Systematic review hacks for the sports and exercise clinician: five essential methodological elements.

Karen is a keen middle-aged tennis player who presents at your busy practice after her family physician told her she has chronic lateral elbow tendinopathy. Karen is anxious to be back playing at her best for a big regional tournament in 6-weeks time. She has consulted with Dr Google and read about a promising treatment called ‘PRP’ (platelet-rich plasma). She asks you what you know about this treatment and whether you think it could help her get back on court. You recall an abstract you scanned some months ago; patients who received PRP injections for chronic lateral epicondylitis (sic) had less pain at 6 months than those who received an active control treatment (needling under local anaesthetic). Promising. However, you know that evidence from more than one study is needed to help you and Karen make an optimal treatment decision. Searching PubMed that evening, you find a randomised, double-blind and placebocontrolled study. Injections of PRP were no better than injections of saline for reducing pain in patients with lateral elbow tendinopathy. So what now? How do you resolve this conflict? Are these the only two relevant articles or is there additional evidence either for or against PRP? PubMed identifies 87 articles reporting on PRP and lateral elbow tendinopathy. Nightmare. However, hooray! There is a recent systematic review! Owing to the structured methodological approach to collating all available evidence that fits a specific and predefined research question, systematic reviews are an attractive and practical way for busy clinicians to keep abreast of new developments. However, not all systematic reviews are equal; a systematic review is only as good as the quality of the studies included in it—if those included studies are open to a large amount of bias, the systematic review might be at risk too. This editorial aims to highlight five important methodological elements of a systematic review and demonstrate the detailed process of a systematic review, so that the clinician knows what to look for when reading and using them. Being able to judge the quality of a systematic review is an important part of making a quality clinical decision.