The Gerontologist

cite as: Gerontologist, 2019, Vol. 59, No. 2, 197–201

doi:10.1093/geront/gny123
Advance Access publication January 30, 2019

Editorial

Methodological Guidance for a Quality Review Article

Patricia C.  Heyn, PhD, FGSA, FACRM,1,* Suzanne  Meeks, PhD, FGSA,2 and

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Rachel Pruchno, PhD, FGSA3
1
Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, Anschutz Medical
Campus, Denver. 2Department of Psychological and Brain Sciences, University of Louisville, Kentucky. 3New Jersey Institute
for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford.

*Address correspondence to: Patricia C. Heyn, PhD, FGSA, FACRM, Department of Physical Medicine and Rehabilitation, School of Medicine,
University of Colorado, Anschutz Medical Campus, 16031 W. 79th Place, Arvada, CO 80007. E-mail: Patricia.Heyn@ucdenver.edu

Readers of The Gerontologist are familiar with popula-
tion changes and projections that have spurred a surge in
gerontological research across disciplines. This prolifera-
tion of research increases the importance of high-quality
review and synthesis for moving research forward and
informing policy and practice. We have therefore witnessed
an increased number of systematic review publications in
the field of gerontology (Shenkin, Harrison, Wilkinson,
Dodds, & Ioannidis, 2017). In 2015, The Gerontologist
began accepting review articles and as of August 2018, The
Gerontologist has received more than 250 review submis-
sions. We are anticipating that this figure will double by
the end of 2019. In response to the high number of review
submissions and the need for rigorous evaluation, Patricia
C. Heyn, PhD, FGSA, joined The Gerontologist’s editorial
leadership team in 2017 as the Associate Editor for review
articles. Dr. Heyn, an expert in the synthesis and system-
atic review methodologies, has led efforts to redesign The
Gerontologist “Review Articles” section by formulating a
clear set of guidelines and instructions for authors interested
in submitting review articles to the journal. The goal of the
section is to produce and disseminate the best evidence
available in the field of gerontology. The purpose of this edi-
torial is to provide to The Gerontologist readers resources
and guidance to prepare a high-quality review report that
requires a thorough and updated search of the literature.
Systematic Literature Reporting Relies on
Synthesis and Appraisal Methods
Contemporary utilization of systematic synthesis meth-
odology is driven by the rapidly increasing number of
scientific publications in the last decades (Rapple, 2011).
Most of the review articles that use synthesis methods
(e.g., scoping review, systematic review, and meta-analy-
sis) have the goal to provide state-of-the-art knowledge
on a topic by summarizing data from primary published
studies and attempting to aggregate and reconcile the sci-
entific results from the individual studies. The synthesis
procedures should be unbiased, clearly organized, and
reproducible (Ketcham & Crawford, 2007). Although sci-
entists are usually recognized for their contribution in pri-
mary research, a timely and properly conducted literature
review can lead to best practices and improve the quality
of future research (Hampton & Parker, 2011). However,
for a review article to be valuable, it needs to be designed
and assembled in a rigorous, reproducible, and system-
atic fashion (Higgins, 2008; Mulrow, 1987) as originally
noted and developed by the Cochrane Collaboration
(1972), an international network of health care profes-
sionals. The popularity of published peer-reviewed articles
can lead to confusion about best practice for synthesizing
the evidence that will lead to appropriate rigor and trans-
parency (CEBM, 2001). A  well-designed and organized
review report should include five important and distinct
phases, as described in Figure 1.
Synthesis-Based Review Versus Narrative Review
A systematic literature review that is based on synthe-
sis methodology includes a protocol and results from
all available studies related to the topic of interest, and
provides a thorough analysis of the results, strengths, and
weaknesses of the collated studies. It addresses a focused,

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198 The Gerontologist, 2019, Vol. 59, No. 2

clearly formulated question and uses systematic and
explicit methods. Narrative Reviews are often just called
Reviews or Literature Review and they are usually opin-
ion review based on selective evidence from the literature.
Narrative review is based on informal process in which
studies are selected and examined in an undefined man-
ner. They do not qualify as adequate evidence to answer
clinical questions (Davidson & Iles, 2013). Rather than
answering a specific clinical question, they provide a
broad and shallow overview of the research landscape of
a given topic and so may be useful for background infor-
The Art of Combining Studies
The main objectives for undertaking a synthesis review
study are to minimize bias and maximize data interpret-
ation by combining and collating similar data from all
the relevant and available evidence. Therefore, to avoid
misleading or erroneous premises, a number of key meth-
odological conditions need to be satisfied. Since the imple-
mentation of the QUOROM (Quality Of Reporting Of
Meta-analysis) statement, a reporting guideline published
in 1999, there have been several conceptual, methodo-
logical, and practical advances regarding the conduct and

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mation. Narrative reviews usually lack systematic search
protocols or explicit criteria for selecting and appraising
evidence and are therefore very prone to bias (Davidson
& Iles, 2013). Synthesis-based reviews, but not narra-
tive reviews, will be considered for publication in The
Gerontologist.
•Establish a review study team and formulate the question
•Develop a priori protocol, database search and inclusion criteria
Phase 1:
Protocol •Register protocol in PROSPERO (https://www.crd.york.ac.uk/prospero/)
•Concepts, key word, and citation databases are defined
Phase 2:
•Search strategy process start with the assistance of librarian
•Download and managed citations with a bibliographic software
Search
reporting of reviews, and these are shown in Table  1. Of
these, the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) statement provides excel-
lent direction for authors developing research reviews.
The PRISMA statement (Liberati et  al., 2009) consists
of a 27-item checklist and a flow diagram: http://prisma-
statement.org/PRISMAStatement/Checklist. PRISMA was
designed to assure transparent reporting on a review and
provides a methodological framework to help prospective
authors of review studies to complete a high-level review to
adequately represent their specialties.

•Apply inclusion and exclusion criteria

•Cite reasons for exclusion and record exclusion in the database Scientific Reporting Relies on Transparency
Phase 3:
Inclusion
•Obtain full reports and reapply inclusion and exclusion criteria and Rigor
•Review each study for synthesis In addition to the methodologies shown in Table 1, many
Phase 4: •Extract the data (variables are pre-identified in the database)
•Critical appraisal: quality and bias assessment
journals have developed standards for scientific report-
Data
ing that emphasize transparency and rigor. Such stand-
•Evidence synthesis: data abstraction, analysis, and summaries ards have been endorsed by international groups such as
•Interpretation of findings (strengths and limitations)
Phase 5:
Report
•Recommendations and full report preparation the International Committee of Medical Journal Editors
•Publication
(ICMJE) and the Committee on Publication Ethics (COPE).
The ICMJE has published general standards for crafting sci-
Figure 1.  Evidence-based practice guided by transparency and rigor. entific articles, the “Uniform Requirements for Manuscripts

Table 1.  Review Article Reporting Standards

Source Description Website

EQUATOR Network The EQUATOR Network for Enhancing the Quality and www.equator-network.org
Transparency of Health Research gathers guidelines for reporting of
different types of trials and research studies. Includes CONSORT,
STROBE, PRISMA, MOOSE, RAMESES, and more.
PRISMA Statement PRISMA is an evidence-based minimum set of items for reporting in www.prisma-statement.org
systematic reviews and meta-analyses.
Cochrane Standards for Conduct The MECIR project aims to specify methodological expectations for training.cochrane.org/
and Reporting of New Reviews Cochrane Protocols, Reviews, and updates of reviews on the effects of resource/cochrane-standards-
interventions, and to ensure that these methodological expectations conduct-and-reporting-new-
are supported and implemented across The Cochrane Collaboration. reviews-interventions
IOM Standards for Systematic The IOM standards, promote objective, transparent, and scientifically www.nationalacademies.org/
Reviews valid systematic reviews. They address the entire systematic review pro- hmd/Reports/2011/Finding-
cess, from locating, screening, and selecting studies for the review, to syn- What-Works-in-Health-Care-
thesizing the findings (including meta-analysis) and assessing the overall Standards-for-Systematic-
quality of the body of evidence, to producing the final review report. Reviews/Standards.aspx

Note: EQUATOR = Enhancing the Quality and Transparency Of health Research; CONSORT = Consolidated Standards of Reporting Trials; STROBE = Strengthening
the Reporting of Observational Studies in Epidemiology; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; MECIR = Methodological
Expectations of Cochrane Intervention Reviews; IOM = Institutes of Medicine
The Gerontologist, 2019, Vol. 59, No. 2
Submitted to Biomedical Journals: Writing and Editing for
Biomedical Publication” (ICMJE, 2009). These guidelines
include suggestions for manuscript preparation and guide-
lines for ethical matters related to publishing, and these
standards apply to review papers as much as to primary
research papers.
Review Typology
Many synthesis methods, variants of the classical system-
atic review method, have emerged in the recent years.
Table 2 shows the most common methods currently in use,
those most likely to be acceptable for The Gerontologist.
Determining the unique contribution of each of these syn-
thesis methods and selecting the most suitable method can
be challenging. The various synthesis types and methodolo-
gies rely on different aspects of the available literature such
as the current state of the knowledge on a specific topic,
how narrow or broad the synthesis will be, as well as the
quality of the current evidence. For detailed information
about the different types of review methodology, Grant and
Booth (2009) provide a comprehensive summary of the
most common types of review methods. Here we summar-
ize the features of the two most popular types.
Systematic reviews (SRs) and meta-analyses (MAs) have
become more and more popular (Moher, Cook, Eastwood,
Olkin, Rennie, & Stroup, 1999), and can offer the highest
grade of evidence (Figure 2) for driving the decision-making
process for consumers, clinicians, funders, payers, research-
ers, and policy-makers. Both SRs and MAs have well-estab-
lished standardized methods for the conduct and reporting,
codified in the Institute of Medicine (IOM) standards and
PRISMA reporting guidelines. SRs are the most common
review approach. They have the goal to appraise, synthe-
size, and summarize current knowledge, and to reconcile
conflicting scientific results from individual primary studies.
They use comprehensive, objective, explicit, and transpar-
ent methods, allowing the reader to follow how conclusions
were reached, duplicate the study, and to generalize the find-
ings (Ketcham & Crawford, 2007). SRs may indicate that
further primary research is needed in areas where no evi-
dence exists or that current evidence is inconclusive. They are
essential knowledge translation tools for researchers, prac-
titioners, and policy-makers who are especially struggling
to keep up with the accumulating, ever-increasing, body of
evidence (Hampton & Parker, 2011). A  well-designed SR
may or may not include an MA that includes statistical pro-
cedures and data (i.e., effect sizes) to reflect a best estimate
of the accumulated evidence. The MA method requires the
studies to have the same outcome measure (Ottenbacher,
Heyn, & Abreu, 2017). Reviews based on synthesis method-
ology, such as SRs and MAs, may be undertaken to confirm
whether current practice is based on evidence (or not) and
to address any uncertainty or variation in practice that may
be occurring. They are also helpful in identifying where evi-
dence is scarce or misleading and can help categorize future
199
research. Most importantly, they are used to produce state-
ments to guide decision making.
Many published reviews are founded upon a select-
ive sample of elementary research and/or rely on expert
opinion lacking the desirable unbiased and systematic
method approach. Thus, they are more akin to narrative
reviews (Bhandari, Morrow, Kulkarni, & Tornetta, 2001;
McKibbon, 1998; Sacks, Reitman, Pagano, & Kupelnick,
1996). The inclusion of poor-quality studies without sub-
stantial appraisal can also mislead the scientific field
(ICMJE, 2009). The overall interpretation of findings
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should be considered with respect to the strength of the best
available evidence to date, the methodological quality and
appraisal of the studies, consistency across studies, applic-
ability to practice, implementation, and generalizability.
Publishing Your Review Article in The
Gerontologist
Prior to deciding what type of review method to conduct,
authors should be knowledgeable about the different review
typologies and synthesis methods to adequately address
the breadth and depth of the research that will be under-
taken. Despite the type of synthesis methodology that the
review article is presenting, The Gerontologist welcomes
review articles that use synthesis methods (such as scop-
ing/systematic review, meta-analysis) that are guided by the
best scientific reporting standards according to the IOM,
PRISMA, and Cochrane. Therefore, authors are expected
to clearly define the review typology (i.e., meta-analysis or
scoping review or systematic review) and the rationale for
the selected methodology in the article. The PRISMA flow
chart and checklist should be included with the submission.
In addition, literature appraisal and evidence quality
evaluation methods are likewise important (Higgins, 2008;
Ottenbacher, Heyn, & Abreu, 2017). Given the significance
of transparency in reporting review articles, authors should
report the study protocol and synthesis results by using sup-
plementary tables such as the “Studies Characteristics” table
(i.e., publication year, study design type, sample size, age,
and diagnosis), and any other pertinent information about
the review protocol such as the search terms, search dates,
and the databases that were used to obtain the included
studies and list the exclusion reasons. The search date
should be up-to-date when submitting the review article to
the journal. Authors should consider including a librarian,
as a function of the expert review team, to comprehensively
design, execute, and update the search, compile the cita-
tions, create a search strategy appendix, and compose the
appropriate components of the methods section.
Because of the limited page budget  allotted for print
publications and the tendency for review articles to be
lengthy, The Gerontologist publish review articles online
only (i.e., the article title would appear in the Table of
Contents for print issues of the journal, but the article itself
would appear online only). Review articles will go through
200
Table 2.  Common Variation in Evidence Synthesis Methodology: Review Article Type
Review type
Meta-analysis
It adheres to the best guidelines and
seeks to systematically search for,
appraise, and synthesize the literature
in an unbiased fashion. It includes
and is characterized by unique
statistical techniques that combine
the results of the included studies to
characterize the current literature
and make recommendations.
Systematic review
It is similar to a meta-analysis
review, but it does not use statistical
procedures to combine the results
of the included studies. It adheres
to the best guidelines and seeks to
systematically search for, appraise,
and synthesize the literature.
Scoping review
It is considered a preliminary
assessment of the size and scope of
the literature. A form of knowledge
synthesis that addresses an
exploratory research question aimed
at mapping key concepts, types
of evidence, and gaps in research
related to a defined area or field by
systematically searching, selecting,
and synthesizing existing knowledge.
Rapid review
Evaluates what is already known
about a policy or practice issue by
applying systematic review methods.
Mapping review
Map out and categorize existing
literature from which to commission
further reviews and/or primary
research by identifying gaps in the
research literature.
Umbrella/Overview review
Compile the evidence from multiple
reviews into one review report.
Note: PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses
The Gerontologist, 2019, Vol. 59, No. 2
Search method Type of synthesis
• Comprehensive and unbiased search strategy. • Statistically combines the data
• Follow PRISMA Statement and procedures. (i.e., outcomes, effect sizes) of
• It is usually based on a priori protocol. the included studies.
• It includes comprehensive literature appraisal results, • It uses data visualization to
evidence quality level, and summaries in tabular data. communicate clearly and
• It includes statistical analysis like effect size estimations. efficiently. Display graphical and
• Includes the PRISMA flow chart and checklist. tabular data with summaries and
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• Includes literature quality appraisal. narrative.
• It generates strong recommendations for the field.
• Comprehensive and unbiased search strategy. • Synthesis is well-planned and
• Follow PRISMA Statement and procedures. organized based on graphical
• Based on a priori protocol. and tabular data visualization
• Should include comprehensive literature appraisal, with summaries and narrative.
quality, and future recommendations.
• Data synthesis is presented in a table (tabular data).
• Although the search strategy is flexible, the scoping • Synthesis methods are organized,
review should be comprehensive and unbiased. and they might include
• The review is determined by time/scope constraints. summaries and narrative.
• It does not require a priori protocol. • Tables, graphics, and related
•  It identifies areas of weaknesses and strengths in the topic. data visualization are included as
• Literature appraisal is not required, but recommended. appropriate.
• Recommendations for practice or future research are
usually inconclusive and subtle since the aim of this
method is to scope the current literature.
• The synthesis should be presented in a table (tabular data).
• Comprehensive search strategy guided by PRISMA • Based on a narrative and tabular
Statement. synthesis.
• The search strategy is flexible, but it should be unbiased • It might include some sort of
and comprehensive. data visualization techniques
• Literature appraisal is not required but recommended. (i.e., table, graphics).
• It identifies areas of weakness and strengths in the topic.
• Recommendations for future practice and/or research are
included.
• The search strategy is determined by time/scope • Based on a narrative and tabular
constraints. format to depict a summary of
• No formal literature appraisal. literature characteristics.
• Recommendations for future practice and/or research are • May include some sort of data
included. visualization techniques (i.e.,
table, graphics).
• Similar to the systematic review approach but does • Graphical and tabular data visu-
not include primary studies only systematic reviews/ alization with summaries and
meta-analysis. narrative.
• It is based on a priori protocol and includes PRISMA flow
chart and appraisal of the included review studies (i.e.,
AMSTAR, ROBIS).
The Gerontologist, 2019, Vol. 59, No. 2
Figure 2.  Levels of evidence. The figure represents the hierarchy of evi-
dence provided by the National Health and Medical Research Council
(NHMRC, 2009).
the same peer review and editing processes that any other
published articles in The Gerontologist undergo. Articles
will receive a DOI, be searchable, and will be available
electronically. Review article submissions are allowed up to
8,000 words in length.
In closing, The Gerontologist publishes research and
analysis on applied social issues with the aim to inform
the broader community of disciplines and professions in
understanding the aging process and providing care to older
adults. The inauguration and expansion of the “Review
Article” section have contributed greatly to the field, having
resulted in the publication of numerous original review arti-
cles since 2015. We have no doubts that our review articles
will influence positively the future of gerontological research
and practice and that the gerontological community will
continue to help us in building the best evidence in the field.
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