Challenges in Systematic Reviews of Therapeutic Devices and Procedures

Challenges in Systematic Reviews of Therapeutic Devices and Procedures

Lisa Hartling, MSc;
Finlay A. McAlister, MD, MSc;
Brian H. Rowe, MD, MSc;
Justin Ezekowitz, MB, BCh, MSc;
Carol Friesen, MA, MLIS; and
Terry P. Klassen, MD, MSc

From The University of Alberta/Capital Health Evidence-based Practice Center and the University of Alberta, Edmonton, Canada.

Abstract

The authors discuss 3 challenges in conducting and interpreting any systematic review that are particularly relevant for systematic reviews of therapeutic devices or surgical procedures: 1) inclusion or exclusion of grey literature, 2) the role of nonrandomized studies, and 3) issues in applying the results to clinical care that are unique to the surgical and therapeutic device literature. The authors also discus s empirical evidence related to these topics and illustrate how reviewers in the Agency for Healthcare Research and Quality's Evidence-based Practice Center program have dealt with these challenges in developing evidence reports for decision makers and clinicians about therapeutic devices or surgical procedures.

Article and Author Information

Acknowledgments: The authors thank John Russell and Michelle Tubman for administrative and technical support.
Grant Support: This paper was produced by the University of Alberta Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality, Rockville, Maryland. Dr. McAlister is supported by the Alberta Heritage Foundation for Medical Research and is the University of Alberta/Merck Frosst/Aventis Chair in Patient Health Management; Drs. Ezekowitz and McAlister are supported by the Canadian Institutes of Health Research Research (CIHR); and Dr. Rowe is supported by a Canada Research Chair from the CIHR.
Potential Financial Conflicts of Interest: Authors of this paper have received funding for Evidence-based Practice Center reports.
Requests for Single Reprints: Finlay A. McAlister, MD, MSc, 2E3.24 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440 112 Street, Edmonton, Alberta T6G 2R7, Canada; e-mail, Finlay.McAlister{at}ualberta.ca.
Current Author Addresses: Ms. Hartling: Aberhart Centre One, Room 9424, 11402 University Avenue, Edmonton, Alberta T6G 2J3, Canada.
Dr. McAlister: 2E3.24 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440 112 Street, Edmonton, Alberta T6G 2R7, Canada.
Dr. Rowe: 1G1.43 Walter Mackenzie Health Sciences Centre, University of Alberta Hospital, 8440 112th Street, Edmonton, Alberta T6G 2B7, Canada.
Dr. Ezekowitz: 2-51 Medical Sciences Building, University of Alberta, Edmonton, Alberta T6G 2H7, Canada.
Ms. Friesen: Aberhart Centre One, Room 9420, 11402 University Avenue, Edmonton, Alberta T6G 2J3, Canada.
Dr. Klassen: 2C3.00 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440 112 Street, Edmonton, Alberta T6G 2B7, Canada.