In the dynamic landscape of health policy and practice, evidence-informed decision-making is critical, yet it is often hampered by the lack of timely and relevant research. This challenge underscores the growing importance of rapid reviews, a methodology designed to expedite the synthesis of research evidence and bridge the crucial ‘know-do gap’.
A significant rapid review by Haby et al. (2016) meticulously investigated the question: “What are the best methodologies to enable a rapid review of research evidence for evidence-informed decision making in health policy and practice?”. Their work provides invaluable insights into the current state of rapid review methodologies and offers crucial guidance for future practice and research.
Study Methodology The review by Haby et al. employed a rigorous systematic review methodology, adhering to a predefined protocol and including clear inclusion criteria. A comprehensive search strategy was executed across eleven databases and two websites, encompassing both published and grey literature written in English, French, Portuguese, or Spanish, from 2004 onwards. Two independent reviewers applied eligibility criteria, and data extraction was performed by one reviewer and checked by a second. The methodological quality of all included studies was independently assessed by two reviewers.
Key Findings The Haby et al. (2016) review synthesized findings from five systematic reviews and one randomized controlled trial (RCT) that investigated rapid review methodologies. The findings revealed several critical areas:
- Lack of Standardization: There is no agreed definition of rapid reviews in the literature and no agreed methodology for conducting them. Various terms such as ‘evidence summaries,’ ‘rapid syntheses,’ and ‘brief reviews’ are used without clear definitions.
- Widespread Use of ‘Shortcuts’: Rapid reviews often employ various ‘shortcuts’ to achieve faster completion times compared to full systematic reviews. Examples include:
- A more targeted research question or reduced scope.
- Searching fewer databases or limiting searches to specialized sources.
- Restricting articles to a specific language (e.g., English only) or a reduced timeframe.
- Exclusion of grey literature.
- Using only one reviewer for study selection and/or data extraction, or limiting dual review for quality assessment.
- Limited Evidence on Impact of Shortcuts: While authors generally agree that changes to scope or timeframe can introduce biases, the review found little empirical evidence to support or refute the claim that these shortcuts impact the conclusions of either rapid or systematic reviews. There are very few comparisons of full and rapid reviews available in the literature to determine the impact of these methodological changes.
- Potential for Improved Clarity: A notable finding from a high-quality RCT included in the review indicates that rapid reviews may improve the clarity and accessibility of research evidence for decision-makers. Short narrative evidence reports were particularly favored for enhanced clarity and ease of use.
- Quality Concerns of Existing Reviews: A significant limitation identified was that none of the systematic reviews investigating rapid review methodologies were of sufficient quality (as assessed by AMSTAR scores) to allow firm conclusions. This highlights the need for caution when interpreting existing literature on this topic.
Conclusions and Implications Haby et al. (2016) concluded that greater care needs to be taken in improving the transparency of methods used in rapid review products. Despite the methodological uncertainties, the review found no evidence to suggest that rapid reviews should not be done or that they are misleading in any way.
The authors propose an improved definition to guide future research and practice: “A rapid review is a type of systematic review in which components of the systematic review process are simplified, omitted or made more efficient in order to produce information in a shorter period of time, preferably with minimal impact on quality. Further, they involve a close relationship with the end-user and are conducted with the needs of the decision-maker in mind.”
Recommendations for Policy and Practice:
- Transparency is Key: Users of rapid reviews should request an AMSTAR rating and a clear indication of the shortcuts taken to make the review process faster.
- Informed Decision on Shortcuts: Producers should give priority to shortcuts that are unlikely to impact the quality or risk of bias of the review, such as limiting scope or data extraction to key characteristics, and should explain the implications of any shortcuts to users.
- Skilled Teams and Efficiency: Maintaining a larger, highly skilled, and experienced staff who can be mobilized quickly can aid timeliness without compromising quality.
Recommendations for Research:
- Investigate Shortcut Impacts: Further research is needed to understand the impact of various ‘shortcuts’ on review findings, ideally through prospective studies comparing rapid reviews to systematic reviews on the same topic, while controlling for methodological quality.
- Develop Reporting Guidelines: The development of specific reporting guidelines for rapid reviews, based on systematic review guidelines but tailored to rapid review characteristics (e.g., the user relationship), would enhance transparency.
- Measure Key Outcomes: Future studies should focus on outcomes such as review quality, satisfaction with methods and products, implementation, and cost-effectiveness, as these were largely unmeasured in previous research.
The Haby et al. (2016) review is a pivotal contribution to the field, emphasizing the significant potential of rapid reviews for evidence-informed decision-making in health while simultaneously calling for enhanced transparency and methodological rigor to maximize their credibility and utility.
Reference Haby, M. M., Chapman, E., Clark, R., Barreto, J., Reveiz, L., & Lavis, J. N. (2016). What are the best methodologies for rapid reviews of the research evidence for evidence-informed decision making in health policy and practice: a rapid review. Systematic Reviews, 5(1), 194. doi:10.1186/s12961-016-0155-7