key: cord-0747373-75v880bf authors: Negrini, S; MG, Ceravolo; Côté, P; Arienti, C title: A systematic review that is "rapid" and "living": a specific answer to the COVID-19 pandemic date: 2021-06-02 journal: J Clin Epidemiol DOI: 10.1016/j.jclinepi.2021.05.025 sha: fb8abeb6e7564c5a79ac8ee7da3b2d8449ab7130 doc_id: 747373 cord_uid: 75v880bf OBJECTIVE: This study aims to describe “rapid living” systematic reviews, an innovative methodological design used to systematically synthesize emerging evidence in the field of rehabilitation during the COVID-19 pandemic. STUDY DESIGN AND SETTING: A methodological paper, with a formative approach to rapid living systematic reviews. RESULTS: Based on our experience, we propose the following definition of rapid living SR: "A dynamic method of knowledge synthesis that allows for the constant updating of new emerging evidence and refinement of its methodological quality". This method has the benefit of accelerating the conduct of traditional systematic reviews and allows for a synergistic adaptation of methodology based on the quality of the evidence with a flexibility to update results, methods and collaborations. CONCLUSION: Our proposed methodology has been helpful to synthesize the rapidly evolving evidence in the field of rehabilitation during the pandemic. Similarly, it may be useful when a rapid answer is urgently needed to make informed decisions. The COVID-19 disease has shown that moderns medical science has the ability to produce new knowledge at a rate never seen before. Therefore, our proposed rapid living systematic reviews provides the scientific community with a method to rapidly synthesize evidence when facing health emergencies. From the beginning, the COVID-19 pandemic required a rapid production of evidence to inform the clinical 35 decision-making and help to give urgent answers. The need to rapidly produce knowledge syntheses is 36 imperative in the field of rehabilitation too, because rehabilitation, as stated by the World Health 37 Organization (WHO), is an essential health service together with promotion, prevention, treatment, and 38 palliative care [1] . Among Cochrane, the Rehabilitation Field [2], is responsible for knowledge translation in 39 this specific area of health [3] by bringing the best available evidence synthesized by Cochrane to 40 rehabilitation stakeholders. Due to the urgent needs for rehabilitation by people with COVID-19, Cochrane 41 Rehabilitation merged the concepts or "rapid" and "living" systematic reviews adapted to the and designed 42 an innovative and dynamic methodological approach for evidence synthesis during times of health 43 emergencies [4] ). 44 Cochrane defines a rapid SR "a form of knowledge synthesis that accelerates the process of conducting a 45 traditional systematic review through streamlining or omitting specific methods to produce evidence for 46 stakeholders in a resource-efficient manner" 47 (https://covidreviews.cochrane.org/sites/covidreviews.cochrane.org/files/public/uploads/cochrane_rr_-48 _guidance-23mar2020-final.pdf). The concept was introduced to face sudden needs of the health systems 49 while accepting necessary methodological limitations to accelerate the speed of publication. Cochrane also 50 defines a living SR a "systematic review which is continually updated, incorporating relevant new evidence 51 as it becomes available" (https://community.cochrane.org/sites/default/files/uploads/inline-52 files/Transform/201912_LSR_Revised_Guidance.pdf). The notion of living reviews was introduced to keep 53 the pace with the growth of evidence, and it can be particularly useful in rapidly evolving research fields. 54 The pandemic brings the two challenges together, i.e. the need for rapid knowledge synthesis but also that 55 of constant update. 56 Therefore, this paper aims to present and define the methodological innovation of "rapid living" systematic 57 reviews and uses our experiences to discuss its strengths and weaknesses. 58 Rehabilitation is currently defined for research purposes by Cochrane Rehabilitation as "a multimodal 60 person-centred process including functioning interventions targeting body functions, and/or activities and 61 participation, and/or the interaction with the environment" (Intervention) aimed at "optimising 62 functioning" (Outcome) in "persons with health conditions (a) experiencing disability or (b) likely to 63 experience disability, and/or persons with disability" (Population)" [5] . Rehabilitation comes partly during, 64 but mostly after the acute phase of illness [6] . Moreover, rehabilitation research faces specific 65 methodological challenges related to its: 1) multimodal approach which involves a combination of behavioural and physical interventions [7] [8] [9] ;2) multi-professional team approach [10]; and 3) focus on 67 optimizing individual functioning while accounting for multi-comorbidities of people who need 68 rehabilitation [11] [12] [13] . These needs often result in delays in completing studies when compared to other 69 fields of medicine. 70 Very early in the pandemic, Cochrane Rehabilitation designed and conducted a SR to meet the demand 71 from the stakeholders to receive timely information about the impact of COVID-19 on rehabilitation 72 activities and patients. In April 2020, the first SR was published within 3 weeks from its initiation and 73 included the evidence produced since the start of the pandemic in China [14] . Therefore, our first review 74 can be defined as "rapid" needed to be flexible by incorporating reported findings from all study designs, 75 including expert opinions. Because this low-quality body of evidence was growing rapidly, we also 76 conceived the SR as "living" to keep it constantly updated (each month from the first edition). In all 2020, 77 we published a first rapid living systematic review (RLSR) (first edition) [14] with two monthly updates [15, 78 16] keeping a time of 3 to 4 weeks between data collection and their publication); the same was done for The new updates [18] [19] [20] followed the same methodology, which will be updated as needed. (Figure 1) . 124 Other groups have also recently proposed rapid SRs that are meant to be living [15] [16] [17] . However, they 125 followed a different methodological evolution, because they were investigating treatments for the acute 126 illness where strong evidence can be retrieved and synthesized more rapidly. Our initiative is not isolated; 127 the COVID-END global network (https://www.mcmasterforum.org/networks/covid-end) is also discussing 128 transitioning from rapid to living reviews, and shift their focus on COVID-19 management from "sprint to 129 marathon" [22] (https://www.mcmasterforum.org/docs/default-source/covidend/presentations/covid-130 end_2020-09-15_cancovid.pdf?sfvrsn=16e956d5_2). To us, this is a strategic evolution, probably due to the 131 COVID-19 pandemic, that needs better understanding. 132 Tricco et al. highlighted many methodological challenges when conducting a rapid review [23] . Using a living 133 model to conduct rapid reviews allows facing some of them gradually. In our experience with rapid, living systematic reviews in rehabilitation, the pandemic has led to dynamic interactions between new partners 135 who developed initiatives that could not be imagined when we launched our review. Keeping our 136 methodology "living" also allows to innovate while keeping our original aims dynamic. Our rapid review 137 "lives" online too, through an interactive living mapping 138 (https://rehabilitation.cochrane.org/sites/rehabilitation.cochrane.org/files/public/uploads/covid/evidmap_ 139 table.html) and a living, dynamic table 140 (https://rehabilitation.cochrane.org/sites/rehabilitation.cochrane.org/files/public/uploads/rapid_review/ra 141 pid_review_dynamic_table.html) available for all rehabilitation stakeholders. They are continually updated 142 with the SR. We found a similar experience in a different field [24, 25] , where a living metanalysis is 143 published online, too [26] . 144 The strengths of our approach include the very high rapidity to provide an initial answer, and flexibility in 146 updating results, methods, collaborations and even authorships. This approach has allowed us to minimize 147 the inherent trade-offs between methodological rigour and need for rapid information, while delivering 148 evidence syntheses that are the most trustworthy and up to date, reducing the time for new research to 149 translate into health practice. Further, Our methodology allows to build a body of evidence that grows for 150 clinical observations to robust experimental designs. 151 The weaknesses of our approach include the initial reporting of papers based on weak methodology and 152 descriptive study designs: nevertheless, they were the only available papers at the start, and stakeholders 153 wanted to know them to start basing their work on some results. This high level of uncertainty could be 154 remedied only by time. As soon as the primary literature became more robust, we updated to a second 155 edition of the SR and retroactively applied our upgraded methodology to the previously included papers. 156 Another critical issue is the need for a firm agreement with a journal based on the understanding of the 157 working group. The concept of a "living" review with a constant flow of new information is not part of the 158 current publishing processes, that is usually more static: at the start, this created an issue in trying to link 159 the new updates to the original paper, and it was necessary to contact the primary databases (PubMed, 160 Web of Science) and starting a discussion with them to find the appropriate solutions. 161 Commitment from authors and journals is another specific concern. Being living and rapid requires 162 significant monthly efforts in data collection, analysis and writing, especially when the volume of research 163 grows continuously. Although we planned to complete the monthly updates in 2 weeks, it was seldom 164 possible in less than three weeks. It is essential to understand that all these efforts subtract energies from 165 other daily tasks of the researchers involved. The job is demanding for journals too, which are not used to 166 rapid publications. Informed by our experience, we propose the following definition of rapid living SR: " A dynamic method of 169 knowledge synthesis that allows for the constant updating of new emerging evidence and refinement of its 170 methodological quality." ". Combination the concepts of "rapid" and "living" allowed us to be very efficient 171 in retrieving and synthesizing the evidence while gradually improving our methodology. We suggest that, 172 with ongoing refinements, our methods will meet the methodological quality of a classical SR while keeping 173 the pace with the updates. 174 Our experience is likely useful not only in pandemics but also in other situations where a sudden and rapid 175 answer is urgently needed to make informed decisions. Nevertheless, we are now facing for the first time a 176 pandemic with the strength of modern medical science. The scientific community should consider this 177 development of the concepts of SRs useful in the future when facing new health emergencies. 178 Implications of self-care for health service provision Cochrane Rehabilitation: 2019 annual report Knowledge Translation: The Bridging Function of Cochrane Rehabilitation The "Rehabilitation Research Framework for COVID-19 patients Cochrane Rehabilitation and the World Health Organization Rehabilitation Programme Rehabilitation definition 190 for scientific research purposes Medicine (PRM) in Europe. Chapter 8. The PRM specialty in the healthcare system and society Evidence in Rehabilitation Medicine: Between Facts and Prejudices In Search of Solutions for Evidence Generation in Rehabilitation: The Second 197 Cochrane Rehabilitation Methodology Meeting The Randomized Controlled Trials Rehabilitation Checklist: Methodology of 199 Development of a Reporting Guideline Specific to Rehabilitation A primary medical specialty: the fundamentals of PRM The Structure of Research Questions in Randomized Controlled Trials in the 205 Rehabilitation Field: A Methodological Study Report from a cochrane 207 rehabilitation methodology meeting Medicine (PRM) in Europe. Chapter 10. Science and research in PRM: specificities and challenges Systematic rapid "living" review on rehabilitation needs due to COVID-19: 212 update to March 31st, 2020 Systematic rapid living review on rehabilitation needs due to COVID-19: update as 214 of April 30th, 2020 Systematic rapid living review on rehabilitation needs due to COVID-19: update 216 to May 31st, 2020 Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living 218 systematic review Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living 220 systematic review. Update as of July 31st, 2020 Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living 222 systematic review. Update as of August 31st, 2020 Rehabilitation and COVID-19: a rapid living systematic review 2020 by 224 Cochrane Rehabilitation Field. 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