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MSOT 525 & 533 - Evidence-Based Practice I & II

[Course description:  This course will provide the students an opportunity to apply basic research skills gained in the OCC 514 course and further develop professional writing skills.  Students will be introduced to evidence-based practice, as well as how to identify and interpret levels of evidence-based knowledge.  In finding the evidence, students will learn to develop a focused clinical question and investigate the research literature comparing different forms of evidence inclusive of systematic reviews and clinical practice guidelines.  Students will learn how to incorporate outcome-measures into evidence-based practice and research as well as understand how to interpret the findings from intervention studies.]

Assignment:  Researching and Writing a Systematic Review

Researching & Writing a Systematic Review

Definition of a Systematic Review 
“… a summary of the literature 
that uses clear methods 
to perform a thorough search 
and critical appraisal 
of individual studies 
on a defined topic area 
for which there are sufficient studies of a similar design.”


Steps of Researching a Systematic Review

1.   Specific clinical question

2.   Comprehensive literature search

3.   Critically appraise the validity of each study

4.   Synthesize and report the results


Simplified Steps of a Comprehensive Literature Search

A.   Search for previous systematic reviews

B.   Define search strategy, inclusion / exclusion criteria

C.   Choose databases, websites, books & other sources of article citations

D.   Search for citations; write down details of each search and the results

E.   Organize results & delete duplicates

F.   Find full text of all articles


Signing in to the WCU Library Catalog and Databases

If you’re on campus, go to, under the Academics tab click on Library, to get to the library’s home page that lists all of the library’s services. If you’re off campus, click My Library Account to sign in with your Library ID -- What’s your Library ID? – it’s the start of your West Coast email address, and a Password – What’s your Password? --  you made it up by clicking the Set/Reset Password link. If you forget to do this right away, you’ll be prompted to sign in when you start any of the databases.

We give you three places to find our databases, these collections of citations and full-text articles.
A-Z Database List – Most of the library’s 30 databases are here; (I’ll explain later why you shouldn’t start with Google Scholar)
A few of the databases that are limited to CGS students are listed only on the CGS A-Z Database List
Search Box – Always use first to get an overview of your topic


Searching for Previous Systematic Reviews

Step A:  Search for Previous Systematic Reviews

  • Search for previous systematic reviews – Has it been done before? Then you will still have to update it. Try broader and more specific terms.
  • Look at a typical Systematic Review – Notice the format of the journal article; the detail of search documentation


Where to Search for Systematic Reviews:
PubMed -- PubMed comprises more than 23 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

Typically, NLM does not retrospectively re-index MEDLINE citations with new MeSH heading concepts. Therefore, searching PubMed for a new MeSH term tagged with [mh] or [majr] effectively limits retrieval to citations indexed after the term was introduced. PubMed Automatic Term Mapping (ATM) expands an untagged subject search to include both MeSH Terms and All Fields index terms and may retrieve relevant citations indexed before the introduction of a new MeSH term. Searchers may consult the MeSH Browser or the MeSH database to see the previous indexing terms most likely used for a particular concept before the new MeSH Heading was introduced.

New feature for 2019: The new publication type Systematic Review will be added to appropriate existing citations in PubMed. NLM made the decision to do this re-indexing based on the importance of providing a mechanism in PubMed to retrieve all citations to articles that are systematic reviews.

What is this about? Is this about a book, or is this a book? Is this about systematic reviews, or is this a review?

autis* AND play AND systematic review [sb]

systematic review [sb] is a special filter in PubMed for finding articles that are systematic reviews.

It combines:  | systematic review | PT Publication Type |
And variations of “systematic review” in the title of unindexed articles,
And systematic reviews discovered by the Cochrane Institute


Cochrane Database of Systematic Reviews -- Cochrane Database of Systematic Reviews contains full text articles, as well as protocols focusing on the effects of healthcare. Data is evidence-based medicine and is often combined statistically (with meta-analysis) to increase the power of the findings of numerous studies, each too small to produce reliable results individually.

Database of Abstracts of Reviews of Effects -- Database of Abstracts of Reviews of Effects (DARE) includes abstracts of published systematic reviews on the effects of health care from around the world, which have been critically analyzed according to a high standard of criteria. This database provides access to quality reviews in subjects for which a Cochrane review may not yet exist. They stopped adding to this collection of abstracts in January 2015. (sample on 2nd slide)


TRIP Database -- A searchable clinical research evidence library--allows searching by PICO.

PEDro -- Physiotherapy Evidence Database, it contains trials, reviews and guidelines of PT interventions for over 20 years.


OT Seeker -- Modeled on PEDro, it contains abstracts of systematic reviews, randomized controlled trials, etc. Content from 2016 to the present is not as comprehensive due to lack of funding.


PROSPERO -- An international registry for prospective systematic reviews.


Define Your Clinical Research Question

Step B:  Define your clinical research question (using PICO)

Choose your protocol (inclusion/exclusion criteria)

Specific clinical question        P. I. C. O.
Patient (Problem)             Intervention       (Comparison)        Outcome    (Time)
 (word OR word)    AND        OR         AND        OR       AND       OR
    NOT word                         NOT                       NOT                   NOT

Your topic should be as narrow as possible so that you can find all of the studies that cover your topic, and minimize the number of full-text articles you will have to request through interlibrary loan or by searching many different databases.

Your selection criteria for articles has to be defined so precisely that any two people could follow the same directions at the same time – since collections change – and come up with the exact same list of articles. It is best to design a search using AND, OR (for synonyms), and NOT (for excluded terms), and parentheses and * (for different suffixes), so that you can copy it into nearly any database search

Some databases have advanced search checkboxes and dropdown menus to save you time with your limits, but if a database doesn’t have it, then you have to create the same limits in your search words, or leave that limit out and look through the title, abstract and subjects of every article yourself, and keep the ones where you see those words in the right fields, as if you are the search engine.

PubMed Medical Subject Headings - Search MeSH and dictionaries to find synonyms, alternate spellings, broader/ narrower/ related terms. Write them in groups under each column, so that you can search for them in every possible combination using AND and OR.


Choose Databases to Collect Citations

Step C: Choose databases to collect citations (including books and nonacademic)
Remember, you are not searching for the few best articles, but collecting all of the citations that come up using your search strategy. Sometimes you find the citation in one place and the full text in another.
Only a couple dozen of them can be searched at one time using the Search Box – here you can find journal articles, journal citations, ebooks, along with books in the campus libraries and at other libraries you can check out. It gets articles from databases that have different collections of articles and have different ways to search and sort and limit the results, so instead of searching “everything”, you target the articles you want and bring them to the top of the list by choosing one collection of articles or one database at a time.

These are the journal article databases that I recommend for most occupational therapy topics.
Medline Complete -- MEDLINE Complete provides authoritative medical information on medicine, nursing, dentistry, veterinary medicine, the health care system, pre-clinical sciences, and much more. With coverage dating back to 1857 and full-text back to 1865.
CINAHL Plus with Full Text -- CINAHL Plus® with Full Text is a collection of full text for nursing & allied health journals. Full text coverage dates back to 1937.
SPORTDiscus with Full Text -- SPORTDiscus with Full Text has full text for sports & sports medicine journals. Full-text coverage dating back to 1985
Health Source: Nursing/Academic Edition -- About 550 scholarly full text journals focusing on many medical disciplines. It includes AHFS Consumer Medication Information.
Health Source - Consumer Edition -- This database has consumer health information in medical sciences, food sciences and nutrition, childcare, sports medicine and general health. From nearly 80 full text, consumer health magazines.
Psychology and Behavioral Sciences Collection --This database provides access to more than 530 full-text journals, in Psychiatry, Neuroscience, Behavioral Medicine, Neuropsychology, Mental Health, and especially child & adolescent psychology and various areas of counseling.
SocINDEX with Full Text -- SocINDEX with Full Text has 1600 full-text journals on sociology research, abstracts for core coverage journals dating as far back as 1895
Rehabilitation Reference Center -- A clinical reference tool designed for use by rehabilitation clinicians, physical therapists, and occupational therapists at the point of care. It has clinical reviews, journal articles, books, and patient information with customizable patient information sheets with illustrated instructions for therapeutic exercises.
ERIC -- ERIC, the Education Resource Information Center, provides has articles on any aspect of teaching and education for all ages, including teaching physically and mentally handicapped persons.
Academic Search Complete -- Academic Search Complete is a comprehensive scholarly, multi-disciplinary full-text database of journal full text and abstracts, monographs, reports, conference proceedings, etc.

Cochrane Central Register of Controlled Trials -- Cochrane Controlled Trials Register is a bibliography of controlled trials identified by contributors to the Cochrane Collaboration and others, as part of an international effort to hand search the world's journals and create an unbiased source of data for systematic reviews.

Notice that I mentioned all of these are provided by EBSCO. You could search all of them at once, but it’s best to search them one at a time since they have different features in their Advanced Search.

We also get journal articles from ProQuest, which has almost 50% more journals than their comparable EBSCO databases. 
You should search these two together, since they have the same Advanced Search features.
ProQuest Nursing & Allied Health Source -- This database has journals and reference books in the fields of nursing and allied health.

ProQuest Health & Medical Complete -- This database has journals covering clinical and biomedical topics, consumer health, health administration and more.

If there is an academic book that has a chapter or article on your topic, then you can check the list of references for more citations:

eBook Academic Collection -- We have more than 250,000 eBooks on all academic subjects.  The 300 ebooks that your West Coast University Librarians individually chose to support our degree programs are in a collection called eBook Collection, without the word Academic.

Credo Reference – Articles in medical reference books have Reference Lists

Those are the databases that I recommend searching for journal citations for almost all topics in Occupational Therapy. And remember, if you need background information about anatomy or an illness or drug, we have other databases with authoritative information in those fields; just read the descriptions in the A-Z Database List. Notice that we also have links to resources that appear to cover all topics like Open Library and Directory of Open Source Journals, but Open Library and Public Library of America have books and photos that are in the public domain, mostly from before 1924, and the articles in open source journals are already included in our databases and PubMed.


Steps A, B and C are called the Scoping stage. At this stage, you should be trying different searches in various databases to get a feel for the amount and focus of previous research in order to adjust the scope of your topic, develop search strategies and compile synonyms for your search terms, and identify some of the key papers as you develop your search protocol.


Search for Citations

Step D:  Search for citations; write down details of each search and the results

Search strategies – I covered these skills last year in your first class.

  • MeSH subjects, keywords, limits, Boolean operators,
  • What search words? You planned your topic, with synonyms and related words, using PICO:  Patient,  Intervention,  Comparison,  Outcome.
  • Boolean and truncation
  • Databases have different collections of articles and an Advanced Search with different ways to search.
  • When you search more than one database at once, you search more articles, but can only use search tools/choices that all have in common.
  • When you want info for comparing which is better, articles that have both words, you may mean AND.
  • When you have a list of synonyms, put them in parentheses with OR between them.
  • Too many results? Use a more specific subject, or add more words, limit by date, article type. 
  • Scrolling through too many articles that are not on target? Put NOT before words you don’t want to appear in the descriptions of articles.
  • In Advanced Search look at the other choices of checkboxes and scrolling boxes.
  • After seeing how much research has been done in the field, limit to the last 5 years, or 10 years, or 1-2 years.
  • Look at the list of Subjects of article descriptions (Major subjects, Minor subjects) and write down ideas for more search words.
  • Too few results? Take away words (no small words). Start broad and then narrow down. Are you using the right words? Browse subject headings and perform a subject search.

Document Each Search (see your professor for the recommended list for this class)
1.    Write details of each search (date found) and results
2.    Notice the key papers; search for their references
     a.    Find papers that cited the key papers using Google Scholar
3.    Export your citations so you can import them into RefWorks.
    a.    To export multiple citations from EBSCO databases, click Save; click the checkmarks next to the articles, choose RIS; click create file; save to computer. To export from ProQuest databases, click the checkmarks next to the articles, click the 3 dots button, and choose RefWorks. Note: these methods only save the citations of the articles, not the full text.

    b.   If the full text is available, download the .pdf file to your computer while it is still available. You can then import the .pdf into RefWorks, which will extract both the citation information and the full text.


PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)

This website has a more detailed checklist of the procedures for researching a systematic review, which you will describe in your final report. Students will be expected to include PRISMA items in their systematic review assignment.


Organize the Results

Step E.  Organize Results

RefWorks ( is an online tool used to gather, organize, read, and cite sources for research papers. Create an account using your WCU email address. Install the bookmark to import citation data from databases, websites, articles, & blogs or tag and annotate citations for your research projects.

1. First, click the "v" in the blue bar at the top of the RefWorks desktop, click Manage Projects, then click Create a new Project so that your systematic review citations stay separate from the citations for other projects.
2. In the Actions box to the right of the project you just made, click Share the Project with the email addresses of other members of your group.

3.    Make folders for acceptable citations/full text, and citations that are under consideration.

4..    When you are done importing articles, under Tools in the top menu, click Find Duplicates to pair possibly duplicate articles, click the checkmark next to the ones you don't want, and click Delete in the top menu to remove them from your project.
     •    New feature added Sep 4, 2018:  change to Table View (lower right corner dropdown) to make references from Systematic Reviews easier to scan and compare.
3.  When you Create Bibliography, choose "APA 7th - Sentence Casing, DOI: https:// "
 After it makes a Reference page, look for any proper nouns in the citations that should be capitalized.


Find Full Text for All Articles

Step F.  Find Full Text for All Articles
      If your topic appears to be too broad or too narrow, change your topic or scope and start over.
      Repeat search strategy with next database

      Get full text for articles that you have only a citation
           Google Scholar / WCU Library Catalog / Interlibrary loan

     You might notice that the other large, free index to academic journal articles, Google Scholar, isn’t on the A-Z Database List. Do not start your search with Google Scholar, since it doesn’t have many search tools. There are a lot of predatory journals on the Internet (more about this in my future lectures, but basically, many of them will publish any article as long the author pays the fee), and Google gathers every article that is mentioned, and doesn’t reveal any secrets about its standards for including and ranking articles when you search. However, if you know that an article with a certain title actually exists, and was cited by a reputable study, you can copy and paste the title to both Google Scholar and the WCU Library catalog, to see if the full text is available for free online, or in our paid databases.


Have a citation that links to a dead end? It may have been mistyped or indexed wrong. Use the WCU Library's A-Z Journal List to browse the titles of journals, then the volume, then the issue, and look around where the article should be.


Interlibrary Loan procedures  -- See the Interlibrary Loan Research Guide, or email the citation & the link where you found it to the Librarian.

Make a profile in ResearchGate (; it is a good way to contact the main author of articles to personally ask them for a copy of one of their papers, or provide data that was not included in the published article.  The service is intended for academics to collaborate with other academics, but I expect that most of them are glad to share copies of their papers for free to students who are genuinely interested in their work. But don’t use the automatic one-sentence canned request; tell them who you are, what you want to use their paper for, and when your paper is due, and thank them for their time. I tried this service three times, and they usually send the article in about a month; it depends upon how busy the author is.


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