Rapid evidence-assessments (REAs)

Reviews of increasing complexity from narrative reviews to systematic reviews...

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Introduction

See also Scoping studies and Systematic review searching

Rapid evidence-assessments (REAs) is a review of evidence of a specific subject that follows some of the principles of a systematic review, but makes some concessions in order to complete reviews in a shorter time frame. REAs are used by researchers and investigators in the U.K. education, government and policy sector.

Do REAs have potential application in medicine? According to the articles describing them, rapid evidence-assessments (REAs) are (re)appraisals of existing evidence that fall between health technology assessments (HTAs) and fully-developed systematic reviews. In that sense, they are like 'scoping the search' or question scans but with more detail than either of those suggest. REAs order and filter research in a similar way to systematic reviews, but meet urgent timelines at national or local levels. The prominence of evidence-based medicine and its principles have led health organizations to develop more rapid methods of accessing, appraising and synthesizing evidence in health care. This can be a slow and expensive and should not be undertaken for every major issue arising in the clinical context; therefore, REAs may offer a suitable alternative. One of the first steps is to find out what has been written and what is already known using the principles of the REA.

Rapid 'cumulation' is critical

The knowledge economy has developed considerably in recent decades. However, the number of publishing outlets and ease of publishing in the digital era is responsible for information overload. The sheer amount of evidence that must be found and processed, coupled with rapid growth of scholarly publishing and communication and information technologies, makes it difficult and time-consuming to cumulate the literature, quickly. The problem of locating many separate but similar studies has led to the creation of new methods of knowledge management. Despite some concerns with REAs, they have been used in the social sciences. Rigorous systematic review searching is needed for a range of academic and scientific disciplines. Health librarians and biomedical researchers may want to consider REA-type reviews for their users in order to address the need to use evidence to make decisions, without having to resort to conducting full systematic reviews.

Health librarians' role in REAs

Reviewing evidence takes time and health librarians can use various techniques to help their clients. One of the key questions for health librarians is how to assist researchers in the process of planning and carrying out research, and whether rapid assessments meet their needs. This requires a range of skills, knowledge and abilities on the part of the attending health librarian, and includes topics as diverse as understanding the challenges of information retrieval in a fragmented literature and the trends associated with finding the grey literature.

REA components

To enhance an REA's transparency, documents can be designed and used to guide the process, such as:

• explicit and documented search strategies;
• assessment protocols (design statements outlining key criteria for review);
• regular, periodic assessments during and after the fact.

Search strategies must be documented and used to guide searching in order to:

• access research using web-based search tools and databases (including Google), informed by a range and combination of search terms
• pursue particular sources suggested by colleagues
• respond to requests for grey literature, unpublished or less widely-circulated papers and reports

Search strategies identify the range of search approaches, terms and resources that were used. Searching generates a list of potentially relevant sources, from which researchers are able to focus on their own ideas and questions.

Elements of REAs

Usually a review of the academic, grey and practitioner literature includes the following five steps:

1. Design and conceptual clarification of the REA
2. Purposeful evidence-based search, and gathering
3. Evidence assessment (for relevance, and then full assessment)
4. Validation and discussion among experts
5. Preparation of interim assessment, and final report.

In addition, search the online and print literature as comprehensively as possible and do the following; • Collate descriptive outlines of the available evidence • Critically appraise evidence (including an economic appraisal) • Sift out studies of poor quality • Provide overview of what the evidence is saying. (Davies, 2003, p.18-19)

Major review types

Literature review

• Narrative, selective review (not systematic); collates relevant studies and draw conclusions from them
• Time required to complete: 1 week to 2 months

Quick scoping review

• Quick overview of research undertaken on a (constrained) topic (not systematic)
• Time required to complete: 1-2 weeks to 2 months

Rapid evidence assessment (REA)

• Systematic search but a quick overview of existing research on a topic
• Synthesis of evidence provided by these studies to answer the REA question
• Time required to complete: 2 to 6 months (quicker than systematic review)

Full systematic review

• Systematic. A broad review of existing research on a topic and synthesis of the evidence provided by these studies to answer the review question.
• Time required to complete: 8 to 12 months minimum

Multi-arm systematic review

• Systematic. Full map and synthesis of different types of evidence to answer the review question
• Time required to complete: 12 months minimum

Review of reviews

• Systematic. Same as any of the above methods but only includes reviews of other reviews
• Time required to complete: Often quicker than other types of full systematic review

See also

• Top Biomedical Texts 2010, Print & Online
• Medline & PubMed
• Expert searching
• Filters (ie. hedges)
• Hand-searching
• Nucleotide searching
• Point of care decision-making tools - Overview

References

• Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology 2005 8(1):19-32.
• Chalmers I. Trying to do more good than harm in policy and practice: the role of rigorous, transparent, up-to-date evaluations. Ann Am Acad Politic Social Science. 2003;589(1): 22-40.
• Davies P. Rapid evidence assessment: A tool for policy making . Government Social Research: London, 2004. http://www.gsr.gov.uk/new_research/archive/rae.asp
• Ganann R, Ciliska D, Thomas H. Expediting systematic reviews: methods and implications of rapid reviews. Implement Sci 2010, 5:56.
• Institute of Medicine (IOM). Clinical Practice Guidelines We Can Trust. 2011.
• Haynes RB, Wilczynski N, McKibbon KA et al. Developing optimal search strategies for detecting clinically sound studies in Medline. JAMIA 1994;1:447-59.
• Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6. In: Cochrane Library, 4, 2006. Chichester, UK: John Wiley & Sons, Ltd.
• Hunt DL, McKibbon KA. Locating and appraising systematic reviews. Ann Intern Med 1997;126: 532-8.
• Pawson R et al. Realist review: a new method of systematic review designed for complex policy interventions. J Health Services Research & Policy 2005;10(S1): 21-34.
• Shojania KG, Sampson M, Ansari MT, Ji J, Doucette S, Moher D. How quickly do systematic reviews go out of date? A survival analysis. Ann Intern Med 2007;147 (4): 224-33.
• United Kingdom. Civil Service. Rapid Evidence Assessment Toolkit - How to do an REA. London, England. 2010
• Uman LS. Systematic reviews and meta-analyses. J Can Acad Child Adolesc Psychiatry. 2011 Feb;20(1):57-9.