Hello all, welcome back after a long break. Hope you have registered your review in PROSPERO by now. We are now moving to the crucial yet less discussed step of a systematic review, which is developing the search terms. Search terms are the engine of a systematic review. If it is in the right direction, it reaches the destination but if it’s in a wrong direction, it can mislead you, and you might not reach your end-point. The search in a systematic review should be as extensive as possible to ensure that all necessary and relevant articles are included. After all, you are generating the evidence!

Before you run the search and retrieve articles, be careful about what and how many search terms you have used. Ask for help if you are unsure about it. Many of my friends have asked me about it, and I have told the same thing which I am going to tell you now…Using more search terms is not wrong but using fewer terms might lead to missing of some pertinent articles. Don’t be scared to use as many terms as possible in the beginning, and later you can delete the irrelevant terms. Let’s see the stepwise procedure.

  • Decide your keywords:

You begin by deciding your keywords. Keywords are the words which summarize your topic. You have to use your PICO terms for deciding your keywords. E.g., if my topic is ‘Effect of TENS on spasticity in adults with stroke’ then my keywords will be ‘TENS’ AND ‘Spasticity’ AND ‘Stroke.’ We also call keywords as concepts.

  • Expand each keyword:

Now that you have decided your keywords start growing the terms for each concept/keyword. You can do that by looking for synonyms for each word. Add singular as well as plural words, e.g., activity and activities. You can use variant spellings, e.g., Disc and disk. You may also add other related terms to widen your search.  Truncation and wildcards are other smart ways to retrieve related articles. E.g., for truncation is ‘random*,’ if you use this truncation, then it will search all terms related to random, i.e., random or randomised or randomized or randomly, etc. E.g., for wildcards is ‘wom?n’  so it will include articles with both woman or women. Another simple way to look for synonyms is jotting down all the MeSH terms of the keyword from PubMed and Cochrane. I have attached the pictures on how to search for MeSH terms. You can also add synonym by going to the appendix of any Cochrane review done on a similar topic and writing down the words used in its search strategy.

Finding MeSH terms in COCHRANE
Finding MeSH terms in PubMed
  • Tabulate the search terms:

For clarity and convenience while running a search, tabulate all your keywords as shown below using the same example of keywords as given earlier.

Stroke TENS Spasticity
cerebrovascular accidents transcutaneous electric nerve stimulation stretch reflex
cerebrovascular disease transcutaneous nerve stimulation muscle hypertonia
brain ischemia transcutaneous electrical neurostimulation spasm
carotid artery disease percutaneous neural stimulation clonus
intracranial embolism micro amperage electrical stimulation spastic paresis
intracranial thrombosis transcutaneous electric stimulation hypermyotone
intracranial hemorrhage   high tone
brain infarction   hypertonia
vertebral artery dissection   hypertonicity
hemiplegia   hyper reflexia
hemiparesis   hyperreflexia
monoparesis   hyper-reflexia
cerebral vascular disorder   spastic reflex
cerebellar vascular disorder   spastic
brainstem vascular disorders    
vertebrobasilar vascular disorders    
subarachnoid hemorrhage    
intracranial aneurysm    
infratentorial hemorrhage,    
supratentorial hemorrhage    
lacunar stroke    
intracranial arteriovenous malformations    
brain attack    
Final result = R1 R2 R3
  • Build your search strategy:

Now build your search strategy by joining the terms under each column with Boolean ‘OR’. Suppose after adding all terms, you get the final result as R1, R2, and R3 for each column respectively, then add all of these with Boolean ‘AND,’ i.e., R1 AND R2 AND R3. You can even add ‘NOT’ if you want to exclude a few terms specifically. See the example in the picture below.

Combining terms with Boolean OR
Combining terms with Boolean AND
  • Running the search:

Once you have completed the herculean task of developing the search terms, you can go ahead with running the search in different databases. You should also include conference abstract and other grey literature. Another important source which may have potential articles are trials registers of ongoing and unpublished trials.

  • Few tips:

Keep a record of all the databases searched and number of articles retrieved from each database. Save the search strategy and include it in the appendix of your manuscript. Additionally, try to keep a fine balance between precision and comprehensiveness. Which means that you should try to keep your search extensive but not so extensive that you retrieve more irrelevant articles. Don’t worry; it will come with practice and experience. Let me know if you have any muddles while building your search strategy.



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