Systematic reviews, scholarly discussion and opportunities
Published 5th March 2020
Gustafsson, L.
The purpose of a systematic review is to identify, appraise and summarise the research evidence around a specific research question. A systematic review identifies clinical practices with high‐level research evidence that are recommended for knowledge translation. It can highlight knowledge gaps that may inform research priorities and agendas or identify common clinical practices that are recommended for discontinuation as they lack high‐level research evidence. Systematic reviews provide an evidence‐based foundation that guides knowledge translation, knowledge generation and scholarly discussion, an essential element of a profession's growth.
The recent systematic review of interventions for children with a disability (Novak & Honan, 2019) has created discussion within the pages of the journal (Berg, 2020; Mills et al., 2020) and on Twitter (@AusOTJournal). It is important to be clear that this is not the first time that this response and discussion have occurred, nor have they been limited to this review or clinical area. However, the review and responses have triggered this editorial. The Letter to the Editor from Berg (2020) undoubtedly mirrors the responses of many who have been trained in, and incorporate, sensory‐based approaches, sensory integration or neurodevelopmental treatment into their practices. It is an innately human response to question the research that does not support your clinical practice. Yet, how should we navigate this common and contentious space as a profession?
The identification of gaps in our knowledge, due to a limited research base, commonly leads to a discovery approach. We may commence with an exploratory study that gathers information from clinical experts and clients. This approach recognises expert opinion within the evidence hierarchy, and clinical expertise plus client values and preferences as important components of evidence‐based practice (Hoffmann, Bennett, & Del Mar, 2017). It reminds us that discovery can be founded in clinical experts who question, trial new approaches and seek new innovations and developments. It also reminds us that acceptability and a client‐centred approach are essential. Importantly however, the evidence hierarchy reminds us that expert opinion is low‐level evidence. There is a professional responsibility to then conduct the exploratory and experimental research (i.e. case series, cohort studies, randomised controlled trials and systematic reviews) that evaluates and demonstrates effectiveness and acceptability of that practice.
A lack of high‐level research evidence should question the appropriateness of any clinical practice irrespective of the innovation, longevity of the practice or the experience of the clinician. As an evidence‐based profession, it is our mandate to provide the right practice, to the right client, at the right time and we each have a role to play as research generators, research collaborators, research participants and/or consumers of research. It is therefore our collective responsibility to react to the findings of systematic reviews by implementing the practices with the high‐level evidence. Moreover, when indicated by expert opinion, we should design and conduct research that systematically develops the evidence base of existing or emerging clinical practices. Scholarly discussion is an excellent foundation upon which to build this research agenda, but this can only occur if we are each clear on the actions required and the role that we will play. How will you contribute?
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