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Systematic Review | Definition, Example & Guide

Published on June 15, 2022 by Shaun Turney . Revised on November 20, 2023.

A systematic review is a type of review that uses repeatable methods to find, select, and synthesize all available evidence. It answers a clearly formulated research question and explicitly states the methods used to arrive at the answer.

They answered the question “What is the effectiveness of probiotics in reducing eczema symptoms and improving quality of life in patients with eczema?”

In this context, a probiotic is a health product that contains live microorganisms and is taken by mouth. Eczema is a common skin condition that causes red, itchy skin.

Table of contents

What is a systematic review, systematic review vs. meta-analysis, systematic review vs. literature review, systematic review vs. scoping review, when to conduct a systematic review, pros and cons of systematic reviews, step-by-step example of a systematic review, other interesting articles, frequently asked questions about systematic reviews.

A review is an overview of the research that’s already been completed on a topic.

What makes a systematic review different from other types of reviews is that the research methods are designed to reduce bias . The methods are repeatable, and the approach is formal and systematic:

  • Formulate a research question
  • Develop a protocol
  • Search for all relevant studies
  • Apply the selection criteria
  • Extract the data
  • Synthesize the data
  • Write and publish a report

Although multiple sets of guidelines exist, the Cochrane Handbook for Systematic Reviews is among the most widely used. It provides detailed guidelines on how to complete each step of the systematic review process.

Systematic reviews are most commonly used in medical and public health research, but they can also be found in other disciplines.

Systematic reviews typically answer their research question by synthesizing all available evidence and evaluating the quality of the evidence. Synthesizing means bringing together different information to tell a single, cohesive story. The synthesis can be narrative ( qualitative ), quantitative , or both.

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Systematic reviews often quantitatively synthesize the evidence using a meta-analysis . A meta-analysis is a statistical analysis, not a type of review.

A meta-analysis is a technique to synthesize results from multiple studies. It’s a statistical analysis that combines the results of two or more studies, usually to estimate an effect size .

A literature review is a type of review that uses a less systematic and formal approach than a systematic review. Typically, an expert in a topic will qualitatively summarize and evaluate previous work, without using a formal, explicit method.

Although literature reviews are often less time-consuming and can be insightful or helpful, they have a higher risk of bias and are less transparent than systematic reviews.

Similar to a systematic review, a scoping review is a type of review that tries to minimize bias by using transparent and repeatable methods.

However, a scoping review isn’t a type of systematic review. The most important difference is the goal: rather than answering a specific question, a scoping review explores a topic. The researcher tries to identify the main concepts, theories, and evidence, as well as gaps in the current research.

Sometimes scoping reviews are an exploratory preparation step for a systematic review, and sometimes they are a standalone project.

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what are systematic literature reviews

A systematic review is a good choice of review if you want to answer a question about the effectiveness of an intervention , such as a medical treatment.

To conduct a systematic review, you’ll need the following:

  • A precise question , usually about the effectiveness of an intervention. The question needs to be about a topic that’s previously been studied by multiple researchers. If there’s no previous research, there’s nothing to review.
  • If you’re doing a systematic review on your own (e.g., for a research paper or thesis ), you should take appropriate measures to ensure the validity and reliability of your research.
  • Access to databases and journal archives. Often, your educational institution provides you with access.
  • Time. A professional systematic review is a time-consuming process: it will take the lead author about six months of full-time work. If you’re a student, you should narrow the scope of your systematic review and stick to a tight schedule.
  • Bibliographic, word-processing, spreadsheet, and statistical software . For example, you could use EndNote, Microsoft Word, Excel, and SPSS.

A systematic review has many pros .

  • They minimize research bias by considering all available evidence and evaluating each study for bias.
  • Their methods are transparent , so they can be scrutinized by others.
  • They’re thorough : they summarize all available evidence.
  • They can be replicated and updated by others.

Systematic reviews also have a few cons .

  • They’re time-consuming .
  • They’re narrow in scope : they only answer the precise research question.

The 7 steps for conducting a systematic review are explained with an example.

Step 1: Formulate a research question

Formulating the research question is probably the most important step of a systematic review. A clear research question will:

  • Allow you to more effectively communicate your research to other researchers and practitioners
  • Guide your decisions as you plan and conduct your systematic review

A good research question for a systematic review has four components, which you can remember with the acronym PICO :

  • Population(s) or problem(s)
  • Intervention(s)
  • Comparison(s)

You can rearrange these four components to write your research question:

  • What is the effectiveness of I versus C for O in P ?

Sometimes, you may want to include a fifth component, the type of study design . In this case, the acronym is PICOT .

  • Type of study design(s)
  • The population of patients with eczema
  • The intervention of probiotics
  • In comparison to no treatment, placebo , or non-probiotic treatment
  • The outcome of changes in participant-, parent-, and doctor-rated symptoms of eczema and quality of life
  • Randomized control trials, a type of study design

Their research question was:

  • What is the effectiveness of probiotics versus no treatment, a placebo, or a non-probiotic treatment for reducing eczema symptoms and improving quality of life in patients with eczema?

Step 2: Develop a protocol

A protocol is a document that contains your research plan for the systematic review. This is an important step because having a plan allows you to work more efficiently and reduces bias.

Your protocol should include the following components:

  • Background information : Provide the context of the research question, including why it’s important.
  • Research objective (s) : Rephrase your research question as an objective.
  • Selection criteria: State how you’ll decide which studies to include or exclude from your review.
  • Search strategy: Discuss your plan for finding studies.
  • Analysis: Explain what information you’ll collect from the studies and how you’ll synthesize the data.

If you’re a professional seeking to publish your review, it’s a good idea to bring together an advisory committee . This is a group of about six people who have experience in the topic you’re researching. They can help you make decisions about your protocol.

It’s highly recommended to register your protocol. Registering your protocol means submitting it to a database such as PROSPERO or ClinicalTrials.gov .

Step 3: Search for all relevant studies

Searching for relevant studies is the most time-consuming step of a systematic review.

To reduce bias, it’s important to search for relevant studies very thoroughly. Your strategy will depend on your field and your research question, but sources generally fall into these four categories:

  • Databases: Search multiple databases of peer-reviewed literature, such as PubMed or Scopus . Think carefully about how to phrase your search terms and include multiple synonyms of each word. Use Boolean operators if relevant.
  • Handsearching: In addition to searching the primary sources using databases, you’ll also need to search manually. One strategy is to scan relevant journals or conference proceedings. Another strategy is to scan the reference lists of relevant studies.
  • Gray literature: Gray literature includes documents produced by governments, universities, and other institutions that aren’t published by traditional publishers. Graduate student theses are an important type of gray literature, which you can search using the Networked Digital Library of Theses and Dissertations (NDLTD) . In medicine, clinical trial registries are another important type of gray literature.
  • Experts: Contact experts in the field to ask if they have unpublished studies that should be included in your review.

At this stage of your review, you won’t read the articles yet. Simply save any potentially relevant citations using bibliographic software, such as Scribbr’s APA or MLA Generator .

  • Databases: EMBASE, PsycINFO, AMED, LILACS, and ISI Web of Science
  • Handsearch: Conference proceedings and reference lists of articles
  • Gray literature: The Cochrane Library, the metaRegister of Controlled Trials, and the Ongoing Skin Trials Register
  • Experts: Authors of unpublished registered trials, pharmaceutical companies, and manufacturers of probiotics

Step 4: Apply the selection criteria

Applying the selection criteria is a three-person job. Two of you will independently read the studies and decide which to include in your review based on the selection criteria you established in your protocol . The third person’s job is to break any ties.

To increase inter-rater reliability , ensure that everyone thoroughly understands the selection criteria before you begin.

If you’re writing a systematic review as a student for an assignment, you might not have a team. In this case, you’ll have to apply the selection criteria on your own; you can mention this as a limitation in your paper’s discussion.

You should apply the selection criteria in two phases:

  • Based on the titles and abstracts : Decide whether each article potentially meets the selection criteria based on the information provided in the abstracts.
  • Based on the full texts: Download the articles that weren’t excluded during the first phase. If an article isn’t available online or through your library, you may need to contact the authors to ask for a copy. Read the articles and decide which articles meet the selection criteria.

It’s very important to keep a meticulous record of why you included or excluded each article. When the selection process is complete, you can summarize what you did using a PRISMA flow diagram .

Next, Boyle and colleagues found the full texts for each of the remaining studies. Boyle and Tang read through the articles to decide if any more studies needed to be excluded based on the selection criteria.

When Boyle and Tang disagreed about whether a study should be excluded, they discussed it with Varigos until the three researchers came to an agreement.

Step 5: Extract the data

Extracting the data means collecting information from the selected studies in a systematic way. There are two types of information you need to collect from each study:

  • Information about the study’s methods and results . The exact information will depend on your research question, but it might include the year, study design , sample size, context, research findings , and conclusions. If any data are missing, you’ll need to contact the study’s authors.
  • Your judgment of the quality of the evidence, including risk of bias .

You should collect this information using forms. You can find sample forms in The Registry of Methods and Tools for Evidence-Informed Decision Making and the Grading of Recommendations, Assessment, Development and Evaluations Working Group .

Extracting the data is also a three-person job. Two people should do this step independently, and the third person will resolve any disagreements.

They also collected data about possible sources of bias, such as how the study participants were randomized into the control and treatment groups.

Step 6: Synthesize the data

Synthesizing the data means bringing together the information you collected into a single, cohesive story. There are two main approaches to synthesizing the data:

  • Narrative ( qualitative ): Summarize the information in words. You’ll need to discuss the studies and assess their overall quality.
  • Quantitative : Use statistical methods to summarize and compare data from different studies. The most common quantitative approach is a meta-analysis , which allows you to combine results from multiple studies into a summary result.

Generally, you should use both approaches together whenever possible. If you don’t have enough data, or the data from different studies aren’t comparable, then you can take just a narrative approach. However, you should justify why a quantitative approach wasn’t possible.

Boyle and colleagues also divided the studies into subgroups, such as studies about babies, children, and adults, and analyzed the effect sizes within each group.

Step 7: Write and publish a report

The purpose of writing a systematic review article is to share the answer to your research question and explain how you arrived at this answer.

Your article should include the following sections:

  • Abstract : A summary of the review
  • Introduction : Including the rationale and objectives
  • Methods : Including the selection criteria, search method, data extraction method, and synthesis method
  • Results : Including results of the search and selection process, study characteristics, risk of bias in the studies, and synthesis results
  • Discussion : Including interpretation of the results and limitations of the review
  • Conclusion : The answer to your research question and implications for practice, policy, or research

To verify that your report includes everything it needs, you can use the PRISMA checklist .

Once your report is written, you can publish it in a systematic review database, such as the Cochrane Database of Systematic Reviews , and/or in a peer-reviewed journal.

In their report, Boyle and colleagues concluded that probiotics cannot be recommended for reducing eczema symptoms or improving quality of life in patients with eczema. Note Generative AI tools like ChatGPT can be useful at various stages of the writing and research process and can help you to write your systematic review. However, we strongly advise against trying to pass AI-generated text off as your own work.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

  • Student’s  t -distribution
  • Normal distribution
  • Null and Alternative Hypotheses
  • Chi square tests
  • Confidence interval
  • Quartiles & Quantiles
  • Cluster sampling
  • Stratified sampling
  • Data cleansing
  • Reproducibility vs Replicability
  • Peer review
  • Prospective cohort study

Research bias

  • Implicit bias
  • Cognitive bias
  • Placebo effect
  • Hawthorne effect
  • Hindsight bias
  • Affect heuristic
  • Social desirability bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

A systematic review is secondary research because it uses existing research. You don’t collect new data yourself.

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Systematic Reviews and Meta Analysis

  • Getting Started
  • Guides and Standards
  • Review Protocols
  • Databases and Sources
  • Randomized Controlled Trials
  • Controlled Clinical Trials
  • Observational Designs
  • Tests of Diagnostic Accuracy
  • Software and Tools
  • Where do I get all those articles?
  • Collaborations
  • EPI 233/528
  • Countway Mediated Search
  • Risk of Bias (RoB)

Systematic review Q & A

What is a systematic review.

A systematic review is guided filtering and synthesis of all available evidence addressing a specific, focused research question, generally about a specific intervention or exposure. The use of standardized, systematic methods and pre-selected eligibility criteria reduce the risk of bias in identifying, selecting and analyzing relevant studies. A well-designed systematic review includes clear objectives, pre-selected criteria for identifying eligible studies, an explicit methodology, a thorough and reproducible search of the literature, an assessment of the validity or risk of bias of each included study, and a systematic synthesis, analysis and presentation of the findings of the included studies. A systematic review may include a meta-analysis.

For details about carrying out systematic reviews, see the Guides and Standards section of this guide.

Is my research topic appropriate for systematic review methods?

A systematic review is best deployed to test a specific hypothesis about a healthcare or public health intervention or exposure. By focusing on a single intervention or a few specific interventions for a particular condition, the investigator can ensure a manageable results set. Moreover, examining a single or small set of related interventions, exposures, or outcomes, will simplify the assessment of studies and the synthesis of the findings.

Systematic reviews are poor tools for hypothesis generation: for instance, to determine what interventions have been used to increase the awareness and acceptability of a vaccine or to investigate the ways that predictive analytics have been used in health care management. In the first case, we don't know what interventions to search for and so have to screen all the articles about awareness and acceptability. In the second, there is no agreed on set of methods that make up predictive analytics, and health care management is far too broad. The search will necessarily be incomplete, vague and very large all at the same time. In most cases, reviews without clearly and exactly specified populations, interventions, exposures, and outcomes will produce results sets that quickly outstrip the resources of a small team and offer no consistent way to assess and synthesize findings from the studies that are identified.

If not a systematic review, then what?

You might consider performing a scoping review . This framework allows iterative searching over a reduced number of data sources and no requirement to assess individual studies for risk of bias. The framework includes built-in mechanisms to adjust the analysis as the work progresses and more is learned about the topic. A scoping review won't help you limit the number of records you'll need to screen (broad questions lead to large results sets) but may give you means of dealing with a large set of results.

This tool can help you decide what kind of review is right for your question.

Can my student complete a systematic review during her summer project?

Probably not. Systematic reviews are a lot of work. Including creating the protocol, building and running a quality search, collecting all the papers, evaluating the studies that meet the inclusion criteria and extracting and analyzing the summary data, a well done review can require dozens to hundreds of hours of work that can span several months. Moreover, a systematic review requires subject expertise, statistical support and a librarian to help design and run the search. Be aware that librarians sometimes have queues for their search time. It may take several weeks to complete and run a search. Moreover, all guidelines for carrying out systematic reviews recommend that at least two subject experts screen the studies identified in the search. The first round of screening can consume 1 hour per screener for every 100-200 records. A systematic review is a labor-intensive team effort.

How can I know if my topic has been been reviewed already?

Before starting out on a systematic review, check to see if someone has done it already. In PubMed you can use the systematic review subset to limit to a broad group of papers that is enriched for systematic reviews. You can invoke the subset by selecting if from the Article Types filters to the left of your PubMed results, or you can append AND systematic[sb] to your search. For example:

"neoadjuvant chemotherapy" AND systematic[sb]

The systematic review subset is very noisy, however. To quickly focus on systematic reviews (knowing that you may be missing some), simply search for the word systematic in the title:

"neoadjuvant chemotherapy" AND systematic[ti]

Any PRISMA-compliant systematic review will be captured by this method since including the words "systematic review" in the title is a requirement of the PRISMA checklist. Cochrane systematic reviews do not include 'systematic' in the title, however. It's worth checking the Cochrane Database of Systematic Reviews independently.

You can also search for protocols that will indicate that another group has set out on a similar project. Many investigators will register their protocols in PROSPERO , a registry of review protocols. Other published protocols as well as Cochrane Review protocols appear in the Cochrane Methodology Register, a part of the Cochrane Library .

  • Next: Guides and Standards >>
  • Last Updated: Feb 14, 2024 2:47 PM
  • URL: https://guides.library.harvard.edu/meta-analysis

Charles Sturt University

Literature Review: Systematic literature reviews

  • Traditional or narrative literature reviews
  • Scoping Reviews
  • Systematic literature reviews
  • Annotated bibliography
  • Keeping up to date with literature
  • Finding a thesis
  • Evaluating sources and critical appraisal of literature
  • Managing and analysing your literature
  • Further reading and resources

Systematic reviews

Systematic and systematic-like reviews

Charles Sturt University library has produced a comprehensive guide for Systematic and systematic-like literature reviews. A comprehensive systematic literature review can often take a team of people up to a year to complete. This guide provides an overview of the steps required for systematic reviews:

  • Identify your research question
  • Develop your protocol
  • Conduct systematic searches (including the search strategy, text mining, choosing databases, documenting and reviewing
  • Critical appraisal
  • Data extraction and synthesis
  • Writing and publishing .
  • Systematic and systematic-like reviews Library Resource Guide

Systematic literature review

A systematic literature review (SLR) identifies, selects and critically appraises research in order to answer a clearly formulated question (Dewey, A. & Drahota, A. 2016). The systematic review should follow a clearly defined protocol or plan where the criteria is clearly stated before the review is conducted. It is a comprehensive, transparent search conducted over multiple databases and grey literature that can be replicated and reproduced by other researchers. It involves planning a well thought out search strategy which has a specific focus or answers a defined question. The review identifies the type of information searched, critiqued and reported within known timeframes. The search terms, search strategies (including database names, platforms, dates of search) and limits all need to be included in the review.

Pittway (2008) outlines seven key principles behind systematic literature reviews

  • Transparency
  • Integration
  • Accessibility

Systematic literature reviews originated in medicine and are linked to evidence based practice. According to Grant & Booth (p 91, 2009) "the expansion in evidence-based practice has lead to an increasing variety of review types". They compare and contrast 14 review types, listing the strengths and weaknesses of each review. 

Tranfield et al (2003) discusses the origins of the evidence-based approach to undertaking a literature review and its application to other disciplines including management and science.

References and additional resources

Dewey, A. & Drahota, A. (2016) Introduction to systematic reviews: online learning module Cochrane Training   https://training.cochrane.org/interactivelearning/module-1-introduction-conducting-systematic-reviews

Gough, David A., David Gough, Sandy Oliver, and James Thomas. An Introduction to Systematic Reviews. Systematic Reviews. London: SAGE, 2012.

Grant, M. J. & Booth, A. (2009) A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information & Libraries Journal 26(2), 91-108

Munn, Z., Peters, M. D. J., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol, 18(1), 143. https://doi.org/10.1186/s12874-018-0611-x 

Pittway, L. (2008) Systematic literature reviews. In Thorpe, R. & Holt, R. The SAGE dictionary of qualitative management research. SAGE Publications Ltd doi:10.4135/9780857020109

Tranfield, D., Denyer, D & Smart, P. (2003) Towards a methodology for developing evidence-informed management knowledge by means of systematic review . British Journal of Management 14 (3), 207-222

Evidence based practice - an introduction : Literature reviews/systematic reviews

Evidence based practice - an introduction is a library guide produced at CSU Library for undergraduates. The information contained in the guide is also relevant for post graduate study and will help you to understand the types of research and levels of evidence required to conduct evidence based research.

  • Evidence based practice an introduction
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  • Next: Annotated bibliography >>
  • Last Updated: Jan 16, 2024 1:39 PM
  • URL: https://libguides.csu.edu.au/review

Acknowledgement of Country

Charles Sturt University is an Australian University, TEQSA Provider Identification: PRV12018. CRICOS Provider: 00005F.

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Systematic Reviews: Home

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  • Systematic review resources

What is a Systematic Review?

A simplified process map, how can the library help, systematic reviews in non-health disciplines, resources for performing systematic reviews.

  • Step 1: Complete Pre-Review Tasks
  • Step 2: Develop a Protocol
  • Step 3: Conduct Literature Searches
  • Step 4: Manage Citations
  • Step 5: Screen Citations
  • Step 6: Assess Quality of Included Studies
  • Step 7: Extract Data from Included Studies
  • Step 8: Write the Review

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There are many types of literature reviews.

Before beginning a systematic review, consider whether it is the best type of review for your question, goals, and resources. The table below compares a few different types of reviews to help you decide which is best for you. 

  • Scoping Review Guide For more information about scoping reviews, refer to the UNC HSL Scoping Review Guide.

Systematic Reviews: A Simplified, Step-by-Step Process  Step 1: Pre-Review. Common tasks include formulating a team, developing research question(s), and scoping literature for published systematic reviews on the topic. Librarians can provide substantial support for Step 1.  Step 2: Develop Protocol. Common tasks include determining eligibility criteria, selecting quality assessment tools and items for data extraction, writing the protocol, and making the protocol accessible via a website or registry.  Step 3: Conduct Literature Searches. Common tasks include partnering with a librarian, searching multiple databases, performing other searching methods like hand searching, and locating grey literature or other unpublished research. Librarians can provide substantial support for Step 3.  Step 4: Manage Citations. Common tasks include exporting citations to a citation manager such as Endnote, preparing a PRISMA flow-chart with numbers of citations for steps, updating as necessary, and de-duplicating citations and uploading them to a screening tool such as Covidence. Librarians can provide substantial support for Step 4.   Step 5: Screen Citations. Common tasks include screening the titles and abstracts of citations using inclusion criteria with at least two reviewers and locating full-text and screen citations that meet the inclusion criteria with at least two reviewers.  UNC Health Sciences Librarians (HSL) Librarians can provide support with using AI or other automation approaches to reduce the volume of literature that must be screened manually. Reach out to HSL for more information.  Step 6: Conduct Quality Assessment. Common tasks include performing quality assessments, like a critical appraisal, of the included studies.  Step 7: Complete Data Extraction. Common tasks include extracting data from included studies and creating tables of studies for the manuscript.  Step 8: Write Review. Common tasks include consulting the PRISMA checklist or other reporting standard, writing the manuscript, and organizing supplementary materials. Librarians can provide substantial support for Step 8.

  • UNC HSL's Simplified, Step-by-Step Process Map A PDF file of the HSL's Systematic Review Process Map.

The average systematic review takes 1,168 hours to complete. ¹   A librarian can help you speed up the process.

Systematic reviews follow established guidelines and best practices to produce high-quality research. Librarian involvement in systematic reviews is based on two levels. In Tier 1, the librarian will collaborate with researchers in a consultative manner. In Tier 2, the librarian will be an active member of your research team and co-author on your review. Roles and expectations of librarians vary based on the level of involvement desired. Examples of these differences are outlined in the table below.

  • Request a systematic or scoping review consultation

Researchers are conducting systematic reviews in a variety of disciplines.  If your focus is on a topic other than health sciences, you may want to also consult the resources below to learn how systematic reviews may vary in your field.  You can also contact a librarian for your discipline with questions.

  • EPPI-Centre methods for conducting systematic reviews The EPPI-Centre develops methods and tools for conducting systematic reviews, including reviews for education, public and social policy.

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Environmental Topics

  • Collaboration for Environmental Evidence (CEE) CEE seeks to promote and deliver evidence syntheses on issues of greatest concern to environmental policy and practice as a public service

Social Sciences

what are systematic literature reviews

  • Siddaway AP, Wood AM, Hedges LV. How to Do a Systematic Review: A Best Practice Guide for Conducting and Reporting Narrative Reviews, Meta-Analyses, and Meta-Syntheses. Annu Rev Psychol. 2019 Jan 4;70:747-770. doi: 10.1146/annurev-psych-010418-102803. A resource for psychology systematic reviews, which also covers qualitative meta-syntheses or met-ethnographies
  • The Campbell Collaboration

Social Work

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Software engineering

  • Guidelines for Performing Systematic Literature Reviews in Software Engineering The objective of this report is to propose comprehensive guidelines for systematic literature reviews appropriate for software engineering researchers, including PhD students.

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Sport, Exercise, & Nutrition

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  • Application of systematic review methodology to the field of nutrition by Tufts Evidence-based Practice Center Publication Date: 2009
  • Systematic Reviews and Meta-Analysis — Open & Free (Open Learning Initiative) The course follows guidelines and standards developed by the Campbell Collaboration, based on empirical evidence about how to produce the most comprehensive and accurate reviews of research

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  • Systematic Reviews by David Gough, Sandy Oliver & James Thomas Publication Date: 2020

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Updating reviews

  • Updating systematic reviews by University of Ottawa Evidence-based Practice Center Publication Date: 2007

Looking for our previous Systematic Review guide?

Our legacy guide was used June 2020 to August 2022

  • Systematic Review Legacy Guide
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  • Last Updated: Feb 8, 2024 9:22 AM
  • URL: https://guides.lib.unc.edu/systematic-reviews

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Systematic Reviews

  • Types of Literature Reviews

What Makes a Systematic Review Different from Other Types of Reviews?

  • Planning Your Systematic Review
  • Database Searching
  • Creating the Search
  • Search Filters & Hedges
  • Grey Literature
  • Managing & Appraising Results
  • Further Resources

Reproduced from Grant, M. J. and Booth, A. (2009), A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26: 91–108. doi:10.1111/j.1471-1842.2009.00848.x

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  • Getting Help with Systematic Reviews from the Library
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This guide aims to support all OHSU members' systematic review education and activities, orienting OHSU members who are new to systematic reviews and facilitating the quality, rigor, and reproducibility of systematic reviews produced by OHSU members.

In it you will find:

  • A definition of what systematic reviews are, how they compare to other evidence, and how they differ from narrative literature reviews
  • Descriptions of the different types of systematic reviews , with links to resources on methods, protocols, reporting, additional information, and selecting the right type of systematic review for your research question
  • Guidance on how to read and evaluate systematic reviews for strength, quality, and potential for bias
  • A high-level overview of how systematic reviews are conducted , including team size and roles, standards, and processes
  • Links to resources and tools for conducting systematic reviews
  • Information about how to get assistance with conducting a systematic review from the OHSU Library
  • A history of systematic reviews to provide contextual understanding of how they have developed over time
"A systematic review is a summary of the medical literature that uses explicit and reproducible methods to systematically search, critically appraise, and synthesize on a specific issue. It synthesizes the results of multiple primary studies related to each other by using strategies that reduce biases and random errors."

Gopalakrishnan S, Ganeshkumar P. Systematic Reviews and Meta-analysis: Understanding the Best Evidence in Primary Healthcare . J Family Med Prim Care . 2013;2(1):9-14. doi:10.4103/2249-4863.109934

Systematic Reviews are a vital resource used in the pursuit of Evidence-Based Practice (EBP):

  • These studies can be found near the top of the Evidence Pyramid , which ranks sources of information and study designs by the level of evidence contained within them
  • This ranking is based on the level of scientific rigor employed in their methods and the quality and reliability of the evidence contained within these sources
  • A higher ranking means that we can be more confident that their conclusions are accurate and have taken measures to limit bias

Research design and evidence , by CFCF , CC BY-SA 4.0 , via Wikimedia Commons

Things to know about systematic reviews:

  • Systematic reviews are a type of research study
  • Systematic reviews aim to provide a comprehensive and unbiased summary of the existing evidence on a particular research question
  • There are many types of systematic reviews , each designed to address a specific type of research purpose and with their own strengths and weaknesses
  • The choice of what type of review to produce typically will depend on the nature of the research question and the resources that are available on the topic

The practice of producing systematic reviews is sometimes referred to by other names such as:

  • Evidence Synthesis
  • Knowledge Synthesis
  • Research Synthesis

This guide tries to stick with the term "Systematic Reviews" unless a specific type of systematic review is being discussed.

While all reviews combat information overload in the health sciences by summarizing the literature on a topic, different types of reviews have different approaches. The term systematic review is often conflated with narrative literature reviews , which can lead to confusion and misunderstandings when seeking help with conducting them. This table helps clarify the differences.

  • Next: Types of Systematic Reviews >>
  • Last Updated: Feb 12, 2024 5:59 PM
  • URL: https://libguides.ohsu.edu/systematic-reviews

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  • Research Process

Systematic Literature Review or Literature Review?

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Table of Contents

As a researcher, you may be required to conduct a literature review. But what kind of review do you need to complete? Is it a systematic literature review or a standard literature review? In this article, we’ll outline the purpose of a systematic literature review, the difference between literature review and systematic review, and other important aspects of systematic literature reviews.

What is a Systematic Literature Review?

The purpose of systematic literature reviews is simple. Essentially, it is to provide a high-level of a particular research question. This question, in and of itself, is highly focused to match the review of the literature related to the topic at hand. For example, a focused question related to medical or clinical outcomes.

The components of a systematic literature review are quite different from the standard literature review research theses that most of us are used to (more on this below). And because of the specificity of the research question, typically a systematic literature review involves more than one primary author. There’s more work related to a systematic literature review, so it makes sense to divide the work among two or three (or even more) researchers.

Your systematic literature review will follow very clear and defined protocols that are decided on prior to any review. This involves extensive planning, and a deliberately designed search strategy that is in tune with the specific research question. Every aspect of a systematic literature review, including the research protocols, which databases are used, and dates of each search, must be transparent so that other researchers can be assured that the systematic literature review is comprehensive and focused.

Most systematic literature reviews originated in the world of medicine science. Now, they also include any evidence-based research questions. In addition to the focus and transparency of these types of reviews, additional aspects of a quality systematic literature review includes:

  • Clear and concise review and summary
  • Comprehensive coverage of the topic
  • Accessibility and equality of the research reviewed

Systematic Review vs Literature Review

The difference between literature review and systematic review comes back to the initial research question. Whereas the systematic review is very specific and focused, the standard literature review is much more general. The components of a literature review, for example, are similar to any other research paper. That is, it includes an introduction, description of the methods used, a discussion and conclusion, as well as a reference list or bibliography.

A systematic review, however, includes entirely different components that reflect the specificity of its research question, and the requirement for transparency and inclusion. For instance, the systematic review will include:

  • Eligibility criteria for included research
  • A description of the systematic research search strategy
  • An assessment of the validity of reviewed research
  • Interpretations of the results of research included in the review

As you can see, contrary to the general overview or summary of a topic, the systematic literature review includes much more detail and work to compile than a standard literature review. Indeed, it can take years to conduct and write a systematic literature review. But the information that practitioners and other researchers can glean from a systematic literature review is, by its very nature, exceptionally valuable.

This is not to diminish the value of the standard literature review. The importance of literature reviews in research writing is discussed in this article . It’s just that the two types of research reviews answer different questions, and, therefore, have different purposes and roles in the world of research and evidence-based writing.

Systematic Literature Review vs Meta Analysis

It would be understandable to think that a systematic literature review is similar to a meta analysis. But, whereas a systematic review can include several research studies to answer a specific question, typically a meta analysis includes a comparison of different studies to suss out any inconsistencies or discrepancies. For more about this topic, check out Systematic Review VS Meta-Analysis article.

Language Editing Plus

With Elsevier’s Language Editing Plus services , you can relax with our complete language review of your systematic literature review or literature review, or any other type of manuscript or scientific presentation. Our editors are PhD or PhD candidates, who are native-English speakers. Language Editing Plus includes checking the logic and flow of your manuscript, reference checks, formatting in accordance to your chosen journal and even a custom cover letter. Our most comprehensive editing package, Language Editing Plus also includes any English-editing needs for up to 180 days.

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Systematic Reviews

Describes what is involved with conducting a systematic review of the literature for evidence-based public health and how the librarian is a partner in the process.

Several CDC librarians have special training in conducting literature searches for systematic reviews.  Literature searches for systematic reviews can take a few weeks to several months from planning to delivery.

Fill out a search request form here  or contact the Stephen B. Thacker CDC Library by email  [email protected] or telephone 404-639-1717.

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Look for systematic reviews that have already been published. 

  • To ensure that the work has not already been done.
  • To provides examples of search strategies for your topic

Look in PROSPERO for registered systematic reviews.

Search Cochrane and CRD-York for systematic reviews.

Search filter for finding systematic reviews in PubMed

Other search filters to locate systematic reviews

A systematic review attempts to collect and analyze all evidence that answers a specific question.  The question must be clearly defined and have inclusion and exclusion criteria. A broad and thorough search of the literature is performed and a critical analysis of the search results is reported and ultimately provides a current evidence-based answer  to the specific question.

Time:  According to Cochrane , it takes 18 months on average to complete a Systematic Review.

The average systematic review from beginning to end requires 18 months of work. “…to find out about a healthcare intervention it is worth searching research literature thoroughly to see if the answer is already known. This may require considerable work over many months…” ( Cochrane Collaboration )

Review Team: Team Members at minimum…

  • Content expert
  • 2 reviewers
  • 1 tie breaker
  • 1 statistician (meta-analysis)
  • 1 economist if conducting an economic analysis
  • *1 librarian (expert searcher) trained in systematic reviews

“Expert searchers are an important part of the systematic review team, crucial throughout the review process-from the development of the proposal and research question to publication.” ( McGowan & Sampson, 2005 )

*Ask your librarian to write a methods section regarding the search methods and to give them co-authorship. You may also want to consider providing a copy of one or all of the search strategies used in an appendix.

The Question to Be Answered: A clearly defined and specific question or questions with inclusion and exclusion criteria.

Written Protocol: Outline the study method, rationale, key questions, inclusion and exclusion criteria, literature searches, data abstraction and data management, analysis of quality of the individual studies, synthesis of data, and grading of the evidience for each key question.

Literature Searches:  Search for any systematic reviews that may already answer the key question(s).  Next, choose appropriate databases and conduct very broad, comprehensive searches.  Search strategies must be documented so that they can be duplicated.  The librarian is integral to this step of the process. Before your librarian creates a search strategy and starts searching in earnest you should write a detailed PICO question , determine the inclusion and exclusion criteria for your study, run a preliminary search, and have 2-4 articles that already fit the criteria for your review.

What is searched depends on the topic of the review but should include…

  • At least 3 standard medical databases like PubMed/Medline, CINAHL, Embase, etc..
  • At least 2 grey literature resources like Clinicaltrials.gov, COS Conference Papers Index, Grey Literature Report,  etc…

Citation Management: EndNote is a bibliographic management tools that assist researchers in managing citations.  The Stephen B. Thacker CDC Library oversees the site license for EndNote.

To request installation:   The library provides EndNote  to CDC staff under a site-wide license. Please use the ITSO Software Request Tool (SRT) and submit a request for the latest version (or upgraded version) of EndNote. Please be sure to include the computer name for the workstation where you would like to have the software installed.

EndNote Training:   CDC Library offers training on EndNote on a regular basis – both a basic and advanced course. To view the course descriptions and upcoming training dates, please visit the CDC Library training page .

For assistance with EndNote software, please contact [email protected]

Vendor Support and Services:   EndNote – Support and Services (Thomson Reuters)  EndNote – Tutorials and Live Online Classes (Thomson Reuters)

Getting Articles:

Articles can be obtained using DocExpress or by searching the electronic journals at the Stephen B. Thacker CDC Library.

IOM Standards for Systematic Reviews: Standard 3.1: Conduct a comprehensive systematic search for evidence

The goal of a systematic review search is to maximize recall and precision while keeping results manageable. Recall (sensitivity) is defined as the number of relevant reports identified divided by the total number of relevant reports in existence. Precision (specificity) is defined as the number of relevant reports identified divided by the total number of reports identified.

Issues to consider when creating a systematic review search:   

  • All concepts are included in the strategy
  • All appropriate subject headings are used
  • Appropriate use of explosion
  • Appropriate use of subheadings and floating subheadings
  • Use of natural language (text words) in addition to controlled vocabulary terms
  • Use of appropriate synonyms, acronyms, etc.
  • Truncation and spelling variation as appropriate
  • Appropriate use of limits such as language, years, etc.
  • Field searching, publication type, author, etc.
  • Boolean operators used appropriately
  • Line errors: when searches are combined using line numbers, be sure the numbers refer to the searches intended
  • Check indexing of relevant articles
  • Search strategy adapted as needed for multiple databases
  • Cochrane Handbook: Searching for Studies See Part 2, Chapter 6

A step-by-step guide to systematically identify all relevant animal studies

Materials listed in these guides are selected to provide awareness of quality public health literature and resources. A material’s inclusion does not necessarily represent the views of the U.S. Department of Health and Human Services (HHS), the Public Health Service (PHS), or the Centers for Disease Control and Prevention (CDC), nor does it imply endorsement of the material’s methods or findings. HHS, PHS, and CDC assume no responsibility for the factual accuracy of the items presented. The selection, omission, or content of items does not imply any endorsement or other position taken by HHS, PHS, and CDC. Opinion, findings, and conclusions expressed by the original authors of items included in these materials, or persons quoted therein, are strictly their own and are in no way meant to represent the opinion or views of HHS, PHS, or CDC. References to publications, news sources, and non-CDC Websites are provided solely for informational purposes and do not imply endorsement by HHS, PHS, or CDC.

Exit Notification / Disclaimer Policy

  • The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
  • Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
  • You will be subject to the destination website's privacy policy when you follow the link.
  • CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

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How to write a systematic literature review [9 steps]

Systematic literature review

What is a systematic literature review?

Where are systematic literature reviews used, what types of systematic literature reviews are there, how to write a systematic literature review, 1. decide on your team, 2. formulate your question, 3. plan your research protocol, 4. search for the literature, 5. screen the literature, 6. assess the quality of the studies, 7. extract the data, 8. analyze the results, 9. interpret and present the results, registering your systematic literature review, frequently asked questions about writing a systematic literature review, related articles.

A systematic literature review is a summary, analysis, and evaluation of all the existing research on a well-formulated and specific question.

Put simply, a systematic review is a study of studies that is popular in medical and healthcare research. In this guide, we will cover:

  • the definition of a systematic literature review
  • the purpose of a systematic literature review
  • the different types of systematic reviews
  • how to write a systematic literature review

➡️ Visit our guide to the best research databases for medicine and health to find resources for your systematic review.

Systematic literature reviews can be utilized in various contexts, but they’re often relied on in clinical or healthcare settings.

Medical professionals read systematic literature reviews to stay up-to-date in their field, and granting agencies sometimes need them to make sure there’s justification for further research in an area. They can even be used as the starting point for developing clinical practice guidelines.

A classic systematic literature review can take different approaches:

  • Effectiveness reviews assess the extent to which a medical intervention or therapy achieves its intended effect. They’re the most common type of systematic literature review.
  • Diagnostic test accuracy reviews produce a summary of diagnostic test performance so that their accuracy can be determined before use by healthcare professionals.
  • Experiential (qualitative) reviews analyze human experiences in a cultural or social context. They can be used to assess the effectiveness of an intervention from a person-centric perspective.
  • Costs/economics evaluation reviews look at the cost implications of an intervention or procedure, to assess the resources needed to implement it.
  • Etiology/risk reviews usually try to determine to what degree a relationship exists between an exposure and a health outcome. This can be used to better inform healthcare planning and resource allocation.
  • Psychometric reviews assess the quality of health measurement tools so that the best instrument can be selected for use.
  • Prevalence/incidence reviews measure both the proportion of a population who have a disease, and how often the disease occurs.
  • Prognostic reviews examine the course of a disease and its potential outcomes.
  • Expert opinion/policy reviews are based around expert narrative or policy. They’re often used to complement, or in the absence of, quantitative data.
  • Methodology systematic reviews can be carried out to analyze any methodological issues in the design, conduct, or review of research studies.

Writing a systematic literature review can feel like an overwhelming undertaking. After all, they can often take 6 to 18 months to complete. Below we’ve prepared a step-by-step guide on how to write a systematic literature review.

  • Decide on your team.
  • Formulate your question.
  • Plan your research protocol.
  • Search for the literature.
  • Screen the literature.
  • Assess the quality of the studies.
  • Extract the data.
  • Analyze the results.
  • Interpret and present the results.

When carrying out a systematic literature review, you should employ multiple reviewers in order to minimize bias and strengthen analysis. A minimum of two is a good rule of thumb, with a third to serve as a tiebreaker if needed.

You may also need to team up with a librarian to help with the search, literature screeners, a statistician to analyze the data, and the relevant subject experts.

Define your answerable question. Then ask yourself, “has someone written a systematic literature review on my question already?” If so, yours may not be needed. A librarian can help you answer this.

You should formulate a “well-built clinical question.” This is the process of generating a good search question. To do this, run through PICO:

  • Patient or Population or Problem/Disease : who or what is the question about? Are there factors about them (e.g. age, race) that could be relevant to the question you’re trying to answer?
  • Intervention : which main intervention or treatment are you considering for assessment?
  • Comparison(s) or Control : is there an alternative intervention or treatment you’re considering? Your systematic literature review doesn’t have to contain a comparison, but you’ll want to stipulate at this stage, either way.
  • Outcome(s) : what are you trying to measure or achieve? What’s the wider goal for the work you’ll be doing?

Now you need a detailed strategy for how you’re going to search for and evaluate the studies relating to your question.

The protocol for your systematic literature review should include:

  • the objectives of your project
  • the specific methods and processes that you’ll use
  • the eligibility criteria of the individual studies
  • how you plan to extract data from individual studies
  • which analyses you’re going to carry out

For a full guide on how to systematically develop your protocol, take a look at the PRISMA checklist . PRISMA has been designed primarily to improve the reporting of systematic literature reviews and meta-analyses.

When writing a systematic literature review, your goal is to find all of the relevant studies relating to your question, so you need to search thoroughly .

This is where your librarian will come in handy again. They should be able to help you formulate a detailed search strategy, and point you to all of the best databases for your topic.

➡️ Read more on on how to efficiently search research databases .

The places to consider in your search are electronic scientific databases (the most popular are PubMed , MEDLINE , and Embase ), controlled clinical trial registers, non-English literature, raw data from published trials, references listed in primary sources, and unpublished sources known to experts in the field.

➡️ Take a look at our list of the top academic research databases .

Tip: Don’t miss out on “gray literature.” You’ll improve the reliability of your findings by including it.

Don’t miss out on “gray literature” sources: those sources outside of the usual academic publishing environment. They include:

  • non-peer-reviewed journals
  • pharmaceutical industry files
  • conference proceedings
  • pharmaceutical company websites
  • internal reports

Gray literature sources are more likely to contain negative conclusions, so you’ll improve the reliability of your findings by including it. You should document details such as:

  • The databases you search and which years they cover
  • The dates you first run the searches, and when they’re updated
  • Which strategies you use, including search terms
  • The numbers of results obtained

➡️ Read more about gray literature .

This should be performed by your two reviewers, using the criteria documented in your research protocol. The screening is done in two phases:

  • Pre-screening of all titles and abstracts, and selecting those appropriate
  • Screening of the full-text articles of the selected studies

Make sure reviewers keep a log of which studies they exclude, with reasons why.

➡️ Visit our guide on what is an abstract?

Your reviewers should evaluate the methodological quality of your chosen full-text articles. Make an assessment checklist that closely aligns with your research protocol, including a consistent scoring system, calculations of the quality of each study, and sensitivity analysis.

The kinds of questions you'll come up with are:

  • Were the participants really randomly allocated to their groups?
  • Were the groups similar in terms of prognostic factors?
  • Could the conclusions of the study have been influenced by bias?

Every step of the data extraction must be documented for transparency and replicability. Create a data extraction form and set your reviewers to work extracting data from the qualified studies.

Here’s a free detailed template for recording data extraction, from Dalhousie University. It should be adapted to your specific question.

Establish a standard measure of outcome which can be applied to each study on the basis of its effect size.

Measures of outcome for studies with:

  • Binary outcomes (e.g. cured/not cured) are odds ratio and risk ratio
  • Continuous outcomes (e.g. blood pressure) are means, difference in means, and standardized difference in means
  • Survival or time-to-event data are hazard ratios

Design a table and populate it with your data results. Draw this out into a forest plot , which provides a simple visual representation of variation between the studies.

Then analyze the data for issues. These can include heterogeneity, which is when studies’ lines within the forest plot don’t overlap with any other studies. Again, record any excluded studies here for reference.

Consider different factors when interpreting your results. These include limitations, strength of evidence, biases, applicability, economic effects, and implications for future practice or research.

Apply appropriate grading of your evidence and consider the strength of your recommendations.

It’s best to formulate a detailed plan for how you’ll present your systematic review results. Take a look at these guidelines for interpreting results from the Cochrane Institute.

Before writing your systematic literature review, you can register it with OSF for additional guidance along the way. You could also register your completed work with PROSPERO .

Systematic literature reviews are often found in clinical or healthcare settings. Medical professionals read systematic literature reviews to stay up-to-date in their field and granting agencies sometimes need them to make sure there’s justification for further research in an area.

The first stage in carrying out a systematic literature review is to put together your team. You should employ multiple reviewers in order to minimize bias and strengthen analysis. A minimum of two is a good rule of thumb, with a third to serve as a tiebreaker if needed.

Your systematic review should include the following details:

A literature review simply provides a summary of the literature available on a topic. A systematic review, on the other hand, is more than just a summary. It also includes an analysis and evaluation of existing research. Put simply, it's a study of studies.

The final stage of conducting a systematic literature review is interpreting and presenting the results. It’s best to formulate a detailed plan for how you’ll present your systematic review results, guidelines can be found for example from the Cochrane institute .

what are systematic literature reviews

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Evidence Syntheses and Systematic Reviews: Overview

  • Choosing a Review

Analyze and Report

What is evidence synthesis.

Evidence Synthesis: general term used to refer to any method of identifying, selecting, and combining results from multiple studies. There are several types of reviews which fall under this term; the main ones are in the table below: 

Types of Reviews

General steps for conducting systematic reviews.

The number of steps for conducting Evidence Synthesis varies a little, depending on the source that one consults. However, the following steps are generally accepted in how Systematic Reviews are done:

  • Identify a gap in the literature and form a well-developed and answerable research question which will form the basis of your search
  • Select a framework that will help guide the type of study you’re undertaking
  • Different guidelines are used for documenting and reporting the protocols of your systematic review before the review is conducted. The protocol is created following whatever guideline you select.
  • Select Databases and Grey Literature Sources
  • For steps 3 and 4, it is advisable to consult a librarian before embarking on this phase of the review process. They can recommend databases and other sources to use and even help design complex searches.
  • A protocol is a detailed plan for the project, and after it is written, it should be registered with an appropriate registry.
  • Search Databases and Other Sources
  • Not all databases use the same search syntax, so when searching multiple databases, use search syntaxes that would work in individual databases.
  • Use a citation management tool to help store and organize your citations during the review process; great help when de-duplicating your citation results
  • Inclusion and exclusion criteria already developed help you remove articles that are not relevant to your topic. 
  • Assess the quality of your findings to eliminate bias in either the design of the study or in the results/conclusions (generally not done outside of Systematic Reviews).

Extract and Synthesize

  • Extract the data from what's left of the studies that have been analyzed
  • Extraction tools are used to get data from individual studies that will be analyzed or summarized. 
  • Synthesize the main findings of your research

Report Findings

Report the results using a statistical approach or in a narrative form.

Need More Help?

Librarians can:

  • Provide guidance on which methodology best suits your goals
  • Recommend databases and other information sources for searching
  • Design and implement comprehensive and reproducible database-specific search strategies 
  • Recommend software for article screening
  • Assist with the use of citation management
  • Offer best practices on documentation of searches

Related Guides

  • Literature Reviews
  • Choose a Citation Manager
  • Project Management

Steps of a Systematic Review - Video

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  • Last Updated: Feb 16, 2024 5:40 PM
  • URL: https://guides.smu.edu/evidencesyntheses

Systematic Reviews

Call for papers: the role of systematic reviews in evidence-based research.

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We welcome submissions of research articles, systematic reviews, methodology and commentaries. 

Aims and scope

Systematic Reviews encompasses all aspects of the design, conduct and reporting of systematic reviews. The journal publishes high quality systematic review products including systematic review protocols, systematic reviews related to a very broad definition of human health, rapid reviews, updates of already completed systematic reviews, and methods research related to the science of systematic reviews, such as decision modelling. At this time Systematic Reviews does not accept reviews of in vitro studies.  The journal also aims to ensure that the results of all well-conducted systematic reviews are published, regardless of their outcome.

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Systematic Reviews considers protocols and results papers of systematic reviews of animal studies relevant for human health. You can now also prospectively register these reviews on PROSPERO .

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Systematic literature reviews

Affiliation.

  • 1 Department of General Practice and Primary Care, Peninsula Medical School, University of Exeter, Institute of Health and Social Care, ITTC Building, Tamar Science Park, Plymouth PL6 8BX, UK. [email protected]
  • PMID: 15907679
  • DOI: 10.1016/j.ctim.2004.12.003

Systematic reviews retrieve, appraise and summarise all the available evidence on a specific health question. They are designed to reduce the effect of the reviewers' own bias, and a full protocol should be written to define and guide the process. The appropriate resources should be in place before undertaking a review. The steps of the review are: frame the question and choose appropriate methods; identify relevant work; extract relevant data on outcomes and quality; summarise the evidence; and, interpret the evidence. Reviews that combine valid, homogeneous studies of treatments that are relevant to health care, in patients who are typical, can provide good evidence to guide health care decisions.

  • Data Collection / methods*
  • Review Literature as Topic*

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  • J Otolaryngol Head Neck Surg

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Systematic and other reviews: criteria and complexities

Robert t. sataloff.

1 Editor-in-Chief, Journal of Voice, Philadephia, USA

2 Editor Emeritus, Ear, Nose and Throat Journal, Philadephia, USA

Matthew L. Bush

3 Assistant Editor, Otology & Neurotology, Lexington, USA

Rakesh Chandra

4 Editor-in-Chief, Ear, Ear, Nose and Throat Journal, Nashville, USA

Douglas Chepeha

5 Editor-in-Chief, Journal of Otolaryngology – Head & Neck Surgery, Toronto, Canada

Brian Rotenberg

6 Editor-in-Chief, Journal of Otolaryngology – Head & Neck Surgery, London, Canada

Edward W. Fisher

7 Senior Editor, Journal of Laryngology and Otology, Birmingham, UK

David Goldenberg

8 Editor-in-Chief, Operative Techniques in Otolaryngology – Head and Neck Surgery, Hershey, USA

Ehab Y. Hanna

9 Editor-in-Chief, Head & Neck, Houston, USA

Joseph E. Kerschner

10 Editor-in-Chief, International Journal of Pediatric Otorhinolaryngology, Milwaukee, USA

Dennis H. Kraus

11 Co-Editor-in-Chief, Journal of Neurological Surgery Part B: Skull Base, New York, USA

John H. Krouse

12 Editor-in-Chief, Otolaryngology – Head and Neck Surgery, Philadelphia, USA

13 Editor-in-Chief, OTO-Open, Philadelphia, USA

14 Editor-in-Chief, Journal for Oto-Rhino-Laryngology, Head and Neck Surgery, Philadelphia, USA

15 Editor-in-Chief, World Journal of Otorhinolaryngology – Head and Neck Surgery, Philadelphia, USA

Michael Link

16 Co-Editor-in-Chief, Journal of Neurological Surgery Part B: Skull Base, Rochester, USA

Lawrence R. Lustig

17 Editor-in-Chief, Otology & Neurotology, New York, USA

Samuel H. Selesnick

18 Editor-in-Chief, The Laryngoscope, New York, USA

Raj Sindwani

19 Editor-in-Chief, American Journal of Rhinology & Allergy, Cleveland, USA

Richard J. Smith

20 Editor-in-Chief, Annals of Otology, Rhinology & Laryngology, Iowa City, USA

James Tysome

21 Editor-in-Chief, Clinical Otolaryngology, Cambridge, UK

Peter C. Weber

22 Editor-in-Chief, American Journal of Otolaryngology, Boston, USA

D. Bradley Welling

23 Editor-in-Chief, Laryngoscope Investigative Otolaryngology, Boston, USA

Review articles can be extremely valuable. They synthesize information for readers, often provide clarity and valuable insights into a topic; and good review articles tend to be cited frequently. Review articles do not require Institutional Review Board (IRB) approval if the data reviewed are public (including private and government databases) and if the articles reviewed have received IRB approval previously. However, some institutions require IRB review and exemption for review articles. So, authors should be familiar with their institution’s policy. In assessing and interpreting review articles, it is important to understand the article’s methodology, scholarly purpose and credibility. Many readers, and some journal reviewers, are not aware that there are different kinds of review articles with different definitions, criteria and academic impact [ 1 ]. In order to understand the importance and potential application of a review article, it is valuable for readers and reviewers to be able to classify review articles correctly.

Systematic reviews

Authors often submit articles that include the term “systematic” in the title without realizing that that term requires strict adherence to specific criteria. A systematic review follows explicit methodology to answer a well-defined research question by searching the literature comprehensively, evaluating the quantity and quality of research evidence rigorously, and analyzing the evidence to synthesize an answer to the research question. The evidence gathered in systematic reviews can be qualitative or quantitative. However, if adequate and comparable quantitative data are available then a meta-analysis can be performed to assess the weighted and summarized effect size of the studies included. Depending on the research question and the data collected, systematic reviews may or may not include quantitative meta-analyses; however, meta-analyses should be performed in the setting of a systematic review to ensure that all of the appropriate data were accessed. The components of a systematic review can be found in an important article by Moher et al. published in 2009 that defined requirements for systematic reviews and meta-analyses [ 2 ].

In order to optimize reporting of meta-analyses, an international group developed the Quality of Reporting of Meta-Analyses (QUOROM) statement at a meeting in 1996 that led to publication of the QUOROM statement in 1999 [ 3 ]. Moher et al. revised that document and re-named the guidelines the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PRISMA statement included both meta-analyses and systematic reviews, and the authors incorporated definitions established by the Cochrane Collaboration [ 4 ]. The PRISMA statement established the current standard for systematic reviews. To qualify as a systematic review, the methods section should acknowledge use of the PRISMA guidelines, and all PRISMA components should be incorporated strictly in all facets of the paper from the research question to the discussion. The PRISMA statement includes a checklist of 27 items that must be included when reporting a systematic review or meta-analysis [ 2 ]. A downloadable version of this checklist can be used by authors, reviewers, and journal editorial staff to ensure compliance with recommended components [ 5 ]. All 27 will not be listed in this brief editorial (although authors and reviewers are encouraged to consult the article by Moher et al. and familiarize themselves with all items), but a few will be highlighted.

The research question, as reflected in the title, should be a hypothesis-based specific research inquiry. The introduction must describe the rationale for the review and provide a specific goal or set of goals to be addressed. The type of systematic review, according to the Cochrane Collaboration, is based on the research question being asked and may assess diagnostic test accuracy, review prognostic studies evidence, evaluate intervention effect, scrutinize research methodology, or summarize qualitative evidence [ 6 ].

In the methods section, the participants, interventions, comparisons, outcomes and study design (PICOS) must be put forward. In addition to mentioning compliance with PRISMA, the methods section should state whether a review protocol exists and, if so, where it can be accessed (including a registration number). Systematic reviews are eligible for registration in the International Prospective Register of Systematic Reviews (PROSPERO) as established at the University of York (York, UK). When PROSPERO is used (it is available but not required for systematic reviews), registration should occur at the initial protocol stage of the review, and the final paper should direct to the information in the register. The methods section also must include specific study characteristics including databases used, years considered, languages of articles included, specific inclusion and exclusion criteria for studies; and rationale for each criterion must be included. Which individuals specifically performed searches should be noted. Electronic search strategy (with a full description of at least one electronic search strategy sufficient to allow replication of the search), process for article selection, data variables sought, assumptions and simplifications, methods for assessing bias risk of each individual study (such as selective reporting in individual studies) and utilization of this information in data synthesis, principal summary measures (risk ratio, hazard ratio, difference in means, etc.), methods of data management and combining study results, outcome level assessment, and other information should be reported.

The results section should include the number of studies identified, screened, evaluated for eligibility (including rationale for exclusion), and those included in the final synthesis. A PRISMA flow diagram should be included to provide this information succinctly [ 7 ]. The results also should include the study characteristics, study results, risk of bias within and across studies, and a qualitative or quantitative synthesis of the results of the included studies. This level of rigor in acquiring and evaluating the evidence of each individual study is one of the criteria that distinguishes systematic reviews from other categories. If the systematic review involves studies with paired samples and quantitative data, a summary of data should be provided for each intervention group along with effect estimates and confidence intervals for all outcomes of each study. If a meta-analysis is performed, then synthesized effect size should be reported with confidence intervals and measures of consistency (i.e. – data heterogeneity such as I 2 ) for each meta-analysis, and assessment of bias risk across studies. A forest plot, which provides a graphical presentation of the meta-analysis results, should be included.

The discussion section should summarize the main findings commenting on the strength of evidence for each outcome, as well as relevance to healthcare providers, policymakers and other key stake-holders; limitations of the study and outcomes; and conclusions highlighting the interpretation of results in the context of other research, and implications for future research.

Without adhering to of all of these criteria and the others listed in the PRISMA statement and checklist, the review does not qualify to be classified as “systematic”.

Meta-analyses

Meta-analyses, when feasible based on available and comparable quantitative data, supplement a systematic review evaluation, by adding a secondary statistical analysis of the pooled weighted outcomes of similar studies. This adds a level of objectivity in the synthesis of the review’s findings. Meta-analyses are appropriate when at least 2 individual studies contain paired samples (experimental group and control group) and provide quantitative outcome data and sample size. Studies that lack a control group may over-estimate the effect size of the experimental intervention or condition being studied and are not ideal for meta-analyses [ 8 ]. It also should be remembered that the conclusions of a meta-analysis are only as valid as the data on which the analysis is based. If the articles included are flawed, then the conclusions of the meta-analysis also may be flawed. Systematic reviews and meta-analyses are the most rigorous categories of review.

Other types of reviews

Mixed methods reviews.

Systematic reviews typically contain a single type of data, either qualitative or quantitative; however, mixed methods reviews bring together a combination of data types or study types. This approach may be utilized when quantitative data, in the setting of an intervention study, only provide a narrow perspective of the efficacy or effectiveness of the intervention. The addition of qualitative data or qualitative studies may provide a more complete picture of the knowledge, attitudes, and behaviors of clinicians, patients or researchers regarding that intervention. This type of review could involve collecting either the quantitative or the qualitative data using systematic review methodology, but often the qualitative data are gathered using a convenience sampling. Many qualitative studies provide useful insights into clinical management and/or implementation of research interventions; and incorporating them into a mixed methods review may provide valuable perspective on a wide range of literature. Mixed methods reviews are not necessarily systematic in nature; however, authors conducting mixed methods reviews should follow systematic review methodology, when possible.

Literature and narrative reviews

Literature reviews include peer-reviewed original research, systematic reviews, and meta-analyses, but also may include conference abstracts, books, graduate degree theses, and other non-peer reviewed publications. The methods used to identify and evaluate studies should be specified, but they are less rigorous and comprehensive than those required for systematic reviews. Literature reviews can evaluate a broad topic but do not specifically articulate a specific question, nor do they synthesize the results of included studies rigorously. Like mixed method reviews, they provide an overview of published information on the topic, although they may be less comprehensive than integrative reviews; and, unlike systematic reviews, they do not need to support evidence-based clinical or research practices, or highlight high-quality evidence for the reader. Narrative reviews are similar to literature reviews and evaluate the same scope of literature. The terms sometimes are used interchangeably, and author bias in article selection and data interpretation is a potential concern in literature and narrative reviews.

Umbrella reviews

An umbrella review integrates previously published, high-quality reviews such as systematic reviews and meta-analyses. Its purpose is to synthesize information in previously published systematic reviews and meta-analyses into one convenient paper.

Rapid review

A rapid review uses systematic review methodology to evaluate existing research. It provides a quick synthesis of evidence and is used most commonly to assist in emergent decision-making such as that required to determine whether COVID-19 vaccines should receive emergent approval.

Scoping, mapping, and systematized reviews

If literature has not been reviewed comprehensively in a specific subject that is varied and complex, a mapping review (also called scoping review) may be useful to organize initial understanding of the topic and its available literature. While mapping reviews may be helpful in crystallizing research findings and may be published, they are particularly useful in helping to determine whether a topic is amenable to systematic review, and to help organize and direct the approach of the systematic review or other reviews of the subject. Systematized reviews are used most commonly by students. The systematized review provides initial assessment of a topic that is potentially appropriate for a systematic review, but a systematized review does not meet the rigorous criteria of a systematic review and has substantially more limited value. Additional types of reviews exist including critical review, state-of-the-art review, and others.

Reviews can be invaluable; but they also can be misleading. Systematic reviews and meta-analyses provide readers with the greatest confidence that rigorous efforts have attempted to eliminate bias and ensure validity, but even they have limitations based upon the strengths and weaknesses of the literature that they have assessed (and the skill and objectivity with which the authors have executed the review). Risks of bias, incomplete information and misinformation increase as the rigor of review methodology decreases. While review articles may summarize research related to a topic for readers, non-systematic reviews lack the rigor to answer adequately hypothesis-driven research questions that can influence evidence-based practice. Journal authors, reviewers, editorial staff, and should be cognizant of the strengths and weaknesses of review methodology and should consider them carefully as they assess the value of published review articles, particularly as they determine whether the information presented should alter their patient care.

Authors’ contributions

The author(s) read and approved the final manuscript.

Declarations

The authors declare no competing interests.

This article is co-published in the following journals: Journal of Voice, Otology & Neurotology, Ear, Nose and Throat Journal, Journal of Laryngology and Otology, Operative Techniques in Otolaryngology – Head and Neck Surgery, Head & Neck, International Journal of Pediatric Otorhinolaryngology, Journal of Neurological Surgery Part B: Skull Base, Otolaryngology – Head and Neck Surgery, World Journal of Otorhinolaryngology – Head and Neck Surgery, The Laryngoscope, American Journal of Rhinology & Allergy, Annals of Otology, Rhinology & Laryngology, Clinical Otolaryngology, American Journal of Otolaryngology, Laryngoscope Investigative Otolaryngology.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Literature Reviews

  • Types of reviews
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Types of reviews and examples

Choosing a review type.

  • 1. Define your research question
  • 2. Plan your search
  • 3. Search the literature
  • 4. Organize your results
  • 5. Synthesize your findings
  • 6. Write the review
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what are systematic literature reviews

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Overview of types of literature reviews

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  • Literature (narrative)
  • Scoping / Evidence map
  • Meta-analysis

Characteristics:

  • Provides examination of recent or current literature on a wide range of subjects
  • Varying levels of completeness / comprehensiveness, non-standardized methodology
  • May or may not include comprehensive searching, quality assessment or critical appraisal

Mitchell, L. E., & Zajchowski, C. A. (2022). The history of air quality in Utah: A narrative review.  Sustainability ,  14 (15), 9653.  doi.org/10.3390/su14159653

  • Assessment of what is already known about an issue
  • Similar to a systematic review but within a time-constrained setting
  • Typically employs methodological shortcuts, increasing risk of introducing bias, includes basic level of quality assessment
  • Best suited for issues needing quick decisions and solutions (i.e., policy recommendations)

Learn more about the method:

Khangura, S., Konnyu, K., Cushman, R., Grimshaw, J., & Moher, D. (2012). Evidence summaries: the evolution of a rapid review approach.  Systematic reviews, 1 (1), 1-9.  https://doi.org/10.1186/2046-4053-1-10

Virginia Commonwealth University Libraries. (2021). Rapid Review Protocol .

Quarmby, S., Santos, G., & Mathias, M. (2019). Air quality strategies and technologies: A rapid review of the international evidence.  Sustainability, 11 (10), 2757.  https://doi.org/10.3390/su11102757

  • Compiles evidence from multiple reviews into one document
  • Often defines a broader question than is typical of a traditional systematic review.

Choi, G. J., & Kang, H. (2022). The umbrella review: a useful strategy in the rain of evidence.  The Korean Journal of Pain ,  35 (2), 127–128.  https://doi.org/10.3344/kjp.2022.35.2.127

Aromataris, E., Fernandez, R., Godfrey, C. M., Holly, C., Khalil, H., & Tungpunkom, P. (2015). Summarizing systematic reviews: Methodological development, conduct and reporting of an umbrella review approach. International Journal of Evidence-Based Healthcare , 13(3), 132–140. https://doi.org/10.1097/XEB.0000000000000055

Rojas-Rueda, D., Morales-Zamora, E., Alsufyani, W. A., Herbst, C. H., Al Balawi, S. M., Alsukait, R., & Alomran, M. (2021). Environmental risk factors and health: An umbrella review of meta-analyses.  International Journal of Environmental Research and Public Dealth ,  18 (2), 704.  https://doi.org/10.3390/ijerph18020704

  • Main purpose is to map out and categorize existing literature, identify gaps in literature
  • Search comprehensiveness determined by time/scope constraints, could take longer than a systematic review
  • No formal quality assessment or critical appraisal

Learn more about the methods :

Arksey, H., & O'Malley, L. (2005) Scoping studies: towards a methodological framework.  International Journal of Social Research Methodology ,  8 (1), 19-32.  https://doi.org/10.1080/1364557032000119616

Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science: IS, 5, 69. https://doi.org/10.1186/1748-5908-5-69

Miake-Lye, I. M., Hempel, S., Shanman, R., & Shekelle, P. G. (2016). What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products.  Systematic reviews, 5 (1), 1-21.  https://doi.org/10.1186/s13643-016-0204-x

Example : 

Rahman, A., Sarkar, A., Yadav, O. P., Achari, G., & Slobodnik, J. (2021). Potential human health risks due to environmental exposure to nano-and microplastics and knowledge gaps: A scoping review.  Science of the Total Environment, 757 , 143872.  https://doi.org/10.1016/j.scitotenv.2020.143872

  • Seeks to systematically search for, appraise, and synthesize research evidence
  • Adheres to strict guidelines, protocols, and frameworks
  • Time-intensive and often take months to a year or more to complete. 
  • The most commonly referred to type of evidence synthesis. Sometimes confused as a blanket term for other types of reviews.

Gascon, M., Triguero-Mas, M., Martínez, D., Dadvand, P., Forns, J., Plasència, A., & Nieuwenhuijsen, M. J. (2015). Mental health benefits of long-term exposure to residential green and blue spaces: a systematic review.  International Journal of Environmental Research and Public Health ,  12 (4), 4354–4379.  https://doi.org/10.3390/ijerph120404354

  • Statistical technique for combining results of quantitative studies to provide more precise effect of results
  • Aims for exhaustive, comprehensive searching
  • Quality assessment may determine inclusion/exclusion criteria
  • May be conducted independently or as part of a systematic review

Berman, N. G., & Parker, R. A. (2002). Meta-analysis: Neither quick nor easy. BMC Medical Research Methodology , 2(1), 10. https://doi.org/10.1186/1471-2288-2-10

Hites R. A. (2004). Polybrominated diphenyl ethers in the environment and in people: a meta-analysis of concentrations.  Environmental Science & Technology ,  38 (4), 945–956.  https://doi.org/10.1021/es035082g

Flowchart of review types

  • Review Decision Tree - Cornell University For more information, check out Cornell's review methodology decision tree.
  • LitR-Ex.com - Eight literature review methodologies Learn more about 8 different review types (incl. Systematic Reviews and Scoping Reviews) with practical tips about strengths and weaknesses of different methods.
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  • Next: 1. Define your research question >>
  • Last Updated: Feb 15, 2024 1:45 PM
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  • Published: 14 February 2024

Benefits and barriers associated with the use of smart home health technologies in the care of older persons: a systematic review

  • Yi Jiao (Angelina) Tian 1 ,
  • Nadine Andrea Felber 1 ,
  • Félix Pageau 2 , 3 ,
  • Delphine Roulet Schwab 4 &
  • Tenzin Wangmo 1  

BMC Geriatrics volume  24 , Article number:  152 ( 2024 ) Cite this article

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Smart home health technologies (SHHTs) have been discussed in the frame of caregiving to enable aging-in-place and independence. A systematic review was conducted in accordance with the PRISMA guidelines to gather the up-to-date knowledge on the benefits and barriers of using SHHTs in the care of older persons from the perspective of older persons and their caregivers.

Ten electronic databases were reviewed for empirical peer-reviewed literature published from 01.01.2000 to 31.12.2021 in English, German, and French reporting on experimental, qualitative, quantitative, and other empirical study designs were included. Included studies contained user-feedback from older persons over 65 years of age or their caregivers (formal and informal). We used an extraction document to collect relevant data from all included studies and applied narrative synthesis to analyze data related to benefits and barriers of SHHTs.

163 empirical peer-reviewed articles were included, the majority of those published between 2014 and 2021. Five first-order categories of benefits and five of barriers were found with individual sub-themes. SHHTs could be useful in the care context where continuous monitoring is needed. They improve self-management and independent living of older persons. Barriers currently exist with respect to ease of usability, social acceptance, and cost.

Conclusions

SHHTs could be useful in the care context but are not without concerns. Researchers and policy makers can use the information as a starting point to better understand how the roles and outcomes of SHHTs could be improved for the care of older persons, while caregivers of older adults could use our findings to comprehend the scope of SHHTs and to decide when and where such technology could best address their individual family needs. Limitations lie in the possible exclusion of relevant articles published outside the inclusion criteria as well as the fact that due to digital divide, our review represents opinions of those who could and wanted to participate in the included 163 studies.

Trial registration

This review has been registered as PROSPERO CRD42021248543. A protocol was completed in March 2021 with the PRISMA-P guidance. We have extended the review period from 2000 to 2020 since the registration of the protocol to 2000–2021.

Peer Review reports

Introduction

Recent developments in medicine, public health, and medical technologies have led to an increase in life expectancy and an upwards trend in the global aging population [ 1 ]. At the same time, these trends are coupled with the rising likelihood for older adults to have increased risks of frailty, falls, disease and a reduced or loss of independence in completing instrumental activities of daily living (IADLs) (running errands, managing finances, using a computer and phone, etc.), and other ADLs (bathing, getting dressed, feeding oneself, etc.) [ 2 ]. To support and manage these declining abilities to independently undertake IADLs and ADLs, both informal and formal caregivers must provide extensive care and supervision, or alternatively consider a move towards institutionalization. Nevertheless, previous studies indicate that most older persons express negative feelings towards uprooting their lives from their homes, which may call for a solution that allows older persons to age-in-place while illness-appropriate and timely care could also be provided [ 3 , 4 ].

With recent technological advances in the field of connected devices and the Internet-of Things (IoTs), homes could be rendered “smart” by being fitted with unobtrusive, non-invasive, and wearable or stand-alone assistive health devices that communicate with each other, other systems, and end-users [ 5 , 6 ]. The definition of the “smart home” used in this paper is from Demiris and Hensel (2008), which is: “a residence wired with technology features that monitor the well-being and activities of their residents to improve overall quality of life, increase independence and prevent emergencies” [ 7 ]. To take this definition into more modern contexts with current advancements in wireless computing and application, this paper focuses on the empirical studies investigating all technologies available from 2000 to 2021 for health-related care and support in a home or residence context. These smart home health technologies (SHHTs) are categorized into 6 types: (a) physiological monitoring, pertaining to the collection and analysis of physiological measurements like heart rate, blood oxygen levels, blood pressure, respiration, temperature, or weight, etc.; (b) functional monitoring of data, including movements and activity levels while walking, sleeping, and eating, along with detecting abnormal movements or postures; (c) safety monitoring and assistance in the home environment for wandering behaviors, reduction of risks of falls or trips through automatic light switches in bathrooms during nighttime etc.; (d) security monitoring and assistance for the detection and responses towards intruders or threats; (e) social interaction monitoring and assistance with additional communication channels for health and well-being information or virtual participation in social events; and (f) cognitive and sensory assistance, including reminder systems for medication or cognitive aid functions for locating objects or practical instructions to aid forgetfulness [ 7 ]. The aspects of interoperability and automation in smart home technologies allow various different devices fulfilling the array of these health-related functions to communicate with one another [ 5 , 8 , 9 ]. Therefore, each health-related device in a residence is not a stand-alone entity but is compatible to be controlled and configured as connected ecosystem of technologies. For example, rather than measuring blood pressure, sleep time, and falls using individual devices at home, then operating and inputting the results onto another interface for a health-visit, the remote and continuous health monitoring function made possible with the installation of interoperable sensors enable any abnormalities in the older persons’ daily habits, postures, meals, and vital signs to be congregated and reported in real-time via another user interface or voice assistants to formal and informal caregivers, where they could continue to provide remote support while aging-in-place.

On a macro level, the concept of “smart homes” has been received positively and its global markets are predicted to grow [ 10 ]. Nevertheless, we agree with Wilson et al [ 11 ] that without evaluation and adoption by their actual end-users into the context of normal lives, their overall effectiveness as a solution for caregiving purposes would stay as theoretical potentials and assumed benefits. Most of the literature reviews and research are “pushed” by technology developers and still lack the feedback of end-users [ 11 , 12 ]. More research is needed to empirically investigate SHHTs from the end-users’ perspective, drawing in the issue of acceptance and adoption in the context of the personal environment that these technologies are used in [ 13 ].

Different from previous reviews of literature on smart home technology and caregiving, we narrowed the focus from reviewing all smart home devices similar to the work of Wilson, Hargreaves and Hauxwell-Baldwin [ 11 ] to SHHTs by adding the limit of the use of health technologies. We believe that this focus on health technologies, rather than those geared towards comfort, convenience, and entertainment could more directly address a few of the major concerns in the aging process, such as frailty, cognitive impairment, age-related disabilities, and risks of mortality [ 14 ]. The systematic review by Majumder and colleagues [ 5 ] focused on specific types of SHHTs used for older persons, such as wearable sensors, or another recent review by Pirzada and colleagues [ 15 ] that did not include assistive robots, whereas our more comprehensive review allows an aggregate overview of devices that fulfill a more diverse portfolio of interactive health needs and personal preferences. Namely, the installation of home sensors also involves the monitoring of health and signs of diseases, but could resolve the issue of forgetfulness common in the adoption of wearable sensors, concerns of waterproofing when the older person is in the shower, or the preferences against wearing devices on the body. The companion robots could address the angle of social isolation, while service robots could allow us to look futuristically towards the new features for hands-on, rather than monitoring functions that technologies could provide. Also different from those that focused on a specific topic in relation to SHHTs, such as loneliness and social isolation from Latikka et al. [ 16 ] and Choi and Lee [ 17 ], our systematic review provides an overview of benefits and barriers while presenting individual issues within a broader perspective of well-being, health, and an improvement of the quality of life of both the older persons and their caregivers. Therefore, we not only heed the calls from existing reviews to empirically examine from an end-user’s perspective, this review also differs from and adds to the works of our colleagues by focusing not only on, but all those, SHHTs used for caregiving purposes with sampling of older persons or those directly involved in their care.

Our systematic review aims to capture the existing knowledge including barriers and opportunities in the uptake of SHHTs in the care of older persons. Specific research questions include (1) What are the benefits and opportunities that SHHTs bring to the caregiving context in the existing empirical literature? (2) What are the barriers to acceptance or areas of improvement in SHHTs when they are used to care for older persons in the existing empirical literature?

Search Strategy

To capture the relevant intersection between older persons, caregivers, and SHHTs, we used a search algorithm (see Table  1 ) organized into four PICO (Population, Intervention, Context, Outcome) categories covering facets of interest: Population 1 (Older adults), Population 2 (Caregivers), Intervention (Smart home technologies), and Context (Home). By “home”, we mean an individual’s place of residence. This would include not only one’s home or apartment in the case of those older persons living in the community but also establishments providing residence and care such as retirement homes, nursing homes, aged care facilities, and assisted living that allows some level of independence for older persons. Each category included synonyms and varying spelling of each term, while also accommodating for possible definition and structure variabilities. The search strategy was also developed by the research team with the help of an information specialist. This algorithm was then adapted to use in ten digital databases: EMBASE, Medline, PsycINFO, CINAHL, SocIndex, SCOPUS, IEEE, Web of Science, Philpapers, and Philosophers Index (See Fig.  1 ). All terms were coupled with database-specific thesaurus terms where available. The search was limited to English, French, and German peer-reviewed papers published between 1 January 2000 and 31 December 2021. This date range was chosen to obtain a comprehensive review of existing studies, while taking into account the time of emergence and development trajectory of SHHTs, such as the advancement of wired to wireless devices or the increase in the number of interoperable multi-functional devices in the home. Although some reviews may purposively forgo searching for publications prior to 2010 (i.e. Liu, Stroulia [ 3 ]’s studied SHHTs’ technological readiness and their evidence to support older adults at home between 2010 and 2014), we believe that as the definitions and empirical work pertinent to early developments of smart homes began emerging as early as 2003 and all throughout the 2000s, there was ample need to include possible research outputs during these years [ 7 , 18 , 19 ].

Eligibility criteria

The inclusion criteria were: (1) The included study must be empirical and peer-reviewed. That is, an article was only included if it gathered the opinions of relevant end-users, such as caregivers and older persons, on the use of SHHTs in caregiving for older persons. (2) The studied population includes older persons over 65 years of age requiring care and support at their place of dwelling (home or nursing home) and/or professional and /or informal caregivers who provide care to older persons. Informal caregivers refer to family members or friends who provide support without monetary benefits. Professional or formal caregivers are those who are paid to help older persons receive medical treatment or perform tasks in their homes. (3) The empirical study concerns the use of SHHTs in the older persons’ place of dwelling. Specifically, these smart home technologies should be integrated into the older person’s place of dwelling, providing an interoperable system of devices that serves caregiving purposes. For example, studies were included if the health monitoring technologies such as cameras, motion detectors, or wearable sensors etc., mentioned were capable of interacting with each other and automatically alert end-users via either smartphones, tablets, or alarm services operated by formal caregivers.

We excluded studies that were (1) non-empirical and /or those published as book chapters, conference proceedings, newspaper articles, commentary, dissertations, and theses. Also excluded were systematic reviews. (2) Studies that did not report on the views of our population of interest or only included the views of researchers; and (3) technologies that are used for caregiving but is not interoperable or communicable with each other over an integration platform, such as stand-alone health devices such as those measuring blood pressure or weight, or the use of the video calling technologies to enable telehealth visits. Technologies that did not fulfill caregiving purposes for the promotion of health, such as single-purpose devices for cooking, cleaning, and comfort, were also excluded.

Selection process

After conducting a systematic search with the algorithm (see Table  1 ), results across all ten databases were consolidated and uploaded to a referencing software, where duplicates were removed automatically. From this point, all screening processes for format, content, and exclusion of additional duplicates were done manually. All titles were first screened manually by the third author. Thereafter, the abstracts of remaining articles were assessed independently by the first and third authors. Disagreements and uncertainties were resolved by the second author, who also proceeded to combine all included articles from the first and third authors and removed any duplicates generated during the abstract screening.

Data collection process

Upon screening both titles and abstracts, full electronically-available copies of remaining articles were retrieved and carefully studied by the first, second, and last authors for data extraction. At this stage, many papers were further deemed ineligible and were excluded with documented reasons. In order to identify appropriate data for extraction, the team developed a customized extraction document detailing information relevant to study demographics, technology specificities, benefits, and barriers, which was tested and adapted using several publications fulfilling the inclusion criteria. For relevant data to be extracted, it was not necessary for the article to use the exact wording of a theme already present on the extraction document. For example, though we were interested broadly in the concerns for the user-friendliness of a device, the researcher would extract data that also mentioned terms such as “slow, required directions, or anxious for making mistakes” which were not limited to whether the device was explicitly evaluated as “easy or difficult to use.” Nevertheless, articles that evaluated user-friendliness or design of a device without the collection of end-user opinions and experiences of a SHHT was not sufficient for extraction.

Ensuring quality of collected data

All data was extracted and coded first using the extraction document by the first, second, or last author, who were each responsible for a portion of articles. During the data extraction process, they discussed any challenges that they were facing in data interpretation and how to consolidate differences, where existed. To avoid bias between the primary coders, two external researchers (the third and fourth authors with backgrounds in geriatrics and psychology) additionally analyzed 10% of all articles, and achieved 80% in consistency in content. For the quality assessment, we used the Critical Appraisal Skills Programme (CASP) Checklists (e.g. CASP qualitative research, CASP case control, CASP cohort studies).

Data synthesis

The final extraction documents were combined across the three primary coders and data were analyzed first according to benefits or barriers to uptake of the SHHTs. Data synthesis was carried out by the first and last authors using narrative synthesis as it is most suited to combine different research designs and thus comprehensively inform policy [ 20 ]. During the data synthesis process, the two authors decided to reorganize similar columns and present them as sub-themes within several first-order categories by virtue of preserving precision while increasing comprehensiveness. Though the data extraction document with pre-existing themes was prepared in advance, the organization of final themes was dynamic, where we continuously discussed among authors on the best way to understand and subsequently portray the data as objectively and comprehensively as possible. A table containing basic information for all included articles can be found in the supplementary files.

Prior to implementing the search, the authors completed a protocol in accordance with PRISMA-P and registered the systematic review on PROSPERO (CRD42021248543) [ 21 ]. The review is designed and implemented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [ 22 , 23 ]. We have extended the review period from 2000 to 2020 since the registration of the protocol to 2000–2021.

Study selection

The search algorithm revealed 12,895 articles across ten databases for the 22 years of study time period. After removing duplicates and independently reviewing titles and abstracts, 403 articles were included at this stage. We sought to retrieve the full-text of all these articles and 21 full-texts were not found. Hence, 382 full-texts were further assessed for eligibility and data extracted where appropriate. During this process, 219 articles were excluded with reasons (see Fig.  1 ). This systematic review finally included 163 empirical articles for data analysis and the results are reported below.

To meet our eligibility criteria, many articles that fulfill some but not all of the required facets were not included in the final review. For example, a study on sleep disturbance in persons with dementia by Harris and Grando [ 24 ] that tested non-interoperable devices such as actigraphs as the sole technology component was also excluded, albeit on nursing home residents over 65 years old and its overall relevance for caregiving.

figure 1

PRISMA 2020 flowchart

Study characteristics

Of the 163 articles included for this review, 117 articles (72%) were published between 2014 and 2021, 37 (23%) between 2007 and 2013, and only 9 articles (5%) between 2000 and 2006. Almost all, with the exception of 3 articles, were published in English. The included studies encompassed a variety of empirical methodologies (see supplementary file). Furthermore, we also categorized the articles by functions of SHHTs tested or studied (Table  2 ), whereby the most studied function included physiological and functioning monitoring technologies (30 articles, 18.40%) followed by those solely promoting social interactions (28 articles, 17.18%). A significant portion of the locations of the included studies were in the U.S. (34 articles, 20.86%), with others in Japan, U.K., Germany, and Canada (Table  3 ).

Types of technology reviewed

Often the articles also involved technologies that fulfilled one or more of the functions noted in Table  2 . We also categorized all 163 articles into the specific types of emerging technologies (Abdi, de Witte & Hawley, 2020) and found that the two often mentioned technologies were intelligent homes (77 articles; 47.24%) and assistive autonomous robots (57 articles; 34.97%). Articles that fall under (1) intelligent homes investigated a collection of real-time monitoring sensors, such as cameras, infrared motion sensors, environmental sensors installed in the bed-mattress, contact sensors on doors, or pressure sensors detecting movements on the floors. (2) Autonomous robots include companion robots such as Pepper and Zora for entertainment and social interactions, or those combined with assistive functions like Care O Bot. In addition, we also included devices that could monitor for the frequency of social interactions of older persons and their families, as well as the inclusion of wearable devices monitoring for vital signs and activity levels within the wider package of smart home technologies under (3) AI-enabled health smart apps and wearables (5 articles; 3.07%). Due to the inclusion criteria of SHHTs needing to be home-based, we did not include articles that only investigated the uses of smart watches and fitness trackers that could be used outside of the home, namely for their GPS locating functions. (4) Voice-activated devices (3 articles; 1.84%) are those already on the market, such as Amazon Echo or Google Home, which articles are only included if they are tested on older persons for caregiving purposes. (5) Drug release mechanisms (2 articles; 1.23%) included smart pill dispensers that ejected specific numbers and types of medication in the homes of older persons, provided reminders when medications are not taken, which was all synced with interfaces accessible by caregivers.

Benefits mentioned in the included studies

From the 163 articles reviewed, we categorized benefits associated with the use of SHHTs into five main categories (see Table  4 ), which are described below.

Enables continuous monitoring of the older person : This category is mentioned in 115 articles, which represented more than two-third of all articles. Within this category, included studies mentioned technologies that could detect abnormality in postures, movements including falls, signs of agitation, and lights turning on at abnormal times (e.g. [ 25 , 26 , 27 , 28 ]). Such monitoring information were deemed as relevant information about the older persons’ health and habits that could be recorded and provided to the caregiver, which makes caregiving simpler, more efficient, holistic, or of higher quality (e.g. [ 29 , 30 , 31 , 32 ]). Furthermore, technologies could also be used to detect declines in the older persons’ cognitive or physical functioning through data related to periodic forgetfulness, vital signs, or mental health state (e.g. [ 33 , 34 , 35 , 36 , 37 ]). Technologies with a monitoring function also works to ensure the older persons’ safety in the home environment, in both aspects of home security and emergency situations (e.g. [ 38 , 39 , 40 , 41 , 42 , 43 ]). Technologies could also give confidence and assurance to the older persons that they are watched over and their knowledge about their own habits are valid (e.g. [ 44 , 45 , 46 ]). At the same time, older persons are also happy that technologies could provide peace-of-mind to their caregivers (e.g. [ 47 ]). Lastly, caregivers anticipate the possible usefulness of this function by enabling the prediction of fall risks from the older persons’ performance on mobility tasks [ 48 ].

Encourages social interactions : 74 articles mentioned benefits associated with promoting relationships, social exposure, and decreasing loneliness. Technology was cited to improve relationships between older persons and their caregivers, both in terms of quality and quantity (e.g. [ 43 , 49 , 50 , 51 , 52 ]). Specifically, technology facilitated communication with others through additional means, such as video calls, social media, or simply through a virtual interface (e.g. [ 53 , 54 , 55 , 56 , 57 ]). Technologies could improve older persons’ mental state by decreasing negative emotional states, such as loneliness and symptoms of apathy (e.g. [ 58 , 59 , 60 , 61 ])., enhancing social bonds by reminiscing about their past, and forming new social bonds (e.g. [ 62 , 63 , 64 , 65 ]). One article cited an older participant becoming more relaxed and positive, as well as more accepting of other people from interacting with the Paro robot [ 66 ].

Promotes independence or independent living for older persons : This category was discussed across 67 articles. Mobile assistive robots helped the older person with basic ADLs, such as walking, showering, and picking up objects from the floor (e.g. [ 67 , 68 , 69 , 70 ]). Such support was reported to allow older adults become less dependent on care from formal and informal caregivers, thereby making them less reliant on children and more independent (e.g. [ 71 , 72 ]). Digital medication dispensers, social robots, and pervasive sensor-equipped home systems could give older persons a sense of independence, self-determination, and empowerment in the home environment by giving them confidence to function well and be in control of their own health at home instead of asking for a human caregiver to come by to attend to their every need (e.g. [ 73 , 74 , 75 , 76 ]).

Reminds older persons to promote self-care and self-management : This category is mentioned across 49 articles. These strategies included the ability of SHHTs to support medication management, thus requiring less support from caregivers (e.g. [ 75 , 77 , 78 , 79 ]). Some enable older persons to analyze their health conditions and making medical information available to them (e.g. [ 80 , 81 , 82 ]). Others provided recommendations and feedback pertinent to diet, physical or cognitive exercises, as a way to encourage older persons to become more motivated to live healthier and happier lifestyles (e.g. [ 38 , 83 , 84 , 85 , 86 ]). Lastly, older persons could also be provided with memory aids for tasks other than medication, such as reminders for keeping appointments, guidance for completing tasks, and the reorientation to time and place (e.g. [ 87 , 88 , 89 , 90 ]).

Other purposes : 75 studies included all the remaining benefits raised, which were comparatively more scattered in definition than the preceding categories. For example, studied technologies were cited to reduce caregiving burden through decreased visits, time, and money combined with increased freedom, peace of mind, and support in caregiving tasks (e.g. [ 66 , 91 , 92 , 93 , 94 , 95 ]). Such technologies could improve older persons’ well-being, specifically in regard to memory, emotional and physical health, sleep, and communication (e.g. [ 57 , 96 , 97 , 98 , 99 , 100 ]). More broadly, they could support caregivers and healthcare systems, improving satisfaction and confidence with work, morale, and healthcare delivery cost and quality (e.g. [ 101 , 102 ]). Lastly, studies found that technologies could entertain older people with games, jokes, music, and humor (e.g. [ 103 , 104 , 105 ]).

Barriers mentioned in the included articles

From the 163 articles reviewed, we categorized barriers to the use to SHHTs into five main categories (see Table  5 ), which are described below.

Usability : In 110 studies, users thought the tested technology was not easy to use, intuitive, or conducive for use and was too bulky and ugly (e.g. [ 39 , 53 , 80 , 106 ]). Fear of a robotic device due to the unfamiliar and humanoid appearances could also lessen the frequency of interactions of older residents [ 107 ]. Technologies’ use was found to result in anxiety or destabilization of the end-user or complaints with the alert system, wearable, and sensors (e.g. [ 96 , 108 , 109 , 110 ]). Technical problems pertinent to battery life, internet connectivity, incompatibility with existing home systems, and password entry were also mentioned (e.g. [ 111 , 112 , 113 , 114 ]). Users were also unsatisfied with the technical limitations such as short screen time and long starting time or the inability to identify wrong postures, for instance, in fitness classes (e.g. [ 35 , 78 , 115 , 116 ]). There were suggestions for more interactive feedback from the devices to guide users, such as those to indicate the completion of a task or a physiological reading. Some complained that the technology was simply too disruptive and intrusive (e.g. [ 87 , 117 , 118 ]). On the other hand, articles also suggested possible improvements such as accounting for the visual, auditory, language barriers, cognitive declines and other limitations and wishes of older persons (e.g. [ 34 , 62 , 101 , 107 , 119 , 120 ]). For example, robotic assistants should be able to speak the language of the users, or devices requiring older participants’ engagement should be split into smaller, sporadic checks to account for cognitive declines in persons with dementia [ 107 , 121 ]. Reliability should be improved with less malfunctions and more accurate alerts and warnings (e.g. [ 27 , 69 , 122 , 123 ]. Lastly, technologies should be adaptive and customizable, that allows end-users with a variety of capabilities, needs, and preferences to maximize their benefits for caregiving [ 60 , 120 , 124 ].

Social acceptance : 69 articles elicited the factors affecting end-users’ decisions for technology adoption. Some end-users found the technology valuable and saw its utility in the future with increasing age and needs (e.g. [ 46 , 83 , 86 , 104 , 125 ]. In addition, the technology would be accepted when it addresses an actual need of an older person, thereby making it a necessity (e.g. [ 125 , 126 , 127 ]). Formal caregivers would accept the technology given its positive benefits for the workplace and the older patients (e.g. [ 62 , 112 ]). A few articles also recorded hesitancy to use technologies. For example, some users believed that the tested SHHTs are too difficult for older persons to use, citing too old to learn and keep up with changing technology (e.g. [ 51 , 114 , 117 , 128 ]). Older persons also worried that family members or the public may not approve, and the device may generate unwanted attention or gossip (e.g. [ 48 , 62 , 102 , 129 ]. In addition, not only did the perception of family member interfere with the older persons’ preferences or uptake of technologies, the relatives of older persons also preferred to be involved in the approval or opinion-gathering processes of the planned usage of technologies [ 130 , 131 ]. Lastly, technology itself could be deemed annoying due to the frequency or presence of alerts (e.g. [ 132 ].

Cost/Affordability : 44 studies questioned the cost-effectiveness and affordability of the tested technologies, noting to both their initial purchase and continued maintenance (e.g. [ 35 , 95 , 104 , 113 , 133 ])., though there was anticipatory comments that sensor usage could reduce healthcare costs and become an effective solution for caregivers and older persons [ 37 ]. However, the technology could be used if it was financed or reimbursed (e.g. [ 119 , 134 , 135 ]). This financial reimbursement extended beyond technologies, but their counselling services from healthcare providers, as this also affected the accessibility issue for many end-users [ 131 ]. While informal caregivers are less sensitive to the cost compared to older persons and buys the technology, it does not give them the right to disrupt the life-style choices of older persons [ 54 , 68 ]. Finally, a few papers pointed out that the high cost of technology risks to create a difference between the haves and the have-nots, such as those with in rural areas with no internet connection, and hence a better option would be when technology are made available to everyone (e.g. [ 37 , 46 , 71 , 92 ]).

Loss of relationships or increase of loneliness : Within the potential loss of relationships, two opposite issues were highlighted across 22 included studies. Firstly, there were concern and regret at the potential loss of social connectedness that older persons cannot enjoy as technology was supposed to provide for the care time that a loved one would have provided (e.g. [ 37 , 48 , 50 , 71 , 76 , 136 ]. On the contrary, family caregivers did not believe that technology would weaken their commitment towards the older persons (e.g. [ 136 ]. Specifically for the use of robots, caregivers also felt that they must supervise those interactions with older persons (e.g. [ 99 ]. Moreover, there were mentions that the robot would decrease loneliness since it is waiting for the older person at home and making the home environment friendlier (e.g. [ 38 , 72 , 88 ].

O ther concerns : The last category cites all other remaining concerns from 25 articles. For example, there were worries especially among formal caregivers that introducing technology would increase workload by requiring ample training and time before their introduction to older persons (e.g. [ 62 , 116 , 117 , 125 ]). This was echoed in an outlier set of articles that cited concerns with workload increases from translating conversations when the robotic agents did not speak the language of the older persons, as well as the necessity to process and react to the alerts generated by the monitoring devices [ 37 , 86 , 107 ]. There were also general complaints that the device is unnecessary, some of the components generated useful information, and procedural uncertainty with the generated data (e.g. [ 34 , 132 , 137 ]).

Considering the context of population aging and resource preparedness needed to support aging at home, it is necessary to consider the scope of viable solutions that could address caregiving to older persons. As a way to support caregivers by continuously providing information and monitoring abnormal health statuses of older persons, technological solutions such as SHHTs have been brought forth to improve well-being for older persons while reducing caregiving burdens. Our systematic review unearths important existing knowledge on SHHTs by studying their benefits and barriers in the care for older persons across the 163 empirical peer-reviewed publications. To supplement this review on the practical benefits and barriers to SHHTs’ adoption, we have published another article on the ethical concerns in the use of SHHTs from empirical and theoretical articles, where the issues of informational privacy in terms of data protection and security, and the impact on autonomy from the gain or loss in independence and control, as well as stigma and responsibility have been elaborated in further detail [ 138 ].

In regard to the existing benefits, most articles cited the capacity of SHHTs to allow continuous monitoring of the older person. This is not surprising as it is the one of the central challenges that many SHHTs aim to enable independently at home [ 10 , 11 , 139 ]. Importantly, monitoring technologies could relieve caregivers of the need to be constantly present to, for example, ensure safety by being able to find older persons who have wandered off [ 140 , 141 ]. As devices within the household communicate with each other via the concept of IoT, they not only allow continuous control and monitoring, but also regulation of the residents’ movement, routines as well as habits, and of the home itself [ 10 , 18 ]. As a critical extended function, older adults could choose to customize the SHHTs to alert any desired party if there are deviations from normal routines and postures. Stated in the results, end-users appreciated the ability of data from sensors to alert caregivers about any declines in cognitive or physical functioning. Having such knowledge could help in planning for increasing future caregiving needs. Furthermore, the function of medical alerts not only enables the provision of relevant emergency information to caregivers, but also provides a better understanding of the older person’s habits. Such information may provide greater insight into the patient and the circumstances of the medical visit.

Potential of SHHTs in supporting older persons with medication management and self-care were evident in our findings. The technologies thus could improve the independence and well-being of older persons [ 142 , 143 , 144 ]. On a larger scale of population aging and the increase in older persons living with chronic diseases, this independence and reduced caregiving supervision also parallels with a call for self-management of one’s own health at home while adapting to “social, physical, and emotional challenges” [ 145 ]. Nonetheless, the individual differences to prefer independence or self-manage conditions, rather than to receive care from another family or professional caregiver, should also be taken into consideration. Peek and colleagues [ 146 ] presented these differences between older participants’ reactions to use computers or mobile phones for ordering groceries. Whereas some self-identified as being “stubborn, proud, [and] handle a lot of things by [them]selves” and would not want to rely on any assistance from caregivers or technology, other older participants selectively relied on certain types of technologies or simply on their children to complete these tasks digitally [ 146 ]. In the context of SHHTs, we also found similar differences that drove participants to prefer reduced human intrusion into the home and the use of reminder technologies for taking medications, while others preferred shared decision-making and in-person visits for these tasks [ 47 , 78 , 105 , 130 ]. Whether an older person prefers to and would have greater confidence from independently accessing health information via technology, or would have greater trust in healthcare providers through in-person visits should also be considered.

Despite the potentials of SHHTs, it is more significant to highlight the several barriers which stand to hinder them from becoming viable solution for providing care for the older population [ 11 , 147 ]. The most cited barrier was usability, which included issues such as difficult to use, obtrusive, intrusive, low in interoperability with existing household automation systems, and also technical limitations that needed to be overcome by developers themselves. As underlined by other studies, [ 147 , 148 ], our systematic review further highlights that end-users had challenges in understanding the technology to the extent of avoidance and in particular, formal caregivers worried that the introduction of technologies could affect their work by requiring training and time for familiarization before allowing the older persons to use it independently. These practical challenges require critical thought and solutions from the part of technology developers. Improvement to user-friendliness could also improve access to the technologies and prevent the exacerbation of the digital divide. The articles reviewed revealed a wide range of knowledge and comfort levels of the designated end-users of SHHTs, where many of whom would likely be deterred by a technology that required lengthy training, frequent troubleshooting, and constant supervision. Conversely, a technology easily accessible and adoptable by more users could improve inequities amongst users of all backgrounds and technical expertise.

Though new developments of SHHTs were able to overcome and realize functional capabilities previously unseen, there were many technical malfunctions that caused frustration in end-users. Namely, there were challenges with the battery life, unstable or low wireless connectivity, incompatibility with existing house automation technologies, or that the technology was spatially inconvenient and could not fit comfortably in the home. Although these barriers seem simple and easy-to-overcome, they could be significantly troublesome for end-users to realistically implement in their home environment where familiarity is greatly valued. On the aspect of an incompatibility with existing home, there is call for adequate consideration towards the integration with existing home layouts while minimizing any modifications and interference to the older person [ 149 ]. As the aging process is dynamic and requires continuous adaptations from both caregivers and older persons, it is important that SHHTs are designed to interoperate with the end-users’ existing routines and home environment. Whilst the ability to access healthcare and constant remote monitoring could allow for a greater participation of the population living at a distance to healthcare resources or their caregivers, the extensive need for internet or cellular connection could again exclude older persons who are living in rural areas. This also plays into the need to incorporate large, bulky devices in the homes of older persons, begging the question of the characteristic or users whose home could meet these spatial requirements [ 150 ].

The aging process involves life transitions with higher risks of stressors, such as grief, bereavement, and a drop in socioeconomic statuses, which may in turn lead to an increased likelihood of loneliness and isolation for older adults [ 151 , 152 ]. The technologies with a social function could allow older people to engage positively in group dynamics, reminiscence, or develop new ways to communicate with others. Confirming the findings from Latikka et al. [ 16 ], we discovered that SHHTs’ overall contribution to the reduction of loneliness was positive, albeit without complete elimination. Our search also contributed a nuanced perspective, whereby end-users felt that while SHHTs could improve the relationships and communication between caregivers and older persons, both in terms of quality and quantity, older persons still worried that these new functions may eventually replace the social connectedness that they enjoyed during in-person visits. To complement this ambivalence, it is helpful to look towards an alternative view (Zhu et al., 2021), where researchers recommended that technologies should act as a collaborator in human caregiving, instead of a substitute for care from children. The question whether technologies would or could or should replace human care is one that has been raised intensively [ 153 , 154 , 155 , 156 ], and necessitates critical and clear discussion among various stakeholders as to what the purpose of their technology is and how it fits the overall societal goals.

The dynamic and complex interactions of cultural values in the adoption of smart technologies may also extend the conversation beyond the technologies themselves. Though there are many mentions of a reduction in caregiving burden, it is interesting to examine the nuance in this argument from a cultural angle towards the presence of a smaller portion of articles with concerns for an increase in workload with the use of technology in caregiving. One study investigating the attitudes of low-income U.S. immigrant older persons towards remote monitoring systems cited high discontinuation of Korean and Chinese American residents, for fear of frequent false alerts or the increase of workload for their children [ 132 ]. Albeit also cited by other studies, a lack of cultural awareness and significant language barriers combined with false alerts from a passive monitoring system could leave “unforgettable negative experience[s]”, where an older user is found be left with embarrassment after a door is broken down by the emergency medical services. Although previous reviews have noted these already [ 18 , 157 ], it is unfortunate that these recommendations have not been picked up and there still requires more development to improve the obtrusiveness and reliability of monitoring systems to reduce high rates of false alerts and malfunctions. Reducing feelings of embarrassment and maybe even stigma that follows are values that require serious attention.

Cost concerns has been raised by previous systematic reviews as a major barrier to adopting SHHTs [ 11 ]. While a stand-alone unit or an individual sensor may cost very little, to enable and maintain the continuous functioning of a complete and pervasive smart home environment could be more complicated than expected [ 5 , 147 ]. Also included in this cost is the hiring of specialized individuals at a service center or in the hospitals, who would also need to invest more time and cost to understand, analyze, and effectively make use of the health data collected. In an article on the “Hidden Work” of implementing GPS tracking devices with emergency contact functions for persons with cognitive impairment, the authors report the human resources necessary for the continuous maintenance of a sustainable program, which include the coordinators, commissioners, occupational therapists, call operators and managers in monitoring centers to receive the calls, and technology suppliers [ 158 ]. On a larger scale, to implement the use of monitoring technologies on a system level requires greater costs for training staff, and interventions to shift habits towards using these new care tools [ 159 ]. Justice issues also come into play with the levels of accessibility of different older persons and their families, depending on their abilities to shoulder one-off and maintenance costs, comfort and knowledge in using technical tools for caregiving, and the friendliness of the local policies towards introducing SHHTs in their populations. These all influence and could exacerbate the digital divide that technologies are already bringing forth now.

The COVID-19 pandemic has forced many older persons around the world into isolation and quarantine at least during early months, which expectedly may lead to a different perspective and necessity to employ the technologies reviewed in this article [ 15 , 160 , 161 ]. Specifically, with the ability for remote monitoring, technologies could allow continuation of care across physical barriers and detection of rapid health declines, countering the effects of social isolation and feelings of reassurance. Due to the nature of reviewing empirical articles published on end-user feedback, those articles that were empirical and contextualized on COVID-19 concentrated on delivering telehealth services, reasonably answering to the demands of providing healthcare remotely, rather than elaborate SHHTs studied in this review. Nonetheless, despite not yet gathering empirical feedback from end-users, an abundance of smart technologies for caregiving of older persons has been developed during COVID-19 that are worthy of mention and shows promise for expediting the diversity of applicable scenarios for a diverse set of users [ 162 , 163 ].

Customization and policy-implications

Whilst customization was a theme that arose in the early studies, the ability for a more personalized approach to the design and implementation of SHHT systems that, if not increased in frequency, but at least persisted in recently published studies in greater detail [ 43 , 53 , 60 , 86 ]. Users expressed that a heightened ability for technologies to “learn” and adapt its configurations, methods of data visualization, frequency of alerts, and complexity in its training programs could satisfy a more diverse array of user needs. This may be due to the improved technical capabilities and the shift towards personalized medicine in recent years. As a way to resolve individual preferences, comfort levels, or cultural norms, studies have cited the benefits of having technologies that were able to learn and adapt to the user [ 48 ]. For varying cost-bearing preferences and to accommodate the different national reimbursement programs, technologies should be offered in incremental stages with greater freedom for trial-periods before purchase. Directions of policy would greatly benefit the adoption or reduction of their barriers if it addresses the individual needs of older persons that are person-centric and situation-specific. Albeit smart homes are gradually making their way into policy decisions, there is a risk and uncertainty in their implementation to households that are of older persons or in rural areas with unstable wireless connectivity [ 164 ]. This would also heed calls for more personalization and tolerance in policy to adhere to the current array of needs and preferences.

Limitations

This systematic review has limitations. Firstly, despite having searched in 10 electronic databases with a 22-year time-period limit to reasonably incorporate the span of technological development of SHHTs, some papers could have still been excluded from our search, for example, those archived in databases outside the ones we included. We stopped our search in December 2021, and thus were not able to include any publications from January 2022. In addition, as we opted to include only peer-review empirical articles, there could have been valuable insight in other forms of data output relevant to our topic that were published as, for example, theoretical papers, book chapters, thesis or have been published as grey literature. Related to this limitation is also the fact that since our work includes end users who were able to participate in studies. In lieu of existing digital divide, it also means that our review was unable to capture the view of those who could not access the technologies or were not interested to participate in these studies. Due to resource limitations (i.e. personnel time, limited funding period) as well as the high number of papers that were included in the full text evaluation, it was not possible to carry out independent double assessment of (a) each included paper as well as (b) complete the risk of bias of included studies. From the positive outcome that we reached by randomly checking 10% of the data for risks of content biases, as well as 10% of articles whose quality we assessed, we are cautiously confident about the quality of the included studies and the data extracted.

Through functions of continuous monitoring, generating health-related reminders, providing additional channels for communication, SHHTs to-date could support caregivers in ways such as detecting falls and declines in functioning, provide assistance for basic activities for daily living, and the promotion and maintenance of a healthier lifestyle. However, our review found critical barriers to uptake that include issues with obtrusiveness and usability (such as technical problems and their limitations), social acceptance, costs, and the concern for loss of relationships. It becomes prudent to find ways to address these barriers as we move forward with technological development to ensure that the benefits generated does not come at higher costs. The data produced in this user-centric attempt to organize the current knowledge on SHHTs will prove informative to inform policy, improve user-acceptance, and serve as an additional resource for those who care for older persons. Finally, to take the call from Marikyan et al. [ 13 ] for further forwarding user-centric research, we encourage future researchers to focus on eliciting end-users’ conditions for acceptability in regards to different SHHTs. It would be interesting to also add independent variables in the equation, such as cultural background, generational gaps, technology readiness, living situation, financial comfort, and the nature of their social environment.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. A supplementary table of the basic information from all articles analyzed for this review and an example of the search string is nevertheless included.

Abbreviations

Activities of daily living

Instrumental activities of daily living

  • Smart home health technologies

Internet of Things

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Acknowledgements

We thank the information specialist who have given valuable guidance in the review’s initial stages, namely for search strategy and database support. We also immensely appreciate and are indebted to the two anonymous reviewers for their careful considerations and meaningful comments. The last author is in the editorial board of this journal and had no role in the peer-review or acceptance of this manuscript.

Open access funding provided by University of Basel. This systematic review was support financially by the Swiss National Science Foundation (SNF NRP-77 Digital Transformation, Grant Number 407740_187464/1) as part of the SmaRt homES, Older adUlts, and caRegivers: Facilitating social aCceptance and negotiating rEsponsibilities [RESOURCE] project. The funder neither took part in the writing process, nor does any part of the views expressed in the review belong to the funder.

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Yi Jiao (Angelina) Tian, Nadine Andrea Felber & Tenzin Wangmo

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Félix Pageau

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Yi Jiao (Angelina) Tian: Formal analysis, Investigation, Writing– Original Draft, Visualization Nadine Andrea Felber: Conceptualization, Formal analysis, Investigation, Writing– Review & Editing Felix Pageau: Validation, Formal analysis, Writing– Review & Editing Delphine Roulet Schwab: Validation, Writing– Review & Editing Tenzin Wangmo: Conceptualization, Methodology, Formal analysis, Investigation, Resources, Writing– Review & Editing, Supervision.

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Correspondence to Yi Jiao (Angelina) Tian .

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Tian, Y.J.(., Felber, N.A., Pageau, F. et al. Benefits and barriers associated with the use of smart home health technologies in the care of older persons: a systematic review. BMC Geriatr 24 , 152 (2024). https://doi.org/10.1186/s12877-024-04702-1

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DOI : https://doi.org/10.1186/s12877-024-04702-1

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Title: artificial intelligence for literature reviews: opportunities and challenges.

Abstract: This manuscript presents a comprehensive review of the use of Artificial Intelligence (AI) in Systematic Literature Reviews (SLRs). A SLR is a rigorous and organised methodology that assesses and integrates previous research on a given topic. Numerous tools have been developed to assist and partially automate the SLR process. The increasing role of AI in this field shows great potential in providing more effective support for researchers, moving towards the semi-automatic creation of literature reviews. Our study focuses on how AI techniques are applied in the semi-automation of SLRs, specifically in the screening and extraction phases. We examine 21 leading SLR tools using a framework that combines 23 traditional features with 11 AI features. We also analyse 11 recent tools that leverage large language models for searching the literature and assisting academic writing. Finally, the paper discusses current trends in the field, outlines key research challenges, and suggests directions for future research.

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IMAGES

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  1. Systematic Review

    A systematic review is a type of review that uses repeatable methods to find, select, and synthesize all available evidence. It answers a clearly formulated research question and explicitly states the methods used to arrive at the answer. Example: Systematic review

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    Systematic literature reviews (SRs) are a way of synthesising scientific evidence to answer a particular research question in a way that is transparent and reproducible, while seeking to include all published evidence on the topic and appraising the quality of this evidence.

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    A Systematic Literature Review (SLR) is a research methodology to collect, identify, and critically analyze the available research studies (e.g., articles, conference proceedings, books, dissertations) through a systematic procedure . An SLR updates the reader with current literature about a subject .

  6. Introduction to systematic review and meta-analysis

    A systematic review collects all possible studies related to a given topic and design, and reviews and analyzes their results [ 1 ]. During the systematic review process, the quality of studies is evaluated, and a statistical meta-analysis of the study results is conducted on the basis of their quality.

  7. How to Do a Systematic Review: A Best Practice Guide ...

    Before discussing systematic reviews and the different types of literature review, it may be instructive to dispel two common misunderstanding about literature reviews. The first is that conducting a literature review is the same as the task of reviewing literature, which occurs when writing the introductory section of all quantitative and ...

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    A systematic review is a summary of the medical literature that uses explicit and reproducible methods to systematically search, critically appraise, and synthesize on a specific issue. It synthesizes the results of multiple primary studies related to each other by using strategies that reduce biases and random errors.[ 7 ]

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    Mixed studies review/mixed methods review: Refers to any combination of methods where one significant component is a literature review (usually systematic). Within a review context it refers to a combination of review approaches for example combining quantitative with qualitative research or outcome with process studies

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    A Systematic Review (SR) is a synthesis of evidence that is identified and critically appraised to understand a specific topic. SRs are more comprehensive than a Literature Review, which most academics will be familiar with, as they follow a methodical process to identify and analyse existing literature ( Cochrane, 2022 ).

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    Screen the literature. Assess the quality of the studies. Extract the data. Analyze the results. Interpret and present the results. 1. Decide on your team. When carrying out a systematic literature review, you should employ multiple reviewers in order to minimize bias and strengthen analysis.

  21. (PDF) Systematic Literature Reviews: An Introduction

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  22. Evidence Syntheses and Systematic Reviews: Overview

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    Aims and scope. Systematic Reviews encompasses all aspects of the design, conduct and reporting of systematic reviews. The journal publishes high quality systematic review products including systematic review protocols, systematic reviews related to a very broad definition of human health, rapid reviews, updates of already completed systematic ...

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    Abstract Systematic reviews retrieve, appraise and summarise all the available evidence on a specific health question. They are designed to reduce the effect of the reviewers' own bias, and a full protocol should be written to define and guide the process. The appropriate resources should be in place before undertaking a review.

  25. Systematic and other reviews: criteria and complexities

    A systematic review follows explicit methodology to answer a well-defined research question by searching the literature comprehensively, evaluating the quantity and quality of research evidence rigorously, and analyzing the evidence to synthesize an answer to the research question. The evidence gathered in systematic reviews can be qualitative ...

  26. Types of reviews

    Main purpose is to map out and categorize existing literature, identify gaps in literature; Search comprehensiveness determined by time/scope constraints, could take longer than a systematic review; No formal quality assessment or critical appraisal; Learn more about the methods:

  27. Benefits and barriers associated with the use of smart home health

    Background Smart home health technologies (SHHTs) have been discussed in the frame of caregiving to enable aging-in-place and independence. A systematic review was conducted in accordance with the PRISMA guidelines to gather the up-to-date knowledge on the benefits and barriers of using SHHTs in the care of older persons from the perspective of older persons and their caregivers. Methods Ten ...

  28. [2402.08565] Artificial Intelligence for Literature Reviews

    This manuscript presents a comprehensive review of the use of Artificial Intelligence (AI) in Systematic Literature Reviews (SLRs). A SLR is a rigorous and organised methodology that assesses and integrates previous research on a given topic. Numerous tools have been developed to assist and partially automate the SLR process. The increasing role of AI in this field shows great potential in ...