Understanding systematic reviews and their implications for evidence-based practice by examining aerobic exercise as a recreational therapy intervention for individuals with major depressive disorders

administrators, and consumers often challenge recreational therapy (RT) practitioners about their practice and the interventions that they use to produce client outcomes. “Federal regulatory agencies [eg, Centers for Medicare and Medicaid Services (CMS)] and accreditation bodies [eg, the Joint Commission on Accreditation of Health Care Organizations (JCAHO)] expect that the best available evidence be the basis for healthcare services. This requires a commitment from all healthcare professional to develop and use evidence-based practices to guide their work.”1(p1) Stumbo2 proposed that recreational therapists begin to develop evidence-based practice guidelines as one mechanism to respond to these challenges and instructively described the first step in this process—conducting systematic reviews of the research evidence for a particular practice. Although some recreational therapists have responded, most notably Buettner and Fitzsimmons,3,4 the majority of practicing recreational therapists and educators have failed to heed Stumbo’s2 urgings. This is not the case in many of our allied disciplines, which disseminate systematic reviews that support their practice via the Cochrane Collaboration. The Cochrane Collaboration maintains the Cochrane Library, which “contains high-quality, independent evidence to inform healthcare decision-making. It includes reliable evidence from Cochrane and other systematic reviews, clinical trials, and more. Cochrane reviews bring you the combined results of the world’s best medical research studies and are recognized as the gold standard in evidence-based healthcare.”5 The Cochrane Collaboration includes the systematic reviews of specific modalities/interventions. These reviews are independent of any particular discipline and are conducted primarily to ascertain whether sufficient evidence exists for a particular