CH A PT ER 9

How to Write a Systematic Review Article

and Meta-Analysis
Lenka Čablová, Richard Pates, Michal Miovský and
Jonathan Noel

Introduction

In science, a review article refers to work that provides a comprehensive and

systematic summary of results available in a given field while making it pos-
sible to see the topic under consideration from a new perspective. Drawing
on recent studies by other researchers, the authors of a review article make a
critical analysis and summarize, appraise, and classify available data to offer a
synthesis of the latest research in a specific subject area, ultimately arriving at
new cumulative conclusions. According to Baumeister and Leary (1997), the
goal of such synthesis may include (a) theory development, (b) theory evalu-
ation, (c) a survey of the state of knowledge on a particular topic, (d) problem
identification, and (e) provision of a historical account of the development of
theory and research on a particular topic. A review can also be useful in science
and practical life for many other reasons, such as in policy making (Bero  &
Jadad, 1997). Review articles have become necessary to advance addiction sci-
ence, but providing a systematic summary of existing evidence while coming
up with new ideas and pointing out the unique contribution of the work may
pose the greatest challenge for inexperienced authors.

How to cite this book chapter:

Čablová, L, Pates, R, Miovský, M and Noel, J. 2017. How to Write a Systematic Review
Article and Meta-Analysis. In: Babor, T F, Stenius, K, Pates, R, Miovský, M,
O’Reilly, J and Candon, P. (eds.) Publishing A
­ ddiction Science: A Guide for the Per-
plexed, Pp. 173–189. London: Ubiquity Press. DOI: https://doi.org/10.5334/bbd.i.
License: CC-BY 4.0.
174  Publishing Addiction Science

What is the Relevance of a Review?

General definitions are one thing; the practical benefit of writing reviews is
another. Why would a novice author/researcher engage in this activity? Why is it
important? What benefits can it bring? First, it provides the authors with a gen-
eral understanding of the subject matter they study as part of their area of exper-
tise. Each field of study has its own terminology, and the more specific a topic
is, the greater the terminological differences that may be found among authors.
It is therefore important to produce a good description and critical appraisal of
existing evidence concerning the topic being explored. Another objective is to
integrate the findings generated by different studies into a meaningful body of
evidence. The process of writing a review article will help the authors obtain a
unique perspective on the issue and assist them in processing the results from
many investigators into a consistent form. It will then be possible to summarize
the results and interpret the existing evidence in a new light. To increase one’s
chances of having a review article accepted for publication, it is useful to address
topical issues in a given field or areas of research featuring a number of hetero-
geneous and controversial studies where a consistent approach is needed.

What is a Review?

It is difficult to provide a single definition of a review. Indeed, each journal

uses its own—slightly different—definition of a review study. For example, the
journal Adiktologie defines a review article as a “cogent summary of topical
issues; the author’s own experience is not the underlying theme of the paper.
The maximum extent is 16 pages, with not more than 50 bibliographical cita-
tions. References to recent literature (not more than five years old) should
prevail” (Gabrhelík, 2013). Addiction, meanwhile, simply states that “reviews
draw together a body of literature to reach one or more major conclusions”
and allows review articles to contain up to 4,000 words with no limit on biblio-
graphic citations (Society for the Study of Addiction, 2015).
Despite these limitations, clear distinctions can be made between the types
of reviews that can be drafted. The traditional type of review is a narrative lit-
erature review, which assesses the quality and results of a selection of literature
using implicit criteria (Culyer, 2014). The conclusions of traditional narrative
reviews are often based on subjective interpretations of the literature and may
be biased in unsystematic ways. Importantly, narrative reviews are essentially
nonreplicable.
In contrast, scientific journals often require reviews to be systematic in
nature. Systematic reviews use explicit literature search strategies, inclusion
and exclusion criteria, and criteria for determining the quality and reliability of
study findings. Systematic reviews are replicable and the conclusions drawn by
authors more easily verified.
 How to Write a Systematic Review Article and Meta-Analysis  175

A systematic review that does not include an evaluation of study findings (i.e.
performs only a systematic search using explicit inclusion and exclusion crite-
ria) is referred to in this chapter as a hybrid narrative review. Hybrid narrative
reviews provide authors greater freedom to interpret and integrate study results
and conclusions compared with systematic reviews but still allow the reader to
determine the authenticity of the author’s findings. These reviews are particu-
larly important for theory development and problem identification, especially
when the peer-reviewed literature may be incomplete and when important
studies may not use rigorous experimental or longitudinal designs.
Meta-analyses are a step beyond systematic reviews; they require a quantita-
tive analysis of previously published findings.
The following sections discuss the steps involved in creating systematic
reviews and meta-analyses. Although not explicitly mentioned, much of the
information applies to hybrid narrative reviews as well. Because traditional
narrative reviews are no longer viewed favorably, they will not be discussed.
It is strongly recommended, however, that before writing any article, authors
should first choose a journal to which to submit their research because of the
subtle differences in journal manuscript definitions. Authors should study
thoroughly the guidelines for authors and keep them on hand to reference
while writing the article. This may save a great deal of time spent on final revi-
sions or even make them unnecessary.

Main Steps to Successful Systematic Review

It is useful to observe the following procedure when designing and writing a

systematic review. If the intention is to arrive at a systematic classification of
evidence, a well-considered and highly structured procedure should be used.
Structure is a crucial requirement, and some specific tools (e.g., PICOS: par-
ticipants, interventions, comparators, outcomes, and study design) can make
this more manageable (Smith et al., 2011). Below, we describe the specific steps
involved in creating a systematic review and meta-analysis, using the develop-
ment of a previously published review as an example of good practice. The fol-
lowing recommended strategies are based on the published systematic review
(Čablová et al., 2014).

Aim of the Review

The aim of a systematic review is set in the same way as in an original research
study; the article must contribute something new to the given research field.
The specific aim should correspond with the research questions. It may be, for
example, “to provide a systematic review of the results of studies published
from 2000 to 2012 that investigate the specific relationship between the level
176  Publishing Addiction Science

of parental control and alcohol use among children and adolescents.” Alter-
natively, it may be “to classify parenting strategies in relation to alcohol-using
children aged 12–15” or “to make a critical appraisal of recent studies of the
emotional bond in young adults who use cannabis.”
The aims are typically stated in the last paragraph of the introduction. The
aims then determine the choice of the specific procedure used to search sources
and process and present the results. In the concluding section of the study, it
should be stated whether and to what extent the aims have been fulfilled.

Inclusion of Research Questions

In a review article, the research question is included and expressed in the

text, formulated as the problem: the topic and the focus of the work. It can be
thought of as a spiral that provides logical connections among the parts of the
article; that is, different parts build on and follow up on each other in a logical
pattern. In terms of a systematic review, the research question must correspond
with the objectives of the study and be aligned with the methodology, which is
particularly relevant for the identification of data sources (the literature search)
and the determination of study inclusion and exclusion criteria. It represents
an imaginary starting point for the selection of key words and other parameters
that are looked for in the relevant studies. As an example, we can use an article
investigating the quality and type of emotional bonds in young adults who use
cannabis and its (implicit) research question: “Can an insecure emotional bond
be associated with a higher rate of cannabis use among young adults?” or: “Is
there a relationship and difference between the lifetime prevalence of cannabis
use among young adults and the individual types of insecure emotional bond?”

Identify Data Sources—Quality Literature Search

The primary and most important data sources are electronic databases, typi-
cally accessed through university libraries. Because access to specific papers
may be limited as a result of financial constrictions, the levels of access granted
to students and staff will depend on the resources of the university subscribing
to the journals. Thus, you may find that although you can get into a number of
databases, you may be able to access only a few full texts (as the others require
payment) and have mostly abstracts available, which may not be sufficient for
systematic reviews. This is dealt with in more detail in the next point.
In the field of addictology, we recommend to use following databases:

• Web of Science: http://www.webofknowledge.com

• Medline/PubMed: http://www.ncbi.nlm.nih.gov/pubmed
• EBSCO: http://search.ebscohost.com
 How to Write a Systematic Review Article and Meta-Analysis  177

• SCOPUS: http://www.scopus.com
• ProQuest Central: http://search.proquest.com/index
• PsycARTICLES: http://www.apa.org/pubs/databases/psycarticles/index.
aspx

Nevertheless, databases and full-text studies are not the only data sources. It
is also possible to include conference presentations if the conference abstracts
have been published. At the same time, some journals could have a problem
with these types of publications because they did not undergo a standard
peer-review process. Also, a quality literature search should not disregard print
sources, such as monographs; articles in peer-reviewed, non-indexed jour-
nals; handbooks and manuals pertaining to the relevant topic; graduate theses;
and dissertations. These could be included into a category “Records identified
through other sources” in the PRISMA (Preferred Reporting Items for System-
atic Reviews and Meta-Analyses) study flow diagram (see below).
We recommend keeping scrupulous notes on the articles read, either using
Endnote or a separate database of references. This is relevant to all research but
particularly to reviews.

Determine Selection Criteria

The relevant publications, the results of which are to be processed, are selected
according to the classification criteria that follow.

• Year of publication—designating the period that is under study—may be

used as the first criterion.
• Number of citations of the article—this information can be found in data-
bases, most often under the heading “Times cited.” Articles with a greater
number of citations report on more prestigious research.
• Key words—they reflect the terminology used in the given field and also
help identify the most relevant studies.
• Relevance of the article—online databases may turn up a number of arti-
cles but, unfortunately, because of the potential overlap of key words and
other parameters, some works may be totally inconsistent with the focus of
the review. It is therefore necessary to look through each publication—in
most cases the abstract will be enough—and exclude any irrelevant studies.
• Type of publications—although you may typically work with original and
review studies only, specific topics may require the use of information from
annual reports, research reports, or guidelines. It is therefore important to
state these factors in the description of the procedure.
• Study design—as far as research studies are concerned, these may be fur-
ther divided into subcategories: for example, reviews versus original works
or, with clinical issues in particular, cross-sectional versus longitudinal.
178  Publishing Addiction Science

• Language of the publications—the languages that currently predominate

in science are English and Spanish, with Chinese emerging as a significant
language of science (in addition to English, Web of Science databases pro-
vide the option of searching studies in Chinese).
• Sociodemographic environment—it is useful to describe the sociodemo-
graphic environment in which the research was conducted because it is
a relevant factor that may influence the review’s results. Thus, the review
needs to take this into account when presenting the research results.
• Funding source and conflicts of interest—last but not least, the fund-
ing source of a study and other conflicts of interest may influence how the
results are interpreted. As explained in other chapters, significant biases in
study reporting have been uncovered when the funding source or authors
have a financial stake in the results of the study.

Entered into a database or observed when working with hard-copy sources,

these criteria make it possible to focus the work on the research question and
the aim of the study you have laid down. Finally, all these criteria/indicators
will be considered and interpreted in the subsequent discussion section.

Process of “Data Collection”

The complete literature search process needs to be recorded and documented.

When evaluating systematic reviews, peer reviewers pay special attention to the
means used to collect the “data” (i.e., specific publications) for the analysis. There
are specific methods that can be applied for this purpose, with the PRISMA
study flow diagram being the most frequently used one in contemporary sci-
ence (Higgins & Green, 2008; Moher et al., 2009). Figure 9.1 shows the PRISMA
study flow diagram used in the systematic review (Čablová et al., 2014).

Explanation of the Specific Items in the Prisma Study

Flow Diagram

The first item, Records identified through database searching, shows the number
of publications found in databases on the basis of the selection criteria. The item
Additional records identified through other sources refers to the number of pub-
lications found in information sources other than those available online (these
are typically print documents, such as research reports, handbooks, and manu-
als). Another step involves the elimination of duplicate articles. If you work with
multiple databases, it is very likely that the same publication will be selected
several times. Such duplicates should therefore be removed. This process is very
easy if you use a citation manager. When using EndNote, for example, this can
be achieved by simply activating the “Find duplicates” function.
 How to Write a Systematic Review Article and Meta-Analysis  179

Records identified through Records identified through

database searching other sources
(n = 371) (n = 21)

Records after duplicates

removed
(n = 386)

Records screened Records excluded

(n = 386) (n = 22)

Full-text articles assessed Full-text articles

for eligibility excluded, with reasons
(n = 364) (n = 348)
Ineligible sample and
subject of interest = 328
Studies included in Different sociocultural
qualitative evaluation setting = 16
(n=16) Others = 4

Studies included in
quantitative evaluation
(n=16)

Figure 9.1: PRISMA study flow diagram.

Source: Čablová et al. (2014, p. 4).

Then you can focus on the articles. The item Records screened indicates the
number of publications that remained after the exclusion of duplicates and
publications rejected after you have read the abstracts. The number of articles
eliminated on the basis of the examination of their abstracts is indicated in
the Records excluded box. On the other hand, articles for which the full text
is available (these should make up as large a proportion of the initial set of
records as possible) are assessed in the next step and their final number is given
under Full-text articles assessed for eligibility. When reading through the stud-
ies, you should continue to bear in mind the selection criteria (ideally, with a
checklist on your desk) and watch carefully for them being met in the studies
under scrutiny. If a more rigorous design is applied, you can also create a table
180  Publishing Addiction Science

specifically for the selection and assessment of publications. If you come across
articles that do not meet the selection criteria, you should state the reasons for
such ineligibility and the respective number of studies; see the item Full-text
articles excluded with reasons. The last figure shows the final number of articles
included in the study. This example contains two alternatives—Studies included
in qualitative evaluation and Studies included in quantitative evaluation—but
one item only, for example, Studies included in quantitative evaluation, is also
possible. For more information about the PRISMA study flow diagram method,
including further illustrations of the procedure or the PRISMA checklist that
helps in keeping a record of the process, visit http://www.prisma-statement.
org/statement.htm.

Interpretation of Results

The results of the studies you have obtained will be further summarized in a
structured form—ideally a table—according to the classification criteria. It is
advisable to compare the qualitative and quantitative perspectives of the stud-
ies when processing the results. (Although meta-analysis is not always the goal,
it is useful to take quantitative as well as qualitative approaches into account.)
When using a quantitative point of view, you can follow the number of stud-
ies that used a longitudinal versus cross-sectional design, how many studies
applied a standardized methodology versus a methodology developed specifi-
cally for the purposes of the study, or how many studies had their samples of
participants well balanced in terms of representativeness and how many did
not. On the other hand, a qualitative perspective makes it possible to look for
broader aspects of the works and fine subtleties in the results that have been
ascertained.
There are a number of available tools that can serve as a guide when examin-
ing study methodologies and results. The Consolidated Standards of Report-
ing Trials (CONSORT) statement provides a standardized way to report and
interpret the results of randomized clinical trials (Schulz et al., 2010). The pri-
mary tool is a 25-item checklist that contains questions on how the trial was
designed, the data analyzed, and the results interpreted. The Strengthening the
Reporting of Observational studies in Epidemiology (STROBE) and Transpar-
ent Reporting of Evaluations with Nonrandomized Designs (TREND) state-
ments are similar checklists for studies using observational study designs (von
Elm et al., 2007; des Jarlais et al., 2004). If a more quantitative analysis of study
design is desired, the recommendations of the Grades of Recommendation,
Assessment, Development, and Evaluation (GRADE) working group may be
used (Atkins et al., 2004). These recommendations contain a point system that
can be used in combination with the CONSORT, STROBE, or TREND state-
ments to further differentiate among studies. Although useful, the results of
using these tools should not be considered as absolute but as guides toward
 How to Write a Systematic Review Article and Meta-Analysis  181

determining the weight that a study’s conclusions should be given. In addi-

tion, systematic reviews should always be attentive to sex and gender issues, as
described in the SAGER Guidelines (Heidari et al., 2016).
Interpretation should always be based on the results and findings specified
in a given study; you must refrain from adding any conclusions of your own,
because the principal rule is to preserve and express the original author’s idea
as precisely as possible. When formulating the ideas and working with other
review studies, you should always look up the primary source and interpret
its results. Other review studies may serve as an inspiration in classifying your
results rather than being their source, functioning rather as “background
material.”
Any copyright rules should be observed when making citations. You should
strictly avoid using findings presented by the original authors in their research
as your interpretations; if at all, you can resort to a secondary citation, which
in itself may appear rather awkward. Therefore, you should seek to be as accu-
rate as possible and restate the author’s original argument, looking up other
relevant works on the topic that you will cite in the same way. In addition, it is
necessary to be attentive and socially sensitive when interpreting the results of
studies from different sociocultural settings; you should be careful not to make
unreasonable generalizations and ensure that the results are always interpreted
in terms of the given social context. This may involve engaging in some addi-
tional research but, particularly in the social science field, this extra effort is an
element that has a major impact on the final product. In Table 9.1 we present an
example that illustrates the processing of the results in a published systematic
review (Čablová et al., 2014). The left hand column lists the studies according
to authors and year, which corresponds with the standard identification of cita-
tions in text. The selection criteria applied to the studies under consideration
are indicated in the heading line. The reader thus has a chance to see the results
of the work in aggregate and in a clearly structured way without having to wade
through a lot of text.

Discussion and Conclusion—was the Aim Really Achieved?

Once the results have been processed and interpreted, what is probably the
most challenging part comes next. For one thing, you may be quite tired by
now, because the previous systematic procedure was rather demanding in
terms of attention and endurance, and now you need to think about the results
and compare them with the conclusions drawn by other relevant studies and
with each other. In particular, this requires you to bring a new perspective to
the subject matter under study, singling out and discussing most salient finding
from the results. Importantly, the discussion should compare and evaluate the
results against other relevant research projects rather than against the presenta-
tion of the author’s opinions on the issue. Each idea or result presented in the
 Research studies Criteria  
Country Study Age category2 Number of Parental Parenting styles4 Methods5
design1 respondents involvement3
L C 1 2 3 Y N 1 2 3 4 5 1 2
Bahr & Hoffmann USA   + + + + 4,938   + + + + +   +  
182  Publishing Addiction Science

(2010)
Barnes et al. (2000)   USA +     + + 506 +   +         +  
Burk et al. (2011) USA +       + 362 +   +           + CRPR
Choquet et al. (2008) France   +   + + 16,532   +       +   +  
Clausen (1996) Norway +     + + 846   + + + + +   +  
Total   8 8 6 12 14   6 10 13 9 9 7 3 12 6

Table 9.1: Example of processing and presenting the results.

1
L = longitudinal study, C = cross-sectional study.
2
1 = younger children (9–12 years); 2 = older children (13–15 years); 3 = adolescence (16–22 years).
3
Y = yes; N = no.
4
1 = authoritative style, 2 = authoritarian style, 3 = permissive style, 4 = neglectful style, 5 = other.
5
1 = questionnaires newly developed for the purposes of the research, 2 = standardised questionnaires.
Source: Čablová et al. (2014, p.5).
 How to Write a Systematic Review Article and Meta-Analysis  183

article needs to be properly cited, too. The conclusion consists of a practical

evaluation of the study; it should not contain any new findings or evidence. Its
purpose is briefly to summarize the results and the contribution of the study as
a whole. Although this can pose a formidable task to an inexperienced author,
it is important to practice the skill of communicating your own views concisely.
The conclusion often includes recommendations (resulting from the study)
for further research and tips for practice. It is also advisable to highlight the
unique contributions of your review. In technical terms, it is recommended to
study carefully the instructions for authors provided by the journal in which
you want to submit the article for publication. Although some journals require
the discussion and conclusion to come in two separate sections, others prefer
to have them combined. The latter requires a slightly different structure, and it
is helpful to be familiar with the format requirements before writing the article.

The Most Frequent Pitfalls

When trying to pursue as systematic and transparent a procedure as possible,

you can encounter several problems. We have already mentioned the poten-
tial problem with differences in terminology used by the authors who publish
research on a given subject in the field. To prevent confusion, it is recommended
that you read a reasonable number of articles pertaining to your topic and look
for the terminology they use. Databases may be helpful in this. The Web of Sci-
ence platform, for example, features a “related records” function, which may
be used to search for similar articles on a certain topic. You may be confronted
with a range of often competing theoretical approaches or backgrounds used
by the authors to explore the subject matter in question. Because the literature
search may be a challenging and time-consuming task, you may need to allow
some time to study the relevant concepts thoroughly (for which the studies you
have identified may not provide all the answers, requiring you to do further
reading), as well as to reflect on such differences in your own conclusions and
interpretations. Other differences may be found in the methodology applied
by the studies under scrutiny. There are authors who work with standardized
methods and their results can be subjected to a simple and valid comparison; on
the other hand, there are authors who use their own methodology and whose
results are thus difficult to measure. Another aspect that will consume time is
the elimination of duplicate records, because researchers sometimes publish
the results of the same study in several parts, divided into various subtopics to
meet the foci of different journals. A mechanical “remove duplicates” function
cannot do all the work. It is necessary to be alert and watch out for any relevant
correlates.
Another problem that may be encountered when comparing results between
studies is the difference in the number of study participants. Many studies do
not use a representative sample of participants, and great differences in their
184  Publishing Addiction Science

sizes may strongly affect study generalizability. You may also face your own
limitations, particularly regarding the inclination toward a selective choice of
studies, where certain studies may not be included, either deliberately or inad-
vertently. Because citation bias may significantly compromise the results, you
should try to avoid it at all costs if you want to arrive at a conclusion that is
relevant to the field. If you fail to do so, it is most likely that reviewers will dis-
cover such a bias, as it is their job to examine related studies in the given area
of research.
The last aspect to consider during the interpretation process is the statisti-
cal versus clinical significance of studies. In a large number of cases, you will
find results that are not reflected in clinical practice, despite being significant.
Therefore, it is important to maintain contact with clinical practitioners (or
consult other experts) and be able to compare the results with real life. You can
then formulate how these significances correlate in the conclusion.
For addiction science, the critical evaluation of systematic reviews is quite
important. It is the key to the correct interpretation of selective data from par-
ticular studies, it provides background for comparing findings, and it can help
to identify potentially disproportionate or inhomogeneous interpretations of
findings. It has always been a sensitive issue in the context of publishing addic-
tion science because of potential conflicts of interest, and the history of the
field contains examples of published papers in which researchers intentionally
distorted data. The tendency to interpret data in a different way and present
specific points of view can be a potential source of bias (Bero & Jadad, 1997).
For example, there are many examples of contrasting study findings in the area
of tobacco policy depending on whether the study was or was not sponsored by
the tobacco industry (Glantz, 2005).

Meta-Analysis

Meta-analysis is a form of systematic review that combines findings from a

number of studies to create aggregate effect sizes. To do this, the size of the
effect is calculated and indexed. This can be used for a number of purposes in
addiction science, including the effects of an intervention (e.g., the use of nal-
trexone and acamprosate for treating alcohol use disorders [Maisel et al., 2013]
or the impact of smoking bans on restaurants and bars [Cornelson et al., 2014])
and epidemiology (e.g., substance use among street children [Embleton et al.,
2013]) or seroconversion of hepatitis C in relation to shared syringes [Pouget
et al., 2012]). By aggregating the effects and applying a statistical analysis, a bet-
ter understanding may be obtained for some of these research questions.
This is a complicated and time consuming process, probably not best
undertaken by inexperienced researchers, but it may add greatly to the better
understanding of science and aid treatment providers and policy makers. The
process is not dissimilar to that described above in terms of selecting articles
 How to Write a Systematic Review Article and Meta-Analysis  185

for systematic reviews but requires a more complicated analysis. There are also
similarities with primary intervention trials, in which one focuses on how well
an intervention works. However, in a meta-analysis, the researcher looks across
studies to determine the magnitude of effects. It is worth following a system-
atic guideline such as PRISMA to establish a framework for the review (Moher
et al., 2009).
The first step is to formulate the research question. Decide the keywords
you will use to search for articles, the date from which you wish articles to be
included, and the inclusion and exclusion criteria. Search the databases you
have chosen for articles that meet your subject and eligibility criteria. It is also
worth looking at reference lists from the articles you have selected to find other
articles not so far identified.
Once the articles for inclusion have been identified they will need to be coded
according to the variables chosen for the meta-analysis. Because these coding
decisions are not always clear, two raters are often used to obtain some meas-
ure of reliability either by percent agreement or by a kappa coefficient. Enter
the data extracted onto a database with relevant details of each study entered
including, for example, type of intervention, follow-up periods, sample size,
type of control group, and research design.
One of the problems in comparing a number of studies is that studies will
report diverse outcomes according to the model they used. To determine effect
sizes so that the meta-analysis is effective, a “common currency” of effects needs
to be established in order for comparisons and aggregation to be made. Finney
and Moyer (2010) suggest that the most common effect sizes used are stand-
ardized mean difference, odds ratio, and correlation coefficient. The standardized
mean difference is “the difference between means on a continuous outcome
variable for an intervention and a comparison condition, typically divided by
the pooled standard deviation of the two groups.” (Finney and Moyer, 2010,
pp 321). By using standard deviations, one can measure by how many standard
deviations, or what proportion of standard deviations, the intervention is per-
forming better than the control group.
Another method of measuring effect size is by using the odds ratio. By calcu-
lating the probability of something changing divided by something not chang-
ing, a ratio may be obtained. An odds ratio of 1.00 would show that there was
no difference between treatment and a control condition in which there were
two possible outcomes.
The third method is the correlation coefficient, which can be used to express
the relationship between a continuous intervention dimension (which is unu-
sual in addiction studies) and the outcome (Finney & Moyer, 2010).
We have now established a method of calculating effect sizes, and, to find
out whether there is indeed an effect and what that effect is, we must now
aggregate them across the studies we have reviewed. This can be done with a
fixed-effects or a random-effects approach. These two approaches deal with the
study sampling errors, with the former assuming that the error in estimating
186  Publishing Addiction Science

the population effect size comes from random factors associated with subject-
level sampling, whereas the latter assumes that there are study sampling errors
in addition to subject-level sampling errors. A random-effects model is used
more frequently because of a greater generalizability, although the fixed-effects
model has a greater statistical power. Effects from larger sample sizes have less
variance across studies and are therefore more precise. To test whether the
overall effect size varies from zero, it is best to use specific statistical software
designed to conduct meta-analyses (Finney & Moyer, 2010).
As with systematic reviews, a table should be presented detailing all the arti-
cles included in the study and describing all the relevant characteristics, includ-
ing author, date of data collection, the main outcome findings, and methods of
collecting the data. A forest plot that shows the range of findings for each study is
also often included, detailing in comparison the range of effects in an intervention.

Issues with Meta-Analysis

There a number of issues that should be considered when conducting a meta-

analysis. One may have to determine whether the effect sizes vary more than
could be expected from subject-level sampling fluctuations in a fixed-effect
model or, in a random-effect model, whether there are study-level random
effects in addition to the subject-level sampling fluctuations. Are there addi-
tional factors that add variation in effect sizes explained by moderator variables?
The moderator variables include different methods and participants across the
studies and the interventions themselves. To test this, a homogeneity test can be
used that will test for whether excess variation exists (Viechtbauer, 2007).
Another problem is publication bias. If the articles are selected carefully from
peer-reviewed journals and conform to the criteria for inclusion, there is still
the problem in that studies that show no positive or neutral results are often
not published, either because the researchers do not submit for publication
or because the papers are rejected for publication. Therefore, any articles that
refute the research question may not be included in the databases searched and
therefore the results may be skewed.
Selection of the articles needs to be done with great care. Only quantitative
articles may be included—qualitative articles will not contribute a statistical
outcome—and if the criteria are too strict, then the number of articles on which
to base the analysis may be too small. On the other hand, if you the selection
criteria are too wide, you may then include studies of poor quality that will
affect the outcome of the meta-analysis. The other problem with selection of
articles may be agenda bias, whereby the authors of the meta-analysis want to
use the results to support a specific issue and may cherry pick the articles they
include. Meta-analysis is complicated, and the analysis of the variance across
articles is complex; therefore, it is always beneficial to get good statistical advice
and to use an established statistical package for analyzing the data.
 How to Write a Systematic Review Article and Meta-Analysis  187

Conclusion and Final Advice

As previously mentioned, a good review article is hardly possible without a

good literature search. The literature search has its own rules that generally
apply to both original and review studies. A systematic review involves a
literature search procedure guided by the principle of keeping an accurate
and transparent record of the entire process! It is useful to create a sum-
mary Excel table where citations of studies will be recorded according to
the selection criteria. It may seem like extra work at the beginning, but the
author will come to appreciate this facility even before the first round of the
peer-review process is over. Indeed, peer reviewers very easily notice any
shortcomings we have tried to hide. It is therefore strongly recommended
to draw up and enclose with the article a diagram in which you document
the procedure for selecting the studies. This will help reviewers understand
the approach and the results obtained, and, if any queries should arise, this
evidence will make it easy to refute and explain any misgivings about the
process or the results. For these purposes, it is also recommended to archive
the documents in both printed and computerized versions; a physical file for
hard copies and a separate electronic folder for computerized counterparts
may be a useful option, with the latter providing the extra convenience of
the “find” functionality.
To summarize, the ultimate goal when developing a review article is a sys-
tematic, straightforward, and transparent procedure. Both the reader and the
editor must be clear about what the aims and methodology are, and all the
results must be in line with the methods used. Although certain variations on
standard procedures are possible, they always need to be explained and justi-
fied in discussion; otherwise you will most likely deal with them in the first
round of the peer-review process. There are some specific approaches and tools
for quality assessment of reviews (e.g., AMSTAR [Smith et al., 2011]; MOOSE
[Stroup et al., 2000]) that can be relevant and very helpful in determining what
is assessed and how to make the manuscript better.

Please visit the website of the International Society of Addiction Jour-

nal Editors (ISAJE) at www.isaje.net to access supplementary materials
related to this chapter. Materials include additional reading, exercises,
examples, PowerPoint presentations, videos, and e-learning lessons.

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