Systematic Review: Impact of Compression Stockings on Post-Op DVT

This report presents a systematic review that explores the impact of graduated compression stockings in preventing deep vein thrombosis (DVT) in post-operated orthopedic patients. The review defines systematic reviews, outlines methodological issues, and emphasizes their importance in healthcare research. It delves into the concept of systematic reviews as a research method, highlighting their role in synthesizing existing knowledge and providing a knowledge base for future research. The report discusses the strengths and weaknesses of systematic reviews compared to other research approaches, explores potential biases in literature, and assesses the impact of bias on the quality of evidence. It details the steps involved in conducting a systematic review, including identifying the research area, formulating a research question, designing the study, searching databases, and analyzing data. The report concludes by summarizing the key findings and addressing limitations, such as bias and authenticity of information, while offering suggestions for improvement. The research question focuses on the effectiveness of graduated compression stockings in preventing DVT in post-operative orthopedic patients, providing a rationale for the study and outlining its objectives.

Running head: SYSTEMATIC REVIEW
SYSTEMATIC REVIEW
Name of the Student:
Name of the University:
Author Note:

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Introduction:
Systematic reviews can be defined as a systematic presentation of literature reviews
that considers a variety of research papers to formulate a comprehensive research finding. A
systematic review vividly considers a set of relevant papers that are critically evaluated and
appraised to gather secondary data that can help in further research within the similar field.
According to Booth et al. (2016), systematic reviews help in the collection of relevant data
from diverse research studies so as to present an overview about the research findings till
date. Shamseer et al. (2015), in this regard has further compared the systematic reviews to an
intensive summary that comprises of research evidences in favour of the devised research
question. Further Korhonen et al. (2013), has mentioned that systematic reviews of
randomised controlled trials serve as a key to formulate practice standards of evidence-based
medicines. It can also be stated in this regard, that an intensive systematic review thus serves
as a quick and feasible reference to the researchers who rely upon the traditional research
methods to proceed with their research idea. It should further be crucially noted here that the
conceptual understanding of the systematic reviews and its effective implementation is highly
recommended in the field of health care studies. This is primarily because it serves as a
spontaneous and affordable research method to embark upon a novel study. Systematic
reviews are not just restricted to the field of health care studies but are also popular in the
fields of application oriented subjects.
Methodological issues in Systematic Reviews:
It should be noted that while conducting a systematic review a number of issues might
be encountered. The complexity of these issues are directly dependent upon the type of data
type that is being considered for the review along with the method that is being used for the
rigorous analysis. It should further be noted that the analysis of systematic reviews is directly

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dependent upon the analysis of observational studies. While the consideration of
observational studies generally contribute positively towards the synthesis of extensive
research, on many instances it has been seen that the research studies generate results that
overestimate the treatment and exposure effects on the target population (Shamseet et al.
(2015). It is worth noting here that an effective systematic review is based upon several
important considerations that include, an expansive research strategy, thorough research over
multiple databases and broad inclusion or exclusion criteria consideration (Korhonen et al.
2013). An effective systematic review of the research studies should thus represent a clear
reproducibility of the selection criteria along with the quality-assessment criteria to perform a
rigorous analysis so as to formulate appropriate findings. The findings would subsequently
help in the explanation of differences between the results obtained after analysing the
relevant research studies. These considerations have been found ti be useful in determining
the research protocol of future studies.
Explore the concept of systematic review as a unique research method:
As has already been discussed in the previous sections of the assignment the concept
of systematic review serves as an authentic research method that helps in the concise
compilation of a set of relevant data. The systematic reviews present a set of information in a
sequential manner that introduces a certain topic, summarises the critical issues and provides
relevant examples that serve as a guideline for the researchers working in the similar area of
interest (Moher et al. 2015).
The topic that has been chosen by me to conduct the systematic review involves an
emerging topic in the field of medical science: what is the impact of graduated
compression stockings to prevent Dvt in post operated orthopaedic patients?

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A number of research studies have focused on the impact of graduated compression
stockings for the prevention of Dvt in post-operated orthopaedic patients but there has not
been a systematic review in this regard. Hence, this systematic review would aid the
researchers in the following ways:
 It would serve as an authentic knowledge base that would include quality research
evidence
 It would serve as a convenient protocol that would help researchers in conducting
future studies
 The systematic review would represent explicit information that can be considered as
a reliable source by the readers
 It would help in developing an overview about the present scenario of incidence of
Dvt
 It would also help in determining the effect of graduated compression stockings on
the standard of life of the post operated orthopaedic patients
Discussion and comparison of strength and weaknesses of systematic review to research
approaches:
Systematic review forms a research study design that has both been appreciated as
well as critiqued by renowned researchers. It has been mentioned in this regard that although
systematic reviews serve as a knowledge bank, one cannot be completely sure about the
authenticity of the information provided by the review (Taylor et al. 2014). Another aspect
that must be considered includes the critical specificationwith respect to the date of
publication of the research studies. Researchers all over the word have agreed upon the fact
that there must be set standards to conduct a vivid systematic review. Further, it should also
be noted that researchers also hold the opinion that inclusion of resources beyond the major

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databases into grey literature would help in enhancing the effectiveness of the systematic
reviews (Taylor et al. 2013).
According to Shamseer et al. (2015), it has been mentioned that systematic reviews
conducted by Cochrane often contain biased reviews are extremely lengthy and are obsolete.
Researchers have further criticized the study design in terms of inappropriate selection of
studies and inclusion of low quality research journals (Moher et al. 2015). On the other hand,
other primary research studies that involve qualitative or quantitative study design or
randomized control is directed towards a specific target population and hence yield accurate
results. However, it should also be mentioned here that systematic review yield an extensive
synthesis on the basis of the relevant data available in the concerned field of research.
Exploring areas of potential bias in literature:
Systematic review presenta range of biasness on the basis of a number of sources.
According to Taylor et al. (2014), a systematic review must be designed well on the basis of
a standard protocol. The review should be made available on a public forum in order to
facilitate critical review by the readers so as to include room for the scope of reporting
biasness (Taylor et al. 2014). On an average a number of potential biasness are identified
within the reviewed set of literatures. These include, time lag biasness, citation biasness,
reporting outcome biasness, biasness in terms of multiple publications and language biasness.
It should be noted here that an instance of evidence selection biasness occurs when there is a
discrepancy in terms of the identification of available relevant data on a specific research
topic. Instances of publication biasness have also been identified when data retrieved from
statistically significant studies are published and studies including data that are not
statistically significant are not published (Taylor et al. 2014). Biasness has also been
identified in the discussion and critique of primary research findings that are appraised in a

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systematically appraised in a systematic review. Further, language biasness in literature
review have also been critiqued by researchers as ideal systematic reviews should not use
language as a constraint to filter and scrutinise relevant papers. Therefore, it should be
highlighted that knowledge about potential bias in literatures can help researchers in the
process of conducting an effective systematic review.
Understanding the potential for bias within studies and its impact on the quality of
evidence:
The hierarchy of evidences retrieved from research papers serves as a tool that helps
in the effective appraisal of research papers. It should further be noted in this context, that the
hierarchy presents an understanding about the latest advancements in the field of interest. For
instance, while performing a systematic review it is appropriate to consider relevant
literatures that are published within the time frame of 7 years from the year when the research
is being conducted. It should further be noted that recent evidences facilitate easier
understanding of the methodology procedures that consequently assist the process of critical
decision making (Taylor et al. 2014). Also, in this regard it can be stated that recent studies
present examples of latest evidences that can be compared and contrasted to a standard
protocol and direct further research. It should also be noted that the hierarchy of evidences
also help in developing an understanding about the historical background of the research
study and recent advancements made through trial and error methods. It further helps in
understanding the critical considerations that facilitate the process of appraising a research on
the basis of the strength and weakness. The researcher clearly develops an insight about the
potential factors that cause biasness within the studies and degrade the quality of the research.
This understanding facilitates increased focus on the part of the researcher to avoid such
discrepancies.

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Steps included in systematic review and associated rationale:
In order to conduct a systematic review a number of steps must stringently be
followed. The primary step involves the identification of the area of research interest. The
second step involves the designing of an appropriate research question. The third step
involves devising an appropriate research-study design. Once this step is completed
appropriately, the next step comprises of scanning popular research databases for relevant
papers. It should be noted here that the papers are scanned on the basis of stringent inclusion
and exclusion criteria (Moher et al. 2015). The inclusion and exclusion criteria might contain
a series of considerations that are devised by the author. Once the relevant papers are
retrieved, the duplicate papers and papers that have repetitive themes are rejected. Finally the
papers that meet all the inclusion and exclusion criteria and do not present similar themes are
short listed for the systematic review. It should be further noted here that the next steps
involve discussion and data analysis. The method chosen for data analysis depends upon the
type of data collected. It can either be discussed under themes or might be analysed through
statistical analysis. After the retrieved data is analysed the findings are discussed and
appraised so as to derive an exhaustive summary of the relevant research papers (Korhonen et
al. 2013).
Summary:
Therefore to summarize it can be said that systematic reviews present a brilliant
overview in relation to the existing data and figures that are available in the concerned field
of research. It should further be noted that systematic review comprises of an exhaustible
summary of all relevant key findings within the concerned research topic. Therefore, it serves
as a guideline for future researchers to design their research study on the basis of the
available research evidences.

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However the study design has been compared to a number of limitations. These
limitations have broadly been based upon biasness and authenticity of information. In order
to deal with these criticalities, researchers have offered valuable suggestions. The devising of
an international guideline to be stringently followed while conducting a systematic review
and the consideration of grey literature to incorporate authentic information enhances the
probability to conduct an efficient review.
Research Question and Research Rationale:
The proposed research question that would be answered through the systematic
review is: what is the impact of graduated compressed stockings to prevent Dvt in the
post-operated orthopaedic patients?
Prior to the in dept analysis of the research topic, the first segment of the paper would
talk about the rationale behind the choice of the topic and devise the objectives of the
research study. Dvt or deep vein thrombosis can be defined as a medical condition when there
is a formation of a blood clot inside the deep veins of the body (Struijik-Mulder et al. 2013).
It has usually been observed that this condition primarily arises within the veins of the leg
Struijik-Mulder et al. 2013). Studies prove that deep vein thrombosis is often accompanied
with inflammation and pain, however it should be noted that there are instances when the
medical condition occurs without any symptoms (Berntsen et al. 2016); (Holmes et al. 2014).
It should be critically noted here that the condition occurs on the basis of the nature of blood
clot formation in an individual. Research studies reveal that the condition might also present
itself in patients who have undergone accident surgeries (Roberts et al. 2013). Post operation,
the movement of the patients is restricted for a long period of time. This leads to the
possibility of developing Dvt. The condition of Dvt is dangerous as the blood clots formed in
the body might travel to all major organs including the lungs and the heart and impair the

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normal physiological functioning of the organ system (Roberts et al. 2013). The most
common symptoms associated with the disease condition include the following:
 Sensation of pain in the affected area
 Discolouration or the formation of reddened skin where the blood clot has formed
 Sensation of warmth within the affected region
The rationale for conducting the research study includes critically analyzing the positive
impact of graduated compression stocking to provide relief to the patients who have been
diagnosed with deep vein thrombosis. This systematic review would help in analyzing the
available literatures that suggest the use of graduated stockings to elicit a positive impact
on the health of the patients. The systematic review intends to compile the best research
papers dealing with the subject in order to devise a comprehensive summary that could be
used by practitioners to help Dvt patients. Therefore, it can be said that the systematic
review would serve as a guideline for the researchers who intend to perform research on
the similar research area. In this regard it should be mentioned that the graduated
compression stockings facilitate the ease of symptoms in the affected patients. The
mechanism of the stockings is to apply pressure in order to prevent the worsening of the
symptoms that include inflammation, accumulation of clot and pain (Struijik-Mulder et
al. 2013). The stockings are designed in a manner that they are snug-fitting and
stretchable and apply gentle pressure on the leg. The use of graduated compression
stockings have been found to be extensively useful in alleviating the adverse symptoms
association with the medical condition of deep vein thrombosis. This systematic review
intends to validate the positive implication of using graduated compression stocking on
the physical health of the patients.

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Research Objectives:
Therefore the devised research objectives of the systematic review would include the
following:
 The incidence rate of deep vein thrombosis in relation to the global scenario
 The available options available as post-operative recovery options
 The impact of graduated compression stockings to provide relief to post-operated
deep vein thrombosis patients
 The impact of the graduated compression stockings on the quality of life,
morbidity and mortality rate among the target population
Primary objective of the review:
The systematic review would broadly be based upon the consideration of the
objectives mentioned above. However it should be critically highlighted here that the primary
objective would include the incidence of Deep vein thrombosis in the orthopaedic patients,
post operation. The systematic review would critically include the global population as the
target population. This is primarily because the study design of the research is a systematic
review that would include the research papers that access the impact of graduated
compression stockings on orthopaedic patients post operation. The research papers selected
would not be country-specific and hence the target population for the research would not be
area specific. In this regard it should also be mentioned that the secondary objective
considered for the study would be to access and evaluate the impact of graduated
compression stocking on the quality of life of the patients and the morbidity and mortality
rate associated with the use of the graduates compression stocking in Deep vein thrombosis
patients.

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Target population considered in the research study:
The identified target population for the research study includes the post-operated
orthopaedic patients who majorly face issues with deep vein thrombosis. According to
research studies it should be noted that post surgery, patients are advised to rest and restrict
their movement and mobilization for a long period of time. This is done primarily to allow
time for recovery. According to the evidences revealed by research studies, it has been
mentioned that the recovery period allows the dislocated or fractured bones to regain the
proper orientation (Jayaraj and Meissner 2015). After a leg surgery, patients are often
plastered and advised complete bed rest (Jayaraj and Meissner 2015). During the resting
phase, the mobilization and movement is restricted to the maximum to allow time for the
process of recovery and proper orientation of the bones (Ayhan et al. 2015). However, it
should be noted that on account of the prolong time interval where the mobilization is
restricted to the maximum, the circulation of blood is also affected. This leads to the
formation of clots in and around the surrounding areas of the veins. The clots thus formed
impede with the smooth circulation of blood and might reach up to major organs that include
the lungs and the heart (Kahn et al. 2014); (Sachdeva et al. 2014). Accumulation of the clot
enhances the probability to develop conditions such as haemorrhoids and infection (Lattimer
et al. 2014). The use of graduated compression stockings have been the most prevalent
remedy used by physicians to provide relief to patients, post-orthopaedic surgery (Wade et al.
2015). The pair of stockings typically make use of the pressure distribution mechanism and
improve the circulation of blood within the leg region (Lim et al. 2014).
Primary and secondary outcomes of interest:
As has already been discussed in the previous sections above, the systematic review is
based upon two major primary and secondary interests. The primary interest outcome

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includes, accessing the incidence of deep vein thrombosis in patients post orthopaedic
surgery. At the same time, it should be mentioned here that the secondary research outcomes
includes validating and analyzing the quality of life of the patients who have been using
graduated compression stockings post surgery. It is expected that the designed interest
outcomes would help in understanding the efficiency of the technique as a recovery process
in the patients. Further, it should also be noted here that the broad interest outcomes would
facilitate the consideration of a large number of papers for the process of systematic review.
The broad synthesis of the findings would facilitate an exhaustive summary that could be
utilized as a future reference for the future researchers.
Criteria for inclusion of studies in the review:
According to Booth and Sutton (2016), it has been mentioned that a standard
systematic review must be based upon the consideration of stringent exclusion and inclusion
criteria. In this regard, it should also be noted that the exclusion and the inclusion criteria
form the basis of the filters that help in the selection and short listing of the research papers.
While the inclusion criteria includes the characteristics that must be critically considered
while short listing a research article in the systematic review, the exclusion criteria forms the
basis of the articles that are not included in the study. For this systematic review, the
inclusion criteria comprised of the research articles that were published between the time
frame of 2008 till the year 2017. Another aspect of the inclusion criteria included the research
articles that were published in the English language. On the other hand, the exclusion criteria
comprised of the articles that were published in foreign languages other than English and
were published prior to the year 2008. It should be critically noted in this regard that the time
frame was considered as a filter because papers that were published prior to the year 2008 are
considered obsolete in the present day context. This is exclusively because papers published