Methods for depicting overlap in overviews of systematic reviews: An introduction to static tabular and graphical displays

  • Konstantinos I. Bougioukas
    Affiliations
    Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
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  • Elpida Vounzoulaki
    Affiliations
    Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK

    National Institute for Health Research Applied Research Collaboration-East Midlands, Leicester Diabetes Centre, Leicester LE5 4PW, UK
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  • Chrysanthi D. Mantsiou
    Affiliations
    Second Medical Department, Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
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  • Eliophotos D. Savvides
    Affiliations
    1st Department of Urology, Medical School, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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  • Christina Karakosta
    Affiliations
    Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
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  • Theodoros Diakonidis
    Affiliations
    Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
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  • Apostolos Tsapas
    Affiliations
    Second Medical Department, Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Second Medical Department, Diabetes Centre, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Harris Manchester College, University of Oxford, Oxford, UK
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  • Anna-Bettina Haidich
    Correspondence
    Corresponding author. Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
    Affiliations
    Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
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Published:December 08, 2020DOI:https://doi.org/10.1016/j.jclinepi.2020.12.004

      Abstract

      Background and Objective

      To introduce potential static tabular and graphical techniques for visually presenting overlap between systematic reviews (SRs) included in overviews of systematic reviews (OoSRs).

      Methods

      The graphical approaches described include Venn and Euler diagrams, as well as matrix-based, node-link, and aggregation-based techniques. We used fundamental concepts of mathematics from set and network theory to develop our novel graphical approaches. The graphical displays were created using R.

      Results

      Overview authors have the flexibility to choose from a variety of visualizations, depending on the characteristics of their study. If the OoSRs include few SRs, a Venn or an Euler diagram can be used. In case of OoSRs with more SRs, Upset plots, heatmaps, and node-link graphs are more appropriate for visualizing overlapping SRs. Stacked bar plots constitute an aggregation-based technique of illustrating overlap. Strengths and limitations of each graphical approach are presented.

      Conclusion

      The degree of overlap should be explored for the entire study and for specific outcomes of interest. The proposed graphical techniques may assist methodologists and authors in identifying overlap, which in turn may improve validity and transparency in OoSRs. More research is needed to understand which technique would be most useful and easiest to understand.

      Graphical abstract

      Keywords

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      References

        • Hartling L.
        • Chisholm A.
        • Thomson D.
        • Dryden D.M.
        A descriptive analysis of overviews of reviews published between 2000 and 2011.
        PLoS One. 2012; 7
        • Hartling L.
        • Vandermeer B.
        • Fernandes R.M.
        Systematic reviews, overviews of reviews and comparative effectiveness reviews: a discussion of approaches to knowledge synthesis.
        Evidence Based Child Heal. 2014; 9: 486-494
        • McKenzie J.E.
        • Brennan S.E.
        Overviews of systematic reviews: great promise, greater challenge.
        Syst Rev. 2017; 6: 185
        • Bougioukas K.I.
        • Bouras E.
        • Apostolidou-Kiouti F.
        • Kokkali S.
        • Arvanitidou M.
        • Haidich A.-B.
        Reporting guidelines on how to write a complete and transparent abstract for overviews of systematic reviews of health care interventions.
        J Clin Epidemiol. 2019; 106: 70-79
        • Bougioukas K.I.
        • Liakos A.
        • Tsapas A.
        • Ntzani E.
        • Haidich A.B.
        Preferred reporting items for overviews of systematic reviews including harms checklist: a pilot tool to be used for balanced reporting of benefits and harms.
        J Clin Epidemiol. 2018; 93: 9-24
        • Hunt H.
        • Pollock A.
        • Campbell P.
        • Estcourt L.
        • Brunton G.
        An introduction to overviews of reviews: planning a relevant research question and objective for an overview.
        Syst Rev. 2018; 7: 39
        • Lunny C.
        • Brennan S.E.
        • McDonald S.
        • McKenzie J.E.
        Toward a comprehensive evidence map of overview of systematic review methods: paper 1-purpose, eligibility, search and data extraction.
        Syst Rev. 2017; 6: 231
        • Lunny C.
        • Brennan S.E.
        • McDonald S.
        • McKenzie J.E.
        Toward a comprehensive evidence map of overview of systematic review methods: paper 2 - risk of bias assessment; Synthesis, presentation and summary of the findings; and assessment of the certainty of the evidence.
        Syst Rev. 2018; 7
        • Ballard M.
        • Montgomery P.
        Risk of bias in overviews of reviews: a scoping review of methodological guidance and four-item checklist.
        Res Synth Methods. 2017; 8: 92-108
        • Pollock M.
        • Fernandes R.M.
        • Newton A.S.
        • Scott S.D.
        • Hartling L.
        The impact of different inclusion decisions on the comprehensiveness and complexity of overviews of reviews of healthcare interventions.
        Syst Rev. 2019; 8: 18
        • Pollock M.
        • Fernandes R.M.
        • Hartling L.
        Evaluation of AMSTAR to assess the methodological quality of systematic reviews in overviews of reviews of healthcare interventions.
        BMC Med Res Methodol. 2017; 17: 48
        • Pollock A.
        • Campbell P.
        • Brunton G.
        • Hunt H.
        • Estcourt L.
        Selecting and implementing overview methods: implications from five exemplar overviews.
        Syst Rev. 2017; 6: 145
        • Hennessy E.A.
        • Johnson B.T.
        • Keenan C.
        Best practice guidelines and essential methodological steps to conduct rigorous and systematic meta-reviews.
        Appl Psychol Health Well Being. 2019; 11: 353-381
        • Pieper D.
        • Antoine S.L.
        • Mathes T.
        • Neugebauer E.A.M.
        • Eikermann M.
        Systematic review finds overlapping reviews were not mentioned in every other overview.
        J Clin Epidemiol. 2014; 67: 368-375
        • Lunny C.
        • Brennan S.E.
        • Reid J.
        • McDonald S.
        • McKenzie J.E.
        Overviews of reviews incompletely report methods for handling overlapping, discordant and problematic data.
        J Clin Epidemiol. 2020; 118: 69-85
        • Cooper H.
        • Koenka A.C.
        The overview of reviews: unique challenges and opportunities when research syntheses are the principal elements of new integrative scholarship.
        Am Psychol. 2012; 67: 446-462
        • Hennessy E.A.
        • Johnson B.T.
        Examining overlap of included studies in meta-reviews: guidance for using the corrected covered area index.
        Res Synth Methods. 2020; 11: 134-145
        • Pollock M.
        • Fernandes R.M.
        • Newton A.S.
        • Scott S.D.
        • Hartling L.
        A decision tool to help researchers make decisions about including systematic reviews in overviews of reviews of healthcare interventions.
        Syst Rev. 2019; 8: 29
        • Pollock P.
        • Fernandes R.
        • Becker L.A.
        • Dawid P.
        • Hartling L.
        Chapter V: overviews of reviews.
        in: Higgins J.P.T. Thomas J. Chandler J. Cumpston M. Li T. Page M.J.W.V. Cochrane Handbook for Systematic Reviews of Interventions version 6.1 (updated September 2020). Cochrane, 2020
        • Alsallakh B.
        • Micallef L.
        • Aigner W.
        • Hauser H.
        • Miksch S.
        • Rodgers P.
        The state-of-the-art of set visualization.
        Comput Graph Forum. 2016; 35: 234-260
        • Alsallakh B.
        • Ren L.
        PowerSet: a comprehensive visualization of set intersections.
        IEEE Trans Vis Comput Graph. 2017; 23: 361-370
        • Alsallakh B.
        • Aigner W.
        • Miksch S.
        • Hauser H.
        Radial sets: interactive visual analysis of large overlapping sets.
        IEEE Trans Vis Comput Graph. 2013; 19: 2496-2505
        • Conway J.R.
        • Lex A.
        • Gehlenborg N.
        UpSetR: an R package for the visualization of intersecting sets and their properties.
        Bioinformatics. 2017; 33: 2938-2940
        • Pavlopoulos G.A.
        • Kontou P.I.
        • Pavlopoulou A.
        • Bouyioukos C.
        • Markou E.
        • Bagos P.G.
        Bipartite graphs in systems biology and medicine: a survey of methods and applications.
        Gigascience. 2018; 7: 1-31
        • Lex A.
        • Gehlenborg N.
        Sets and intersections.
        Nat Methods. 2014; 11: 779
        • Newman M.
        Chapter 6: mathematics of networks.
        in: Newman M. Networks An Introd. 2nd ed. Oxford University Press, Oxford2018
        • R Core Team. R
        A Language and Environment for Statistical Computing.
        2020
        • Byrne P.
        • Cullinan J.
        • Smith A.
        • Smith S.M.
        Statins for the primary prevention of cardiovascular disease: an overview of systematic reviews.
        BMJ Open. 2019; 9: e023085
        • Xing D.
        • Wang Q.
        • Yang Z.
        • Hou Y.
        • Zhang W.
        • Chen Y.
        • et al.
        Mesenchymal stem cells injections for knee osteoarthritis: a systematic overview.
        Rheumatol Int. 2018; 38: 1399-1411
        • Wells C.
        • Kolt G.S.
        • Marshall P.
        • Hill B.
        • Bialocerkowski A.
        Effectiveness of Pilates exercise in treating people with chronic low back pain: a systematic review of systematic reviews.
        BMC Med Res Methodol. 2013; 13: 7
        • Miyazaki C.
        • Tanase-Nakao K.
        • Arata N.
        • Mori R.
        • Kawasaki M.
        • Ota E.
        Nonpharmacological interventions to prevent type 2 diabetes in women diagnosed with gestational diabetes mellitus: a systematic overview.
        Diabetol Int. 2017; 8: 160-180
        • Lex A.
        • Gehlenborg N.
        • Strobelt H.
        • Vuillemot R.
        • Pfister H.
        UpSet: visualization of intersecting sets.
        IEEE Trans Vis Comput Graph. 2014; 20: 1983-1992
        • Pérez-Bracchiglione J.
        • Niño de Guzmán E.
        • Roqué Figuls M.
        • Urrútia G.
        Graphical representation of overlap degree of primary studies in systematic reviews included in overviews. Abstr. 26th Cochrane Colloquium, Santiago, Chile.
        Cochrane Database Syst Rev. 2020; 1: 151-152
        • Zhou T.
        • Ren J.
        • Medo M.
        • Zhang Y.-C.
        Bipartite network projection and personal recommendation.
        Phys Rev E Stat Nonlin Soft Matter Phys. 2007; 76: 46115
        • Kho M.E.
        • Poitras V.J.
        • Janssen I.
        • Chaput J.-P.
        • Saunders T.J.
        • Giangregorio L.M.
        • et al.
        Development and application of an outcome-centric approach for conducting overviews of reviews.
        Appl Physiol Nutr Metab. 2020; 45: S151-S164
        • Chen S.-Y.
        • Zhang X.-R.
        • Chen J.
        • Ge W.-Q.
        • Wang W.-W.
        • Wang X.-S.
        • et al.
        An overview of meta-analyses of endovascular bridging therapies for acute ischemic stroke.
        Biomed Res Int. 2018; 2018: 9831210
        • Grassi A.
        • Compagnoni R.
        • Ferrua P.
        • Zaffagnini S.
        • Berruto M.
        • Samuelsson K.
        • et al.
        Patellar resurfacing versus patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 3206-3218
        • Ooi S.L.
        • Giovino M.
        • Pak S.C.
        Transcendental meditation for lowering blood pressure: an overview of systematic reviews and meta-analyses.
        Complement Ther Med. 2017; 34: 26-34
        • Schussel V.
        • Kenzo L.
        • Santos A.
        • Bueno J.
        • Yoshimura E.
        • de Oliveira Cruz Latorraca C.
        • et al.
        Cannabinoids for nausea and vomiting related to chemotherapy: overview of systematic reviews.
        Phytother Res. 2018; 32: 567-576
        • Wijnhoven B.P.L.
        • Van Lanschot JJB
        • Tilanus H.W.
        • Steyerberg E.W.
        • Van Der Gaast A.
        Neoadjuvant chemoradiotherapy for esophageal cancer: a review of meta-analyses.
        World J Surg. 2009; 33: 2606-2614
        • Young B.
        • Wynn P.M.
        • He Z.
        • Kendrick D.
        Preventing childhood falls within the home: overview of systematic reviews and a systematic review of primary studies.
        Accid Anal Prev. 2013; 60: 158-171
        • Xing D.
        • Wang B.
        • Zhang W.
        • Yang Z.
        • Hou Y.
        • Chen Y.
        • et al.
        Intra-articular platelet-rich plasma injections for knee osteoarthritis: an overview of systematic reviews and risk of bias considerations.
        Int J Rheum Dis. 2017; 20: 1612-1630
        • Tamayo-Velázquez M.-I.
        • Simón-Lorda P.
        • Villegas-Portero R.
        • Higueras-Callejón C.
        • García-Gutiérrez J.-F.
        • Martínez-Pecino F.
        • et al.
        Interventions to promote the use of advance directives: an overview of systematic reviews.
        Patient Educ Couns. 2010; 80: 10-20
        • Bidonde J.
        • Busch A.J.
        • Bath B.
        • Milosavljevic S.
        Exercise for adults with fibromyalgia: an umbrella systematic review with synthesis of best evidence.
        Curr Rheumatol Rev. 2014; 10: 45-79
        • Fishta A.
        • Backe E.-M.
        Psychosocial stress at work and cardiovascular diseases: an overview of systematic reviews.
        Int Arch Occup Environ Health. 2015; 88: 997-1014
        • Guo P.-P.
        • Li P.
        • Zhang X.-H.
        • Liu N.
        • Wang J.
        • Chen D.-D.
        • et al.
        Complementary and alternative medicine for natural and treatment-induced vasomotor symptoms: an overview of systematic reviews and meta-analyses.
        Complement Ther Clin Pract. 2019; 36: 181-194
        • Andersen J.H.
        • Fallentin N.
        • Thomsen J.F.
        • Mikkelsen S.
        Risk factors for neck and upper extremity disorders among computers users and the effect of interventions: an overview of systematic reviews.
        PLoS One. 2011; 6: e19691
        • Plaszewski M.
        • Bettany-Saltikov J.
        Are current scoliosis school screening recommendations evidence-based and up to date? A best evidence synthesis umbrella review.
        Eur Spine J. 2014; 23: 2572-2585
        • List T.
        • Axelsson S.
        Management of TMD: evidence from systematic reviews and meta-analyses.
        J Oral Rehabil. 2010; 37: 430-451
        • Ilomäki J.
        • Jokanovic N.
        • Tan E.C.K.
        • Lönnroos E.
        Alcohol consumption, dementia and cognitive decline: an overview of systematic reviews.
        Curr Clin Pharmacol. 2015; 10: 204-212