Ensure that any language limits are justified and clearly explained (see subsection w2 in the supplementary file).

Recommendation 3.6: Prioritise the inclusion of high quality study designs relevant to the review question or objective —Determine what levels of evidence to include and ensure the decision for this approach is well explained (see subsection w2 in the supplementary file). For example, if one or more well conducted systematic reviews has been done that address the question of the rapid review, including and updating these systematic reviews may be sufficient. Randomised controlled trials should be considered for effectiveness questions if no well conducted systematic reviews exist or do not address the PICOs sufficiently. In the absence of well conducted randomised controlled trials for effectiveness questions, or if time permits, or both, non-randomised studies may be considered. This implies that researchers should understand study designs and their characteristics, relationship to the review question or objective, and potential for bias. Importantly, systematic reviews and randomised controlled trials may not be available for new healthcare interventions—for example, no randomised controlled trials were available on covid-19 during the early era of the pandemic but emerged as the pandemic evolved. 36

Recommendation 4: Involve an information specialist to develop the search strategy, and consider search methods, resources, and search limits

Planning a search is integral to the overall preparation of a rapid review and should form part of protocol development. At minimum an information specialist such as a librarian should be consulted to select information sources (eg, bibliographic databases, type of supplementary searches) and provide feedback on the primary search strategy. 37 Information specialists can assist in selecting appropriate search methods and resources, defining search limits, designing and executing search strategies, and reporting the search methods. A preliminary or scoping search should be performed during the topic refinement stage and may help inform eligibility criteria. If the rapid review is being done by updating an existing systematic review, information specialists may use the original search strategy and adapt as necessary. Overall, the search process for a rapid review follows the same steps as for a systematic review; therefore, rapid review teams must be familiar with the general standards of systematic searching and reporting of searches. 38

Recommendation 5: Select a small number (but at least two) bibliographic databases that are likely to contain relevant literature

Rapid review teams should prioritise the most relevant information sources for the topic, the type of evidence required, and access to sources. We recommend a conventional approach of selecting at least two electronic bibliographic databases, dependent on the study type and topic most likely to retrieve relevant literature based on recent evidence. 12 35 39 In addition to electronic bibliographic databases, grey literature sources and targeted supplementary search methods may be used (see recommendation 7).

For rapid reviews focused on randomised controlled trials only, use a combination of two of the following databases (if you have access): Medline, CENTRAL, and Embase. 39

Additional considerations:

▪ For Cochrane rapid reviews of health interventions, where search strategies are always designed by information specialists and peer reviewed using the Peer Review of Electronic Search Strategies (PRESS) statement 37 (see recommendation 6), we recommend using CENTRAL as the primary database. This is a highly concentrated source of reports of randomised controlled trials and quasi-randomised controlled trials. In many regions, CENTRAL is free through the Cochrane Library. 40 In addition, it is accessible to Cochrane members through the Cochrane Register of Studies Online ( https://crso.cochrane.org/ ). 41 Additional searches of Medline, such as through PubMed, and possibly Embase (if access is available) may be limited to the previous two months to capture the most recently published studies, as CENTRAL is currently only updated once a month. 9 39 42

▪ If CENTRAL and Embase are not available, searching Medline combined with an appropriate supplementary search (eg, a study register such as ClinicalTrials.gov, using the PubMed similar articles feature) can be considered, but this strategy might not be appropriate for all topics. 9 14

For other rapid reviews that include non-randomised studies, database selection should be carefully considered depending on available time and resources. In many cases, Medline will be the most relevant database, but this is not always the case. 10 43 Searching specialised databases such as CINAHL, PsycInfo, and the Education Resources Information Center (ERIC), may be necessary for specialised review topics (eg, CINAHL for rapid reviews related to nursing care, PsycInfo for rapid reviews related to mental health, or ERIC for rapid reviews related to educational interventions); see subsection w2 in the supplementary file.

Recommendation 6: Use the PRESS checklist to peer review the primary search strategy

The primary search strategy should be peer reviewed using the PRESS checklist when possible. 37 If the use of PRESS is not possible, at a minimum the search strategies should be double checked for typographical or spelling errors, missed keywords, and correct use of Boolean operators (AND, OR, NOT). Evidence suggests that the absence of peer review of the search strategy often results in many missed studies, and unless captured in accompanying supplementary searches, these studies would not appear in the published rapid review. 44

Recommendation 7: Assess the need for grey literature and supplemental searching. Justify the sources to be searched

For rapid reviews, we recommend limiting grey literature and supplemental searches. For some topics, however, a search of grey literature may be more important than a search of conventional databases. If warranted, consider limiting supplemental searches to clinical trial registries and review of reference lists in included studies or similar articles searches to identify potentially relevant studies (see subsection w2 in the supplementary file file). More in-depth best practice suggestions on searching for rapid reviews are available. 14 45

Study selection—title and abstract and full text screening

Recommendation 8: Employ piloting exercises at abstract and full text screening levels to allow team members to test the study selection process on a selected sample of records to ensure a consistent approach to screening

Before the start of screening, a pilot exercise should be conducted using a purposive selection of records (eg, 50-100 records that reflect the complexity of the topic) assessed by the entire team of screeners to test and revise the screening forms and adapt the eligibility criteria, if necessary. This pilot exercise also allows a discussion of unclear abstracts and identification of potential difficulties in the study selection process. To ensure a consistent approach to screening is used across the entire team, all screeners should use a title and abstract screening form followed by a full text screening form. These forms should include details on the eligibility criteria with examples and can be phrased as screening questions. The screening forms should be adapted after discussions among the team, if necessary.

Recommendation 9: Conduct dual and independent screening of a proportion of records, assess reviewer agreement, and proceed with single screening if agreement is good

Generally, we recommend that two reviewers should screen at least 20% of the records, check the level of agreement, and discuss any discrepancies. Teams can proceed with single screening if agreement is high (eg, κ is ≥0.8). 46 47 If agreement is low, the screening team should proceed with dual reviewer screening until a better agreement has been achieved. The suggestion of 20% is based on our experience and is therefore not evidence based. The proportion may differ depending on the number of records to be screened, available resources, complexity of the review topic, and reviewers’ experience. We recommend the same approach for full text screening (see subsection w2 in the supplementary file). If resources allow, one person could check all excluded full texts to ensure no relevant study was unintentionally excluded. Further details on this process are available elsewhere. 15

If a search yields a small number of records, such as a few hundred citations, consider dual, independent screening, if it is feasible. Although screening with only one reviewer for each record may be a practical solution for certain rapid reviews, we do not recommend this for Cochrane rapid reviews. Findings from two studies indicate that single screening of the titles and abstracts is not equivalent to dual screening, as more studies are missed. 5 48 Nonetheless, forthcoming advances in automation (eg, active machine learning) 49 50 and crowdsourcing 8 51 have the potential to reduce screening time when conducting rapid reviews.

Recommendation 10: Limit data extraction to only the most important data fields relevant to address the review question

No minimum set of data extraction items exists for study characteristics and outcome data. For a rapid review, however, extraction should be limited to only the most important data fields. For example, outcome data should only be extracted for those outcomes deemed as most relevant for decision making (see recommendation 3.2).

Recommendation 11: For data extraction, employ a piloting exercise to ensure all team members perform it consistently and correctly

We recommend using a form for data extraction (eg, a table or spreadsheet) and involving all reviewers in a data extraction pilot test using the same studies (at least two). This should help to identify misunderstandings early on and should reduce disagreements during the data verification step (see recommendation 12). The form should also help in deciding which study characteristics and outcome data should be extracted using concise descriptions of participant, intervention, comparator characteristics, and outcomes assessed (see recommendation 10).

Recommendation 12: Have one person extract the data, and for critical data that can affect the results or conclusions, have a second person verify the data for accuracy and completeness

We recommend that one person should extract the data for rapid reviews, with a second person verifying the key data (eg, definitions of outcomes, outcome data) for completeness and correctness to ensure integrity of the review. The second reviewer will also need to check the full texts. Any disagreements should be resolved through discussion and consensus between reviewers, involving a third reviewer if agreement cannot be reached (see subsection w2 in the supplementary file). If time and resources allow, a second person should verify the remaining data, such as characteristics of the study.

Recommendation 13: When available, extract data directly from existing systematic reviews rather than from primary studies

If good quality systematic reviews are included in the rapid review, consider extracting data directly from the systematic review. According to a case study, this approach saved time and did not alter the review results. 52 However, extracting data directly from a systematic review requires good reporting of the data included in the review. As stated in recommendation 11, a second person should check the critical data extracted from the systematic review for completeness and correctness (see subsection w2 of the supplementary file).

Risk of bias assessment

We discourage omitting the risk of bias assessment entirely, as it informs the interpretation of the results.

Recommendation 14: Use validated and study design specific tools to assess the risk of bias of the included studies

To effectively manage the risk of bias assessments, it is important to use validated assessment tools specific to the study design(s) included in the rapid review. For example, for Cochrane rapid reviews, versions 1 and 2 of the Cochrane risk of bias tool for randomised trials (RoB 1 and RoB 2, respectively) 53 54 should be used for randomised controlled trials. Permitting both outcome level risk of bias (RoB 2) and domain level risk of bias (RoB 1) assessments in rapid reviews is suggested for practical purposes. RoB 1 assessments are generally quicker and require fewer resources than RoB 2 assessments at the outcome level. However, different rapid reviews may require different levels of detail and granularity in the risk of bias assessment that may depend on the specific characteristics of the review, such as the complexity of the interventions, type of outcomes, and available data. Allowing either approach ensures an efficient use of available resources while maintaining the quality of the review.

For non-randomised interventional studies, the Risk Of Bias In Non-Randomised Studies-of Interventions (ROBINS-I) 55 should be used. AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews) 56 or ROBIS 57 may be used to assess risk of bias in systematic reviews.

Recommendation 15: Focus the risk of bias assessment at least on the most important outcomes

When using risk of bias tools with questions that rate the risk at an outcome level (not study level), such as RoB 2, limit the risk of bias ratings to the outcomes important for decision making (see recommendation 3.2).

Recommendation 16: Have one person perform the risk of bias assessment, with a second person verifying the judgements

The recommended approach to risk of bias assessment involves one reviewer performing the assessment, and another reviewer verifying the judgements. If only a small number of studies are eligible for inclusion, consider dual, independent risk of bias assessments for key outcomes, if feasible. In preparation, it may be helpful for all involved in risk of bias assessment to assess a small number of studies, such as two or three, concurrently and discuss the corresponding judgements so that any discrepancies may be identified and resolved (see subsection w2 in the supplementary file).

Teams involved in rapid reviews need to develop an appropriate analysis plan, which should be included in the protocol (see recommendation 2).

Recommendation 17: Provide a descriptive summary of the included studies

Providing a descriptive summary of the included studies at the outset of the synthesis stage helps to confirm if the studies are similar and reliable enough to synthesise and if it is possible to pool results. “Similar” studies means that they have similar PICOs, and, ideally, study designs.

Recommendation 18: Perform a synthesis of the findings

For rapid reviews that only include primary studies, reviewers need to decide how to group and tabulate data based on the review question, the type of data included, and what was planned for in the protocol, to the extent possible. Beyond a simple descriptive summary, a narrative interpretation of the evidence from multiple studies should be conducted for all rapid reviews. Reviewers should organise the synthesis around the elements of the PICO question framework, with findings grouped by key questions, comparisons, interventions, and outcomes. If a meta-analysis is possible, a descriptive summary of the body of evidence contributing to the meta-analysis is needed to interpret the collective evidence fully. Synthesis without meta-analysis (SWiM) reporting guidelines should be considered to promote transparency of narrative reporting of evidence synthesis. 58

Recommendation 19: Consider a meta-analysis if appropriate and resources permit

If data are sufficient to consider a meta-analysis, the standards for a systematic review equally apply to a rapid review; meta-analysis will depend on the type of data and information provided in the individual studies. It is important to involve a statistician familiar with systematic reviews and meta-analyses. The depth and details of analysis will vary depending on the volume and type of included studies.

Recommendation 20: Consider how to synthesise evidence when including one systematic review or more

When including systematic reviews in a rapid review, synthesis may involve adding primary studies to an existing meta-analysis or narrative synthesis from the systematic review. If more than one systematic review is included, the overlap of primary studies must be identified. A formal study of overlap (eg, corrected covered area 59 ) does not need to be undertaken for a rapid review. Instead, a cursory examination of overlap may be presented in tabular form to identify all included systematic reviews with the relevant primary studies to explore why reviews agree or disagree on important findings. A publication on synthesis for rapid reviews will be forthcoming as part of the Rapid Reviews Methods Series led by the Cochrane Rapid Review Methods Group.

Certainty of the evidence

Recommendation 21: Use the GRADE approach to assess certainty of evidence if time and resources allow

Cochrane Reviews incorporate the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for rating the certainty of evidence 60 as it is the established benchmark for use in guideline development. Several examples have been published where the GRADE approach has been used for rapid reviews. 61 62 63 We therefore recommend fully implementing GRADE for both Cochrane and non-Cochrane rapid reviews if time and resources allow. We also recommend using GRADEpro, an open access software tool for rating certainty of evidence in evidence syntheses to apply GRADE. 64 Reviewers should always present results in a summary of findings table when rating certainty of evidence and use explanatory footnotes to outline reasons for uprating or downrating judgements.

Recommendation 22: Limit the certainty of evidence ratings to the main intervention and comparator and focus on critical outcomes

If time and other resources do not permit the full implementation of GRADE, we recommend that reviewers limit certainty of evidence ratings to the main intervention and comparator and focus on critical outcomes of benefits and harms. See recommendation 3.2 on the selection of critical outcomes. 33 60 The approach chosen should, in any case, be transparent, and any limitations acknowledged.

Recommendation 23: Have one person complete the GRADE assessment, with a second person to verify the assessment

To accelerate GRADE application, we recommend a single reviewer rating, and verification of all decisions (and footnoted rationales) by a second reviewer (see subsection w2 in the supplementary file). If effect estimates of a well conducted systematic review, meta-analysis, or network meta-analysis are incorporated to address parts of a key question of the rapid review, we advise using existing certainty of evidence grades from such systematic reviews. 16 Further details on assessing the certainty of evidence for rapid reviews are available. 16

Other best practice considerations

Recommendation 24: Provide a clear description of the selected rapid review approach, which includes outlining the restricted methods used. Additionally, discuss the potential limitations of these chosen methods and how they may influence the interpretation of the research findings

Describing the restricted methods used and pinpointing potential sources of bias or uncertainty in the findings resulting from methodological restrictions, enables end users to better assess the validity and reliability of the rapid review. This includes determining whether the methods were appropriate for the specific research question, studied population, and context being investigated. Additionally, this process serves to put the results in perspective, given the restrictions imposed by the methods of rapid reviews, helping to limit overgeneralisation of results or unwarranted conclusions.

Rapid reviews involve an iterative process

Sometimes, changes to the review protocol are necessary once a rapid review has started. For example, search variables may be expanded or limited depending on what the search yields, or eligibility criteria may need to be refined after the pilot screening. Therefore, the rapid review process should allow for post hoc changes to the protocol. Substantial changes should be discussed with the knowledge users involved, and any amendments should be tracked and reported in the rapid review. Moreover, authors should seek feedback from the knowledge users throughout the process to ensure the review meets their needs.

Incorporate the use of systematic review software to streamline the process

We strongly encourage using software to help produce rapid reviews to improve the efficiency of screening, tracking, and documentation, and to reduce human error. Online systematic review software enhances collaboration by allowing real time project management and multiuser participation across geographical boundaries. Importantly, the software enables members of the rapid review team to work in parallel across all stages of the review, and it provides a fully transparent process. It also facilitates the incorporation of protocol amendments and other post hoc changes that may be needed during the conduct of a rapid review. The use of software also increases efficiency through the automated collation of the screening results (inclusions and exclusions). Those undertaking rapid reviews and other types of syntheses should look for ways to harness innovation, using software and adopting automation tools that reliably assist in streamlining stages of a review’s conduct. One such example is Cochrane Crowd, which uses a machine learning platform and crowdsourcing to identify randomised controlled trials 8 (for examples, see SR ToolBox at http://systematicreviewtools.com/ ).

Apply appropriate reporting guidelines

Importantly, given the methodological modifications inherent to rapid reviews, authors must be transparent in reporting their methods and results. See the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) for reporting of rapid review protocols 32 and PRIMSA-S for searches. 38 Although an extension to PRISMA for rapid reviews is ongoing, 65 until it is officially completed we suggest authors use the general PRISMA statement 66 to the extent possible, and adapt it accordingly.

This updated guidance on methods used in Cochrane rapid reviews of effectiveness has the potential to benefit many producers and users of this review type. Although this guidance is heavily posited within the Cochrane landscape, the recommended methods apply widely to anyone conducting a rapid review. This guidance builds upon our interim guidance and is based on an evaluation of the recommendations used in real time, the expertise of a broader group of experts in rapid reviews within and external to Cochrane, and a scan of the literature for additional publications on rapid review methods since our recommendations were first published. Therefore, the recommendations are both evidence informed and user informed.

Noteworthy changes to the updated recommendations include modifications to search sources for both Cochrane and non-Cochrane rapid reviews of randomised controlled trials and for study selection at both the title and abstract and the full text screening stages, where the process has been simplified. Subsection w3 in the supplementary file provides a comparison between the interim and updated recommendations. In addition, a new section on certainty of evidence has been added as a separate element from the synthesis of results. Using appropriate reporting guidance for the protocol, search strategies and review itself are also emphasised. Importantly, further explanations and available examples are included to help clarify considerations and recommendations for methods in rapid reviews. Some additional practical tips for rapid review teams to increase efficiencies in the review process are also provided.

Although a multipronged approach, where more than one method restriction is combined, may increase timely production of reviews, users of this guidance can still label a review as a rapid review even if some of the recommendations are not followed. The key is that the pros and cons of each methodological restriction used in a rapid review should be weighed against the scope and complexity of the review topic and other circumstances of the review, including the timeline, number of team members involved at various stages of the review and their level of expertise, along with the potential for introducing bias. Rapid review teams therefore need expertise in systematic review methods to provide balanced methodological judgements when deciding which methods restrictions to use and how this might impact the findings of a particular review.

It is important to clarify the distinction between recommendations targeting Cochrane rapid reviews and those with a more general applicability. Some recommendations are tailored to Cochrane rapid reviews because they align with Cochrane’s standards, procedures, and objectives that do not apply to all contexts of rapid reviews. On the one hand, the guidance ensures that Cochrane rapid reviews consistently meet the organisation’s rigorous quality standards. On the other hand, certain recommendations have broader applicability across all methodologies and contexts of rapid reviews. These recommendations encompass fundamental principles and best practices that are not exclusive to Cochrane but are relevant for all rapid reviews of effectiveness. The recommendations address core aspects of conducting rapid reviews, such as the importance of involving knowledge users, use of protocols, transparency, and documentation, which are essential regardless of the specific review framework. Recognising that the methodology of rapid reviews is an evolving discipline with diverse applications, the guidance aims to balance between providing Cochrane specific direction and accommodating the broader community involved in rapid reviews. This approach acknowledges the need for flexibility and adaptability, enabling the authors of rapid reviews to apply relevant guidance while considering their specific requirements and objectives.

Our approach to the methods of rapid reviews stands out from existing guidance because it was crafted explicitly within the Cochrane context, concentrating on rapid reviews of interventions. In contrast, other guides for rapid reviews have targeted health policy and systems research, public health, or rapid guideline development during public health emergencies. 67 68 69 What also distinguishes our guidance is its sharp focus on the conduct of rapid reviews rather than planning, packaging, or dissemination. Notably, our recommendations for each step of the review process are specific, setting the guidance apart from others that typically offer a more general overview of common practices in rapid reviews. It is also worth noting that Cochrane rapid reviews are explicitly designed to address urgent and high priority questions requested by decision makers, aligning with a specific mandate that not all other guides necessitate. Although these other guides are also evidence informed and we encourage their use, our guide is uniquely grounded in empirical evidence evaluating methods of rapid reviews, 1 2 further enriched by expert input 13 14 15 16 and feedback from a formal evaluation of its real world use. 7

Although not all stages of a rapid review had corresponding evidence to inform the updated recommendation, as stated previously, we know that many established steps in the systematic review process are also based on evidence that is limited, outdated, or not available. Therefore, any future methodological research that informs rapid reviews will also be beneficial for systematic reviews. Future research should examine ways to adapt this guidance beyond interventions of effectiveness to other review question types, such as rapid reviews of diagnostic test accuracy or screening. Developing criteria for determining the appropriateness of undertaking rapid reviews versus systematic reviews or living systematic reviews would also be of value.

Optimising the review process, including study selection, data extraction, and synthesis of results, enables quicker production of rapid reviews. A variety of software tools, involving extraction of metadata, automation, screening software, and machine learning, have the potential to contribute to this optimisation. These tools aim to help streamline the review process, enhance transparency and reproducibility, and minimise reviewer bias. Collaboration software and live documents also facilitate real time exchanges, keeping all stakeholders in alignment throughout the process. Looking to the future, the potential of artificial intelligence (AI) will likely further advance the overall process for both rapid reviews and systematic reviews by providing intelligent assisted solutions to potentially speed up and increase efficiency of many review steps. AI may also reduce errors, improve accuracy, and improve repeatability and reproducibility of rapid reviews.

Overall, the Cochrane Rapid Reviews Methods Group offers updated, actionable recommendations to support the conduct of rapid reviews when the need for evidence is urgent. Because best practice is still limited by the lack of currently available evidence for some shortcuts used for rapid review methods, the Cochrane Rapid Review Methods Group will continue to promote research to close these gaps, monitor the published literature as additional abbreviated methods are formally evaluated, and update these recommendations as needed. Ultimately, we hope that uptake of this guidance will lead to more useful, robust, and rigorous rapid reviews, thus facilitating timely, evidence based decision making in healthcare.

Conclusions

This article offers updated guidance composed of 24 recommendations on methods for conducting rapid reviews of effectiveness produced within Cochrane and beyond to address urgent and high priority questions often requested by decision makers. The guidance aims to encourage the thoughtful use of best practices that are both user informed and evidence informed when applying abbreviated systematic review methods to rapid reviews.

Ethics statements

Ethical approval.

Not required.

Acknowledgments

We thank the collaborators who contributed to this updated guidance, and Piotr Ratajczak who updated the literature scan for newly published studies. We also thank our colleagues who worked with the convenors of the Cochrane Rapid Reviews Methods Group to create a series of articles in BMJ Evidence-Based Medicine. These articles give more details about the guidance we recommend in the current article. As such, we want to recognise these colleagues for their expertise in suggesting changes to the guidance: Andrea Tricco, Maureen Smith, Danielle Pollock, Irma Klerings, Shannon Robalino, Andrew Booth, Camila Micaela Escobar-Liquitay, Isolde Sommer, Siw Waffenschmidt, Anna Noel-Storr, Livia Puljak, Leila Kahwati, Meera Viswanathan, Amir Qaseem, Eli Akl, Holger Schuenemann, Jane Noyes, Catherine Houghton, Fiona Campbell, Anthea Sutton, Hanan Khalil, Lisa Affengruber, Miriam Van der Maten, James Thomas, Chris Mavergames, and René Spijker. In addition, a special thank you to Irma Klerings and Anna Noel-Storr for their specific review of the search related recommendations. We would also like to thank members of the Cochrane Methods Executive for reviewing and providing comments.

Contributors: CG, CH, MT, GG, BNS, DD, CK, UG, and VJK contributed to the conceptualisation of this paper. CG wrote the first draft of the manuscript and revised the manuscript with input from CH, MT, GG, BNS, DD, CK, UG, and VJK. All authors read and approved the final version. CG is the guarantor and attests that all authors meet authorship criteria and that no others meeting the criteria have been omitted.

Funding: This work was funded in part by Cochrane and in-kind support provided by Cochrane Austria, University for Continuing Education Krems, Krems, Austria. The funder had no role in the development of this guidance, writing of the report, or decision to submit the article for publication.

Competing interests: All authors have completed the ICMJE disclosure form at http://www.icmje.org/disclosure-of-interest/ and declare: support from Cochrane for the submitted work. Certain methods studies upon which some of the recommendations are based have been carried out by authors of this guidance (GG, BNS, CH, CG, VJK, and CK). UG, BNS, and MT planned and carried out the evaluation study of the interim rapid review methods guidance.

Provenance and peer review: Not commissioned; externally peer reviewed.

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• Published: 30 July 2022

Paper 2: Performing rapid reviews

• Valerie J. King 1 ,
• Adrienne Stevens 2 ,
• Barbara Nussbaumer-Streit 3 ,
• Chris Kamel 4 &
• Chantelle Garritty 5  

Systematic Reviews volume  11 , Article number:  151 ( 2022 ) Cite this article

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Health policy-makers must often make decisions in compressed time frames and with limited resources. Hence, rapid reviews have become a pragmatic alternative to comprehensive systematic reviews. However, it is important that rapid review methods remain rigorous to support good policy development and decisions. There is currently little evidence about which streamlined steps in a rapid review are less likely to introduce unacceptable levels of uncertainty while still producing a product that remains useful to policy-makers.

This paper summarizes current research describing commonly used methods and practices that are used to conduct rapid reviews and presents key considerations and options to guide methodological choices for a rapid review.

The most important step for a rapid review is for an experienced research team to have early and ongoing engagement with the people who have requested the review. A clear research protocol, derived from a needs assessment conducted with the requester, serves to focus the review, defines the scope of the rapid review, and guides all subsequent steps. Common recommendations for rapid review methods include tailoring the literature search in terms of databases, dates, and languages. Researchers can consider using a staged search to locate high-quality systematic reviews and then subsequently published primary studies. The approaches used for study screening and selection, data extraction, and risk-of-bias assessment should be tailored to the topic, researcher experience, and available resources. Many rapid reviews use a single reviewer for study selection, risk-of-bias assessment, or data abstraction, sometimes with partial or full verification by a second reviewer. Rapid reviews usually use a descriptive synthesis method rather than quantitative meta-analysis. Use of brief report templates and standardized production methods helps to speed final report publication.

Conclusions

Researchers conducting rapid reviews need to make transparent methodological choices, informed by stakeholder input, to ensure that rapid reviews meet their intended purpose. Transparency is critical because it is unclear how or how much streamlined methods can bias the conclusions of reviews. There are not yet internationally accepted standards for conducting or reporting rapid reviews. Thus, this article proposes interim guidance for researchers who are increasingly employing these methods.

Peer Review reports

Introduction

Health policy-makers and other stakeholders need evidence to inform their decisions. However, their decisions must often be made in short time frames, and they may have other resource constraints, such as the available budget or personnel [ 1 , 2 , 3 , 4 , 5 , 6 ]. Rapid reviews are increasingly being used and are increasingly influential in the health policy and system arena [ 3 , 7 , 8 , 9 , 10 ]. One needs assessment [ 11 ] showed that policy-makers want evidence reviews to answer the right question, be completed in days to weeks, rather than months or years, be accurate and reproducible, and be affordable.

As much as policy-makers may desire faster and more efficient evidence syntheses, it is not yet clear whether rapid reviews are sufficiently rigorous and valid, compared to systematic reviews which are considered the “gold standard” evidence synthesis, to inform policy [ 12 ]. Only a few empirical studies have compared the findings of rapid reviews and systematic reviews on the same topic, and their results are conflicting and inconclusive, leaving questions about the level of bias that may be introduced because of rapid review methods [ 7 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ].

A standardized or commonly agreed-upon set of methods for conducting rapid reviews had not existed until recently, [ 1 , 9 , 14 , 20 , 21 , 22 , 23 ] and while there is little empiric evidence on some of the standard elements of systematic reviews, [ 24 ] those standards are well articulated [ 25 , 26 ]. A minimum interim set of standards has was developed by the Cochrane Rapid Reviews Methods Group [ 1 , 2 ] to help guide rapid review production during the SARS-CoV-19 pandemic, and other researchers have proposed methods and approaches to guide rapid reviews [ 5 , 21 , 22 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].

This article gives an overview of potential ways to produce a rapid review while maintaining a synthesis process that is sufficiently rigorous, yet tailored as needed, to support health policy-making. We present options for common methods choices, summarized from descriptions and evaluations of rapid review products and programs in Table 1 , along with key considerations for each methodological step.

The World Health Organization (WHO) published Rapid reviews to strengthen health policy and systems: a practical guide [ 5 ] in 2017. The initial work for this article was completed as a chapter for that publication and included multiple literature searches and layers of peer review to identify important studies and concepts. We conducted new searches using Ovid MEDLINE, the Cochrane Library’s methodology collection, and the bibliography of studies maintained by the Cochrane Rapid Reviews Methods Group, to identify articles, including both examples of rapid reviews and those on rapid review methodology, published after the publication of the WHO guide. We have not attempted to perform a comprehensive identification or catalog of all potential articles on rapid reviews or examples of reviews conducted with these methods. As this work was not a systematic review of rapid review methods, we do not include a flow of articles from search to inclusion and have not undertaken any formal critical appraisal of the articles we did include.

Needs assessment, topic selection, and topic refinement

Rapid reviews are typically conducted at the request of a particular decision-maker, who has a key role in posing the question, setting the parameters of the review, and defining the timeline [ 40 , 41 , 42 ]. The most common strategy for completing a rapid review within a limited time frame is to narrow its scope. This can be accomplished by limiting the number of questions, interventions, and outcomes considered in the review [ 13 , 15 ]. Early and continuing engagement of the requester and any other relevant stakeholders is critical to understand their needs, the intended use of the review, and the expected timeline and deliverables [ 15 , 28 , 29 , 40 , 41 , 42 ]. Policy-makers and other requesters may have vaguely defined questions or unrealistic expectations about what any type of review can accomplish [ 41 , 42 ]. A probing conversation or formal needs assessment is the critical first step in any knowledge synthesis approach to determine the scope of the request, the intended purpose for the completed review, and to obtain a commitment for collaboration over the duration of the project [ 28 , 30 , 41 ]. Once the request and its context are understood, researchers should fully develop the question(s), including any needed refinement with the requester or other stakeholders, before starting the project [ 5 ]. This process can be iterative and may require multiple contacts between the reviewers and the requester to ensure that the final rapid review is fit for its intended purpose [ 41 , 42 ]. In situations where a definitive systematic review might be needed, it may be useful to discuss with the requester the possibility of conducting a full systematic review, either in parallel or serially with the rapid review [ 43 ].

Protocol development

A research protocol clearly lays out the scope of the review, including the research questions and the approaches that will be used to conduct the review [ 44 ]. We suggest using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement for guidance [ 37 ]. Most reviewers use the PICO format (population, intervention, comparator, outcome), with some adding elements for time frame, setting, and study design. The PICO elements help to define the research questions, and the initial development of questions can point to needed changes in the PICO elements. For some types of research questions or data, other framework variations such as SPICE (setting, perspective, intervention, comparison, evaluation) may be used, although the PICO framework can generally be adapted [ 45 ]. Health services and policy research questions may call for more complex frameworks [ 5 ]. This initial approach assists both researchers and knowledge users to know what is planned and enables documentation of any protocol deviations; however, the customized and iterative nature of rapid reviews means that some flexibility may be required. Some rapid review producers include the concept of methods adjustment in the protocol itself [ 46 , 47 ]. However, changes made beyond the protocol stage and the rationale for making them must be transparent and documented in the final report.

The international prospective register of systematic reviews (PROSPERO) [ 44 ] ( https://www.crd.york.ac.uk/PROSPERO/ ) accepts registration of protocols that include at least one clinically or patient-relevant outcome. The Open Science Framework (OSF) [ 48 ] platform ( https://osf.io/ ) also accepts protocol registrations for rapid reviews. We advise protocol submitters to include the term “rapid review” or another similar term in the registered title, as this will assist tracking the use, validity, and value of rapid reviews [ 1 ]. Protocol registration helps to decrease research waste and allows both requesters and review authors to avoid duplication. Currently, most rapid review producers report using a protocol, but few register their protocols [ 13 , 17 ].

Literature search

Multiple authors have conducted inventories of the characteristics of and methods used for rapid reviews, including the broad categories of literature search, study selection, data extraction, and synthesis steps [ 13 , 15 , 17 , 20 , 24 , 49 ]. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards call for documentation of the full search strategy for all electronic databases used [ 38 ]. Most published rapid reviews search two or more databases, with PubMed, Embase, and the Cochrane Library mentioned frequently [ 13 , 17 , 20 , 49 ]. Rapid reviews often streamline systematic review methods by limiting the number of databases searched and the search itself by date, language, geographical area, or study design, and some rapid reviews search only for existing systematic reviews [ 13 , 15 , 17 , 20 , 49 , 50 ]. Other rapid reviews use a layered searching approach, identifying existing systematic reviews and then updating them with a summary of more recent eligible primary studies [ 13 , 15 , 18 , 20 , 36 ]. Studies of simplified search strategies have generally demonstrated acceptable retrieval characteristics for most types of rapid review reports [ 51 , 52 ]. Searching the reference lists of eligible studies (sometimes known as the “snowballing” technique) and searching the gray literature (i.e., reports that are difficult to locate or unpublished) are done in about half of published rapid reviews and may be essential for certain topics [ 13 , 15 , 20 , 49 ]. However, rapid reviews seldom report contact with authors and other experts to identify additional unpublished studies [ 13 , 15 , 20 , 49 ]. One study found that peer review of the search strategy, using a tool such as the PRESS (peer review of electronic search strategies) checklist, [ 39 ] was reported in 38% of rapid reviews, but that it was usually performed internally rather than by external information specialist reviewers [ 13 ]. Peer review of search strategies has been reported to increase retrieval of relevant records, particularly for nonrandomized studies [ 53 ].

Screening and study selection

Methodological standards for systematic reviews generally require independent screening of citations and abstracts by at least two researchers to arrive at a set of potentially eligible references, which are in turn subjected to dual review in full-text format to arrive at a final inclusion set. Rapid reviews often streamline this process, with up to 40% using a single researcher at each stage [ 13 , 15 , 17 , 18 , 20 , 49 ]. Some rapid reviews report verification of a sample of the articles by a second researcher or, occasionally, use of full dual screening by two independent researchers [ 13 , 17 , 20 , 49 ]. One methodological study reported that single screener selection missed an average of 5% of eligible studies, ranging from 3% for experienced reviewers and 6% for those with less experience [ 54 ]. If time and resources allow, we recommend that dual screening of all excluded studies, at both the title and full-text stages, be used to minimize the risk of selection bias through the inappropriate exclusion of relevant studies. However, there is some evidence that the use of a single experienced reviewer for particular topics may be sufficient [ 18 , 46 , 54 ].

Data extraction

As with citation screening and study selection, the number of independent reviewers who extract study data for a rapid review can vary. One study found that the most common approach is single-reviewer extraction (41%), although another 25% report verification of a sample by a second reviewer and nearly as many used dual extraction [ 13 ]. A more recent study reported that only about 10% of rapid reviews examined reported dual data extraction, although nearly twice as many simply did not report this feature [ 17 ]. Data abstraction generally includes PICO elements, although data abstraction was often limited by the scope of the review, and authors were contacted for missing data very infrequently [ 13 ].

Risk-of-bias assessment

Risk-of-bias assessment, sometimes called critical appraisal or methodological quality appraisal, examines the quality of the methods employed for each included study and is a standard element of systematic reviews [ 25 ]. The vast majority of rapid review producers perform some type of critical appraisal [ 17 , 20 ]. Some rapid reviews report the use of a single assessor with verification of a sample of study assessments by another assessor [ 17 , 49 ]. There is no consensus as to which risk-of-bias assessment tools should be used, although most reviews use study design-specific instruments (e.g., an instrument designed for randomized controlled trials (RCTs) if assessing RCTs) intended for assessing internal validity [ 13 , 20 ].

Knowledge synthesis

Nearly all rapid review producers conduct a descriptive synthesis (also often called a narrative synthesis) of results, but a few perform additional meta-analyses or economic analyses [ 13 , 17 , 20 ]. The synthesis that is conducted is often limited to a basic descriptive summary of studies and their results, rather than the full synthesis that is recommended for systematic reviews [ 26 ]. Most rapid reviews present conclusions, recommendations, or implications for policy or clinical practice as another component of the synthesis. Multiple experts also recommend that rapid reviews clearly describe and discuss the potential limitations arising from methodological choices [ 5 , 9 , 13 , 15 , 23 ].

Many systematic review producers use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system [ 55 ] ( http://www.gradeworkinggroup.org/ ) to rate the certainty of the evidence about health outcomes. Guideline developers and others who make recommendations or policy decisions use GRADE to rate the strength of recommendations based on that evidence. The GRADE evidence to decisions (EtD) framework has also been used to help decision-makers developing health system and public health [ 56 ] and coverage [ 57 ] policies. Rapid review authors can also employ GRADE to rate the certainty of synthesized evidence and develop policy implications for decision-makers if time and resources permit. However, the GRADE system works best for interventions that have been subject to RCTs and where there is at least one meta-analysis to provide a single estimate of effect.

Report production and dissemination

Standard templates for each stage of the review, from protocol development to report production, can assist the review team in performing each step efficiently. Use of a report template, with minimum methodological standards, reporting requirements, and standard report sections, can assist the producer in streamlining production of the report and can also enhance transparency [ 15 , 20 , 28 , 40 ]. An extension of the PRISMA statement for rapid reviews is under development and has been registered with the EQUATOR Network [ 58 ]. Until it is available, the PRISMA checklist for systematic reviews can serve as a reporting template to increase the transparency of rapid reviews [ 8 , 40 , 59 ].

Research about review formatting and presentation of rapid review is being conducted, but it is likely that the forms employed and tested will need to be adapted to the individual requester and stakeholder audiences [ 47 ]. Khangura and colleagues [ 28 ] have presented a figure showing formatted sections of a sample report, and many other rapid review producers have examples of reports online that can serve as formatting examples. In addition, findings from evidence summary presentation research for decision-makers in low- and middle-income countries can be translated into other settings [ 60 , 61 ].

Most rapid review producers conduct some form of peer review for the resulting reports, but such review is often internal and may include feedback from the requester [ 13 ]. Most producers disseminate their reports beyond the requester, but dissemination varies by the sensitivity or proprietary nature of the product [ 13 , 20 ]. When reports are disseminated, it is common for them to be posted online, for example, at an organizational website [ 13 , 20 ].

Operational considerations

Evaluations and descriptions of research programs that produce rapid reviews typically include some helpful pragmatic and operational considerations for undertaking a rapid review or developing a rapid review program [ 5 , 15 , 18 , 27 , 28 , 29 , 31 , 36 , 40 , 62 , 63 ]. Highly experienced, permanent staff with the right skill mix, including systematic reviewers, information specialists, methodologists, and content experts [ 15 , 18 , 30 , 40 , 49 ], are essential. It is time-consuming to assemble staff on a per-project basis, so the presence of an existing team (which may only do rapid reviews or may also do systematic reviews or other research) with review infrastructure already in place allows projects to get off to a quick start. The existence of a dedicated team also creates the potential to build relationships with requesters and to cultivate mutual trust. Staff with experience conducting systematic reviews will be familiar with standard methods and may be alert to any needed protocol changes as the review proceeds [ 49 ]. The rapid review team must understand the methodological implications of decisions taken and must convey these implications to the requesters, to allow them to understand the caveats and potential limitations. Continuing relationships and longer-term contracting with requesters, to allow for a quick start and “good faith” initiation of work before a contract is in place, can speed the early development stages [ 31 , 40 ]. It is important for rapid review producers to confirm that the choices they make to streamline the review are acceptable to the requester [ 41 ]. Whether it is a decision to limit the scope to a single intervention or outcome, restrict the literature search to existing systematic reviews, or forgo a meta-analysis, the knowledge user must be aware of the implications of streamlining decisions [ 15 , 27 , 31 , 41 ]. Some programs also emphasize the need for follow-up with review requesters to develop the relationship and continuously improve knowledge products [ 28 , 63 ]. Although it is beyond the scope of this article, we note that both systematic and rapid review producers are currently using various automated technologies to speed review production. There are examples of tools to help search for references, screen citations, abstract data, organize reviews, and enhance collaboration, but few evaluations of their validity and value in report production [ 64 , 65 ]. The Systematic Review Toolbox [ 66 ] ( http://systematicreviewtools.com/ ) is an online searchable database of tools that can help perform tasks in the evidence synthesis process.

Table 1 summarizes the commonly described approaches and key considerations for the major steps in a rapid review that are discussed in detail in the preceding sections.

Suggested approaches to rapid reviews

The previous sections have summarized the numerous approaches to conducting rapid reviews. Abrami and colleagues [ 27 ] summarized several methods of conducting rapid reviews and developed a brief review checklist of considerations and recommendations, which may serve as a useful parallel to Table 2 . A “one-size-fits-all” approach may not be suitable to cover the variety of topics and requester needs put forward. Watt and colleagues [ 9 ] observed over a decade ago, “It may not be possible to validate methodological strategies for conducting rapid reviews and apply them to every subject. Rather, each topic must be evaluated by thorough scoping, and appropriate methodology defined.” Plüddemann and colleagues [ 23 ] advocated for a flexible framework for what they term “restricted reviews,” with a set of minimum requirements and additional steps to reduce the risk of bias when time and resources allow. Thomas, Newman, and Oliver [ 29 ] noted that it might be more difficult to apply rapid approaches to questions of social policy than to technology assessment, in part because of the complexity of the topics, underlying studies, and uses of these reviews. The application of mixed methods, such as key informant interviews, stakeholder surveys, primary data, and policy analysis, may be required for questions with a paucity of published literature and those involving complex subjects [ 29 ]. However, rapid review producers should remain aware that streamlined methods may not be appropriate for all questions, settings, or stakeholder needs, and they should be honest with requesters about what can and cannot be accomplished within the timelines and resources available [ 31 ]. For example, a rapid review would likely be inappropriate as the foundation for a national guideline on cancer treatment due to be launched 5 years in the future. A decision tool, STARR (SelecTing Approaches for Rapid Reviews) has been published by Pandor and colleagues [ 67 ] to help guide decisions about interacting with report requesters, making informed choices regarding to the evidence base, methods for data extraction and synthesis, and reporting on the approaches used for the report.

Tricco and colleagues [ 21 ] conducted an international survey of rapid review producers, using a modified Delphi ranking to solicit opinions about the feasibility, timeliness, comprehensiveness, and risk of bias of six different rapid review approaches. Ranked best in terms of both risk of bias and feasibility was “approach 1,” which included published literature only, based on a search of one or more electronic databases, limited in terms of both date and language. With this approach, a single reviewer conducts study screening, and both data extraction and risk-of-bias assessment are done by a single reviewer, with verification by a second researcher. Other approaches were ranked best in terms of timeliness and comprehensiveness, [ 21 ] representing trade-offs that review producers and knowledge users may want to consider. Because the survey report was based on expert opinion, it did not provide empirical evidence about the implications of each streamlined approach [ 21 ]. However, in the absence of empirical evidence, it may serve as a resource for rapid review producers looking to optimize one of these review characteristics. Given that evidence regarding the implications of methodological decisions for rapid reviews is limited, we have developed interim guidance for those conducting rapid reviews (Table 2 ).

Rapid reviews are being used with increasing frequency to support clinical and policy decisions [ 6 , 22 , 34 ]. While policymakers are generally willing to trade some certainty for speed and efficiency, they do expect rapid reviews to come close to the validity of systematic reviews [ 51 ]. There is no universally accepted definition of a rapid review [ 2 ]. This lack of consensus is, in part, related to the grouping of products with different purposes, audiences, timelines, and resources. Although we have attempted to summarize the major choices available to reviewers and requesters of information, there are few empiric data to guide these choices. We may have missed examples of rapid reviews and methodological research that could add to the conclusions of this paper. However, our approach to this work has been pragmatic, much like a rapid review itself, and is based on our international experience as researchers involved in the Cochrane Rapid Reviews Methods Group, as well as authors who participated in the writing and dissemination of Rapid reviews to strengthen health policy and systems: a practical guide [ 5 ]. This paper has, in addition, been informed by our research about rapid reviews and our collective work across several groups that conduct rapid reviews [ 1 , 68 ]. The Cochrane Rapid Review Methods Group also conducted a methods opinion survey in 2019 and released interim recommendations to guide Cochrane rapid reviews during the SARS-CoV-2 pandemic [ 2 ]. These recommendations are specific to the needs of Cochrane reviews and offer more detailed guidance for rapid review producers than those presented in this paper. We encourage readers to sign up for the Cochrane Rapid Reviews Methods Group newsletter on the website ( https://methods.cochrane.org/rapidreviews/ ) and to check the list of methodological publications which is updated regularly to continue to learn about research pertinent to rapid reviews [ 68 ].

We have summarized the rapid review methods that can be used to balance timeliness and resource constraints with a rigorous knowledge synthesis process to inform health policy-making. Interim guidance suggestions for the conduct of rapid reviews are outlined in Table 2 . The most fundamental key to success is early and continuing engagement with the research requester to focus the rapid review and ensure that it is appropriate to the needs of stakeholders. Although the protocol serves as the starting point for the review, methodological decisions are often iterative, involving the requester. Any changes to the protocol should be reflected in the final report. Methods can be streamlined at all stages of the review process, from search to synthesis, by limiting the search in terms of dates and language; limiting the number of electronic databases searched; using one reviewer to perform study selection, risk-of-bias assessment, and data abstraction (often with verification by another reviewer); and using a descriptive synthesis rather than a quantitative summary. Researchers need to make transparent methodological choices, informed by stakeholder input, to ensure that the evidence review is fit for its intended purpose. Given that it is not clear how these choices can bias a review, transparency is essential. We are aware that an increasing number of journals publish rapid reviews and related evidence synthesis products, which we hope will further increase the availability, transparency, and empiric research base for progress on rapid review methodologies.

Abbreviations

Enhancing the QUAlity and Transparency Of health Research

Grading of Recommendations Assessment, Development and Evaluation

Population, intervention, comparator, outcomes

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols

Randomized controlled trial

Setting, Perspective, Intervention, Comparator, Evaluation

SelecTing Approaches for Rapid Reviews

Peer review of electronic search strategies

World Health Organization

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King, V.J., Stevens, A., Nussbaumer-Streit, B. et al. Paper 2: Performing rapid reviews. Syst Rev 11 , 151 (2022). https://doi.org/10.1186/s13643-022-02011-5

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While the concept of rapid evidence synthesis, or rapid review (RR) , is not novel, it remains a poorly understood and as yet ill-defined set of diverse methodologies supported by a paucity of published, available scientific literature. The speed with which RRs are gaining prominence and are being incorporated into urgent decision-making underscores the need to explore their characteristics and use further. While rapid review producers must answer the time-sensitive needs of the health decision makers they serve, they must simultaneously ensure that the scientific imperative of methodological rigor is satisfied. In order to a dequately address this inherent tension, a need for methodological research and standard development has been identified.   For these reasons, we have established the  Cochrane Rapid Reviews Methods Group (RRMG)  to better inform ‘rapid review’ methodology. 

Scope of the RRMG  will be serve to inform rapid reviews in general, both within the Cochrane Collaboration and beyond. Including a scope that is beyond the current purview of Cochrane’s work is an opportunity for Cochrane to position itself as a leader in rapid review methodology, just as it has been influential for systematic reviews, in general. 

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Rapid Reviews: the easier and speedier way to evaluate papers, but with some limitations

Posted on 24th September 2020 by Georgina Ford

When it comes to reviewing literature there are many different strategies. These vary in their complexity and timescale. As students, the type we are most likely to be able to perform is the rapid review – but what exactly does this entail?

Systematic Reviews

Systematic reviews are the long, detailed papers we commonly have to read. They bring together evidence from sometimes hundreds of different sources to identify corroborating and conflicting results, synthesise data and inform areas for future research. They take up to a year or more to produce with 2 or more people involved.

Rapid Reviews

A rapid review uses shortcuts in the systematic review process, but should still be rigorous and they need to ask a very focused question. You can also have updates of existing reviews incorporating data published since the previous review.

Pros and Cons

Pros: They take much less time to produce and the workload is suitable for a smaller number of reviewers than a full systematic review, hence their suitability for students. They still need a rigorous search method to identify new data to include, however, concessions in breadth and depth of evaluation are made.

Cons: Taking methodological shortcuts does leave rapid reviews more vulnerable to bias and errors. For example, the search for existing studies may be less comprehensive. It can be difficult to access all the literature if it is restricted or in a different language, exposing it to publication bias . The review should include details of these concessions and challenges to give context to any of the claims made.

The writing process

The process of performing a rapid review is laid out below:

• THE LITERATURE SEARCH •Ask a focused question. Try using the PICO method (Population/Intervention/Comparison/Outcome). •Identify the last systematic review of data answering your question. •Perform a literature search for relevant papers written since the last review, using different iterations, spellings, and phrases. •Use limits on your search to narrow down to papers in your timeframe, language, and study design. •If required, repeat with other search databases.
• STREAMLINING STUDIES •Go through each paper you have identified and read their abstracts. •Discard those that are not the required study design or sufficiently relevant to your question. •Check you can access all of the remaining studies. •The process up to now should have left you with a manageable number of studies.
• REVIEW THE DATA •Read the full articles in detail, as many times as you have to. Make notes on them highlighting their methods, and key similarities and differences to the other papers. •Organise similar studies so they are discussed together and compared. •Write a clear conclusions paragraph. Explore any differences between the conclusions you draw and the results of the previous systematic review. Think about why any differences may have occurred, for example changes of policy.
• REVIEW YOUR PROCESS •Make sure to include a paragraph detailing your search criteria and process. •Your methods and reasons for them should be clearly outlined. We have said that rapid reviews can be shorter and less in-depth but the shortcuts you have taken must be explained. •Write about what you think the limitations of your methods are. •In a separate paragraph, usually at the end, you should discuss what the limitations of the studies themselves are and how these may have affected your conclusions. •It can be easier to leave writing your abstract until the very end, as it needs to be clear and concise. Once you have analysed all of your data and come to your conclusions it is far easier to summarise your work than at the beginning. Starting is always the hardest part, and abstracts are not easy to write anyway.

Here are some examples of published rapid reviews that may help you, particularly look at how they have detailed their methods and search strategies:

Hu et al., (2016): Cisplatin for testicular germ cell tumors: a rapid review

Kreindler et al., (2016): Patient characteristics associated with longer emergency department stay: a rapid review

With the current COVID-19 pandemic, the need for evidence is more urgent, making rapid reviews a very popular choice. One example from Public Health Scotland is: Rapid Review of the literature: Assessing the infection prevention and control measures for the prevention and management of COVID-19 in healthcare settings

An article by Grant and Booth (2009) highlights the key differences between different review types and was very helpful for writing this blog.

References (pdf)

Feature image by  Gerd Altmann  from  Pixabay  

Georgina Ford

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• Research article
• Open access
• Published: 16 September 2015

A scoping review of rapid review methods

• Andrea C. Tricco 1 , 2 ,
• Jesmin Antony 1 ,
• Wasifa Zarin 1 ,
• Lisa Strifler 1 , 3 ,
• Marco Ghassemi 1 ,
• John Ivory 1 ,
• Laure Perrier 3 ,
• Brian Hutton 4 ,
• David Moher 4 &
• Sharon E. Straus 1 , 5  

BMC Medicine volume  13 , Article number:  224 ( 2015 ) Cite this article

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Rapid reviews are a form of knowledge synthesis in which components of the systematic review process are simplified or omitted to produce information in a timely manner. Although numerous centers are conducting rapid reviews internationally, few studies have examined the methodological characteristics of rapid reviews. We aimed to examine articles, books, and reports that evaluated, compared, used or described rapid reviews or methods through a scoping review.

MEDLINE, EMBASE, the Cochrane Library, internet websites of rapid review producers, and reference lists were searched to identify articles for inclusion. Two reviewers independently screened literature search results and abstracted data from included studies. Descriptive analysis was conducted.

We included 100 articles plus one companion report that were published between 1997 and 2013. The studies were categorized as 84 application papers, seven development papers, six impact papers, and four comparison papers (one was included in two categories). The rapid reviews were conducted between 1 and 12 months, predominantly in Europe (58 %) and North America (20 %). The included studies failed to report 6 % to 73 % of the specific systematic review steps examined. Fifty unique rapid review methods were identified; 16 methods occurred more than once. Streamlined methods that were used in the 82 rapid reviews included limiting the literature search to published literature (24 %) or one database (2 %), limiting inclusion criteria by date (68 %) or language (49 %), having one person screen and another verify or screen excluded studies (6 %), having one person abstract data and another verify (23 %), not conducting risk of bias/quality appraisal (7 %) or having only one reviewer conduct the quality appraisal (7 %), and presenting results as a narrative summary (78 %). Four case studies were identified that compared the results of rapid reviews to systematic reviews. Three studies found that the conclusions between rapid reviews and systematic reviews were congruent.

Conclusions

Numerous rapid review approaches were identified and few were used consistently in the literature. Poor quality of reporting was observed. A prospective study comparing the results from rapid reviews to those obtained through systematic reviews is warranted.

Systematic reviews are a useful tool for decision-makers because they can be used to interpret the results of individual studies within the context of the totality of evidence and provide the evidence-base for knowledge translation products, such as patient decision aids, clinical practice guidelines or policy briefs [ 1 ]. However, due to the high level of methodological rigour, systematic reviews take from 0.5 to 2 years to conduct [ 2 ] and require considerable skill to execute. According to the Cochrane Collaboration, all procedures including screening citations (titles and abstracts), screening full-text articles, data abstraction, and risk of bias appraisal, should be conducted by two individuals, independently [ 3 ]. In addition, technical expertise from librarians, research coordinators, content experts, and statisticians is required.

Health decision-makers (including clinicians, patients, managers, and policy-makers) often need timely access to health information. Although this information can be obtained through a systematic review, these research endeavours require enormous resources to complete and the timeframe required to conduct a systematic review may not suit the needs of some decision-makers. For example, it has been estimated that systematic reviews take, on average, 1,139 hours (range 216–2,518 hours) to complete and usually require a budget of at least $100,000 [ 4 ]. Consequently, decision-makers may be forced to rely on less robust evidence, such as expert opinion or the results of a single small study [ 5 ], leading to suboptimal decision-making.

Rapid reviews are a form of knowledge synthesis in which components of the systematic review process are simplified or omitted to produce information in a timely manner [ 2 ]. Yet rapid reviews might be susceptible to biased results as a consequence of streamlining the systematic review process [ 6 ]. Although numerous rapid review programs exist internationally [ 7 ], few studies have examined their methodology. We aimed to examine rapid review approaches, guidance, impact, and comparisons through a scoping review.

Definition of a rapid review

A formal definition for a rapid review does not exist. As such, we used the following working definition, ‘a rapid review is a type of knowledge synthesis in which components of the systematic review process are simplified or omitted to produce information in a short period of time’ [ 2 ].

A scoping review protocol was compiled using guidance from Arksey and O’Malley [ 8 ], and revised upon feedback received from the Canadian Institutes of Health Research peer review panel. It is available from the corresponding author upon request.

Information sources and literature search

To identify potentially relevant studies for inclusion, the following electronic databases were searched: MEDLINE; EMBASE; and the Cochrane Library. Since two systematic reviews have already been published on rapid reviews [ 6 , 7 ], we limited our search from 2008 until May 2013. An experienced librarian (LP) drafted the literature searches based on the previous reviews, which was refined through team discussion. The MEDLINE search strategy is presented in Additional file 1 : Appendix 1 and the other searches are available from the corresponding author upon request.

Our literature search was supplemented by targeted internet searches for unpublished rapid review reports posted on the websites of producers of rapid reviews. For this search, we took a random 10 % sample of the unpublished rapid reviews available on the producers’ websites. Often only the title was available for the rapid reviews, so, we focused inclusion to the full rapid review, if available. The reference lists of relevant reviews were scanned [ 6 , 7 ], as were the reference lists of all included rapid reviews.

Inclusion criteria

Articles, papers, books, and reports were included if they evaluated, compared, used or described a rapid review according to the authors.

Screening process

The screening criteria were established a priori (as outlined in our protocol) and calibrated amongst the team through a series of pilot tests. After >90 % agreement was observed, pairs of reviewers screened the literature search results independently, and discrepancies were resolved through discussion. All screening was performed using our online tool, synthesi. sr [ 9 ].

Data items and data abstraction process

A data abstraction form was developed a priori and the draft form was calibrated amongst the team using a random sample of ten included studies. After this exercise, the data abstraction form was revised and all included studies were abstracted by two reviewers working independently. Discrepancies were resolved through discussion.

Data items included study characteristics (for example, first author, year of publication), terminology used to describe the rapid review, full citation of previous methods papers that were used to guide the rapid review design, timeframe (in months) for completing the rapid review, and operationalized steps of the rapid review, if reported. The rapid review type was categorized as an application (for example, a rapid review report), development (paper attempts to further refine the rapid review method), impact (examines the impact of rapid reviews) or comparison (compares the results of a rapid review to a systematic review). We abstracted the assessment of the rapid review approach, including accuracy of results, comprehensiveness, potential for risk of bias, timeliness, cost-effectiveness, and feasibility as reported by the publication authors. We also abstracted the skills or knowledge required to conduct the rapid review as reported by the authors.

To synthesize the descriptive results, we conducted qualitative analysis using NVivo 10 [ 10 ]. Content analysis was conducted by one team member (WZ) and verified by another team member (ACT) to synthesize common methodologies used across the included rapid reviews using a framework. The framework was developed by the review team and presented in Additional file 1 : Appendix 2. The framework focused on the following steps for a rapid review: literature search (number of databases and grey literature); inclusion criteria (limited by date, language, and study design); screening (title/abstract and full-text); data abstraction; risk of bias/quality appraisal; and data synthesis. In order to depict the frequency of the terms used to describe the rapid reviews, a word cloud was created using Wordle, which is software that generates ‘word clouds’ from text that the user provides and places more emphasis on words that occur with greater frequency [ 11 ].

Literature search

A total of 3,397 citations and 262 potentially relevant full-text papers were screened. Subsequently, 100 articles [ 2 , 12 – 110 ] plus one companion report [ 111 ] fulfilled the eligibility criteria and were included [ 31 ] (Fig.  1 ). Forty-seven of the included papers were unpublished rapid reviews posted on websites [ 13 , 24 , 29 , 31 – 36 , 39 , 45 , 47 , 50 , 52 – 57 , 62 , 63 , 66 , 68 , 70 , 73 – 75 , 77 , 81 – 83 , 86 – 94 , 99 , 100 , 103 , 104 , 107 , 109 , 112 ].

Study flow diagram

Rapid review characteristics and assessment

The rapid reviews were published between 1997 and 2013, and 58 were conducted in Europe, while 20 were conducted in North America (Table  1 , Additional file 1 : Appendix 3). The type of articles included 84 application papers (two did not report any methods), seven development papers, six impact papers, and four comparison papers; one article [ 20 ] was categorized in two categories. Ten of the rapid reviews were reported in 5 pages or less, suggesting that they were brief reports or research letters. Most of the articles (73 %) did not report the duration of conduct for the rapid review. For the minority that reported this, the duration ranged from less than 1 month to 12 months, and 18 were between 1 and 6 months. For the application articles, 74 % examined interventions, 12 % charted the frequency of literature (for example, regarding outcomes or frameworks), 5 % examined associations between exposure and disease, 5 % assessed diagnosis or screening techniques, and 2 % examined the patient experience or barriers/facilitators.

Sixty-five articles assessed rapid review characteristics (Table  2 ) [ 2 , 12 , 14 – 22 , 24 , 26 – 30 , 32 , 37 – 39 , 41 – 43 , 45 – 49 , 51 – 59 , 61 , 63 , 64 , 66 , 69 , 72 – 76 , 78 – 80 , 84 , 86 , 88 – 94 , 100 , 103 – 105 , 110 ]. Sixty percent of the authors reported that the report was timely, 29 % believed that the method had potential risk of bias, 23 % deemed that the approach was accurate compared to a full systematic review, 8 % believed the approach was comprehensive, 5 % reported that the approach was cost-effective, and 6 % believed it was a feasible approach.

Terminology used to describe the rapid review method

The most frequent term used to describe the rapid review approaches was ‘rapid review’, used in 34 of the included articles (Fig.  2 ). This was followed by ‘rapid evidence assessment’, which was used in 11 papers, ‘rapid systematic review’ in ten papers, and ‘health technology assessment’ or ‘rapid health technology assessment’ in six papers. All of the other terms occurred two times or less.

Word cloud for the frequency of terms

Citation analysis

Twenty-six [ 2 , 12 , 13 , 17 , 20 – 22 , 27 , 28 , 30 , 40 , 42 – 44 , 48 , 49 , 61 , 76 , 78 – 80 , 84 , 88 , 103 , 105 , 110 ] articles provided citations of previous methods papers that were used to guide the rapid review method (Fig.  3 , Additional file 1 : Appendix 4). The citations were Ganann and colleagues [ 6 ] (cited in eight papers), Watt and colleagues [ 7 , 111 ] (cited in seven papers), a Civil Service paper [ 113 ] (cited in four papers), Ehlers and colleagues [ 114 ] (cited in one paper), Armitage and colleagues [ 14 ] (cited in one paper), and Grant and colleagues [ 115 ] (cited in one paper).

Citation analysis. *Twenty-six papers referenced another seminal paper to establish their rapid review framework

Skills and knowledge required to conduct the rapid reviews

Thirteen [ 16 , 32 , 39 , 42 , 46 , 48 , 49 , 52 , 79 , 84 , 88 , 90 , 94 ] of the included papers reported the skills and knowledge required to conduct the rapid reviews (Table  3 ). These were content experts in seven articles [ 16 , 32 , 42 , 48 , 49 , 79 , 90 ], information specialists in five articles [ 39 , 49 , 52 , 84 , 88 ], systematic review methodologists in four papers [ 16 , 42 , 48 , 79 ], staff experienced in conducting reviews in four papers [ 46 , 48 , 49 , 84 ], and knowledge users in three papers [ 32 , 79 , 94 ].

Operationalized steps to conduct the rapid review applications

The 84 rapid review applications were categorized using our framework (Additional file 1 : Appendix 2) and 50 unique methods were observed. Of these, only 16 occurred more than once; three approaches occurred five times [ 21 , 36 , 40 , 44 , 45 , 47 , 53 , 54 , 56 , 57 , 65 , 75 , 83 , 91 , 92 ], another two occurred four times [ 18 , 37 , 39 , 64 , 86 , 93 , 99 , 107 ], three approaches were used three times [ 49 , 51 , 58 , 61 , 62 , 69 , 73 , 76 , 81 ], and eight approaches occurred two times [ 14 , 16 , 20 , 25 , 27 , 30 , 31 , 66 – 68 , 70 , 79 , 82 , 96 , 100 , 104 ]. The characteristics of the rapid review approaches that occurred more than four times were analyzed (Table  4 ). Rapid Approach 1 had the most details reported, with 5/5 papers mentioning that it was accurate and timely (but did not report the amount of time it took to conduct their rapid review), and had limited comprehensiveness.

Many of the steps used in the rapid reviews were not fully reported (Table  5 , Additional file 1 : Appendix 5). For example, 40 % (33/82) did not report whether reference lists were scanned and 67 % (55/82) did not report whether authors were contacted to obtain further material or information.

Streamlined methods that were used in the 82 rapid reviews included limiting the literature search to published literature (24 %) or one database (2 %), limiting inclusion criteria by date (68 %) or language (49 %), having one person screen and another verify or screen excluded studies (6 %), having one person abstract data and another verify (23 %), not conducting risk of bias/quality appraisal (7 %) or having only one reviewer conduct the quality appraisal (7 %), and presenting results as a narrative summary (78 %) (Fig.  4 ).

Streamlined steps used across the rapid reviews (n = 82 studies reporting this information). SR, systematic review

Comparing results from rapid reviews to systematic reviews

Four studies were comparisons, providing details on differences in results between rapid reviews and systematic reviews [ 20 , 31 , 34 , 106 ]. Cameron and colleagues identified rapid reviews from health technology assessment (HTA) organization websites and then conducted a literature search to identify systematic reviews on the same topic [ 31 ]. Eight rapid review products were identified on four different topics. However, the authors did not appraise the methodological quality of the systematic reviews, so it is unclear whether shortcuts were also taken in the included systematic reviews. The authors noted that the conclusions did not differ substantially between the rapid and systematic reviews. Corabian and colleagues compared six rapid review products (called ‘technotes’) with their final peer-reviewed publications [ 34 ]. The authors found that the conclusions differed only in 1/6 cases. Van de Velde and colleagues compared the results from their rapid review to a systematic review that was conducted by another group and published on the same topic [ 106 ]. Despite having literature searches that were conducted for the same dates, conflicting results were observed; the rapid review concluded that potato peel was effective for burns, while the systematic review concluded that potato peel was not effective for treating burns. Finally, Best and colleagues noted that two of the rapid reviews they conducted were in agreement with systematic reviews published at a later point in time on the same topic [ 20 ].

Development papers on rapid reviews

Seven papers proposed methods to refine the rapid review approach [ 2 , 12 , 16 , 20 , 46 , 79 , 80 ]. Best and colleagues (1997) described their experience conducting 63 rapid reviews for decision-making beginning in 1991, through the Development and Evaluation Committee in the UK [ 20 ]. Abrami and colleagues (2010) described ways to produce brief reviews efficiently, and presented a checklist for the conduct and reporting of brief reviews [ 12 ]. Bambra and colleagues (2010) described their experience conducting nine rapid reviews for the Secretary of State for Health [ 16 ]. Jahangirian and colleagues (2011) described their experience conducting five rapid reviews for the Research into Global Healthcare Tools consortium and proposed a framework for the conduct of rapid reviews [ 46 ]. Khangura and colleagues (2012) described their approach to the conduct of 11 rapid reviews through the collaboration between the Ottawa Hospital Research Institute and the Champlain Local Health Integrated Network [ 2 ]. Thigpen and colleagues (2012) described their experience conducting rapid reviews using the 6-step Prevention Synthesis and Translation System process for the Division of Violence Prevention, National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention [ 79 ]. Thomas and colleagues (2013) described their experience of conducting two rapid reviews for the UK Treasury to inform the 2006/07 Comprehensive Spending Review [ 80 ].

Guidance to streamline the rapid review process varied, yet some consistencies were observed (Table  6 ). For example, four papers suggested using integrated knowledge translation, in which researchers work closely with the knowledge users to complete the rapid review [ 2 , 16 , 19 , 79 ]. Four papers suggested the use of a research question with a limited scope [ 12 , 16 , 80 , 110 ]. Seven publications recommended streamlining the literature search [ 2 , 12 , 16 , 46 , 79 , 80 , 110 ] and three suggested restricting the eligibility criteria [ 2 , 12 , 80 ]. Two papers provided suggestions for efficiently appraising risk of bias [ 2 , 80 ] and none suggested conducting a meta-analysis as part of the rapid review.

Articles assessing the impact and use of rapid reviews

Six papers examined the impact of rapid reviews on decision-making [ 41 – 43 , 60 , 85 , 110 ]. Hailey and colleagues (2000) examined the impact of 20 rapid review products [ 43 ] and found that 14 had an influence on policy decision-making, four provided guidance, and two had no perceived impact. McGregor and Brophy (2005) evaluated the success of the conduct of 16 rapid reviews for a hospital rapid review service [ 60 ]. The results of all 16 products were directly implemented in the hospital, saving approximately $3 million per year. Hailey (2006) wrote a paper summarizing the impact of HTA in general, as well as related to rapid HTA. Overall, it was concluded that these reports can influence decision-making. Hailey (2009) conducted a survey of HTA organizations to examine the use of rapid reviews for decision-making [ 42 ]. Fifteen rapid review products were included; all influenced a decision, including using the rapid review for reference material (67 %) and directly using the rapid review’s conclusions for the decision (53 %). Zechmeister (2012) examined the impact of 58 rapid assessments and observed that 56 of these products were directly used for reimbursement decisions and two were used for disinvestment decisions [ 85 ]. Finally, Batten (2012) wrote an editorial discussing how rapid reviews can be used by school nurses [ 110 ].

Our results suggest that the conduct of rapid reviews is recondite across the literature. Through our study, 50 different rapid review approaches were identified and only 16 occurred more than once. Furthermore, many different terms were used to describe a rapid review, making the identification of these types of knowledge synthesis products difficult.

Using a framework of rapid review methods, we observed numerous strategies employed to conduct reviews in a streamlined manner. These included not using a protocol, limiting the literature search, limiting inclusion criteria, only having one person screen the literature search results, not conducting quality appraisal, and not conducting a meta-analysis. In general, combining multiple shortcuts led to a timelier conduct of the review.

Only four of the included studies compared the results of rapid reviews to systematic reviews. Three of these found that the results for both knowledge synthesis products were in agreement. However, the results of these studies should be interpreted with caution because a very small sample of reviews were included (ranging from 1 to 8) and none of these were prospectively conducted. The latter is of particular importance, since it is unclear whether the authors of the full systematic reviews used the rapid review as a starting point to identify articles for inclusion (or vice versa). Interestingly, none of the included studies compared the results across rapid reviews on the same topic. Such a study may provide further clarity into the impact of streamlining different steps on the risk of bias and comprehensiveness of the review.

Seven papers provided recommendations on making rapid reviews more efficient. Consistent guidance included using an integrated knowledge translation approach, limiting the scope of the question and literature search, and not conducting a meta-analysis. Furthermore, six papers examined the impact of rapid reviews on decision-making and all found that they were valuable products. These results suggest that decision-makers are currently using rapid reviews to inform their decision-making processes. Further supporting this observation was the recent Canadian Agency for Drugs and Technologies in Health Rapid review summit [ 116 ], for which a large number of international decision-making organizations were in attendance.

Across the application papers, many of the methods were poorly reported suggesting that improvement in the reporting of rapid reviews is warranted. Thorough reporting of the methods is important because it is difficult to judge the bias of these reports without fully understanding what shortcuts were taken. As well, transparent reporting allows the reproducibility of research. It is important to note that 10 % of the included papers were reported in 5 pages or less, suggesting that perhaps there was insufficient room to report the methods fully.

Prior to establishing a quality of reporting guidelines for rapid reviews, a common terminology and definition is required [ 117 ]. Some of the team members are currently involved with research that is attempting to tackle this issue. At the bare minimum, one of the included papers provided a checklist to examine the reporting of rapid reviews [ 12 ], which can be used by producers of rapid reviews to ensure their reports are reported in a consistent manner.

We have also conducted other research on rapid reviews that builds on this scoping review [ 118 ]. Specifically, we conducted an international survey of 40 rapid review producers who identified several rapid review approaches, such as updating the literature search of previous reviews and limiting the search strategy by date of publication. Most of the rapid review products were conducted within 12 weeks. A modified Delphi approach was used to include input from 113 stakeholders (for example, researchers, policy-makers, industry, journal editors, and healthcare providers) to agree upon an attractive rapid review method that would be used in a future comparative study. The stakeholders ranked the following method as being the most feasible, timely, and having a low perceived risk of bias: literature search limited by date and language; study selection by one reviewer only; and data abstraction and quality appraisal conducted by one reviewer and verified by a second reviewer. We are currently in the process of seeking funding of a comparative study to test the accuracy of this rapid review approach versus the gold standard, systematic review.

A recent project on rapid reviews was commissioned by the Agency for Healthcare Research and Quality in the United States [ 119 , 120 ]. The authors summarized evidence from 12 review articles of rapid reviews [ 120 ], as well as 35 different rapid reviews produced by 20 different organizations [ 119 ]. This information was obtained through literature searches and key informant interviews with 18 individuals who had experience of conducting rapid reviews. The authors are currently conducting interviews with policy-makers to obtain their perceptions on rapid reviews, including their utility and importance.

Our scoping review has some limitations. To make our review more feasible, we were only able to include a random sample of rapid reviews from websites of rapid review producers. Further adding to this issue is that many rapid reviews contain proprietary information and are not publicly available. As such, our results are only likely generalizable to rapid reviews that are publicly available. Furthermore, this scoping review was an enormous undertaking and our results are only up to date as of May 2013. However, we believe that our results provide important information on rapid reviews and ours is the most comprehensive scoping review that we are currently aware of.

In conclusion, numerous rapid review approaches were identified and few were used consistently in the literature. Poor quality of reporting was observed. Further research on rapid reviews is warranted. In particular, the consequences of various methodological shortcuts should be investigated. This could be examined through a prospective study comparing the results of rapid reviews to those obtained through systematic reviews on the same topic. Team members are currently seeking funding to conduct such a study and it is hoped that our results will provide pertinent information on the utility and risk of bias of rapid reviews.

Abbreviations

Health technology assessment

Not reported

Risk of bias

• Systematic review

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Acknowledgements

The study was funded by a Canadian Institutes of Health Research (CIHR) Operating Grant (grant # DC0190GP, application # 294284). ACT and BH hold a CIHR/Drug Safety and Effectiveness Network New Investigator Award, DM holds a University of Ottawa Research Chair, and SES holds a Tier 1 Canada Research Chair in Knowledge Translation.

We thank Drs Donna Ciliska and Diana Sherifali who provided support and expertise in rapid reviews and knowledge translation on our systematic review protocol. We also thank Ana Guzman for formatting the paper.

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Li Ka Shing Knowledge Institute of St Michael’s Hospital, 209 Victoria Street, East Building, Room 716, Toronto, ON, M5B 1 W8, Canada

Andrea C. Tricco, Jesmin Antony, Wasifa Zarin, Lisa Strifler, Marco Ghassemi, John Ivory & Sharon E. Straus

Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, ON, M5T 3 M7, Canada

Andrea C. Tricco

Institute for Health Policy Management and Evaluation, University of Toronto, 4th Floor, 155 College Street, Toronto, ON, M5T 3 M6, Canada

Lisa Strifler & Laure Perrier

Ottawa Hospital Research Institute, Ottawa Methods Centre, Ottawa, ON, Canada

Brian Hutton & David Moher

Department of Medicine, Faculty of Medicine, University of Toronto, 27 King’s College Circle, Toronto, ON, M5S 1A1, Canada

Sharon E. Straus

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Correspondence to Sharon E. Straus .

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The authors declare that they have no competing interests.

Authors’ contributions

ACT conceived the study, obtained funding for the study, participated in all pilot tests of study eligibility and data abstraction, helped develop the framework of rapid reviews, interpreted the data, and wrote the manuscript. JA coordinated the study, screened citations and full-text articles for inclusion, abstracted, coded, analyzed the data, and edited the manuscript. WZ verified and coded the data, conducted content analysis, helped develop the framework, and edited the manuscript. LS screened citations and full-text articles, abstracted data, and edited the manuscript. MG abstracted and verified the data, and edited the manuscript. JDI abstracted data and edited the manuscript. LP screened citations and full-text articles, abstracted some data, conducted the literature search, and edited the manuscript. BH and DM helped obtain funding for the study, helped conceive the study, and edited the manuscript. SES conceived the study, obtained funding for the study, participated in pilot tests of eligibility criteria, and edited the manuscript. All authors read and approved the final manuscript.

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Tricco, A.C., Antony, J., Zarin, W. et al. A scoping review of rapid review methods. BMC Med 13 , 224 (2015). https://doi.org/10.1186/s12916-015-0465-6

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Article Contents

The problem: what if you need a synthesis of the evidence now, a solution: rapid reviews, examples of rapid reviews, limitations and pitfalls of rapid reviews, data availability.

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Rapid reviews: the pros and cons of an accelerated review process

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Philip Moons, Eva Goossens, David R. Thompson, Rapid reviews: the pros and cons of an accelerated review process, European Journal of Cardiovascular Nursing , Volume 20, Issue 5, June 2021, Pages 515–519, https://doi.org/10.1093/eurjcn/zvab041

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Although systematic reviews are the method of choice to synthesize scientific evidence, they can take years to complete and publish. Clinicians, managers, and policy-makers often need input from scientific evidence in a more timely and resource-efficient manner. For this purpose, rapid reviews are conducted. Rapid reviews are performed using an accelerated process. However, they should not be less systematic than standard systematic reviews, and the introduction of bias must be avoided. In this article, we describe what rapid reviews are, present their characteristics, give some examples, highlight potential pitfalls, and draw attention to the importance of evidence summaries in order to facilitate adoption in clinical decision-making.

Knowing what rapid reviews are.

Understanding the features and benefits of rapid reviews.

Recognizing the limitations of rapid reviews and knowing when they are not the preferred choice.

Researchers, clinicians, managers, and policy-makers are typical consumers of empirical work published in the scientific literature. For researchers, reviewing the literature is part of the empirical cycle, in order to generate new research questions and to discuss their own study findings. When the available evidence has to be searched for, collated, critiqued, and summarized, systematic reviews are the gold standard. 1 Systematic reviews are rigorous in approach and transparent about how studies were searched, selected, and assessed. Doing so, they limit bias and random error, and hence, they yield the most valid and trustworthy evidence. Systematic reviews can be complemented by meta-analyses to compute an overall mean effect, proportion, or relationship. 2 Systematic reviews and meta-analyses are seen as the pillars of evidence-based healthcare. The rigour in the methodology of a systematic review, however, also means that it often takes between 6 months and 2 years to undertake. 3

Clinicians, managers, and policy-makers also use the literature for their decision-making. They often cannot afford to wait for 2 years to get the answer to their questions by means of a systematic review. The evidence must be synthesized without undue delays. 4 Furthermore, the synthesis and reporting of systematic reviews often fail to address the needs of the users at the point of care 5 and are considered to be too large and too complex. 3 To facilitate the uptake of research findings in clinical practice, other types of reviews with a shorter lead time are needed, and alternative evidence summaries have to be developed. 5

Rapid reviews have been proposed as a method to provide summaries of the literature in a timely and resource-efficient manner by using methods to accelerate or streamline traditional systematic review processes. 5 , 6 It is argued that rapid reviews should be conducted in less than 8 weeks. 4 The purpose of rapid reviews is to respond to urgent situations or political pressures, often in a rapidly changing field. The typical target audiences for rapid reviews are policy-makers, healthcare institutions, managers, professionals, and patient associations. 6 The first rapid reviews were published in the 1960s and proliferated in the mid-2010s. Not surprisingly, the number of rapid reviews have boomed in 2020, in response to the global SARS-CoV-2/COVID-19 pandemic (see Figure 1 ). Indeed, this pandemic has had a huge impact on healthcare delivery, 7–9 and triggered unprecedented clinical questions that needed a prompt answer. 10 Healthcare research, also, has had to adapt swiftly to the drastically changed situation. 11

Number of publications in the Pubmed database (1960–2020) referring to ‘rapid review’ (search performed 16 March 2021).

A rapid review is a ‘a form of knowledge synthesis that accelerates the process of conducting a traditional systematic review through streamlining or omitting various methods to produce evidence for stakeholders in a resource-efficient manner’. 12 There is not a single-validated methodology in conducting rapid reviews. 13 Therefore, variation in methodological quality of rapid reviews can be observed. 14 When adopting the ‘Search, AppraisaL, Synthesis and Analysis (SALSA) framework’ to rapid reviews, it is stipulated that the completeness of the search is determined by time constraints; the quality appraisal is time-limited, if performed at all; the synthesis is narrative and tabular; and the analysis pertains to the overall quality/direction of effect of literature. 15 In Table 1 , we describe the SALSA characteristics of rapid reviews and systematic reviews. Rapid reviews should not be less systematic, and they must adhere to the core principles of systematic reviews to avoid bias in the inclusion, assessment, and synthesis of studies. 4 The typical characteristic of a rapid review is that it provides less in-depth information and detail in its recommendations. 6 It is essential, however, that deviations from traditional systematic review methods are described well in the methods section. This can, for instance, be done by explicating where the PRISMA criteria were omitted or adapted. 4 The speed with which a rapid review is conducted largely depends on the availability of human and financial resources. 4 There is also often a close interaction between the commissioners and the reviewers because the review purports to guide decision-making.

Distinction between rapid and systematic reviews

Based on Grant and Booth. 15

Although rapid reviews do not meet the gold standard of systematic reviews, and therefore do have their limitations (see below), they frequently provide adequate advice on which to base clinical and policy decisions. 13 A direct comparison of the findings from rapid and full systematic reviews showed that the essential conclusions did not differ extensively. 13 Given the importance of rapid reviews, the Cochrane collaboration has established the Cochrane Rapid Reviews Methods Group, which recently developed actionable recommendations and minimum standards for rapid reviews ( Table 2 ). 16

Cochrane rapid review methods recommendations

Reproduced from Garritty et al . 16 published under the CC BY-NC-ND license.

To date, three rapid reviews have been published in the European Journal of Cardiovascular Nursing . 17–19 The first, published in 2017, assessed the efficacy of non-pharmacological interventions on psychological distress in patients undergoing cardiac catheterization. 17 A second rapid review, published in 2020 amidst the first wave of the SARS-CoV-2/COVID-19 pandemic in Asia, Europe, and North America, looked at the evidence for remote healthcare during quarantine situations to support people living with cardiovascular diseases. 18 Given the unprecedented global situation and the sense of urgency, this was a pre-eminent example for which a rapid review was appropriate. A third rapid review, published in 2021, investigated if participation in a support-based intervention exclusively for caregivers of people living with heart failure change their psychological and emotional wellbeing. 19 The authors explicitly chose the streamlined method of a rapid review to inform the methodological approach of a future caregiver-based intervention. 19

Although rapid and systematic reviews have shown to yield similar conclusions, 13 , 20 there are definitely some limitations or pitfalls to bear in mind. For instance, rapidity may lead to brevity. 4 In such cases, the search may be restricted to one database; limited inclusion criteria by date or language; having one person screen and another verify studies; not conducting quality appraisal; or presenting results only as a narrative summary. 14 If only one database is used, it is recommended to search Pubmed, because rapid reviews that did not use Pubmed as a database are more likely to obtain results that differ from systematic reviews. 21 It is also recommended that a quality appraisal of the included studies is not skipped. For this purpose, appraisal tools that account for different methodologies are very suitable, such as the Mixed Methods Appraisal Tool (MMAT). 22 It has also been observed that rapid reviews are often not explicitly defining the methodology that had been used. 4 , 13 Consequently, the search cannot always be replicated and the reasons for the differences between the findings are difficult to comprehend. Further, it is not clear if the review was performed in a systematic fashion, which is also mandatory for rapid reviews. Otherwise, they may bear the risks of any other narrative review or poorly conducted systematic review. 4 Rapid reviews should not be seen as a quick alternative to a full systematic review, 13 and authors must avoid making shortcuts that could lead to bias. 6 Therefore, a thorough evaluation of the appropriateness of a rapid review methodology, being the need for a summary of the evidence without delay, is imperative. If there is no urgent need to obtain the evidence for clinical practice or policy-making, a full systematic review would be more suitable. Furthermore, when there is a high need for accuracy, for instance for clinical guidelines or regulatory affairs, a systematic review is still the best option. 21

Transparency in the description of the methods used is of critical importance to appraise the quality of the rapid review. 4 A scoping review of rapid reviews found that the quality of reporting is generally poor. 14 This may lead to the interpretation that rapid reviews are inherently inferior to full systematic reviews, whereas this is not the case if properly conducted and reported. It is also vital to acknowledge the potential limitations of rapidity.

Since the typical reports of systematic reviews are often too long and too complex for clinicians and decision-makers, 3 new formats of evidence summaries have been developed. 5 Evidence summaries are synopses that summarize existing international evidence on healthcare interventions or activities’. 5 For rapid reviews, reporting the evidence in tabular format is indispensable to be used at the point of care. Such evidence summaries can be even integrated in electronic patient records, to provide recommendations for the care for that patient, based on their specific characteristics. 5 An extensive database with evidence summaries has been developed by the Joanna Briggs Institute ( https://www.wolterskluwer.com/en/know/jbi-resources/jbi-ebp-database, last accessed 27 March 2021 ).

Rapid reviews are meant to inform specific clinical or policy decisions in a timely and resource-efficient fashion. They are conducted within a timeframe of some weeks. The rapidity refers to the accelerated process but should not come at the cost of losing any of the important information that could be expected from full systematic reviews, and the introduction of biases that may jeopardize the validity of the conclusions must be avoided. The quality of rapid reviews is as important as for traditional systematic reviews. Rapid reviews need to be explicit in the methodology that has been used and clearly state how the review differs from a full systematic review. Sufficient attention ought to be given to the evidence summaries because the format of these summaries will largely determine the adoption in clinical care or decision-making.

The article is based on a review of the literature. No specific data sources have been used.

Conflict of interest : none declared.

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Tricco AC , Garritty CM , Boulos L , Lockwood C , Wilson M , McGowan J , McCaul M , Hutton B , Clement F , Mittmann N , Devane D , Langlois EV , Abou-Setta AM , Houghton C , Glenton C , Kelly SE , Welch VA , LeBlanc A , Wells GA , Pham B , Lewin S , Straus SE. Rapid review methods more challenging during COVID-19: commentary with a focus on 8 knowledge synthesis steps . J Clin Epidemiol 2020 ; 126 : 177 – 183 .

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What are the best methodologies for rapid reviews of the research evidence for evidence-informed decision making in health policy and practice: a rapid review

Michelle m. haby.

1 Department of Chemical and Biological Sciences, Universidad de Sonora, Hermosillo, Sonora Mexico

2 Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria Australia

Evelina Chapman

3 Pan American Health Organization, Brasilia, DF Brazil

Rachel Clark

4 London School of Hygiene and Tropical Medicine, London, United Kingdom

Jorge Barreto

5 Fundação Oswaldo Cruz, Diretoria de Brasília, Brasilia, Brazil

Ludovic Reveiz

6 Knowledge Management, Bioethics and Research, Pan American Health Organization, Washington, DC, United States of America

John N. Lavis

7 McMaster Health Forum, Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, and Department of Political Science, McMaster University, Hamilton, Canada

8 Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA United States of America

Associated Data

The datasets supporting the conclusions of this article are included within the article and its additional files.

Rapid reviews have the potential to overcome a key barrier to the use of research evidence in decision making, namely that of the lack of timely and relevant research. This rapid review of systematic reviews and primary studies sought to answer the question: What are the best methodologies to enable a rapid review of research evidence for evidence-informed decision making in health policy and practice?

This rapid review utilised systematic review methods and was conducted according to a pre-defined protocol including clear inclusion criteria (PROSPERO registration: CRD42015015998). A comprehensive search strategy was used, including published and grey literature, written in English, French, Portuguese or Spanish, from 2004 onwards. Eleven databases and two websites were searched. Two review authors independently applied the eligibility criteria. Data extraction was done by one reviewer and checked by a second. The methodological quality of included studies was assessed independently by two reviewers. A narrative summary of the results is presented.

Five systematic reviews and one randomised controlled trial (RCT) that investigated methodologies for rapid reviews met the inclusion criteria. None of the systematic reviews were of sufficient quality to allow firm conclusions to be made. Thus, the findings need to be treated with caution. There is no agreed definition of rapid reviews in the literature and no agreed methodology for conducting rapid reviews. While a wide range of ‘shortcuts’ are used to make rapid reviews faster than a full systematic review, the included studies found little empirical evidence of their impact on the conclusions of either rapid or systematic reviews. There is some evidence from the included RCT (that had a low risk of bias) that rapid reviews may improve clarity and accessibility of research evidence for decision makers.

Conclusions

Greater care needs to be taken in improving the transparency of the methods used in rapid review products. There is no evidence available to suggest that rapid reviews should not be done or that they are misleading in any way. We offer an improved definition of rapid reviews to guide future research as well as clearer guidance for policy and practice.

Electronic supplementary material

The online version of this article (doi:10.1186/s12961-016-0155-7) contains supplementary material, which is available to authorized users.

In May 2005, the World Health Assembly called on WHO Member States to “establish or strengthen mechanisms to transfer knowledge in support of evidence-based public health and healthcare delivery systems, and evidence-based health-related policies ” [ 1 ]. Knowledge translation has been defined by WHO as: “ the synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health ” [ 2 ]. Knowledge translation seeks to address the challenges to the use of scientific evidence in order to close the gap between the evidence generated and decisions being made.

To achieve better translation of knowledge from research into policy and practice it is important to be aware of the barriers and facilitators that influence the use of research evidence in health policy and practice decision making [ 3 – 8 ]. The most frequently reported barriers to evidence uptake are poor access to good quality relevant research and lack of timely and relevant research output [ 7 , 9 ]. The most frequently reported facilitators are collaboration between researchers and policymakers, improved relationships and skills [ 7 ], and research that accords with the beliefs, values, interests or practical goals and strategies of decision makers [ 10 ].

In relation to access to good quality relevant research, systematic reviews are considered the gold standard and these are used as a basis for products such as practice guidelines, health technology assessments, and evidence briefs for policy [ 11 – 14 ]. However, there is a growing need to provide these evidence products faster and with the needs of the decision-maker in mind, while also maintaining credibility and technical quality. This should help to overcome the barrier of lack of timely and relevant research, thereby facilitating their use in decision making. With this in mind, a range of methods for rapid reviews of the research evidence have been developed and put into practice [ 15 – 18 ]. These often include modifications to systematic review methods to make them faster than a full systematic review. Some examples of modifications that have been made include (1) a more targeted research question/reduced scope; (2) a reduced list of sources searched, including limiting these to specialised sources (e.g. of systematic reviews, economic evaluations); (3) articles searched in the English language only; (4) reduced timeframe of search; (5) exclusion of grey literature; (7) use of search tools that make it easier to find literature; and (7) use of only one reviewer for study selection and/or data extraction. Given the emergence of this approach, it is important to develop a knowledge base regarding the implications of such ‘shortcuts’ on the strength of evidence being delivered to decision makers. At the time of conducting this review, we were not aware of any high quality systematic reviews on rapid reviews and their methods.

It is important to note that a range of terms have been used to describe rapid reviews of the research evidence, including evidence summaries, rapid reviews, rapid syntheses, and brief reviews, with no clear definitions [ 15 , 16 , 18 – 22 ]. In this paper, we have used the term ‘rapid review’, despite starting with the term ‘rapid evidence synthesis’ in our protocol, as it became clear during the conduct of our review that it is the most widely used term in the literature [ 23 ]. We consider a broad range of rapid reviews, including rapid reviews of effectiveness, problem definition, aetiology, diagnostic tests, and reviews of cost and cost-effectiveness.

The rapid review presented in this article is part of a larger project aimed at designing a rapid response program to support evidence-informed decision making in health policy and practice [ 24 ]. The expectation is that a rapid response will facilitate the use of research for decision making. We have labelled this study as a rapid review because it was conducted in a limited timeframe and with the needs of health policy decision-makers in mind. It was commissioned by policy decision-makers for their immediate use.

The objective of this rapid review was to use the best available evidence to answer the following research question: What are the best methodologies to enable a rapid review of research evidence for evidence-informed decision making in health policy and practice? Both systematic reviews and primary studies were included. Note that we have deliberately used the term ‘best methodologies’ as it is likely that a variety of methods will be needed depending on the research question, timeframe and needs of the decision maker.

This rapid review used systematic review methodology and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement [ 25 ]. A systematic review protocol was written and registered prior to undertaking the searches [ 26 ]. Deviations from the protocol are listed in Additional file 1 .

Inclusion criteria for studies

Studies were selected based on the inclusion criteria stated below.

Types of studies

Both systematic reviews and primary studies were sought. For inclusion, priority was given to systematic reviews and to primary studies that used one of the following designs: (1) individual or cluster randomised controlled trials (RCTs) and quasi-randomised controlled trials; (2) controlled before and after studies where participants are allocated to control and intervention groups using non-randomised methods; (3) interrupted time series with before and after measurements (and preferably with at least three measures); and (4) cost-effectiveness/cost-utility/cost-benefit. Other types of studies were also identified for consideration for inclusion in case no systematic reviews and few primary studies with strong study designs (as indicated above in 1–4) could be found. They were initially selected provided that they described some type of evaluation of methodologies for rapid reviews.

Types of participants

Apart from needing to be within the field of health policy and practice, the types of participants were not restricted, and the level of analysis could be at the level of the individual, organisation, system or geographical area. During the study selection process, we made a decision to also include ‘products’, i.e. papers that include rapid reviews as the unit of inclusion rather than people.

Types of articles/interventions

Studies that evaluated methodologies or approaches to rapid reviews for health policy and/or practice, including systematic reviews, practice guidelines, technology assessments, and evidence briefs for policy, were included.

Types of comparisons

Suitable comparisons (where relevant to the article type) included no intervention, another intervention, or current practice.

Types of outcome measures

Relevant outcome measures included time to complete; resources required to complete (e.g. cost, personnel); measures of synthesis quality; measures of efficiency of methods (measures that combine aspects of quality with time to complete, e.g. limiting data extraction to key characteristics and results that may reduce the time needed to complete without impacting on review quality); satisfaction with methods and products; and implementation. During the study selection process the authors agreed to include two additional outcomes that were not in the published protocol but important for the review, namely comparison of findings between the different synthesis methods (e.g. rapid vs. systematic review) and cost-effectiveness.

Publications in English, French, Portuguese or Spanish, from any country and published from 2004 onwards were included. The year 2004 was chosen as this is the year of the Mexico Ministerial Summit on Health Research, where the know-do gap was first given serious attention by health ministers [ 27 ]. Both grey and peer-reviewed literature was sought and included.

Search methods for identification of studies

A comprehensive search of eleven databases and two websites was conducted. The databases searched were CINAHL, the Cochrane Library (including Cochrane Reviews, the Database of Abstracts of Reviews of Effectiveness, the Health Technology Assessment database, NHS Economic Evaluation Database, and the database of Methods Studies), EconLit, EMBASE, Health Systems Evidence, LILACS and Medline. The websites searched were Google and Google Scholar.

Grey literature and manual search

Some of the selected databases index a combination of published and unpublished studies (for example, doctoral dissertations, conference abstracts and unpublished reports); therefore, unpublished studies were partially captured through the electronic search process. In addition, Google and Google Scholar were searched. The authors’ own databases of knowledge translation literature were also searched by hand for relevant studies. The reference list of each included study was searched. Contact was made with nine key authors and experts in the area for further studies, of whom five responded.

Search strategy

Searches were conducted between 15th January and 3rd February 2015 and supplementary searches (reference lists, contact with authors) were conducted in May 2015. Databases were searched using the keywords: “rapid literature review*” OR “rapid systematic review*” or “rapid scoping review*” OR “rapid review*” OR “rapid approach*” OR “rapid synthesis” OR “rapid syntheses” OR “rapid evidence assess*” OR “evidence summar*” OR “realist review*” OR “realist synthesis” OR “realist syntheses” OR “realist evaluation” OR “meta-method*” OR “meta method*” OR “realist approach*” OR “meta-evaluation*” OR “meta evaluation*”. Keywords were searched for in title and abstract, except where otherwise stated in Additional file 2 . Results were downloaded into the EndNote reference management program (version X7) and duplicates removed. The Internet search utilised the search terms: “rapid review”; “rapid systematic review”; “realist review”; “rapid synthesis”; and “rapid evidence”.

Screening and selection of studies

Searches were conducted and screened according to the selection criteria by one review author (MH). The full text of any potentially relevant papers was retrieved for closer examination. This reviewer erred on the side of inclusion where there was any doubt about its inclusion to ensure no potentially relevant papers were missed. The inclusion criteria were then applied against the full text version of the papers (where available) independently by two reviewers (MH and RC). For studies in Portuguese and Spanish, other authors (EC, LR or JB) played the role of second reviewer. Disagreements regarding eligibility of studies were resolved by discussion and consensus. Where the two reviewers were still uncertain about inclusion, the other reviewers (EC, LR, JB, JL) were asked to provide input to reach consensus. All studies which initially appeared to meet the inclusion criteria, but on inspection of the full text paper did not, were detailed in a table ‘Characteristics of excluded systematic reviews,’ together with reasons for their exclusion.

Application of the inclusion criteria by the two reviewers was performed as follows. First, all studies that met the inclusion criteria for participants, interventions and outcomes were selected, providing that they described some type of evaluation of methodologies for rapid evidence synthesis. At this stage, the study type was assessed and categorised by the two reviewers as being a (1) systematic review; (2) primary study with a strong study design, i.e. of one of the four types identified above; or (3) ‘other’ study design (that provided some type of evaluation of methodologies for rapid evidence synthesis). The reason for this was to enable the reviewers to make a decision as to which study designs should be included (based on available evidence, it was not known if sufficient evidence would be found if only systematic reviews and primary studies with strong study designs were included from the outset) and because of interest from the funders in other study types. Following discussion between all co-authors it was decided that it was likely that sufficient evidence could be provided from the first two categories of study type. Thus, the third group was excluded from data extraction but are listed in Additional file 3 .

Data extraction

Information extracted from studies and reviewed included objectives, target population, method/s tested, outcomes reported, country of study/studies and results. For systematic reviews we also extracted the date of last search, the included study designs and the number of studies. For primary studies, we also extracted the year of study, the study design and the population size. Data extraction was performed by one reviewer (MH) and checked by a second reviewer (RC). Disagreements were resolved through discussion and consensus.

Assessment of methodological quality

The methodological quality of included studies was assessed independently by two reviewers using AMSTAR: A MeaSurement Tool to Assess Reviews [ 28 ] for systematic reviews and the Cochrane Risk of Bias Tool for RCTs [ 29 ]. Disagreements in scoring were resolved by discussion and consensus. For this review, systematic reviews that achieved AMSTAR scores of 8 to 11 were considered high quality; scores of 4 to 7 medium quality; and scores of 0 to 3 low quality. These cut-offs are commonly used in Cochrane Collaboration overviews. The study quality assessment was used to interpret their results when synthesised in this review and in the formulation of conclusions.

Data analysis

Findings from the included publications were synthesised using tables and a narrative summary. Meta-analysis was not possible because the included studies were heterogeneous in terms of the populations, methods and outcomes tested.

Search results

Five systematic reviews (from seven articles) [ 18 , 19 , 21 , 30 – 33 ] and one primary study with a strong study design – a RCT [ 34 ] – met the inclusion criteria for the review. The selection process for studies and the numbers at each stage are shown in Fig.  1 . The reasons for exclusion of the 75 papers at full text stage are shown in Additional file 3 . The 12 evaluation studies excluded from data extraction due to weak study designs are also listed at the end of Additional file 3 .

Study selection flow chart – Methods for rapid reviews

Characteristics of included studies and quality assessment

Characteristics of the included systematic reviews are summarised in Table  1 , with full details provided in Additional file 4 . All rapid reviews were targeted at healthcare decision makers and/or agencies conducting rapid reviews (including rapid health technology assessments). Only two of the systematic reviews offered a definition of “rapid review” to guide their reviews [ 19 , 30 , 33 ]. Three of the systematic reviews obtained samples of rapid review products – though not necessarily randomly – and examined aspects of the methods used in their production [ 18 , 19 , 21 ]. Three of the systematic reviews reviewed articles on rapid review methods [ 18 , 30 , 32 ]. Two of these also included a comparison of findings from rapid reviews and systematic reviews conducted for the same topic [ 18 , 32 ].

Characteristics of the included systematic reviews. Reviews are ordered chronologically, from most to least recent, and alphabetically within years

a The outcome ‘methods used’ refers to the method used in the included rapid reviews. This outcome is important for determining the quality of the review

HTA health technology assessment, RR rapid review, SR systematic review

None of the systematic reviews that were identified examined the outcomes of resources required to complete, synthesis quality, efficiency of methods, satisfaction with methods and products, implementation, or cost-effectiveness. However, while not explicitly assessing synthesis/review quality, all of the reviews did report the methods used to conduct the rapid reviews. We have reported these details as they give an indication of the quality of the review. Therefore, the outcomes reported in the included systematic reviews and recorded in Table  1 and Additional file 4 do not align perfectly with those proposed in our inclusion criteria. In addition, we have included some information that was not pre-defined but for which we extracted information because it provided important contextual information, e.g. type of product, definition, rapid review initiation and rationale, nomenclature, and content. The reporting of the results was also further complicated by the use of a narrative, rather than a quantitative, synthesis of the results in the included studies.

It is not possible to say how many unique studies are included in these systematic reviews because only one review actually included a list of included studies [ 30 ] and one a characteristics of included studies table (but not in a form that was easy to use) [ 21 ]. However, it is clear that there is likely to be significant overlap in studies between reviews. For example, the most recent systematic review by Hartling et al. [ 31 , 32 ] also included the four previous systematic reviews included in this rapid review [ 18 , 19 , 21 , 30 , 33 ].

The RCT was targeted at healthcare professionals involved in clinical guideline development [ 34 ]. It aimed to assess the effectiveness of different evidence summary formats for use in clinical guideline development. Three different packs were tested – pack A: a systematic review alone; pack B: a systematic review with summary-of-findings tables included; and pack C: an evidence synthesis and systematic review. Pack C is described by the authors of the study as: “ a locally prepared, short, contextually framed, narrative report in which the results of the systematic review (and other evidence where relevant) were described and locally relevant factors that could influence the implementation of evidence-based guideline recommendations (e.g. resource capacity) were highlighted ” [ 34 ]. We interpreted pack C as being a ‘rapid review’ for the purposes of this review as the authors state that it is based on a comprehensive search and critical appraisal of the best currently available literature, which included a Cochrane review, an overview of systematic reviews and RCTs, and additional RCTs but was likely to have been done in a short timeframe. It was also conducted to help improve decision-making. The primary outcome measured was the proportion of correct responses to key clinical questions, whilst the secondary outcome was a composite score comprised of clarity of presentation and ease of locating the quality of evidence [ 34 ]. This study was not included in any previous systematic reviews.

Four of the systematic reviews obtained AMSTAR scores of 2 (low quality) and one a score of 4 (medium quality). No high quality systematic reviews were found. Thus, the findings of the systematic reviews should be taken as indicative only and no firm conclusions can be made. The RCT was classified as low risk of bias on the Cochrane Risk of Bias tool. The quality assessments can be found in Additional file 5 .

Definition of a ‘rapid review’

The five systematic reviews are consistent in stating that there is no agreed definition of rapid reviews and no agreed methodology for conducting rapid reviews [ 18 , 19 , 21 , 30 – 33 ]. According to the authors of one review: “ the term ‘rapid review’ does not appear to have one single definition but is framed in the literature as utilizing various stipulated time frames between 1 and 6 months ” [ 21 , p. 398]. The definitions offered to guide the reviews by Abrami et al. [ 19 ] and Cameron et al. [ 30 ] both use a timeframe of up to 6 months (Table  1 ). Cameron et al. [ 30 ] also include in their definition the requirement that the review contains the elements of a comprehensive search – though they do not offer criteria to assess this.

Abrami et al. [ 19 ] use the term ‘brief review’ rather than ‘rapid review’ to emphasise that both timeframe and scope may be affected. They write that “ a brief review is an examination of empirical evidence that is limited in its timeframe (e.g. six months or less to complete) and/or its scope, where scope may include:

• the breadth of the question being explored (e.g. a review of one-to-one laptop programs versus a review of technology integration in schools);
• the timeliness of the evidence included (e.g. the last several years of research versus no time limits);
• the geographic boundaries of the evidence (e.g. inclusion of regional or national studies only versus international evidence);
• the depth and detail of analyses (e.g. reporting only overall findings versus also exploring variability among the findings); or
• otherwise more restrictive study inclusion criteria than might be seen in a comprehensive review .” [ 19 , p. 372].

All other included systematic reviews used the term ‘rapid review’ or ‘rapid health technology assessment’ to describe rapid reviews.

Methods used based on examples of rapid reviews

While the word ‘rapid’ indicates that it will be carried out quickly, there is no consistency in published rapid reviews as to how it is made rapid and which part, or parts, of the review are carried out at a faster pace than a full systematic review [ 18 , 19 , 21 ]. A further complexity is the reporting of methods used in the rapid review, with about 43% of the rapid reviews examined by Abrami et al. [ 19 ] not describing their methodology comprehensively. Three examples of ‘shortcuts’ taken are (1) not using two reviewers for study selection and/or data extraction; (2) not conducting a quality assessment of included studies; and (3) not searching for grey literature [ 18 , 19 , 21 ]. However, it is important to note that the rapid reviews examined in these three systematic reviews were not necessarily selected randomly and, thus, it is not possible to accurately quantify the proportion of rapid reviews taking various ‘shortcuts’ and which ‘shortcuts’ are the most common. The time taken for the reviews examined varied from several days to one year [ 19 ]; 3 weeks to 6 months [ 18 ]; and 7–12 (mean 10.42, SD 7.1) months [ 21 ].

Methods used based on studies of rapid review methods

Methodological approaches or ‘shortcuts’ used in rapid reviews to make them faster than a full systematic review include [ 18 , 19 , 32 ] limiting the number of questions; limiting the scope of questions; searching fewer databases; limited use of grey literature; restricting the types of studies included (e.g. English only, most recent 5 years); relying on existing systematic reviews; eliminating or limiting hand searching of reference lists and relevant journals; narrow time frame for article retrieval; using non-iterative search strategy; eliminating consultation with experts; limiting full-text review; limiting dual review for study selection, data extraction and/or quality assessment; limiting data extraction; limiting risk of bias assessment or grading; minimal evidence synthesis; providing minimal conclusions or recommendations; and limiting external peer review. Harker et al. [ 21 ] found that, with increasing timeframes, fewer of the ‘shortcuts’ were used and that, with longer timeframes, it was more likely that risk of bias assessment, evidence grading and external peer review would be conducted [ 21 ].

None of the included systematic reviews offer firm guidelines for the methodology underpinning rapid reviews. Rather, they report that many articles written about rapid reviews offer only examples and discussion surrounding the complexity of the area [ 30 ].

Supporting evidence for shortcuts

While authors of the included systematic reviews tend to agree that changes to scope or timeframe can introduce biases (e.g. selection bias, publication bias, language of publication bias) they found little empirical evidence to support or refute that claim [ 18 , 19 , 21 , 30 , 32 ].

The review by Ganann et al. [ 18 ] included 45 methodological studies that considered issues such as the impact of limiting the number of databases searched, hand searching of reference lists and relevant journals, omitting grey literature, only including studies published in English, and omitting quality assessment. However, they were unable to provide clear methodological guidelines based on the findings of these studies.

Comparison of findings – rapid reviews versus systematic reviews

A key question is whether the conclusions of a rapid review are fundamentally different to a full systematic review, i.e. whether they are sufficiently different to change the resulting decision. This is an area where the research is extremely limited. There are few comparisons of full and rapid reviews that are available in the literature to be able to determine the impact of the above methodological changes – only two primary studies were reported in the included systematic reviews [ 35 , 36 ]. It is important to note that neither of these studies met, on their own, the inclusion criteria for the review in that they did not have a sufficiently strong study design. Both are included in the list of 12 studies excluded from data extraction (Fig.  1 and Additional file 3 ). Thus, they provide a very low level of evidence.

One of the primary studies compared full and rapid reviews on the topics of drug eluting stents, lung volume reduction surgery, living donor liver transplantation and hip resurfacing [ 30 , 36 ]. There were no instances in which the essential conclusions of the rapid and full reviews were opposed [ 32 ]. The other compared a rapid review with a full systematic review on the use of potato peels for burns [ 35 ]. The results and conclusions of the two reports were different. The authors of the rapid review suggest that this is because the systematic review was not of sufficiently good quality – as they missed two important trials in their search [ 35 ]. However, the limited detail on the methods used to conduct the systematic review makes this case study of limited value. Further research is needed in this area.

Impact of rapid syntheses on understanding of decision makers

The included RCT by Opiyo et al. [ 34 ] examined the impact of different evidence summary or synthesis formats on knowledge of the evidence, with each participant receiving a pack containing three different summaries; they found no differences between packs in the odds of correct responses to key clinical questions. Pack C (the rapid review) was associated with a higher mean composite score for clarity and accessibility of information about the quality of evidence for critical neonatal outcomes compared to systematic reviews alone (pack A) (adjusted mean difference 0.52, 95% confidence interval, 0.06–0.99). Findings from interviews with 16 panellists indicated that short narrative evidence reports (pack C) were preferred for the improved clarity of information presentation and ease of use. The authors concluded that their “ findings suggest that ‘graded-entry’ evidence summary formats may improve clarity and accessibility of research evidence in clinical guideline development ” [ 34 , p. 1].

This review is the first high quality review (using systematic reviews as the gold standard for literature reviews) published in the literature that provides a comprehensive overview of the state of the rapid review literature. It highlights the lack of definition, lack of defined methods and lack of research evidence showing the implications of methodological choices on the results of both rapid reviews and systematic reviews. It also adds to the literature by offering clearer guidance for policy and practice than has been offered in previous reviews (see Implications for policy and practice ).

While five systematic reviews of methods for rapid reviews were found, none of these were of sufficient quality to allow firm conclusions to be made. Thus, the findings need to be treated with caution. There is no agreed definition of rapid reviews in the literature and no agreed methodology for conducting rapid reviews [ 18 , 19 , 21 , 30 – 33 ]. However, the systematic reviews included in this review are consistent in stating that a rapid review is generally conducted in a shorter timeframe and may have a reduced scope. A wide range of ‘shortcuts’ are used to make rapid reviews faster than a full systematic review. While authors of the included systematic reviews tend to agree that changes to scope or timeframe can introduce biases (e.g. selection bias, publication bias, language of publication bias) they found little empirical evidence to support or refute that claim [ 18 , 19 , 21 , 30 , 32 ]. Further, there are few comparisons available in the literature of full and rapid reviews to be able to determine the impact of these ‘shortcuts’. There is some evidence from a good quality RCT with low risk of bias that rapid reviews may improve clarity and accessibility of research evidence for decision makers [ 34 ], which is a unique finding from our review.

A scoping review published after our search found over 20 different names for rapid reviews, with the most frequent term being ‘rapid review’, followed by ‘rapid evidence assessment’ and ‘rapid systematic review’ [ 23 ]. An associated international survey of rapid review producers and modified Delphi approach counted 31 different names [ 37 ]. With regards to rapid review methods and definitions, the scoping review found 50 unique methods, with 16 methods occurring more than once [ 23 ]. For their scoping review and international survey, Tricco et al. utilised the working definition: “ a rapid review is a type of knowledge synthesis in which components of the systematic review process are simplified or omitted to produce information in a short period of time ” [ 23 , 37 ].

The authors of the most recent systematic review of rapid review methods suggest that: “ the similarity of rapid products lies in their close relationship with the end-user to meet decision making needs in a limited timeframe ” [ 32 , p. vii]. They suggest that this feature drives other differences, including the large range of products often produced by rapid response groups, and the wide variation in methods used [ 32 ] – even within the same product type produced by the same group. We suggest that this feature of rapid reviews needs to be part of the definition and considered in future research on rapid reviews, including whether it actually leads to better uptake of research. To aid future research, we propose the following definition: a rapid review is a type of systematic review in which components of the systematic review process are simplified, omitted or made more efficient in order to produce information in a shorter period of time, preferably with minimal impact on quality. Further, they involve a close relationship with the end-user and are conducted with the needs of the decision-maker in mind.

When comparing rapid reviews to systematic reviews, the confounding effects of quality of the methods used must be considered. If rapid syntheses of research are seen as systematic reviews performed faster and if systematic reviews are seen as the gold standard for evidence synthesis, the quality of the review is likely to depend on which ‘shortcuts’ were taken and this can be assessed using available quality measures, e.g. AMSTAR [ 28 ]. While Cochrane Collaboration systematic reviews are consistently of a very high quality (achieving 10 or 11 on the AMSTAR scale, based on our own experience) the same cannot be said for all systematic reviews that can be found in the published literature or in databases of systematic reviews – as is demonstrated by this review where AMSTAR scores were quite low (Additional file 5 ) and a related overview where AMSTAR scores varied between two and ten [ 24 , Additional file one]. This fact has not been acknowledged in previous syntheses of the rapid review literature. It is also possible for rapid reviews to achieve high AMSTAR scores if conducted and reported well. Therefore, it can be easily argued that a high quality rapid review is likely to provide an answer closer to the ‘truth’ than a systematic review of low quality. It is also an argument for using the same tool for assessing the quality of both systematic and rapid reviews.

Authors of the published systematic reviews of rapid reviews suggest that, rather than focusing on developing a formalised methodology, which may not be appropriate, researchers and users should focus on increasing the transparency of the methods used for each review [ 18 , 30 , 33 ]. Indeed, several AMSTAR criteria are highly dependent on the transparency of the write-up rather than the methodology itself. For example, there are many examples of both systematic and rapid review authors not stating that they used a protocol for their review when, in fact, they did use one, leading to a loss of 1 point on the AMSTAR scale. Another example is review authors failing to provide an adequate description of the study selection and data extraction process, thus making it hard for those assessing the quality of the review to determine if this was done in duplicate, which is again a loss of 1 point on the AMSTAR scale.

While it could be argued that none of the included reviews described their review as a systematic review, we believe that it is appropriate to assess their quality using the AMSTAR tool. This the best tool available, to our knowledge, to assess and compare the quality of review methods and considers the major potential sources for bias in reviews of the literature [ 28 , 38 ]. Further, the five reviews included were clearly not narrative reviews as each described their methods, including sources of studies, search terms and inclusion criteria used.

Strengths and limitations

A key strength of this rapid review is the use of high quality systematic review methodology, including the consideration of the scientific quality of the included studies in formulating conclusions. A meta-analysis was not possible due to the heterogeneity in terms of intervention types and populations studied in the included systematic reviews. As a result publication bias could not be assessed quantitatively in this review and no clear methods are available for assessing publication bias qualitatively [ 39 ]. Shortcuts taken to make this review more rapid, as well as an AMSTAR assessment of the review, are shown in Additional file 6 . The AMSTAR assessment is based on the published tool [ 28 ] and additional guidance provided on the AMSTAR website ( http://amstar.ca/Amstar_Checklist.php ).

The current rapid review is evidence that a review can include several shortcuts and be produced in a relatively short amount of time without sacrificing quality, as shown by the high AMSTAR score (Additional file 6 ). The time taken to complete this review was 7 months from signing of contract (November 2014) to submission of the final report to the funder (June 2015). Alternatively, if publication of the protocol on PROSPERO and the start of literature searching (January 2014) are taken as the starting point, the time taken was 5 months.

Limitations of this review include (1) the low quality of the systematic reviews found, with three of the four included systematic reviews judged as low quality on the AMSTAR criteria and the fourth just making it to medium quality (Additional file 5 ); (2) the fact that few primary studies were conducted in developing countries, which is an issue for the generalisability of the results; and (3) restricting the search to articles in English, French, Spanish or Portuguese (languages with which the review authors are competent) and to the last 10 years. However, this was done to expedite the review process and is unlikely to have resulted in the loss of important evidence.

Implications for policy and practice

Users of rapid reviews should request an AMSTAR rating and a clear indication of the shortcuts taken to make the review process faster. Producers of rapid reviews should give greater consideration to the ‘write-up’ or presentation of their reviews to make their review methods more transparent and to enable a fair quality assessment. This could be facilitated by including the appropriate elements in templates and/or guidelines. If a shorter report is required, the necessary detail could be placed in appendices.

When deciding what methods and/or process to use for their rapid reviews, producers of rapid reviews should give priority to shortcuts that are unlikely to impact on the quality or risk of bias of the review. Examples include limiting the scope of the review [ 19 ], limiting data extraction to key characteristics and results [ 32 ], and restricting the study types included in the review [ 32 ]. When planning the rapid review, the review producer should explain to the user the implications of any shortcuts taken to make the review faster, if any.

Producers of rapid reviews should consider maintaining a larger highly skilled and experienced staff, who can be mobilised quickly, and understands the type of products that might meet the needs of the decision maker [ 19 , 32 ]. Consideration should also be given to making the process more efficient [ 19 ]. These measures can aid timelines without compromising quality.

Implications for research

The impact on the results of rapid reviews (and systematic reviews) of any ‘shortcuts’ used requires further research, including which ‘shortcuts’ have the greatest impact on the review findings. Tricco et al. [ 23 , 37 ] suggest that this could be examined through a prospective study that compares the results of rapid reviews to those obtained through systematic reviews on the same topic. However, to do this, it will be important to consider quality as a confounding factor and ensure random selection and blinding of the rapid review producers. If random selection and blinding cannot be guaranteed, we suggest that retrospective comparisons may be more appropriate. Another, related approach, would be to compare findings of reviews (be they systematic or rapid) for each type of shortcut, controlling for methodological quality. Other issues, such as the breadth of the inclusion criteria used and number of studies included would also need to be considered as possible confounding factors.

The development of reporting guidelines for rapid reviews, as are available for full systematic reviews, would also help [ 18 , 25 ]. These should be heavily based on systematic review guidelines but also consider characteristics specific to rapid reviews such as the relationship with the review user.

Finally, future studies and reviews should also address the outcomes of review quality, satisfaction with methods and products, implementation and cost-effectiveness as these outcomes were not measured in any of the included studies or reviews. Effectiveness of rapid reviews in increasing the use of research evidence in policy decision-making is also an important area for further research.

Care needs to be taken in interpreting the results of this rapid review on the best methodologies for rapid review given the limited state of the literature. There is a wide range of methods currently used for rapid reviews and wide range of products available. However, greater care needs to be taken in improving the transparency of the methods used in rapid review products to enable better analysis of the implications of methodological ‘shortcuts’ taken for both rapid reviews and systematic reviews. This requires the input of policymakers and practitioners, as well as researchers. There is no evidence available to suggest that rapid reviews should not be done or that they are misleading in any way.

Acknowledgements

We thank the authors of included studies and other experts in the field who responded to our request to identify further studies that could meet our inclusion criteria and/or responded to our queries regarding their study.

This work was developed and funded under the cooperation agreement # 47 between the Department of Science and Technology of the Ministry of Health of Brazil and the Pan American Health Organization. The funders of this study set the terms of reference for the project but, apart from the input of JB, EC and LR to the conduct of the study, did not significantly influence the work. Manuscript preparation was funded by the Ministry of Health Brazil, through an EVIPNet Brazil project with the Bireme/PAHO.

Availability of data and materials

Authors’ contributions.

EC and JB had the original idea for the review and obtained funding; MH and EC wrote the protocol with input from RC, JB, and LR; MH and RC undertook the article selection, data extraction and quality assessment; MH undertook data synthesis and drafted the manuscript; JL, EC, RC, JB and LR provided guidance throughout the selection, data extraction and synthesis phase of the review; all authors provided commentary on and approved the final manuscript.

Competing interests

The author(s) declare that they have no competing interests. Neither the Ministry of Health of Brazil nor the Pan American Health Organization (PAHO), the funders of this research, have a vested interest in any of the interventions included in this review – though they do have a professional interest in increasing the uptake of research evidence in decision making. EC and LR are employees of PAHO and JB was an employee of the Ministry of Health of Brazil at the time of the study. However, the views and opinions expressed herein are those of the review authors and do not necessarily reflect the views of the Ministry of Health of Brazil or PAHO. JNL is involved in a rapid response service but was not involved in the selection or data extraction phases. MH, as part of her previous employment with an Australian state government department of health, was responsible for commissioning and using rapid reviews to inform decision making.

Consent for publication

Not applicable.

Ethics approval and consent to participate

Abbreviations, additional files.

Changes to the protocol. (DOCX 28 kb)

Search terms. (DOCX 31 kb)

Characteristics of excluded studies and reference details. (DOCX 40 kb)

Characteristics of included studies. (DOCX 47 kb)

Quality assessment of included studies. (DOCX 29 kb)

Shortcuts and quality assessment of this review. (DOCX 30 kb)

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Introduction to Rapid Reviews

During the COVID-19 pandemic, the number of rapid reviews increased and became a popular method of conducting a rigorous literature review, using systematic review methodology in a shorter time frame. This type of review helps synthesize the available evidence in a narrative descriptive format and can be done at a faster pace than a full systematic review. The introductory class will discuss what research questions are best suited for a rapid review, best practices for their conduct, and review the required methodological steps on how to conduct an effective rapid review. 

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Rapid literature review: definition and methodology

Affiliations.

• 1 Assignity, Cracow, Poland.
• 2 Public Health Department, Aix-Marseille University, Marseille, France.
• 3 Studio Slowa, Wroclaw, Poland.
• 4 Clever-Access, Paris, France.
• PMID: 37533549
• PMCID: PMC10392303
• DOI: 10.1080/20016689.2023.2241234

Introduction: A rapid literature review (RLR) is an alternative to systematic literature review (SLR) that can speed up the analysis of newly published data. The objective was to identify and summarize available information regarding different approaches to defining RLR and the methodology applied to the conduct of such reviews. Methods: The Medline and EMBASE databases, as well as the grey literature, were searched using the set of keywords and their combination related to the targeted and rapid review, as well as design, approach, and methodology. Of the 3,898 records retrieved, 12 articles were included. Results: Specific definition of RLRs has only been developed in 2021. In terms of methodology, the RLR should be completed within shorter timeframes using simplified procedures in comparison to SLRs, while maintaining a similar level of transparency and minimizing bias. Inherent components of the RLR process should be a clear research question, search protocol, simplified process of study selection, data extraction, and quality assurance. Conclusions: There is a lack of consensus on the formal definition of the RLR and the best approaches to perform it. The evidence-based supporting methods are evolving, and more work is needed to define the most robust approaches.

Keywords: Delphi consensus; Rapid review; methodology; systematic literature review.

© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Publication types

• Open access
• Published: 23 April 2024

Prevalence of metabolic syndrome and associated factors among patient with type 2 diabetes mellitus in Ethiopia, 2023: asystematic review and meta analysis

• Betelhem Mesfin Demissie 1 ,
• Fentaw Girmaw 2 ,
• Nimona Amena 3 &
• Getachew Ashagrie 2  

BMC Public Health volume  24 , Article number:  1128 ( 2024 ) Cite this article

Metrics details

Metabolic syndrome is a complex pathophysiologic state which characterized by abdominal obesity, insulin resistance, hypertension, and hyperlipidaemia. The Adult Treatment Panel III report (ATP III) of the National Cholesterol Education Programme identified the metabolic syndrome as a serious public health issue in the modern era. In Western and Asian nations, the frequency of metabolic syndrome is rising, especially in developing regions experiencing rapid socio-environmental changes, in Sub-Saharan Africa; metabolic syndrome may be present in more than 70% of people with type 2 diabetes mellitus. Therefore the objective of our study was to estimate the pooled prevalence of metabolic syndrome and associated factors among type II diabetes mellitus patient.

This systematic review and meta-analysis included original articles of cross sectional studies published in the English language. Searches were carried out in PubMed, Web of Science, Google Scholar, and grey literature Journals from 2013 to June 2023. A random-effects model was used to estimate the pooled prevalence of metabolic syndrome among type II Diabetes mellitus patient in Ethiopia. Heterogeneity was assessed using the I 2 statistic. Subgroup analysis was also conducted based on study area. Egger’s test was used to assess publication bias. Sensitivity analysis was also conducted.

Out of 300 potential articles, 8 cross sectional studies were included in this systematic review and meta-analysis study. The pooled prevalence of metabolic syndrome among patient with type II diabetes mellitus in Ethiopia was found to be 64.49% (95% CI: 62.39, 66.59) and 52.38% (95% CI: 50.05, 54.73) by using NCEP/ATP III and IDF criteria, respectively. The weighted pooled prevalence of metabolic syndrome among type II diabetes mellitus patients by sub group analysis based on the study region was 63.79% (95% CI: 56.48, 71.11) and 52.23% (95%CI: 47.37, 57.22) by using NCEP/ATP III and IDF criteria, respectively. Being female and increased body mass index were factors associated with metabolic syndrome among type II diabetes mellitus patients.

The prevalence of metabolic syndrome among type II patient is high. Therefore, policymakers, clinicians, and concerned stakeholders shall urge effective strategies in the control, prevention, and management of metabolic syndrome among type II diabetes mellitus.

Peer Review reports

Introduction

The complicated pathophysiologic condition known as the metabolic syndrome is characterised by insulin resistance, hypertension, hyperlipidaemia, and abdominal obesity and which originate primarily from an imbalance between energy expenditure and calorie intake [ 1 ]. Even though the NCEP-ATPIII, IDF, and WHO criteria are the most often utilised clinical criteria for the diagnosis of metabolic syndrome, there are numerous similarities between them, there are also notable differences in the perspectives on the underlying causes of the metabolic syndrome [ 2 ]. The prevalence of metabolic syndrome is increasing in Western and Asian countries, particularly in emerging areas that are undergoing fast socio-environmental change. Numerous studies have demonstrated that metabolic syndrome is a major risk factor for type 2 diabetes mellitus, cardiovascular disease (CVD), and overall mortality [ 3 ].

Global estimates suggest that about one-third of the world’s population, primarily in developing countries, may have metabolic syndrome [ 4 ]. The National Cholesterol Education Programme’s Adult Treatment Panel III report (ATP III) recognised metabolic syndrome as a significant contemporary public health concern. It is a multiplex risk factor for cardiovascular disease (CVD) that requires more therapeutic care, and it also raises the risk of cancer, mental problems, renal illness, and early mortality [ 2 , 5 ].

Compared to those in Western countries, the urban population in several developing nations has a greater prevalence of metabolic syndrome. The two main causes of this disease’s growth are the increase in fast food consumption—high-calorie, low-fiber foods—and the decline in physical activity brought on by sedentary leisure activities and the use of automated transportation [ 1 ].

In Sub-Saharan Africa, metabolic syndrome may be present in more than 70% of people with type 2 diabetes mellitus. According to research which is done in two rural clinics of Ghana, the prevalence of metabolic syndrome among type II diabetes mellitus patients was 68.6% (95% CI: 64.0-72.8), and having diabetes for more than five years, being female, and being overweight are significantly associated with metabolic syndrome [ 4 ]. A study done by Lira Neto JCG et al., Stated that among 201 study participants, 50.7% were diagnosed with metabolic syndrome [ 5 ].

A cross sectional study conducted in Ethiopia reported that the prevalence of metabolic syndrome was 20.3% among 325 study participants [ 6 ]. A Systematic Review and Meta-analysis study conducted in Ethiopia stated that the pooled prevalence of metabolic syndrome in Ethiopia was found to be 34.89% (95% CI: 26.77, 43.01) and 27.92% (95% CI: 21.32, 34.51) by using NCEP/ATP III and IDF criteria, respectively. Subgroup analysis based on the study subjects using NCEP/ATP III showed that the weighted pooled prevalence was 63.78%(95% CI: 56.17, 71.40) among type 2 Diabetes Mellitus patients [ 7 ].

Even though this topic has been studied before, our work is unique since we look at aspects outside prevalence. Thus, our study’s goal was to analyse the pooled prevalence of metabolic syndrome and associated factors among patients with type II diabetes mellitus. How much is the prevalence of metabolic syndrome among Ethiopian patients with type II diabetes mellitus? And what variables are associated with metabolic syndrome patients with type II diabetes in Ethiopian?

Protocol and search strategy

The systematic review and meta-analysis was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guideline (Fig.  1 ). The study protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42023442704). An inclusive literature search was conducted to identify studies about the prevalence of metabolic syndrome among patients with type II diabetes mellitus reported among the Ethiopian population of various study subjects. Both electronic and gray literature searches were carried out systematically. PubMed, Web of Science, Google Scholar, and grey literature, were searched for material between 2013 and 2023. The search terms were used separately and in combination using Boolean operators like “OR” or “AND.” An example of keywords used in PubMed to select relevant studies was as follows: (((“Metabolic Syndrome“[Mesh] OR Metabolic syndrome*[tiab]) AND (“Diabetes Mellitus, Type 2“[Mesh] OR “Diabetes Mellitus, Type 2*“[tiab])) AND (“Prevalence“[Mesh] OR “Magnitude*“[tiab])) AND (“Ethiopia“[Mesh] OR “Ethiopia*“[tiab]). Moreover, each database’s specific search parameters were customized accordingly.

Study selection (inclusion and exclusion criteria)

Inclusion criteria.

Studies were selected according to the following criteria: study design, participants, exposures and condition or outcome(s) of interest. Eligible studies were only quantitative full- text, and observational studies (cross-sectional) reporting prevalence and associated factors in terms of the odds ratio. Only articles written in English were retrieved for review. We included studies involving only type II diabetes mellitus patients aged greater than 30.

The primary outcome was the prevalence of metabolic syndrome. We used author reported definitions (according ATP III &IDF) (Table  1 ). Secondary outcome was factors associated with metabolic syndrome among type 2 diabetes mellitus patients. We were used unpublished articles to identify any potential studies that might have been missed from our search.

Exclusion criteria

We excluded reviews, case reports, case series, qualitative studies, and opinion articles. We were exclude abstract-only papers.

Data extraction and quality assessment

Data extraction was done independently by the two reviewers in a pre-piloted data extraction form created in MS Excel. Any discrepancies in the extracted data were resolved by consensus or discussion with a third reviewer. The following details will be extracted from each study:- details of the study (first author’s last name, year of publication), study region, study design, sample size, Prevalence of metabolic syndrome, associated factors.

The Joanna Brigg Institute’s quality evaluation criteria’s (JBI) were used to evaluate the studies’ quality. We assessed each of the chosen publications using the JBI assessment checklist. Research with a quality score of at least 50% was deemed to be of high quality.

Data analysis

Version 17 of STATA was used to analyse the retrieved data after they were imported into Microsoft Excel. To get a general summary estimate of the prevalence across trials, a random-effects model was employed. We employed point estimate with a 95% confidence interval. Sensitivity analysis was used to evaluate each study’s contribution to the outcome by eliminating each one individually. Using Egger’s test, the existence of publication bias was evaluated. The Cochran’s Q statistic and I2 statistics were used to assess the heterogeneity of the studies. Moreover, meta-regression has been conducted that represents linear predictions for the metabolic syndrome among type 2 diabetes mellitus patients prevalence as a function of published year. Subgroup analysis was performed based on study region and study subjects since there was unexplained significant heterogeneity.

Publication bias

Funnel plot and Egger’s test was used to assess publication bias and a P-value of less than 0.05 was used to declare the publication bias. The included studies were assessed for potential publication bias and separate analyses were done based on IDF and NCEP/ATPIII criteria (p values were 0.58 and 0.88, respectively) which indicated the absence of publication bias (Figs.  2 and 3 ).

PRISMA flow diagram of study selection for systematic review and meta-analysis of prevalence of metabolic syndrome among type II Diabetes mellitus patients in Ethiopia [ 11 ]

Forest plot showing the pooled prevalence of metabolic syndrome among type II Diabetes mellitus patients in Ethiopia (according to NCEP ATP III Criteria)

Forest plot showing the pooled prevalence of metabolic syndrome among type II Diabetes mellitus patients in Ethiopia (according to IDF Criteria)

Characteristics of included studies

The title and abstract screening of 300 potential articles yielded 102 that were included relevant to the topic of interest; the full-text screening of 50 of these articles indicated their eligibility for full-text assessment; 8 of these articles, involving 2375 study participants, were found to be eligible for systematic review and meta-analysis. Based on the NCEP/ATPIII and IDF criteria, the prevalence of metabolic syndrome in patients with type 2 diabetes mellitus was assessed among the Ethiopian population of different study participants. Five studies reported the prevalence of metabolic syndrome among type 2 diabetes mellitus based on both IDF and NCEP/ATPIII criteria, whereas seven studies based on NCEP/ATPIII criteria only and six studies by IDF criteria only (Table  2 ).

Prevalence of metabolic syndrome among type 2 diabetes mellitus patients using IDF and NCEP ATP III Criteria

The random-effects model was applied since the heterogeneity index of the studies were significant. The pooled prevalence of metabolic syndrome was found to be 64.49% (95% CI: 62.39, 66.59) by using NCEP/ATP III (Figs.  4 ) and 52.38% (95% CI: 50.05, 54.73) by using IDF criteria (Fig.  5 ). Subgroup analysis based on the study region using NCEP/ ATP III showed that the weighted pooled prevalence was 63.79% (95% CI: 56.48, 71.11) among type 2 diabetes patients (Fig.  6 ). Using IDF criteria, subgroup analysis based on the study region showed that the weighted pooled prevalence was 52.23% (95%CI: 47.37, 57.22).

Sub group analysis based on study region using NCEP ATP III Criteria

the pooled odds ratio of the association between sex and prevalence of metabolic syndrome among type II diabetes mellitus patients

The pooled odds ratio of the association between BMI and prevalence of metabolic

Factors associated with metabolic syndrome among type II DM

Association between sex and prevalence of metabolic syndrome.

The association between being female and prevalence of metabolic syndrome was examined based on the finding from five studies ( 1 , 2 , 4 , 5 and 7 ). The pooled odds ratio (AOR: 0.5, 95% CI: -0.32-1.31) showed that prevalence of metabolic syndrome associated with being female. The studies showed very high heterogeneity (I²=86.3% and P  = 0.00) (Fig.  7 ). Hence, a random effects model was employed to do the final analysis.

Funnel plot for prevalence of metabolic syndrome according to NCE ATPIII

Association between BMI and prevalence of metabolic syndrome

The association between BMI and prevalence of metabolic syndrome was examined based on the finding from four studies ( 1 , 2 , 4 and 8 ). The pooled odds ratio (AOR: 3.86, 95% CI: 2.57–5.15) showed that prevalence of metabolic syndrome associated with BMI. The studies showed high heterogeneity (I²= 68.2% and P  = 0.034) (Fig.  8 ). Hence, a random effects model was employed to do the final analysis.

Funnel plot for prevalence of metabolic syndrome according to IDF

Sensitivity analysis

Sensitivity analysis was carried out by gradually removing each research from the analytic process according to the two provided diagnostic criteria (NCEP/ATP III and IDF) in order to evaluate the impact of each study on the pooled estimated prevalence of metabolic syndrome among type II diabetes mellitus patients. The result showed that excluded studies led to significant changes in the shared estimation of the prevalence of metabolic syndrome (Figs.  9 and 10 ).

Sensitivity analysis based on NCEP/ATP III diagnostic criteria

Sensitivity analysis based on IDF diagnostic criteria

This systematic review and meta- analysis study provides evidence of an estimated pooled prevalence of metabolic syndrome among type II diabetes mellitus patients of the Ethiopian population. According to this review, the combined pooled prevalence of Metabolic syndrome among type II diabetes mellitus patients were 64.49% (95% CI: 62.39, 66.59) and 52.38% (95% CI: 50.05, 54.73) by using NCEP/ATP III and IDF criteria, respectively.

The finding of this study similar with the study conducted in African populations, which reported that the prevalence of metabolic syndrome among type 2 diabetes mellitus was 66.9%(95%CI: 60.3–73.1) [ 9 ]. In addition, the study which was done in sub-Saharan African countries in line with this finding which reports that prevalence of metabolic syndrome among type II diabetes melituse patients were 64.8% (95% CI: 54.74, 74.86) and 57.15% by using NCEP/ATP III and IDF criteria, respectively.

Furture more, the study which was done in Sub-Saharan Africa reported that, among others sub-Saharan Africa countries the prevalence of metabolic syndrome was highest in Ethiopia, (61.14%, 95% CI: 51.74, 70.53), which is almost similar with our study findings [ 8 ].

Similarly the study conducted in Ethiopian population showed that the weighted pooled prevalence of metabolic syndrome among type II diabetes mellitus patient was 63.78% (95% CI: 56.17, 71.40) [ 7 ].

This study result supported by the fact that metabolic syndrome has been associated with type 2 diabetes due to its high prevalence worldwide since it is both related to the increase in obesity and a sedentary lifestyle. Several studies suggest that individuals with Metabolic syndrome are 5 times more likely to develop type 2 diabetes [ 10 ].

This meta-analysis assessed factors determining metabolic syndrome among type II diabetes mellitus patients. The current meta-analysis demonstrated that the prevalence rate of metabolic syndrome was higher in females compared to that in males. This has been shown in all the Middle Eastern countries, and the prevalence was much higher among women than men [ 6 ]. The prevalence rate of metabolic syndrome associated with the individual’s body mass index.

This study has implications for clinical practice. Determining the prevalence of metabolic syndrome among type 2 diabetic patients is critical to guide healthcare professionals to minimize the risk of metabolic syndrome by providing guidance to the patient who has undergone diabetic care follow up. Moreover, it gives information about the burden and public health impact of metabolic syndrome for possible consideration during routine diabetic patient care.

This meta-analysis study has its own limitations that should be considered in the future research. Few studies are included due to limited research in Ethiopia which makes it difficult to generalize the findings to all type 2 diabetic patients in the countery and which makes the discussion part more shallow.

In conclusion, according to this systematic review the prevalence of metabolic syndrome among type II patient is high in Ethiopia and recommends an urgent attention from both the clinical and public health viewpoint Therefore, policymakers, clinicians, and concerned stakeholders shall urge effective strategies in the control, prevention, and management of metabolic syndrome among type II diabetes mellitus. In addition country context-specific preventive strategies should be developed to reduce the burden of metabolic syndrome.

Data availability

The data used to support the findings of this study are available from the corresponding author upon request.

Abbreviations

Cardiovascular Disease

National Cholesterol Education Program–Adult Treatment Panel III

International diabetes federation

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

World Health Organization

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“B.M involved in the entire work of the manuscript which is a design of the study, review of literature, and data analysis, “F.G.” was involved in, design of the study, review of the literature, data extraction, and statistical analysis. “N.A”. and “G.A” were involved in data analysis and interpretation and drafting of the manuscript. All authors critically revised the paper, and they agreed to be accountable for all aspects of the work.

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Demissie, B.M., Girmaw, F., Amena, N. et al. Prevalence of metabolic syndrome and associated factors among patient with type 2 diabetes mellitus in Ethiopia, 2023: asystematic review and meta analysis. BMC Public Health 24 , 1128 (2024). https://doi.org/10.1186/s12889-024-18580-0

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Received : 10 November 2023

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DOI : https://doi.org/10.1186/s12889-024-18580-0

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