Recommendations to keep a living systematic review alive during a pandemic
2Institute of Social and Preventive Medicine, University of Bern. Jacobs Center for Productive Youth Development,University of Zurich, Switzerland
3Wageningen Bioveterinary Research, Wageningen University & Research, Wageningen, The Netherlands
Background: Living systematic reviews (LSRs) gained special attention during the COVID-19 pandemic and have addressed many prioritised research questions. However, the rapid emergence, and persistently high volume, of research evidence on COVID-19 created challenges for keeping LSRs up to date.
Objectives: To summarise LSRs about COVID-19 and to offer practical recommendations based on the experience of an LSR group.
Methods: We searched the World Health Organization COVID-19 database using the search term ‘living systematic review’ on 7th November 2022. We extracted and described information about the review topic, population, type of studies included in the review and the number of updates. We used an LSR cycle to give recommendations at each stage, based on our LSR of asymptomatic SARS-CoV-2 infections.
Results: We identified 97 living systematic reviews on COVID-19, which focused mainly on the effects of pharmacological interventions (n=46, 47%) or the prevalence of associated conditions or risk factors (n=30, 31%). The topics and aims of many reviews overlapped substantially. One third of the reviews (n=34, 35%) had published any update; most authors only published one update after starting an LSR (n=16). We provide an achievable set of steps for LSRs, starting with a core team with skills to oversee and manage the workload and workflow. Crowdsourcing reviewers can help with workload. Automating steps, such as the search process, and online tools can speed up selection, extraction and risk of bias assessment. We also provide recommendations to update and stop the review (Figure 1).
Conclusions: Fulfilling the LSR approach involves considerable human and technical resources. The low proportion of LSRs that were updated by 12-18 months after the search highlights the challenges of keeping reviews alive. Authors should consider this before starting an LSR. We propose steps that make the living process realistic and bring evidence up to date to provide trusted evidence. Even when the LSR method is appropriate, we believe that knowing when to end an LSR is as important as knowing when to start.