Introduction to scoping reviews

Dr. D. Y. Patil Dental College and Hospital, Pune Department of Public Health Dentistry
Dr. S. A. Rizwan, M.D.,Scoping reviews: An introduction
Scoping reviews:
An introduction
Dr. S. A. Rizwan, M.D.,
7.11.2020

Ground rules
• Mute your mic
• Keep pen and paper to write
• Unmute and answer when called
• Questions are in Red
• Type questions in the chat box
• Queries answered at the end

Acknowledgements
• Joanna Briggs Institute
• Cochrane Collaboration

Things that you’ll learn in this lecture
• What is scoping review?
• How is it different from systematic
review?
• When is it carried out? – Scope of a
Scoping review
• What are the steps?
• What are the tools/formats available?
• What resources are available to learn
more?

Learning objectives
• At the end of this lecture you should
• Define scoping review and describe its
role in knowledge synthesis
• Describe the key concepts and the steps
in carrying out a scoping review
• Read and appraise a scoping review
paper
• Take home basic tools for starting off
• Identify resources for further learning

Definition of scoping review
• Exploratory projects that
systematically map the
literature available on a topic,
identifying key concepts,
theories, sources of evidence
and gaps in the research -
Colquhoun (2014)
What do you understand by the word ‘systematically’?

Birth of scoping reviews – 1/2
• Since early 2000s
• 25 different types of knowledge
synthesis
• Most common member - systematic
review
• Terminology
• Mapping studies, systematic scoping
studies, scoping studies
• Don’t confuse with evidence mapping
or evidence gap maps
J. Hosp. Med. 2019 July;14(7):416-418.

Birth of scoping reviews – 2/2

Scope of a scoping review
• Precursor to systematic review
• Identify types of evidence available in a
field
• Analyze knowledge gaps
• Clarify key concepts/definitions
• Examine how is research conducted on a
certain topic
• Nature and diversity of knowledge in the
field
• ‘MAP’ of available evidence
• Esp. when field is complex, heterogenous
‘ab tak iss field mein kya kya kaam hua hai,
kaise kaise kaam hua hai aur
kitna kaam hua hai’
Correia et al. BMC Public Health (2019) 19:1542

ScR is different from SR – 1/2
• Broad objective
• PCC instead of PICO(ST)
• Less restrictive inclusion criteria, not
restricted to one type of study design
• No synthesis of results (meta-analysis)
• No risk of bias assessment
• Limited in informing clinical practice or
policy making
What is the PICO(ST) format?

ScR is different from SR – 2/2

PICO(ST)
PCC Definition Example
Population
Important characteristics of participants (age,
criteria or other) – May not be applicable in
some situations
Adults with no apparent disease
condition
Intervention Main treatment we are interested in Herbal mouthrinse
Comparator
Control group with another intervention or
placebo or standard care
Regular toothpaste with/without
placebo
Outcomes
Main effect of the treatment expected, how it
will be measured, single or multiple, can also
specify the time to effect
Gingival inflammation by Loe’s
Gingival index at 6 weeks of use
Study designs Types that will be included Randomized controlled trials (RCTs)
Timeframe Year of publication or time of outcome 2005-2015

PCC (population, concept, context)
PCC Definition Example
Population
Important characteristics of
participants (age, criteria or
other) – May not be applicable
in some situations
Adults,
Children with caries,
Patients with facial injury, Women with
diabetes, Obese patients
Concept
Core idea of the review,
interventions, phenomenon of
interest, outcomes
Caries interventions, types of bleaching
agents, dental problems in autistic children,
surgeries for facial reconstruction, root canal
irrigants, mouthwashes, use of stem cells
Context
Cultural factors, geographic
location, race or gender based,
health-care setting
Emergency dental care, primary care setting,
advanced dental care centre, South-Asia,
minorities and economically backward
sections

Precise Vs. Broad review question
• What is the effectiveness of using 5% Potassium Nitrate as a desensitizer
(compared to placebo) before in-office bleaching with 35% hydrogen peroxide (over
3 sittings) for reducing post-operative sensitivity as measured by VAS score after 48
hours in adult patients indicated for tooth bleaching?
• What are the different types of desensitizing procedures used before tooth
bleaching (with any agent) in general dental practice in adult patients for any
indication?
ü Which of the above is a systematic review question and which is the scoping
review question?
ü Identify the PCC and PICO(ST) items for the above.

Framework and steps of ScR
1. Protocol development & registration
a) Title, Abstract, Introduction
b) Objectives
c) Methods: eligibility criteria, approach to
literature search, selection, data extraction,
presentation of evidence
2. Searching the literature
3. Selecting studies/documents
4. Data extraction – ‘charting’ the evidence
5. Analysis of the evidence
6. Presentation of the evidence
7. Summary, conclusions and implications

Framework and steps of ScR
Arksey and O’Malley (2005)

Protocol & registration
• Write the protocol as per
guidelines (JBI format)
• Register in Open Science
Framework (PROSPERO in future)
• Enables transparency
• May publish protocols in journals

Title and review question
• Title should include ‘scoping
review’
• Review question should follow PCC
• May have sub-questions to focus on
one or two aspects of the topic
What are the different types of desensitizing procedures used before tooth bleaching
(with any agent) in general dental practice in adult patients for any indication?
Can you think of a title, identify PCC and some sub-questions for the above?

Introduction and objective
• Introduction should clearly
articulate the rationale for the
review and provide clear
explanations for PCC
• The last line should mention the
objective
This scoping review was conducted to map key concepts of dental management
approaches for children with dentinogenesis imperfecta type II and identify,
summarize and describe strategies aimed to improve the oral health of this
population.

Inclusion criteria
• Inclusion criteria for the studies to
be selected
• Should be based on the PCC and
the types of literature that will be
included
• May or may not restrict types of
studies
Studies in dentistry that considered the effect of irrigant solutions on the mechanical properties of
endodontically treated teeth. This included studies that evaluated the study design and the effect of at
least one irrigant solution on dentin, regardless of origin (human or animal), but only studies written in
English were included.
Criteria Example
Population Human or animal origin tooth
Concept Effect of irrigant solutions on the
mechanical properties of
endodontically treated teeth
Context Dentistry (general dental
practice)
Type of
evidence
Study design and time duration
not restricted but only English

Search strategy
• Search strategy - comprehensive,
grey literature included, primary
and reviews
• Language and time frame
• Atleast 2 online databases
• Iterative process as new terms
become evident
PUBMED
"Tooth, Nonvital"[Mesh] OR "Tooth, Nonvital" OR “Nonvital Tooth” OR “Tooth,
Devitalized” OR “Devitalized Tooth” OR “Tooth, Pulpless” OR “Pulpless Tooth” OR
“Teeth, Pulpless” OR “Pulpless Teeth” OR “Teeth, Devitalized” OR “Devitalized
Teeth” OR “Teeth, Nonvital” OR “Nonvital Teeth” OR “Teeth, Endodontically-
Treated” OR “Endodontically-Treated Teeth” OR “Teeth, Endodontically Treated”
OR “Tooth, Endodontically-Treated” OR “Endodontically-Treated Tooth” OR
“Tooth, Endodontically Treated” OR “dentin*” AND "Root Canal Irrigants"[Mesh]
OR “Root Canal Irrigants" OR “Canal Irrigants, Root” OR “Irrigants, Root Canal”
OR “Root Canal Medicaments” OR “Canal Medicaments, Root” OR
“Medicaments, Root Canal” OR “Chlorhexidine” OR “EDTA” OR “Sodium
hypochlorite” OR “chemical irrigant” OR “NaOCl” OR “CHX” OR “ethylenediamine
tetraacetic acid” AND “fracture” OR “strength” OR “resistance” OR “fatigue” OR
“mechanical properties” OR “flexural strength” OR “microhardness” OR
“modulus of elasticity” NOT “bond”
SCOPUS
"Tooth, Nonvital" OR "Nonvital Tooth" OR "Tooth, Devitalized" OR
"Devitalized Tooth" OR "Tooth, Pulpless" OR "Pulpless Tooth" OR "Teeth,
Pulpless" OR "Pulpless Teeth" OR "Teeth, Devitalized" OR "Devitalized Teeth"
OR "Teeth, Nonvital" OR "Nonvital Teeth" OR "Teeth, Endodontically-Treated"
OR "Endodontically-Treated Teeth" OR "Teeth, Endodontically Treated" OR
"Tooth, Endodontically-Treated" OR "Endodontically-Treated Tooth" OR "Tooth,
Endodontically Treated" AND "Root Canal Irrigants" OR "Canal Irrigants, Root"
OR "Irrigants, Root Canal" OR "Root Canal Medicaments" OR "Canal
Medicaments, Root" OR "Medicaments, Root Canal" OR "Chlorhexidine" OR
"EDTA" OR "Sodium hypochlorite" AND "fracture" OR "strength" OR
"resistance" OR "fatigue" OR "mechanical properties" OR "flexural strength"
OR "microhardness" OR "modulus of elasticity" AND NOT bond AND ( LIMIT-
TO ( DOCTYPE , "ar" ) ) AND ( LIMIT-TO ( SUBJAREA , "DENT" )

Selection of studies
• Selection of studies - based on
inclusion criteria
• Atleast two reviewers with a third
one for disagreement situations
• Flowchart as per PRISMA-ScR

Data extraction – ‘charting’
• Data extraction – a standardized
form
• Iterative process – pilot tested
Items to extract
Citation (author, year)
Country
Aims
Population and sample size
Methods
Intervention type, comparison group,
duration of intervention
Outcomes and details
Key findings that relate to the objectives
of the review

Analysis of the evidence
• Multiple ways
• Simple counts of concepts,
populations, characteristics
• Sometimes, qualitative content
analysis
• Sometimes, advanced analysis
may be required
• Usually, meta-analysis is NOT
done

Presentation of the evidence
• Purpose is to identify, characterize
and summarise the available
evidence on a topic
• Several forms of presentation can
be used

• Qualitative form
• Major themes

• Tabular form
• Simple counts according to
subgroups are given

• Graphical form

Discussion
• Results should be discussed in the
context of current literature,
practice and policy
• Scoping reviews are subject to the
limitations
• As no rating of the quality of
evidence is provided, implications
for practice or policy cannot be
graded

Conclusions and recommendations
• Overall conclusion based on the
results
• Clear, specific implications for
future research
• Future conduct of systematic
reviews
• May not be possible to develop
implications for practice/policy
Regardless of the considered irrigation solution, most
existing cases corroborate the occurrence of some
damage to the mechanical properties of endodontically
treated teeth.
The findings from this scoping review show that aesthetic
perception is not directly related to acceptability and
satisfaction of patients and parents but related to a lower
professional's acceptance. Therefore, it is recommended
that professionals should be encouraged to offer this
treatment to patients and their parents, better advising
them about the facilities and effectiveness of the Silver
Diamine Fluoride technique.

Appendices
• A detailed search strategy for all
sources searched
• Sources excluded following full-
text review
• Data extraction form
• Table of study characteristics
• PRISMA-ScR filled
• Protocol

Resources
• JBI Manual
https://wiki.jbi.global/display/MANUAL/Chapter+11%3A+Scoping+reviews
• Cochrane website
https://training.cochrane.org/resource/scoping-reviews-what-they-are-and-how-you-can-do-them
• Papers
Arksey, H & O’Malley, L 2005, ‘Scoping studies: towards a methodological framework’, Int J Soc Res
Methodol, vol. 8, no. 1, pp.19-32.
Levac, D, Colquhoun, H & O’Brien, KK 2010, ‘Scoping studies: advancing the
methodology’, Implement Sci, vol. 5, no. 69, pp. 1-9.
• PRISMA-ScR
https://knowledgetranslation.net/portfolios/the-prisma-scr-prisma-extension-for-scoping-
reviews/

Tools shared with you
• JBI format for protocol
• Example protocol
• Example studies
• Gail Davidson Workbook for practice
• PRISMA-ScR checklist for reporting a scoping review

Time for questions

Thank you

Introduction to scoping reviews

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