Reviewing reviews

systematic reviews
Image courtesy of: http://www.cochrane.org/what-is-cochrane-evidence

I have been reading about systematic reviews recently. They are a useful starting point for any research project as they enable a researcher to scope-out what is already known about their research subject and therefore provide a foundation on which to build the research study. Systematic reviews use defined methods for exploring the literature in a consistent way, and reviewing the results in order to draw conclusions. They must be explicit, comprehensive and reproducible. Methods for conducting systematic reviews frequently, but not always, start by identifying a question that needs answering. They then require a clear framework for identifying suitable research papers: who are the focus of the papers, what intervention is being investigated and what outcomes are important? Systematic reviews also necessitate the reviewer to clarify the types of literature that will be searched, how information will be extracted from that literature and how the results of the search will be analysed in order to draw conclusions. It all should be quite simple. Identify a question, choose a method, carry out a search, evaluate the findings, report. Boom! And yet I am now on week two of reading about systematic reviews and I don’t appear to be any closer to step one: finding a question.

The aim of the review for this project is to find out the words, themes and narratives are used by people who rely on communication aids to define the outcomes and impact of using them. This does not, however, seem to be a very systematically reviewable question. Systematic reviews evaluate the effects or the implementation of interventions. I need a clearly defined population (adults, children, young people, people with acquired communication difficulties, people with communication difficulties from birth), a specific intervention (e.g. AAC in general, low-tech communication aids, high tech communication aids, picture based communication aids, text-based communication aids,), a control group (e.g. other people with speech, language or communication needs, or non-disabled peers) and an outcome (e.g. quality of life, satisfaction, access to work/education, improved relationships). I am reluctant to limit the parameters of my search as I am aware that there is a limited amount of information available on the topic of AAC (The case of the missing perspective…). Yet if the question for the review is too broad, the search will produce too many results to manage, most of which will almost certainly be irrelevant.

My lack of clearly defined question has led me to consider carrying out a ‘Realist review’; a specific method of systematically reviewing information which builds an understanding of the underlying mechanisms at work within an intervention rather than producing an overall review of the results of other studies. In theory, it is an obvious answer to my dilemma. I don’t need a pre-defined question; realist reviews do not focus on the effects of interventions specifically rather they explore what works for who and why; all types of literature can be used to strengthen the theory, not just academic literature of which the pool for AAC is limited. They also allow for the integration of number-based data (quantitative studies) and descriptive data (qualitative studies), and can result in narrative and figurative findings. My review of reviews so far does indicate that this particular method does not have strong presence in healthcare research and I have yet to find any examples of its adoption within either the fields of AAC or speech and language therapy. There are a small number of very well established academics using this method but it still appears to be on the fringes of systematic review methodology. I am not sure that I have the confidence or the experience to blaze this trail at such an early stage of my academic journey. I think I may need to re-read some reviews of reviews and head back to the drawing board.

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