Evidence Based Practice

This document discusses a study on evidence based practice and its impact on the quality of life for colorectal cancer survivors. The study focuses on the recruitment of participants, methodology, analysis of results, and implications of the findings. It provides valuable insights into the effectiveness of exercise programs in improving the quality of life for cancer survivors.

Evidence Based Practice
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Assignment 1
Section A :
1. Yes. In the current trial, focused issue related to the quality of life (QOL) of the patients
with cancer treatment has been addressed. Outcome of the intervention completely depends
on the targeted population, validated methodology and measured outcome. In this trial,
patients with cancer treatment should be recruited to assess the improvement of quality of life
of the survivors of colorectal cancer patients. Quality of life of patients with different types of
cancers would affect differently (Nayak et al., 2017). Hence, it is necessary to recruit patients
with specific types of cancers for accurate assessment of the quality of life. Henceforth,
survivors of the colorectal cancer recruited in this study. Recruitment of participants with the
different types of cancers would not have provided relevant outcome related to the research
question. In randomized control trial, specific intervention needs to be given to address the
clinical question. Home-based personalised exercise programme was assigned to all the
participants in the intervention group. However, participants in the control group were not
assigned to home based personalised training programme. Moreover, flexible exercise
programme was assigned to participants depends on their capability to do exercise. Assigning
flexible exercise programme to participants would be helpful in getting accurate outcome
without any harm or discomfort to the participants. Incorporation of the control group is
necessary in this controlled trial because it would be helpful in getting confirmation about the
improvement due to personalised exercise programme (Bisschop et al., 2015). In this
controlled trial, both primary and secondary outcomes were assessed. Primary outcomes in
the controlled trial are very critical because these outcomes are helpful in arriving exact
outcomes of the trial which address specific research question. Moreover, primary outcome
should be measured using validated scale which would be helpful in producing valid and
robust results. In this study, Functional Assessment of Cancer Therapy-Colorectal (FACT-C)
scale was implemented to assess quality of life. FACT-C scale consist of subscales like
physical, functional, emotional and social/family well-being and a colorectal cancer subscale.
This scale would be helpful in the assessment of all the activities together and it would be
helpful in establishing correlation among all the activities. Correlation among all the
activities would be helpful in assessing overall QOL of the participants (Liu et al., 2018).
Secondary outcomes should be clearly differentiated from the primary outcomes; however,
these should be support as evidence for the primary outcomes. If primary outcomes are not
lending evidence support to primary outcomes; there would not be any relevance to the
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secondary outcomes (Vetter and Mascha, 2017). Secondary outcomes measured in this study
were satisfaction with life, depression, anxiety, fatigue, cardiovascular fitness, body
composition and flexibility. All these parameters extend support to the primary outcomes;
moreover, all these parameters were assessed using validated scales.
2. Yes. In this trial, colorectal cancer survivors were recruited from the Cross-Cancer Institute
(CCI) in Edmonton, Alberta. All the participants were recruited based on certain eligibility
criteria. Hence, it would be helpful in the recruitment of participants with the similar
characteristics. Recruitment of the participants with similar characteristics would be helpful
in reducing variability of the results (Chevan and Haskvitz, 2015). Participants were
randomised using random table method. However, method was not fully explained in the
paper. Detailed explanation of the method would have been helpful in assessing
appropriateness of the method of randomisation (Somers et al., 2017). Allocation of the
participants and methodology implemented in this study were explained to both researchers
and participants. Information related to the study was provided to the participants in the form
of information package ‘Notice of Research Study’.
3. Recruited participants were accounted for the results and conclusion at the end study.
Exercise and control group participants with 89.9 and 93.9 % respectively were retained till
the end of the study (Courneya et al., 2003). This retention can be considered as good
retention for getting necessary outcome from the study. Number of participants during the
study design usually decided based on the probable outcome of the study (Bower et al.,
2014). Hence, retention of participants is important aspect in the randomised control trial
because conclusion of the trial depends on the number of participants. Analysis of the
outcome of the intervention and control group participants performed separately because it
helped in differentiating effect of intervention.
4. No, patients and study personal were not blinded to the intervention. However, certified
fitness consultants were blinded to the study. Blinding in the study is important aspect
because blinding helps in avoiding biasness in the outcome of the study. Study personal,
study director and statistician in this trial should have blinded to the obtained results because
final outcome and conclusion of the study depends on the study director and statistician. It
can be argued that there is no bias in the outcome of this study because results analysis was
performed by employing different statistical analysis methods (Mansournia et al., 2017).
Participants bias in this trial cannot be overlooked because some of the collected data was
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subjective data. Hence, participants should have blinded in this study. It is highly possible
that there would be biasness in the subjective data collection.
5. Yes. In this study, two groups like intervention and control group were assigned. Average
age of the participants in both the groups is approximately similar. However, % males were
approximately 10 % more in control group in comparison to the exercise group. Married
participants were approximately 13 % more in exercise group in comparison to control group.
Education status was 11 % more in control group as compared to the exercise group. Family
income was approximately 12 % more in exercise group as compared to the control
(Courneya et al., 2003). However, most of the factors except age would not affect outcome of
this trial. Hence, participants can be considered as similar at the start of the study. Duration of
illness and medical data is approximately similar in both control and exercise group.
However, total duration of exercise per week is more in exercise group as compared to the
control group. Hence, adaptation to the exercise would be faster in control group. It would
exhibit more favourable outcome in terms of QOL in control group in comparison to the
exercise group. Similar duration of exercise in both the groups would have demonstrated
more accurate effect of exercise on the QOL of in cancer patients.
6. Yes. Except intervention like home-based personalised exercise programme to the exercise
group, both the groups were treated equally. Fitness test was carried out to both the control
and exercise group. Fitness test was carried out by the certified fitness trainer (Courneya et
al., 2003). However, only exercise group was blinded to the fitness test. Fitness test is
important aspect in this trial because outcome of this trial is based on the exercise related
QOL (Navigante &, 2016 Morgado). Exercise is mainly dependent on the fitness of the
individual. Fitness necessary for the exercise mainly depends on the factors like strength,
endurance, flexibility and balance (Buffart et al., 2018). Hence, fitness is necessary for the
QOL improvement.
Section B :
7. In this study, primary QOL outcome like FACT-C was assessed. Different secondary QOL
outcomes like satisfaction with life, anxiety, depression, fatigue, FACT-G, trial outcome
index, physical well-being, social/family well-being and colorectal cancer subscale were
assessed. Moreover, secondary fitness outcomes like treadmill time, resting heart rate, sum of
skinfolds, body mass index and flexibility were assessed. Assessment of these parameters
would be helpful in the assessment of different aspects like physical, functional, emotional
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and social, which are directly related to the overall QOL (Hummler et al., 2015). Hence, it is
necessary to assess all these parameters to establish relationship between exercise and QOL
in colorectal cancer survivors.
8. During the analysis of the results, it has been found that there is no difference in the overall
QOL between the exercise and control group at the baseline. Hence, it is feasible to assess the
effect of intervention on the overall QOL. It has been observed that significant difference
between the increased fitness group as compared to the decreased fitness group in terms of
FACT-C. FACT-C increased by 4.3 points in increased fitness group and decreased by 2.2
points in the decreased fitness. Reporting of decrease in FACT-C in the decreased fitness
group indicate detailed assessment of the FACT-C. Similar trend was observed for the
anxiety and trial outcome index (TOI). Anxiety was decreased in the increased fitness group
and increased in the decreased fitness group. On the other hand, TOI was increased in the
increased fitness group and decreased in the decreased fitness group. Results for the FACT-
C, anxiety and TOI were compared in terms of baseline and post-intervention values.
Marginal significant difference was reported for different parameters like satisfaction with
life (p = 0.084), depression (p = 0.055), the FACT-G (p= 0.056), physical well-being
(p=0.076) and the colorectal cancer subscale (p=0.063). Significant difference was observed
at post-test among the increased and decreased fitness groups considering covariate like
baseline value. Observed values for different parameters were as follows: FACT-C
(p=0.024), anxiety (p=0.001), depression (p=0.004), FACT-G (p=0.036), TOI (p=0.023),
physical well-being (p=0.046), emotional well-being (p=0.039) and colorectal cancer
subscale (p=0.019). Marginal significant difference was reported for different parameters like
satisfaction with life (p=0.078), fatigue (p=0.069) and functional well-being (p=0.057)
(Courneya et al., 2003).
Comparison of the results for increased and decreased fitness group provided more detailed
information about the effect of exercise and fitness on the QOL. Intention-to-treat analysis
was performed to compare the results between the exercise group and control group.
Intention-to-treat analysis data revealed that there was no significant difference between the
FACT-C between the exercise and control group. Intention-to-treat analysis was performed
differently for different parameters secondary QOL outcomes. This type of analysis would be
helpful in evaluating effect of exercise on individual parameter. Analysis of the individual
parameters would be helpful in selecting parameters with positive effect due to exercise.
Selected parameters would be helpful in designing further more elaborative studies (Shochet
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et al., 2017). However, based on these results, it would be difficult to select few of the
parameters to select for the further elaborative studies. Moreover, primary and secondary
outcomes were measured separately. This type of analysis would be helpful in assessing
whether outcome of the trial demonstrate exact end point or it exhibits results which
demonstrate supporting data for achieving end point of the trial (Pozuelo-Carrascosa et al.,
2015).
8. It is difficult to report whether estimate of the intervention is precise. During statistical
analysis, it has been found that confidence interval for all parameters straddle zero when
comparison was made between the control and exercise group. Confidence interval with
straddle zero value indicate no statistical significance (Lin et al., 2016). It has been observed
that confidence interval was large for both the groups.
Section C :
9. These results would be useful as evidence-based decisions for the effect of exercise on the
QOL of colorectal cancer survivors. However, age range of participants is not evident from
the provided data (Courneya et al., 2003). Hence, it would be difficult to make conclusions
whether these results can be applicable to the colorectal cancer survivors above age 80 years.
These results can also be applicable to the patients who cannot attend hospitals because
exercise programme was being provided at their respective homes. These results can not be
applicable to the colorectal cancer survivors with life expectancy ˂ 1 years.
10. In this trial, all the clinically relevant parameters were assessed in detailed manner. All
the clinically relevant parameters were useful in assessing the QOL of colorectal cancer
survivors. Moreover, supporting parameters necessary for making final conclusion of trial
were also assessed in this trial. Hence, results obtained in this study were optimum to assess
comprehensive QOL of colorectal cancer survivors (Courneya et al., 2003).
11. In this trial, adverse effects due to intervention were not addressed. Adverse events would
have been mentioned in this trial because colorectal cancer survivors might be associated
with self-harm and life-threatening events. In this trial, cost incurred for the trial was not
mentioned. Though, incurred cost of the trial would be more, it would be worth considering
beneficial outcome of the trial (Dakin & Gray, 2017).
References:
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Bower, P., Brueton, V., Gamble, C., Treweek, S., Smith, C.T., Young, B., …and Williamson,
P. (2014) Interventions to improve recruitment and retention in clinical trials: a survey and
workshop to assess current practice and future priorities. Trials, 15, 399. doi: 10.1186/1745-
6215-15-399.
Bisschop C. N. S., et al. (2015) Contamination and Drop-Out in Exercise Oncology Trials: A
Systematic Review. PLoS One, 10(3), e0120996. doi: 10.1371/journal.pone.0120996.
Buffart, L.M., Sweegers, M.G., May, A.M., Chinapaw, M.J., van Vulpen, J.K., Newton,
R.U., …and Aaronson NK. (2018) Targeting Exercise Interventions to Patients With Cancer
in Need: An Individual Patient Data Meta-Analysis. Journal of the National Cancer Institute,
110(11), pp. 1190-1200.
Chevan, J., and Haskvitz, E.M. (2015) Reported characteristics of participants in physical
therapy-related clinical trials. Physical Therapy, 95(6), pp. 884-90.
Courneya, K.S., Friedenreich, C.M., Quinney, H.A., Fields, A.L., Jones, L.W.,…and Fairey,
A.S. (2003) A randomized trial of exercise and quality of life in colorectal cancer survivors.
European Journal of Cancer Care, 12(4), pp. 347-57.
Dakin, H., and Gray, A. (2017) Economic evaluation of factorial randomised controlled
trials: challenges, methods and recommendations. Statistics in Medicine, 36(18), pp. 2814-
2830.
Hummler, S., Thomas, M., Hoffmann, B., Gärtner, P., Zoz, M., Huber, G.,…and
Wiskemann, J. (2014) Physical performance and psychosocial status in lung cancer patients:
results from a pilot study. Oncology Research and Treatment, 37(1-2), pp. 36-41.
Lin, D.Y., Dai, L., Cheng, G., and Sailer, M.O. (2016) On confidence intervals for the hazard
ratio in randomized clinical trials. Biometrics, 72(4), pp. 1098-1102.
Liu, M., Sun, W., Cai, Y. Y., and Wu, H. Z. (2018) Validation of Quality of Life Instruments
for Cancer Patients – Colorectal Cancer (QLICP-CR) in patients with colorectal cancer in
Northeast China. BMC Cancer, 28, doi: 10.1186/s12885-018-5135-6.
Mansournia, M.A., Higgins, J.P., Sterne, J.A., & Hernán, M.A. (2017) Biases in Randomized
Trials: A Conversation Between Trialists and Epidemiologists. Epidemiology, 28(1), pp. 54-
59.
Nayak, M. G., et al. (2017) Quality of Life among Cancer Patients. Indian Journal of
Palliative Care, 23(4), pp. 445–450.
Navigante, A., & Morgado, P.C. (2016) Does physical exercise improve quality of life of
advanced cancer patients? Current Opinion in Supportive and Palliative Care, 10(4), pp.
306-309.
Pozuelo-Carrascosa, D.P., García-Hermoso, A., Álvarez-Bueno, C., Sánchez-López, M., and
Martinez-Vizcaino, V. (2018) Effectiveness of school-based physical activity programmes on
cardiorespiratory fitness in children: a meta-analysis of randomised controlled trials. British
Journal of Sports Medicine, 52(19), pp. 1234-1240.
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Shochet, L.R., Kerr, P.G., and Polkinghorne, K.R. (2017) The fragility of significant results
underscores the need of larger randomized controlled trials in nephrology. Kidney
International, 92(6), pp. 1469-1475.
Somers, R., Van Staden, C., & Steffens, F. (2017) Views of clinical trial participants on the
readability and their understanding of informed consent documents. AJOB Empirical
Bioethics, 8(4), pp. 277-284.
Vetter, T.R., and Mascha, E.J. (2017) Defining the Primary Outcomes and Justifying
Secondary Outcomes of a Study: Usually, the Fewer, the Better. Anesthesia & Analgesia,
125(2), pp. 678-681.
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Assignment 2
Literature search is a process which is useful in understanding a research topic, establishing
importance of research topic, developing own ideas about the research topic, ensuring that
there is no repeatability of the literature search carried out by another researcher,
demonstrating knowledge about the research question and demonstrating how your current
research work closely associated with the available research (Baker, 2016). Hence, literature
search was undertaken on the topic, ‘effect of exercise or physical activity on QOL of
colorectal cancer survivors’.
Literature search was carried out over period of six months. Hence, it helped in inclusion of
most of the relevant publications. Publication search was carried out through different
databases like PubMed, Web of Science, PsychINFO and CINAHL. Cross-referencing was
also carried out to find additional publications which were not able to identify from the used
databases. Studies with QOL in colorectal patients with more than 5 years of diagnosis and
physical activity through the diagnosis period were included in the literature search. Studies
comprising of both short-term and long-term survivors were included in the literature search.
Studies comprising of all types of QOL and physical activity were included in this study.
Studies incorporated in the literature search comprised of QOL assessment with more than
one scale. Inclusion of these types of studies would be helpful in obtaining the
multidimensional information related to the QOL in colorectal cancer patients. Studies in
other forms like conference abstracts, study protocols, editorials, commentaries, qualitative
studies, theses, reviews and meta-analysis were not incorporated in this literature search
despite its publication dates.
Data extraction:
Screening of all the searched titles and abstracts was carried out by the first reviewer. It was
followed by checking of the full text articles for their eligibility in the literature search. Study
characteristics were independently reviewed by two reviewers. Following were the study
characteristics considered for review : first author, year, journal, sample size, country, sex,
age, tumor site, cancer stage, cancer treatment, sampling, study design, comorbidities,
inclusion and exclusion criteria, baseline response rate, timing/type of PA assessment,
timing/type of QOL assessment, confounders/adjustment, statistical methods, results.
Discrepancies among two reviewers about the characteristic of the studies was discussed with
the third reviewer.
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PICO model was implemented for the identification of different thesaurus and free-text terms
for searching review articles.
P Patient, Population, or
Problem
Colorectal cancer, colorectal
cancer survivor, colorectal
cancer diagnosis  5 years,
Age between 35 to 80 years
and expected life expectancy
˂1.
I Intervention, Prognostic
Factor, or Exposure
Personalised exercise,
personalised home based
training. Randomised
controlled trials and cross-
sectional study
C Comparison or Intervention Participants without
personalised home based
intervention. EORTC QLQ-
C30, SF-36, EQ-5D, FACT-
C, PROMIS.
O Outcome you would like to
measure or achieve
Overall QOL/ global health,
General health and global
health composite score,
Overall health related
quality of life (HRQOL),
Physical HRQOL, Physical
functioning, Physical well-
being, Physical functioning
and physical health
composite score, Role
functioning, Functional
well-being, Role physical,
Social well-being, Social
functioning, Social
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functioning, Emotional well-
being, Mental health and
Emotional functioning.
Using PICOS model search terms were used to identify the review articles for incorporation
in the literature search. Patient related search items like colorectal cancer, colorectal cancer
survivor, colorectal cancer diagnosis  5 years, Age between 35 to 80 years and expected life
expectancy ˂1 were used because these search terms helped in identifying exact population
relevant to the research question. It is necessary to identify relevant patient population to
assess the effect of intervention. Hence, it is necessary to use specific patient related search
themes which comprises of name of disease, duration post-diagnosis and age of the patients.
Moreover, it is also necessary to include expected life expectancy of the patients.
Intervention, Prognostic Factor, or Exposure related factors like personalised exercise and
personalised home-based training were incorporated in this search strategy. Moreover, type
of study design search terms like randomised controlled trials and cross-sectional study
design were also incorporated in this search strategy. In this literature search, search term
related to study design is important because outcome and analysis of the article mainly based
on the type of study design. Comparison or intervention related factors like participants
without personalised home based intervention and questionaries’ like EORTC QLQ-C30, SF-
36, EQ-5D, FACT-C and PROMIS were incorporated in the search strategy. Different types
questionaries’ with different scales for the assessment helped in multidimensional analysis of
the research question related to the QOL in colorectal cancer survivors. Outcome related
factors like Overall QOL/ global health, General health and global health composite score,
Overall health related quality of life (HRQOL), Physical HRQOL, Physical functioning,
Physical well-being, Physical functioning and physical health composite score, Role
functioning, Functional well-being, Role physical, Social well-being, Social functioning,
Social functioning, Emotional well-being, Mental health and Emotional functioning were
incorporated in the search strategy because all these terms helped in gathering relevant
articles related to the effect of exercise on QOL of the colorectal survivor.
Different data bases were searched for mentioned keywords. These databases include
PubMed, Web of Science, psychINFO and CINAHL. Each of these keywords were searched
in each database. Total 1108 articles were found together in all the databases. Highest number
of articles were found in the Web of Science (621). In PubMed, psychINFO and CINAHL
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articles found were 268, 121 and 98 respectively. Out of these, 1108 articles, 265 were
duplicate articles. Hence, remaining 843 articles were reviewed for titles and abstracts.
During review process of titles and abstracts, it was evident that 690 articles were not
relevant. Non-relevant articles were selected based upon whether these articles answering
relevant questions related to colorectal cancer patients. Hence, 153 articles were selected for
the further review. Out of these 153 articles, 50 articles were not original. Hence, obtained
original articles were 103 articles. Few articles were again omitted from the literature search
based on different aspects like lack of patients with long term survivors, QOL with one scale,
physical analysis outcome not mentioned and colorectal cancer results not mentioned
separately. Articles found with lack of patients with long term survivors, QOL with one scale,
physical analysis outcome not mentioned and colorectal cancer results not mentioned
separately were 78, 2, 2 and 1 respectively. Hence, finally 20 articles were selected for the
literature search. The CASP RCT tool was used to appraise the articles with quantitative
research. It helped in establishing validity and reliability of the research articles which is
useful as evidence for providing answer to the research question related to the colorectal
cancer survivors. Appraising articles also proved helpful in the rating recommendation
whether strong or weak for the selected articles. Full appraisal is not within the scope of this
literature search; hence, key points were identified for the appraisal of the selected articles. It
was found that 10 articles out of 20 articles were with consistent appraisal score.
Truncation, Wildcards and Proximity were used to monitor similar spellings, multiple
character and identifying terms used together. Truncation was used to identify similar
spellings by keeping tilde (~) symbol through end of the search item. Use of truncation
helped in narrowing the words from large number of words. Wildcard was implemented to
identify multiple character searching. Wildcards were used in one or more characters. Single
character searching was carried out by using question mark (?) symbol. Multiple character
searching was carried out by asterisk (*) symbol. Wildcards proved useful in identifying
alternate spellings and deviation from the root word. Combination of wildcards were also
used for few of the search terms. Proximity searching was used to find terms used together.
Tilde (~) symbol followed by numerical value to identify required proximity was used for
proximity searching. Numerical value proved useful for identifying terms within specific
number of words (Harris et al., 2014; Pati and Lorusso, 2018).
In few of the databases, use of combination of keywords and subject headings also did not
provide complete information. Hence, it proved difficult to get the required information to
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validate the findings. In such scenario, repeatable search strategy proved helpful. Repeatable
search helped in searching the articles over the period of time. Repeatable search in the
proved useful in the improving sensitivity of the search. Highly sensitive search strategy
(HSSS) comprising of different algorithm proved useful in repeating the search. Repeatable
search strategy proved helpful in the identifying RCTs which were not included in the review
articles (Clark and Buckley, 2017). Moreover, repeatable search strategy also proved useful
in identifying diversity in reviews with different RCTs. Repeatable search strategy in
PubMed comprises of different steps like developing research question, developing search
strategy, running the search in PubMed, applying filters and exporting references to citation
manager. Broad question was developed to get a greater number of articles. In this search
strategy broad question was ‘effect of home-based exercise programme on the QOL of
colorectal cancer survivors’. Search strategy was developed by following different steps like
breaking question into different concepts, identifying subject headings for each concept and
identifying terms for every concept (McDougall, 2015). All these steps were completed using
PICO. Different concepts need to be identified using MeSH. MeSH is medical subject
headings which are available in the NLM controlled vocabulary thesaurus for indexing
articles for PubMed. MeSH is useful in identifying target article. In the similar manner all the
words were searched using MeSH. Search for the specific word was run through PubMed
Advanced Search Builder. Sequentially, all the words were searched and all these searches
were combined. Moreover, these searches were combined with synonymous searches; also
combined with the search history. Subsequently, all the concepts were searched in the similar
manner. During the search different filters were applied like date of publication (2013 -
2018), age of the participants, publication language and research design.
It is difficult to get all the necessary information form one database. Hence, it is necessary to
carry out trials in different databases to search the research question. Selection of database for
the literature is based on different considerations like subject coverage, publication coverage,
date coverage, updates and timeliness (Shamseer et al., 2015). Subject coverage include
covering all the subjects included in the databases. Moreover, separate segregation should be
there in the database for the search of specific subject. MeSH in PubMed is useful in
searching articles related to the medical filed. Hence, PubMed is effective in collecting
articles for this literature search because medical articles are required for this literature
search. Publication coverage include different types of publications available in the database.
PubMed include research articles, review articles and book chapters. However, other types of
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publications like government documents, dissertations and conference proceedings are not
available in the PubMed. In the current literature search, it is necessary to search review
articles. Hence, PubMed was the suitable database because there was no much complication
in filtering publications. Date coverage provide flexibility to select specific duration for the
search of articles (Zorzela et al., 2016; Stewart et al., 2015). In PubMed specific duration can
be given; hence, PubMed was the suitable database for searching articles because in this
literature search most recent articles are required. Few of the databases update on the regular
basis; hence, it is difficult to retrieve the articles beyond certain time. PubMed is a controlled
and sponsored by the Government; hence, anybody can access it freely. However, for few
articles full-text are available with free of cost. PubMed database is easier to search. PubMed
database is useful in providing well-defined set of journals (Cals and Kotz, 2016).
References:
Baker, J.D. (2016) The Purpose, Process, and Methods of Writing a Literature Review.
AORN Journal, 103(3), pp. 265-9.
Harris, J.D., Quatman, C.E., Manring, M.M., Siston, R.A., and Flanigan, D.C. (2014) How to
write a systematic review. American Journal of Sports Medicine, 42(11), pp. 2761-8.
Pati, D., and Lorusso, L.N. (2018) How to Write a Systematic Review of the Literature.
Health Environments Research & Design, 11(1), pp. 15-30.
Clark, K.R., and Buckley, M.B. (2017) Using a Synthesis Matrix to Plan a Literature Review.
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Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., …and Stewart,
L.A. (2015) Preferred reporting items for systematic review and meta-analysis protocols
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Zorzela, L., Loke, Y.K., Ioannidis, J.P., Golder, S., Santaguida, P., Altman, D.G.,…and
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Stewart, L.A., Clarke, M., Rovers, M., Riley, R.D., Simmonds, M., Stewart, G.,…and
Tierney J.F. (2015) Preferred Reporting Items for Systematic Review and Meta-Analyses of
individual participant data: the PRISMA-IPD Statement. Journal of the American Medical
Association, 313(16), pp. 1657-65.
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