An approach to addressing subpopulation considerations in systematic reviews: the experience of reviewers supporting the U.S. Preventive Services Task ForceReportar como inadecuado

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Systematic Reviews

, 6:41

First Online: 02 March 2017Received: 06 October 2016Accepted: 17 February 2017DOI: 10.1186-s13643-017-0437-3

Cite this article as: Whitlock, E.P., Eder, M., Thompson, J.H. et al. Syst Rev 2017 6: 41. doi:10.1186-s13643-017-0437-3


BackgroundGuideline developers and other users of systematic reviews need information about whether a medical or preventive intervention is likely to benefit or harm some patients more or less than the average in order to make clinical practice recommendations tailored to these populations. However, guidance is lacking on how to include patient subpopulation considerations into the systematic reviews upon which guidelines are often based. In this article, we describe methods developed to consistently consider the evidence for relevant subpopulations in systematic reviews conducted to support primary care clinical preventive service recommendations made by the U.S. Preventive Services Task Force USPSTF.

Proposed approachOur approach is grounded in our experience conducting systematic reviews for the USPSTF and informed by a review of existing guidance on subgroup analysis and subpopulation issues. We developed and refined our approach based on feedback from the Subpopulation Workgroup of the USPSTF and pilot testing on reviews being conducted for the USPSTF. This paper provides processes and tools for incorporating evidence-based identification of important sources of potential heterogeneity of intervention effects into all phases of systematic reviews. Key components of our proposed approach include targeted literature searches and key informant interviews to identify the most important subpopulations a priori during topic scoping, a framework for assessing the credibility of subgroup analyses reported in studies, and structured investigation of sources of heterogeneity of intervention effects.

ConclusionsFurther testing and evaluation are necessary to refine this proposed approach and demonstrate its utility to the producers and users of systematic reviews beyond the context of the USPSTF. Gaps in the evidence on important subpopulations identified by routinely applying this process in systematic reviews will also inform future research needs.

KeywordsPatient subpopulation Subgroup Heterogeneity Systematic review AbbreviationsAAFPAmerican Academy of Family Physicians

AAPAmerican Academy of Pediatrics

ACOGAmerican Congress of Obstetricians and Gynecologists

ACPAmerican College of Physicians

AHRQAgency for Healthcare Research and Quality

CIConfidence interval

CPAPContinuous positive airway pressure

CPSTFCommunity Preventive Services Task Force

CTFPHCCanadian Task Force on Preventive Health Care

CVDCardiovascular disease

EPCEvidence-based Practice Center

GRADEGrading of Recommendations Assessment, Development and Evaluation

IOMInstitute of Medicine

MIMyocardial infarction

NICENational Institute for Health and Care Excellence

NRNot reported

NSNot significant

OISOptimal information size

OSAObstructive sleep apnea

PADPeripheral artery disease

PICOTSPopulation, intervention, comparator, outcome, timing, and study design

PRISMAPreferred reporting items for systematic reviews and meta-analyses

RCTRandomized clinical trial


USPSTFU.S. Preventive Services Task Force

Autor: Evelyn P. Whitlock - Michelle Eder - Jamie H. Thompson - Daniel E. Jonas - Corinne V. Evans - Janelle M. Guirguis-Blake


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