systematic literature review vs narrative literature review

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The Difference Between Narrative Review and Systematic Review

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Reviews in scientific research are tools that help synthesize literature on a topic of interest and describe its current state. Different types of reviews are conducted depending on the research question and the scope of the review. A systematic review is one such review that is robust, reproducible, and transparent. It involves collating evidence by using all of the eligible and critically appraised literature available on a certain topic. To know more about how to do a systematic review , you can check out our article at the link. The primary aim of a systematic review is to recommend best practices and inform policy development. Hence, there is a need for high-quality, focused, and precise methods and reporting. For more exploratory research questions, methods such as a scoping review are employed. Be sure you understand the difference between a systematic review and a scoping review , if you don’t, check out the link to learn more.

When the word “review” alone is used to describe a research paper, the first thing that should come to mind is that it is a literature review. Almost every researcher starts off their career with literature reviews. To know the difference between a systematic review and a literature review , read on here.  Traditional literature reviews are also sometimes referred to as narrative reviews since they use narrative analysis to synthesize data. In this article, we will explore the differences between a systematic review and a narrative review, in further detail.

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Narrative Review vs Systematic Review

Both systematic and narrative reviews are classified as secondary research studies since they both use existing primary research studies e.g. case studies. Despite this similarity, there are key differences in their methodology and scope. The major differences between them lie in their objectives, methodology, and application areas.

Differences In Objective

The main objective of a systematic review is to formulate a well-defined research question and use qualitative and quantitative methods to analyze all the available evidence attempting to answer the question. In contrast, narrative reviews can address one or more questions with a much broader scope. The efficacy of narrative reviews is irreplaceable in tracking the development of a scientific principle, or a clinical concept. This ability to conduct a wider exploration could be lost in the restrictive framework of a systematic review.

Differences in Methodology

For systematic reviews, there are guidelines provided by the Cochrane Handbook, ROSES, and the PRISMA statement that can help determine the protocol, and methodology to be used. However, for narrative reviews, such standard guidelines do not exist. Although, there are recommendations available.

Systematic reviews comprise an explicit, transparent, and pre-specified methodology. The methodology followed in a systematic review is as follows,

• Formulating the clinical research question to answer (PICO approach)
• Developing a protocol (with strict inclusion and exclusion criteria for the selection of primary studies)
• Performing a detailed and broad literature search
• Critical appraisal of the selected studies
• Data extraction from the primary studies included in the review
• Data synthesis and analysis using qualitative or quantitative methods [3].
• Reporting and discussing results of data synthesis.
• Developing conclusions based on the findings.

A narrative review on the other hand does not have a strict protocol to be followed. The design of the review depends on its author and the objectives of the review. As yet, there is no consensus on the standard structure of a narrative review. The preferred approach is the IMRAD (Introduction, Methods, Results, and Discussion) [2]. Apart from the author’s preferences, a narrative review structure must respect the journal style and conventions followed in the respective field.

Differences in Application areas

Narrative reviews are aimed at identifying and summarizing what has previously been published. Their general applications include exploring existing debates, the appraisal of previous studies conducted on a certain topic, identifying knowledge gaps, and speculating on the latest interventions available. They are also used to track and report on changes that have occurred in an existing field of research. The main purpose is to deepen the understanding in a certain research area. The results of a systematic review provide the most valid evidence to guide clinical decision-making and inform policy development [1]. They have now become the gold standard in evidence-based medicine [1].

Although both types of reviews come with their own benefits and limitations, researchers should carefully consider the differences between them before making a decision on which review type to use.

• Aromataris E, Pearson A. The systematic review: an overview. AJN. Am J Nurs. 2014;114(3):53–8.
• Green BN, Johnson CD, Adams A. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Chiropratic Medicine 2006;5:101–117.
• Linares-Espinós E, Hernández V, Domínguez-Escrig JL, Fernández-Pello S, Hevia V, Mayor J, et al. Metodología de una revisión sistemática. Actas Urol Esp. 2018;42:499–506.

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Systematic, Scoping, and Other Literature Reviews: Overview

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What Is a Systematic Review?

Regular literature reviews are simply summaries of the literature on a particular topic. A systematic review, however, is a comprehensive literature review conducted to answer a specific research question. Authors of a systematic review aim to find, code, appraise, and synthesize all of the previous research on their question in an unbiased and well-documented manner. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) outline the minimum amount of information that needs to be reported at the conclusion of a systematic review project. 

Other types of what are known as "evidence syntheses," such as scoping, rapid, and integrative reviews, have varying methodologies. While systematic reviews originated with and continue to be a popular publication type in medicine and other health sciences fields, more and more researchers in other disciplines are choosing to conduct evidence syntheses. 

This guide will walk you through the major steps of a systematic review and point you to key resources including Covidence, a systematic review project management tool. For help with systematic reviews and other major literature review projects, please send us an email at  [email protected] .

Getting Help with Reviews

Organization such as the Institute of Medicine recommend that you consult a librarian when conducting a systematic review. Librarians at the University of Nevada, Reno can help you:

• Understand best practices for conducting systematic reviews and other evidence syntheses in your discipline
• Choose and formulate a research question
• Decide which review type (e.g., systematic, scoping, rapid, etc.) is the best fit for your project
• Determine what to include and where to register a systematic review protocol
• Select search terms and develop a search strategy
• Identify databases and platforms to search
• Find the full text of articles and other sources
• Become familiar with free citation management (e.g., EndNote, Zotero)
• Get access to you and help using Covidence, a systematic review project management tool

Doing a Systematic Review

• Plan - This is the project planning stage. You and your team will need to develop a good research question, determine the type of review you will conduct (systematic, scoping, rapid, etc.), and establish the inclusion and exclusion criteria (e.g., you're only going to look at studies that use a certain methodology). All of this information needs to be included in your protocol. You'll also need to ensure that the project is viable - has someone already done a systematic review on this topic? Do some searches and check the various protocol registries to find out. 
• Identify - Next, a comprehensive search of the literature is undertaken to ensure all studies that meet the predetermined criteria are identified. Each research question is different, so the number and types of databases you'll search - as well as other online publication venues - will vary. Some standards and guidelines specify that certain databases (e.g., MEDLINE, EMBASE) should be searched regardless. Your subject librarian can help you select appropriate databases to search and develop search strings for each of those databases.  
• Evaluate - In this step, retrieved articles are screened and sorted using the predetermined inclusion and exclusion criteria. The risk of bias for each included study is also assessed around this time. It's best if you import search results into a citation management tool (see below) to clean up the citations and remove any duplicates. You can then use a tool like Rayyan (see below) to screen the results. You should begin by screening titles and abstracts only, and then you'll examine the full text of any remaining articles. Each study should be reviewed by a minimum of two people on the project team. 
• Collect - Each included study is coded and the quantitative or qualitative data contained in these studies is then synthesized. You'll have to either find or develop a coding strategy or form that meets your needs. 
• Explain - The synthesized results are articulated and contextualized. What do the results mean? How have they answered your research question?
• Summarize - The final report provides a complete description of the methods and results in a clear, transparent fashion. 

Adapted from

Types of reviews, systematic review.

These types of studies employ a systematic method to analyze and synthesize the results of numerous studies. "Systematic" in this case means following a strict set of steps - as outlined by entities like PRISMA and the Institute of Medicine - so as to make the review more reproducible and less biased. Consistent, thorough documentation is also key. Reviews of this type are not meant to be conducted by an individual but rather a (small) team of researchers. Systematic reviews are widely used in the health sciences, often to find a generalized conclusion from multiple evidence-based studies. 

Meta-Analysis

A systematic method that uses statistics to analyze the data from numerous studies. The researchers combine the data from studies with similar data types and analyze them as a single, expanded dataset. Meta-analyses are a type of systematic review.

Scoping Review

A scoping review employs the systematic review methodology to explore a broader topic or question rather than a specific and answerable one, as is generally the case with a systematic review. Authors of these types of reviews seek to collect and categorize the existing literature so as to identify any gaps.

Rapid Review

Rapid reviews are systematic reviews conducted under a time constraint. Researchers make use of workarounds to complete the review quickly (e.g., only looking at English-language publications), which can lead to a less thorough and more biased review. 

Narrative Review

A traditional literature review that summarizes and synthesizes the findings of numerous original research articles. The purpose and scope of narrative literature reviews vary widely and do not follow a set protocol. Most literature reviews are narrative reviews. 

Umbrella Review

Umbrella reviews are, essentially, systematic reviews of systematic reviews. These compile evidence from multiple review studies into one usable document. 

Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal , vol. 26, no. 2, 2009, pp. 91-108. doi: 10.1111/j.1471-1842.2009.00848.x .

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Reproduced from Grant, M. J. and Booth, A. (2009), A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26: 91–108. doi:10.1111/j.1471-1842.2009.00848.x

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Literature Review vs Systematic Review

• Literature Review vs. Systematic Review
• Primary vs. Secondary Sources
• Databases and Articles
• Specific Journal or Article

Subject Guide

Definitions

It’s common to confuse systematic and literature reviews because both are used to provide a summary of the existent literature or research on a specific topic. Regardless of this commonality, both types of review vary significantly. The following table provides a detailed explanation as well as the differences between systematic and literature reviews. 

Kysh, Lynn (2013): Difference between a systematic review and a literature review. [figshare]. Available at:  http://dx.doi.org/10.6084/m9.figshare.766364

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Systematic Review Process: Types of Reviews

• Definitions of a Systematic Review

Types of Reviews

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• Resources Needed to Conduct a Review
• Reporting Guidelines
• Where to Search
• How to Search
• Screening and Study Selection
• Data Extraction
• Appraisal and Analysis
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• Additional Resources: Guides and Books
• Using Covidence for Your Systematic Review
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Narrative vs. Systematic Reviews

People often confuse systematic and literature (narrative) reviews. They both are used to provide a summary of the existing literature or research on a specific topic.

A narrative or traditional literature review is a comprehensive, critical, and objective analysis of the current knowledge on a topic. They are an essential part of the research process and help to establish a theoretical framework and focus or context for your research. A literature review will help you to identify patterns and trends in the literature so that you can identify gaps or inconsistencies in a body of knowledge. This should lead you to a sufficiently focused research question that justifies your research.

A systematic review is comprehensive and has minimal bias. It is based on a specific question and uses eligibility criteria and a pre-planned protocol. This type of study evaluates the quality of evidence. 

A systematic review can be either quantitative or qualitative:

• If quantitative, the review will include studies that have numerical data.
• If qualitative, the review derives data from observation, interviews, or verbal interactions and focuses on the meanings and interpretations of the participants. It will include focus groups, interviews, observations and diaries.

Narrative reviews in comparison provide a perspective on topic (like a textbook chapter), may have no specified search strategy, might have significant bias issues, and may not evaluate quality of evidence.

This table provides a detailed comparison of systematic and literature (narrative) reviews.

Tools to Help You Choose a Review Type

There are other comprehensive literature reviews of similar methodology to the systematic review. These tools can help you determine which type of review you may want to conduct. 

• The Review Ready Reckoner - Assessment Tool (RRRsAT) is a chart created as an adaptation of Andrew Booth's article on review typology. The chart that describes the features of multiple review types listing characteristics that distinguish each type and including sample of each type of review.
• The What Review is Right for You tool asks five short questions to help you identify the most appropriate method for a review.

Use this chart  to determine the type of review you are interested in writing and to learn the differences in the stages and processes of various reviews compared to systematic reviews.

Source: Yale University

The type of review you conduct will depend on the purpose of the review, your question, your resources, expertise, and type of data.

Here are two suggested articles to consult if you want to know more about review types:

Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies.   Health information & libraries journal ,  26 (2), 91-108. This article defines 14 types of reviews. There is a helpful summary table on pp.94-95

Sutton A, Clowes M, Preston L, Booth A.  Meeting the review family: exploring review types and associated information retrieval requirements.   Health information & libraries journal . 2019;36(3):202–222. doi:10.1111/hir.12276

This Comparison table is derived from a guide which is licensed under Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license , and was originally included in a workbook by Amanda Wanner at Plymouth University for Systematic Reviews and Scoping Reviews. Stephanie Roth at Temple University remixed the original version. Many thanks and much appreciation to Amanda Wanner and Stephanie Roth for allowing me to create a derivative of their work.

Funaro, M., Nyhan, K., & Brackett, A. (n.d.).   What type of review could you write?  Yale Harvey Cushing/John Hay Whitney Medical Library.

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Traditional reviews vs. systematic reviews

Posted on 3rd February 2016 by Weyinmi Demeyin

Millions of articles are published yearly (1) , making it difficult for clinicians to keep abreast of the literature. Reviews of literature are necessary in order to provide clinicians with accurate, up to date information to ensure appropriate management of their patients. Reviews usually involve summaries and synthesis of primary research findings on a particular topic of interest and can be grouped into 2 main categories; the ‘traditional’ review and the ‘systematic’ review with major differences between them.

Traditional reviews provide a broad overview of a research topic with no clear methodological approach (2) . Information is collected and interpreted unsystematically with subjective summaries of findings. Authors aim to describe and discuss the literature from a contextual or theoretical point of view. Although the reviews may be conducted by topic experts, due to preconceived ideas or conclusions, they could be subject to bias.

Systematic reviews are overviews of the literature undertaken by identifying, critically appraising and synthesising results of primary research studies using an explicit, methodological approach(3). They aim to summarise the best available evidence on a particular research topic.

The main differences between traditional reviews and systematic reviews are summarised below in terms of the following characteristics: Authors, Study protocol, Research question, Search strategy, Sources of literature, Selection criteria, Critical appraisal, Synthesis, Conclusions, Reproducibility, and Update.

Traditional reviews

• Authors: One or more authors usually experts in the topic of interest
• Study protocol: No study protocol
• Research question: Broad to specific question, hypothesis not stated
• Search strategy: No detailed search strategy, search is probably conducted using keywords
• Sources of literature: Not usually stated and non-exhaustive, usually well-known articles. Prone to publication bias
• Selection criteria: No specific selection criteria, usually subjective. Prone to selection bias
• Critical appraisal: Variable evaluation of study quality or method
• Synthesis: Often qualitative synthesis of evidence
• Conclusions: Sometimes evidence based but can be influenced by author’s personal belief
• Reproducibility: Findings cannot be reproduced independently as conclusions may be subjective
• Update: Cannot be continuously updated

Systematic reviews

• Authors: Two or more authors are involved in good quality systematic reviews, may comprise experts in the different stages of the review
• Study protocol: Written study protocol which includes details of the methods to be used
• Research question: Specific question which may have all or some of PICO components (Population, Intervention, Comparator, and Outcome). Hypothesis is stated
• Search strategy: Detailed and comprehensive search strategy is developed
• Sources of literature: List of databases, websites and other sources of included studies are listed. Both published and unpublished literature are considered
• Selection criteria: Specific inclusion and exclusion criteria
• Critical appraisal: Rigorous appraisal of study quality
• Synthesis: Narrative, quantitative or qualitative synthesis
• Conclusions: Conclusions drawn are evidence based
• Reproducibility: Accurate documentation of method means results can be reproduced
• Update: Systematic reviews can be periodically updated to include new evidence

Decisions and health policies about patient care should be evidence based in order to provide the best treatment for patients. Systematic reviews provide a means of systematically identifying and synthesising the evidence, making it easier for policy makers and practitioners to assess such relevant information and hopefully improve patient outcomes.

• Fletcher RH, Fletcher SW. Evidence-Based Approach to the Medical Literature. Journal of General Internal Medicine. 1997; 12(Suppl 2):S5-S14. doi:10.1046/j.1525-1497.12.s2.1.x. Available from:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497222/
• Rother ET. Systematic literature review X narrative review. Acta paul. enferm. [Internet]. 2007 June [cited 2015 Dec 25]; 20(2): v-vi. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-21002007000200001&lng=en. http://dx.doi.org/10.1590/S0103-21002007000200001
• Khan KS, Ter Riet G, Glanville J, Sowden AJ, Kleijnen J. Undertaking systematic reviews of research on effectiveness: CRD’s guidance for carrying out or commissioning reviews. NHS Centre for Reviews and Dissemination; 2001.

Weyinmi Demeyin

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No Comments on Traditional reviews vs. systematic reviews

THE INFORMATION IS VERY MUCH VALUABLE, A LOT IS INDEED EXPECTED IN ORDER TO MASTER SYSTEMATIC REVIEW

Thank you very much for the information here. My question is : Is it possible for me to do a systematic review which is not directed toward patients but just a specific population? To be specific can I do a systematic review on the mental health needs of students?

Hi Rosemary, I wonder whether it would be useful for you to look at Module 1 of the Cochrane Interactive Learning modules. This is a free module, open to everyone (you will just need to register for a Cochrane account if you don’t already have one). This guides you through conducting a systematic review, with a section specifically around defining your research question, which I feel will help you in understanding your question further. Head to this link for more details: https://training.cochrane.org/interactivelearning

I wonder if you have had a search on the Cochrane Library as yet, to see what Cochrane systematic reviews already exist? There is one review, titled “Psychological interventions to foster resilience in healthcare students” which may be of interest: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013684/full You can run searches on the library by the population and intervention you are interested in.

I hope these help you start in your investigations. Best wishes. Emma.

La revisión sistemática vale si hay solo un autor?

HI Alex, so sorry for the delay in replying to you. Yes, that is a very good point. I have copied a paragraph from the Cochrane Handbook, here, which does say that for a Cochrane Review, you should have more than one author.

“Cochrane Reviews should be undertaken by more than one person. In putting together a team, authors should consider the need for clinical and methodological expertise for the review, as well as the perspectives of stakeholders. Cochrane author teams are encouraged to seek and incorporate the views of users, including consumers, clinicians and those from varying regions and settings to develop protocols and reviews. Author teams for reviews relevant to particular settings (e.g. neglected tropical diseases) should involve contributors experienced in those settings”.

Thank you for the discussion point, much appreciated.

Hello, I’d like to ask you a question: what’s the difference between systematic review and systematized review? In addition, if the screening process of the review was made by only one author, is still a systematic or is a systematized review? Thanks

Hi. This article from Grant & Booth is a really good one to look at explaining different types of reviews: https://onlinelibrary.wiley.com/doi/10.1111/j.1471-1842.2009.00848.x It includes Systematic Reviews and Systematized Reviews. In answer to your second question, have a look at this Chapter from the Cochrane handbook. It covers the question about ‘Who should do a systematic review’. https://training.cochrane.org/handbook/current/chapter-01

A really relevant part of this chapter is this: “Systematic reviews should be undertaken by a team. Indeed, Cochrane will not publish a review that is proposed to be undertaken by a single person. Working as a team not only spreads the effort, but ensures that tasks such as the selection of studies for eligibility, data extraction and rating the certainty of the evidence will be performed by at least two people independently, minimizing the likelihood of errors.”

I hope this helps with the question. Best wishes. Emma.

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Know the Difference! Systematic Review vs. Literature Review

It is common to confuse systematic and literature reviews as both are used to provide a summary of the existent literature or research on a specific topic.  Even with this common ground, both types vary significantly.  Please review the following chart (and its corresponding poster linked below) for the detailed explanation of each as well as the differences between each type of review.

• What's in a name? The difference between a Systematic Review and a Literature Review, and why it matters by Lynn Kysh, MLIS, University of Southern California - Norris Medical Library
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Systematic, Scoping and Narrative Reviews

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• First Online: 24 October 2021

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• Samiran Nundy 4 ,
• Atul Kakar 5 &
• Zulfiqar A. Bhutta 6  

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A Systematic Review is an attempt to distill the essence of a large number of studies in medicine by first asking a research question and then first identifying and later synthesizing carefully chosen studies of a high quality which might provide the answers. A more precise definition is ‘a summary of the medical literature that uses explicit and reproducible methods to systematically search, critically appraise and synthesise the results of multiple primary studies related to each other by using strategies to reduce bias and random errors’ [1].

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Systematic Reviewing

Critical Appraisal of Systematic Reviews and Meta-Analyses

Systematic Reviews and Meta-Analysis: A Guide for Beginners

Joseph L. Mathew

1 What Is a Systematic Review?

A Systematic Review is an attempt to distill the essence of a large number of studies in medicine by first asking a research question and then first identifying and later synthesizing carefully chosen studies of a high quality which might provide the answers. A more precise definition is ‘a summary of the medical literature that uses explicit and reproducible methods to systematically search, critically appraise and synthesise the results of multiple primary studies related to each other by using strategies to reduce bias and random errors’ [ 1 ].

In 1979, Archibald Cochrane, a Scottish doctor, proposed: ‘It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials’. Cochrane was one of the founding fathers of evidence-based medicine (Fig. 29.1 ). He highlighted and advocated the importance of critically summarizing the findings of research studies and designated the systematic review as a method of providing such a summary. This ultimately led to the development of the Cochrane Collaboration in 1993 [ 2 ]. The findings of systematic reviews are now widely used for clinical decision-making and have become integral towards the development of sound clinical practice guidelines and recommendations. In fact, they now occupy the summit of the pyramid for the quality of evidence.

Shows the quality of evidence from various types of research papers

2 How Is a Systematic Review Done?

It is done using the following steps:

Step 1 —Defining the research question clearly and formulating criteria for which reports to include.

Searching for and selecting these studies and collecting their data. This will involve a review of all the available databases and citation indexes like the Web of Science, Embase, PubMed and others using different search technologies or even artificial intelligence-based tools. Each study should conform to the PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analyses) guidelines or the standards of the Cochrane Collaboration [ 3 ].

The PRISMA guidelines (Fig. 29.2 ) are steps that depict the flow of information through the different phases of a systematic review. It maps out the number of records identified, included and excluded, and the reasons for exclusions.

PRISMA guidelines

Step 2 —Assess their risk of bias. The review should use an objective and transparent approach for collection and synthesizing the data to minimize bias.

Step 3 —Analyse the data and undertake a meta-analysis. This may involve using complex statistical methods and the more data that is analyzed the more confident we can be of the result.

Step 4 —Write conclusions. Present the results and summarize the findings. Interpret the results, draw conclusions and suggest a message.

3 Why Is a Systematic Review Useful?

Many clinical decisions are guided by published studies but, unfortunately, there are now too many to choose from for a busy clinician. These studies often vary in their design, methodological quality, population involved and the intervention or condition considered. To take a rational clinical decision involves trying to reconcile the results of studies that provide different answers to the same question. Because it is often impractical for readers to track down and read all of the primary studies, systematic review articles are an important source of summarized evidence on a particular topic [ 4 , 5 ].

4 What Are Its Weaknesses?

Most systematic reviews focus on a single question when more than one may be relevant in a particular situation, e.g., the best treatment for variceal bleeding in a developed country may be endoscopic sclerotherapy but not in a person in a developing country who is poor, has good liver function and does not have access to sophisticated medical facilities. In him or her a portosystemic shunt operation and a one-time procedure may be the more appropriate.

Then search strategies are often not provided in detail, the selection of studies may be biased, and only the positive results may reach publication. It also takes about 6 months to complete a single systematic review [ 6 , 7 ].

5 What Is a Meta-Analysis? How Does It Differ from a Systematic Review?

A meta-analysis is a summary of data collected from multiple sources by collating it and helping to frame guidelines. While a systematic review includes the entire process of collecting, reviewing and presenting all available evidence, a meta-analysis only refers to the statistical technique of extracting and combining the data to produce a summary [ 7 , 8 ].

6 What Are Scoping and Narrative Reviews? How Do They Differ from a Systematic Review?

A Scoping review is a preliminary assessment of the potential size and scope of the available research literature. It aims to identify the nature and extent of research evidence (usually including ongoing research) and present an overview of a potentially large and diverse body of literature pertaining to a broad topic. In contrast, a systematic review attempts to collate empirical evidence from a relatively smaller number of studies pertaining to a focused research question.

A Narrative review is the type first-year college students often learn as a general approach. Its purpose is to identify a few studies that describe a problem of interest. Narrative reviews have no predetermined research question or specified search strategy, only a topic of interest. They are not systematic and follow no specified protocol. No standards or protocols guide the review. Although the reviewers will learn about the problem, they will not arrive at a comprehensive understanding of the state of the science related to the problem [ 9 , 10 ]. No strict rules are there for narrative review and can be done using the keywords.

7 Conclusions

A Systemic review gives a comprehensive and complete plan and search approach to study a topic of interest. This reduces the bias by recognizing, assessing and creating all relevant studies on a particular topic.

Systematic reviews can be ambiguous, not helpful, or even harmful when data are incorrectly handled.

A Meta-analysis involves using statistical methods to create the data from several studies into a single quantitative study.

Outcomes from a meta-analysis may help to estimate the effect of treatment or risk factors for disease, or other outcomes.

Uman LS. Systematic reviews and meta-analyses. J Can Acad Child Adolesc Psychiatry. 2011;20:57–9.

Article   Google Scholar  

Stavrou A, Challoumas D, Dimitrakakis G. Archibald Cochrane (1909–1988): the father of evidence-based medicine. Interact Cardiovasc Thorac Surg. 2014;18:121–4.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Last accessed on 3rd August 2020. Available on http://www.prisma-statement.org/ .

Gopalakrishnan S, Ganeshkumar P. Systematic reviews and meta-analysis: understanding the best evidence in primary healthcare. J Family Med Prim Care. 2013;2:9–14.

Article   CAS   Google Scholar  

Why systematic reviews matter. A brief history, overview and practical guide for authors. Last accessed on 3rd August 2020. Available on https://www.elsevier.com/connect/authors-update/why-systematic-reviews-matter .

Yuan Y, Hunt RH. Systematic reviews: the good, the bad, and the ugly. Am J Gastroenterol. 2009;104:1086–92.

Ahn E, Kang H. Introduction to systematic review and meta-analysis. Korean J Anesthesiol. 2018;71(2):103–12.

Haidich AB. Meta-analysis in medical research. Hippokratia. 2010;14(Suppl 1):29–37.

CAS   PubMed   PubMed Central   Google Scholar  

Munn Z, Peters MDJ, Stern C, et al. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18:143.

Pham MT, Rajić A, Greig JD, Sargeant JM, Papadopoulos A, McEwen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Res Synth Methods. 2014;5(4):371–85.

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Nundy, S., Kakar, A., Bhutta, Z.A. (2022). Systematic, Scoping and Narrative Reviews. In: How to Practice Academic Medicine and Publish from Developing Countries?. Springer, Singapore. https://doi.org/10.1007/978-981-16-5248-6_29

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Systematic and scoping reviews: A comparison and overview

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• 1 Division of Vascular Surgery, Western University, London, Ontario, Canada.
• 2 Division of Vascular Surgery, Western University, London, Ontario, Canada. Electronic address: [email protected].
• PMID: 36414363
• DOI: 10.1053/j.semvascsurg.2022.09.001

In this article, we compare and contrast methods of reviewing, summarizing, and synthesizing the literature, including systematic reviews, scoping reviews, and narrative reviews. Review articles are essential to help investigators wade through the plethora of exponentially growing medical literature. In the era of evidence-based medicine, a systematic approach is required. A systematic review is a formalized method to address a specific clinical question by analyzing the breadth of published literature while minimizing bias. Systematic reviews are designed to answer narrow clinical questions in the PICO (population, intervention, comparison, and outcome) format. Alternatively, scoping reviews use a similar systematic approach to a literature search in order to determine the breadth and depth of knowledge on a topic; to clarify definitions, concepts, and themes; or sometimes as a precursor to a systematic review or hypothesis generator to guide future research. However, scoping reviews are less constrained by a priori decisions about which interventions, controls, and outcomes may be of interest. Traditional narrative reviews still have a role in informing practice and guiding research, particularly when there is a paucity of high-quality evidence on a topic.

Copyright © 2022. Published by Elsevier Inc.

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Why Systematic Review rather than Narrative Review?

1 Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea.

2 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.

Sir: Recently review articles including systematic and narrative reviews have been significantly increasing in most psychiatric journals in the world alongside "Psychiatry Investigation (PI)". Since the launch of the "PI" at March 2004, there have been a number of review articles; indeed 54 papers were published as format of regular review papers or special articles in the "PI" from 2004 to 2014. However, of the 54 papers, only one review paper partially met the contemporary criteria of systematic review, otherwise were written as a format of narrative review for diverse topics such as epidemiological findings, concept and hypothesis of certain psychiatric disease, current understandings on certain disease, psychopharmacology, and treatment guidelines. This is unsatisfactory when reflecting the fact that systematic reviews have been rapidly and increasingly replacing traditional narrative (explicit) reviews as a standard platform of providing and updating currently available research findings as confident evidence. Most journals have started to change their policy in acceptance of review papers, they have been giving a priority to systematic review only as a regular review article and excluding narrative reviews, to provide the best evidence for all basic and clinical questions and further hypotheses. Of course, there should be Pros and Cons between systematic and narrative reviews; for instance, the major advantage of systematic reviews is that they are based on the findings of comprehensive and systematic literature searches in all available resources, with minimization of selection bias avoiding subjective selection bias, while narrative reviews, if they can be written experts in certain research area, can provide experts' intuitive, experiential and explicit perspectives in focused topics. 1

The absence of objective and systematic selection criteria in review method substantially results in a number of methodological shortcomings leading to clear bias of the author's interpretation and conclusions. Such differences are quite clear when referring to the review paper of Drs. Cipriani and Geddess, 2 where 7 narrative and 2 systematic reviews were compared and found that narrative reviews including same studies reached different conclusions against each other, indicating the difficulties of appraising and using narrative reviews to have conclusion on specific topic. Hence, narrative reviews may be evidence-based, but they are not truly useful as scientific evidence.

Even in reported as systematic review, it is also frequent that those papers are not true systematic review or they have certain bias in data search method and conclusions. For instance, due to lack of satisfactory pharmacotherapy for post-traumatic stress disorder (PTSD) and its frequent comorbid psychotic symptoms, a possible role of atypical antipsychotics (AAs) for PTSD has been consistently proposed. 3 In fact various AAs have demonstrated positive antidepressant and ant-anxiety effects in a number of small-scale, open-label studies (OLSs) or randomised, controlled clinical trials (RCTs). 4 In this context, a recent systematic review (4 olanzapine, 7 risperidone and 1 ziprasidone trials) by Wang et al. 5 has also suggested the positive prospect on the role of AAs for the treatment of PTSD; however, the review has a number of faulty and wrong selection of clinical trials data and interpretation of studies included in their review. The authors neglected wide range of clinical information such as patient characteristics (particularly, initial severity of disease), comorbidity issues, trial duration issues, trial design characteristics, primary endpoint difference, study sponsoring; that is, heterogeneity of clinical trials would substantially influence the quality and clinical implications of the study results. The basic problem of non-systematic search of data is that beneath the shining surface, it seems that the authors utilizing it often misunderstand the true value, underpinning meanings and correct nature of the data, or their true limitations and strengths, and they often go too far or short with the interpretation. 6 Indeed, the main conclusion of a narrative review may often be based on evidence, but such reviews themselves are not rigorous evidence since such reviews are too selective and thus little good quality information could be included. 2 In addition, I found one olanzapine trial was OLS but they included the study in the result (this is a mixture of data yielding a huge heterogeneity). 7 This clearly indicates they were not consistent in collection of the study for their review. Olanzapine has a lot of OLSs beyond the study, likewise other AAs also have a plenty of OLSs. Regarding an inclusion of OLSs for systematic reviews, an interesting metaanalyses are available on the role of olanzapine for adolescent bipolar disorder 8 and aripiprazole augmentation therapy 9 for depression. According to Pae et al. 9 the treatment effects were not significantly different between OLSs and RCTs in efficacy of aripiprazole augmentation for treating depression; the pooled effect size was statistically significant in both study design and also in a meta-analysis regression, study design was not a significant predictor of mean change in the primary endpoint, clearly indicating that OLSs are useful predictors of the potential safety and efficacy of a given compound. This finding was also supported by another meta-analysis. 8 Hence, the value of OLSs should be carefully re-evaluated for practical information source, development of new drugs or acquisition for new indications, and should not be neglected for data research, especially for narrative reviews. Furthermore, Dr. Wang et al. 5 did not include one important RCT; quetiapine has a RCT for PTSD, 10 which was presented in the thematic meeting of the CINP 2009. A 12-week RCT was conducted for 80 PTSD patients. Finally, Wang et al. 5 surprisingly did not present any effect size (ES) for studies, although such calculations are conventionally included in the review papers. Another critical example is Hickie and Rogers's review, 11 according to their article, agomelatine was efficacious antidepressant; however, subsequent researchers who avoided selection bias have clearly demonstrated its weak efficacy as an antidepressant. 12 Therefore, reflecting two review papers, 5 , 11 we can realize that inappropriate aggregation of studies may definitely bias conclusion. Hence, entire published and unpublished dataset should be considered in systematic review, especially, when clinical data is not sufficient and the medication has no officially approved indication by the regulatory agency.

To summarize, systematic review should include followings respecting recommendation from currently available systematic review guidelines (e.g., The Cochrane Library www.cochrane.org ); clear basic and clinical hypothesis, predefined protocol, designation of search resources, through data search (regardless of publication), transparent selection criteria, qualification of studies selected, synthesis of study data and information, relevant summary and conclusion. Table 1 compares systematic and narrative reviews ( Table 1 ). Since the evidence-based medicine is the current trend and also mandatory for establishment of heath policy, the PI should also turn to encourage submission of systematic reviews rather than narrative reviews.

Acknowledgments

This work was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HI12C0003).

• Open access
• Published: 13 December 2023

Arts and creativity interventions for improving health and wellbeing in older adults: a systematic literature review of economic evaluation studies

• Grainne Crealey 1 ,
• Laura McQuade 2 ,
• Roger O’Sullivan 2 &
• Ciaran O’Neill 3  

BMC Public Health volume  23 , Article number:  2496 ( 2023 ) Cite this article

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As the population ages, older people account for a larger proportion of the health and social care budget. A significant body of evidence suggests that arts and creativity interventions can improve the physical, mental and social wellbeing of older adults, however the value and/or cost-effectiveness of such interventions remains unclear.

We systematically reviewed the economic evidence relating to such interventions, reporting our findings according to PRISMA guidelines. We searched bibliographic databases (MEDLINE, EMBASE, Econlit and Web of Science and NHSEED), trial registries and grey literature. No language or temporal restrictions were applied. Two screening rounds were conducted independently by health economists experienced in systematic literature review. Methodological quality was assessed, and key information extracted and tabulated to provide an overview of the published literature. A narrative synthesis without meta-analysis was conducted.

Only six studies were identified which provided evidence relating to the value or cost-effectiveness of arts and creativity interventions to improve health and wellbeing in older adults. The evidence which was identified was encouraging, with five out of the six studies reporting an acceptable probability of cost-effectiveness or positive return on investment (ranging from £1.20 to over £8 for every £1 of expenditure). However, considerable heterogeneity was observed with respect to study participants, design, and outcomes assessed. Of particular concern were potential biases inherent in social value analyses.

Conclusions

Despite many studies reporting positive health and wellbeing benefits of arts and creativity interventions in this population, we found meagre evidence on their value or cost-effectiveness. Such evidence is costly and time-consuming to generate, but essential if innovative non-pharmacological interventions are to be introduced to minimise the burden of illness in this population and ensure efficient use of public funds. The findings from this review suggests that capturing data on the value and/or cost-effectiveness of such interventions should be prioritised; furthermore, research effort should be directed to developing evaluative methods which move beyond the confines of current health technology assessment frameworks, to capture a broader picture of ‘value’ more applicable to arts and creativity interventions and public health interventions more generally.

PROSPERO registration

CRD42021267944 (14/07/2021).

Peer Review reports

The number and proportion of older adults in the population has increased in virtually every country in the world over past decades [ 1 ]. In 2015, there were around 901 million people aged 60 years and over worldwide, by 2030, this will have increased to 1.4 billion [ 2 ]. An ageing population is one of the greatest successes of public health but it has implications for economies in numerous ways: slower labour force growth; working-age people will have to make greater provisions in welfare payments for older people who are no longer economically active; provisions for increased long-term care; and, society must adjust to the changing needs, expectations and capabilities of an expanding group of its citizens.

The Covid-19 pandemic shone an uncompromising light on the health and social care sector, highlighting the seriousness of gaps in policies, systems and services. It also focused attention on the physical and mental health consequences of loneliness and social isolation. To foster healthy ageing and improve the lives of older people, their families and communities, sustained and equitable investment in health and wellbeing is required [ 3 ]. The prevailing model of health and social care which is based ostensibly on formal care provision is unlikely to be sustainable over the longer term. New models, which promote healthy ageing and recognise the need for increasing reliance on self-care are required, as will be evidence of their effectiveness, cost-effectiveness and scalability.

Arts and creativity interventions (ACIs) can have positive effects on health and well-being, as several reviews have shown [ 4 , 5 ]. For older people, ACI’s can enhance wellbeing [ 6 , 7 , 8 , 9 ], quality of life [ 10 , 11 ] and cognitive function [ 12 , 13 , 14 , 15 , 16 ]. They can also foster social cohesion [ 17 , 18 , 19 ] and reduce social disparities and injustices [ 20 ]; promote healthy behaviour; prevent ill health (including enhancing well-being and mental health) [ 21 , 22 , 23 , 24 , 25 ], reducing cognitive decline [ 26 , 27 ], frailty [ 28 , 29 , 30 , 31 , 32 , 33 ] and premature mortality [ 34 , 35 , 36 , 37 , 38 ]); support people with stroke [ 39 , 40 , 41 , 42 ]; degenerative neurological disorders and dementias and support end of life care [ 43 , 44 ]. Moreover, ACIs can benefit not only individuals, but also others, such as supporting the well-being of formal and informal carers, enriching our knowledge of health, and improving clinical skills [ 4 , 5 ].

The benefits of ACIs have also been acknowledged at a governmental level by those responsible for delivering health and care services: The UK All-Party Parliamentary Special Interest group on Arts, Health and Wellbeing produced a comprehensive review of creative intervention for health and wellbeing [ 45 ]. This report contained three key messages: that the arts can keep us well, aid recovery and support longer better lived lives; they can help meet major challenges facing health and social care; and that the arts can save money for the health service and social care.

Despite robust scientific evidence and governmental support, no systematic literature review has collated the evidence with respect to the value, cost or cost-effectiveness of such interventions. Our objective was to assess the economic impact of ACIs aimed at improving the health and wellbeing of older adults; to determine the range and quality of available studies; identify gaps in the evidence-base; and guide future research, practice and policy.

A protocol for this review was registered at PROSPERO, an international prospective register of systematic reviews (Registration ID CRD42021267944). We used pre-determined criteria for considering studies to include in the review, in terms of types of studies, participant and intervention characteristics.

The review followed the five-step approach on how to prepare a Systematic Review of Economic Evaluations (SR-EE) for informing evidence-based healthcare decisions [ 46 , 47 , 48 ]. Subsequent to developing and registering the protocol, the International Society for Pharmacoeconomic Outcomes and Research (ISPOR) published a good practice task force report for the critical appraisal of systematic reviews with costs and cost-effectiveness outcomes (SR-CCEOs) [ 49 ]. This was also used to inform the conduct of this review.

Eligibility criteria

Full economic evaluations are regarded as the optimal type of evidence for inclusion in a SR-EE [ 46 ], hence cost-minimisation analyses (CMA), cost-effectiveness analyses (CEA), cost-utility analyses (CUA) and cost–benefit analyses (CBA) were included. Social value analyses were also included as they are frequently used to inform decision-making and commissioning of services within local government. Additionally, they represent an important intermediate stage in our understanding of the costs and consequences of public health interventions, where significant challenges exist with regard to performing full evaluations [ 50 , 51 , 52 , 53 ].

Development of search strategies

The population (P), intervention (I), comparator (C) and outcomes (O) (PICO) tool provided a framework for development of the search strategy. Studies were included if participants were aged 50 years or older (or if the average age of the study population was 50 years or over). Interventions could relate to performance art (dance, singing, theatre, drama etc.), creative and visual arts (painting, sculpture, art making and design), or creative writing (writing narratives, poetry, storytelling). The intervention had to be active (for example, creating art as opposed to viewing art; playing an instrument as opposed to listening to music). The objective of the intervention had to be to improve health and wellbeing; it had to be delivered under the guidance of a professional; delivered in a group setting and delivered on more than one occasion. No restrictions were placed on the type of comparator(s) or the type of outcomes captured in the study. We deliberately limited the study to professionally led activities to provide a sharper distinction between social events where arts and creativity may occur and arts and creativity interventions per se. We set no language restriction nor a restriction on the date from which studies were reported.

Search methods

PRESS (peer-review electronic search strategies) guidelines informed the design our search strategy [ 54 , 55 ] and an information specialist adapted the search terms (outlined in Table S 1 ) for the following electronic bibliographic databases: MEDLINE, PubMed, EMBASE, Econlit and Web of Science and NHSEED. We also inspected references of all relevant studies; and searched trials registers (ClinicalTrials.gov). Search terms used included cost, return on investment, economic, arts, music, storytelling, dancing, writing and older adult as well as social return on investment (SROI). The last search was performed on 09/11/2022. As many economic evaluations of ACIs (especially SROIs) are commissioned by government bodies or charitable organisations, a search of the grey literature was undertaken.

Handling searches

A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow chart was used to document study selection, illustrating the numbers of records retrieved and selection flow through the screening rounds [ 56 , 57 , 58 ]; all excluded records (with rationale for exclusion) were documented.

Selection of studies

Two screening rounds were conducted independently by two health economists experienced in undertaking reviews (GC, CO’N). The first round screened the title and abstract of articles based on the eligibility criteria; those selected at this stage entered a second round of full text screening with eligibility based on the inclusion and exclusion criteria. Any disagreements were discussed among the two reviewers, with access to a third reviewer available to resolve disagreements, though this proved unnecessary.

Data extraction and management

Two reviewers extracted relevant information independently using an proforma developed specifically for the purposes of this study, which included all 35 items suggested by Wijnen et al. (2016) [ 48 ]. Information was extracted in relation to the following factors: (1) general information including study title, author, year, funding source, country, setting and study design; (2) recruitment details, sample size, demographic characteristics (age, gender) and baseline health data (diagnosis, comorbidities); (3) interventions, effectiveness and cost data; (4) type of economic evaluation, perspective, payer, beneficiary, time horizon, measure of benefit and scale of intervention; (5) quality assessment, strength of evidence, any other important information; (6) results; (7) analysis of uncertainty and (8) conclusions. The quality assessment/risk of bias checklists were included in the data extraction proforma, and picklists were used to enhance uniformity of responses. The data extraction form was piloted by two reviewers (GC and CON) on one paper and discussion used to ensure consistent application thereafter.

Assessment of study quality

Two reviewers (GC & CON) independently assessed study quality, with recourse to a third reviewer for resolution of differences though this proved unnecessary. Quality assessment was based on the type of economic evaluation undertaken. Full and partial trial-based economic evaluations were assessed using the CHEC-extended checklist [ 59 ]. SROI analyses were assessed using a SROI-specific quality framework developed for the purpose of systematic review [ 60 ].

Data analysis methods

Due to the small number of evaluations detected, possible sources of heterogeneity and a lack of consensus on appropriate methods for pooling cost-effectiveness estimates [ 61 ] a narrative synthesis analysis was undertaken.

Database searches returned 11,619 records; from this, 402 duplicates were removed leaving 11,214 reports. From these 113 reports were assessment against the inclusion and exclusion criteria resulting in 4 studies for inclusion in the review. Over 40 websites were searched for relevant content returning 2 further studies for inclusion. The PRISMA 2020 diagram is presented in Fig.  1 . A high sensitivity search strategy was adopted to ensure all relevant studies were identified, resulting in a large number of studies being excluded at the first stage of screening.

PRISMA 2020 flow diagram for new systematic reviews which include searches of databases, registers and other sources

A total of six studies were identified; key characteristics are presented in Table 1 . Identified studies were published between 2011 and 2020. Two studies used a health technology assessment (HTA) framework alongside clinical trials [ 62 , 63 ] to assess the cost-effectiveness of community singing interventions. Both evaluations scored highly on the CHEC-extended checklist (Table 2 ), with findings reported in line with the CHEERS (Consolidated Health Economic Estimation Reporting Standards) checklist 2022 [ 64 ].

Four further studies employed an SROI framework to assess art and/or craft interventions: two studies were published in the peer-reviewed literature [ 65 , 66 ] and a further two in the grey literature [ 67 , 68 ]. All four adhered closely to the suggested steps for performing an SROI and consequently secured high scores (Table 3 ). No quality differential was discerned between those studies published in the academic literature when compared with those from the grey literature.

Five of the studies were undertaken in the UK [ 63 , 66 , 67 , 68 , 69 ] and one in the US [ 63 ]. Four of the studies were designed for older adults with no cognitive impairment [ 62 , 63 , 67 , 68 ]; one was designed for participants with or without dementia [ 65 ], and another was specifically for older adults with dementia and their caregivers [ 66 ]. Three of the studies were delivered in a community setting [ 62 , 63 , 67 ], two in care homes [ 65 , 68 ] and one across a range of settings (hospital, community and residential) [ 66 ]. The length and duration of the ACIs varied; some lasted 1–2 h (with multiple classes available to participants) [ 65 ], whereas others were structured programmes with sessions lasting 90 min over a 14-week period [ 62 ]. The number of participants included in studies varied; the largest study contained data from 390 participants [ 63 ], whereas other studies measured engagement using numbers of care homes or housing associations included [ 67 , 68 ].

Costs were captured from a narrower perspective (i.e., the payer—health service) for those economic evaluations which followed a health technology assessment (HTA) framework [ 62 , 63 ]. Costs associated with providing the programme and health and social care utilisation costs were captured using cost diaries. Valuation of resource usage was in line with the reference case specified for each jurisdiction.

Social value analyses included in the review [ 65 , 66 , 67 , 68 ] captured a broader picture of cost; programme provision costs included were similar in nature to those identified using an HTA framework, however, the benefits captured went beyond the individual to capture costs to a wide range of stakeholders such as family members, activity co-ordinations and care home personnel. Costs were apportioned using financial proxies from a range of sources including HACT Social Value Bank [ 69 ] and market-based valuation methods.

The range of outcomes captured and valued across HTAs and SROIs was extensive: including, but not limited to, wellbeing, quality of life, physical health, cognitive functioning, communication, control over daily life choices, engagement and empowerment, social isolation, mobility, community inclusion, depressive symptoms, sadness, anxiety, loneliness, positive affect and interest in daily life. In the programmes assessed using an HTA framework, outcomes were captured using standardised and validated instruments, for both control and intervention groups across multiple time points. Statistical methods were used to assess changes in outcomes over time. Programmes assessed using SROI relied primarily on qualitative methods (such as reflective diaries and in-depth interviews) combined with routinely collected administrative data.

The evidence from the singing interventions was encouraging but not conclusive. The ‘Silver Song Club’ programme [ 62 ] reported a 64% probability of being cost-effective at a willingness-to-pay threshold of £30,000. This study was also included in the Public Health England (PHE) decision tool to support local commissioners in designing and implementing services to support older people’s healthy ageing, reporting a positive societal return on investment [ 70 ]. Evidence from the ‘Community of Voices’ trial [ 63 ] suggested that although intervention group members experienced statistically significant improvements in loneliness and interest in life compared to control participants, no significant group differences were observed for cognitive or physical outcomes or for healthcare costs.

A positive return on investment was reported by all social value analyses undertaken. The ‘Imagine Arts’ programme, reported a positive SROI of £1.20 for every £1 of expenditure [ 65 ]. A higher yield of between £3.20-£6.62 for each £1 invested was reported in the ‘Dementia and Imagination’ programme [ 66 ]. The ‘Craft Café’ programme, reported an SROI of £8.27 per £1 invested [ 68 ], and the ‘Creative Caring’ programme predicted a SROI of between £3 to £4 for every £1 spent [ 67 ]. The time period over which return on investment was calculated differed for each evaluation from less than one year to 4 years.

The primary finding from our review concerns the paucity of evidence relating to the value, cost and/or cost-effectiveness of ACIs aimed at improving health and wellbeing in this population. Despite few restrictions being applied to our search, only six studies were found which met our inclusion criteria. This is not indicative of research into ACIs in this population, as evidenced by the identification of ninety-three studies where arts and creativity interventions were found to support better health and wellbeing outcomes in another recent review [ 5 ]. An alternative explanation is that funders do not see the added value of undertaking such evaluations in this area. That is, for funders, the cost of evaluating an ACIs is likely to be deemed unjustified given the relatively small welfare loss a misallocation of resources to them might produce. While at first glance this may seem reasonable, it disadvantages ACIs in competing with other interventions for funding and arguably exposes an implicit prejudice in the treatment of interventions from which it may be difficult to extract profit in general. That is, the paucity of evidence, may reflect inherent biases within our political economy that favour the generation of marketable solutions to health issues from which value can be appropriated as profit. Pharmaceuticals are an obvious example of such solutions, where the literature is replete with examples of evaluations sponsored by pharmaceutical companies or where public funds are used to test the claims made by pharmaceutical companies in respect of the value of their products. If the potential of ACIs to improve health and well-being is to be robustly established, ACIs must effectively compete for funding with other interventions including those from pharma. This requires a larger, more robust evidence base than is currently available and investment in the creation of such an evidence base. As there is currently no ‘for-profit’ industry to generate such an evidence base, public funding of evaluations will be central to its creation.

Our second finding concerns the values reported in the meagre evidence we did find. In five of the six studies we identified, evidence indicated that ACIs targeted at older people offered value for money [ 62 , 65 , 66 , 67 , 68 ]. One study provided mixed evidence [ 63 ], however, in this study a ‘payer’ perspective was adopted when applying an HTA framework which, by virtue of the perspective adopted, excluded a range of benefits attributable to ACIs and public health interventions more generally. Among the four studies that adopted a SROI approach, estimated returns per £1 invested ranged from £1.20 to £8.27. Given the evident heterogeneity among studies in terms of context and methods, care is warranted in comparing estimates with each other or with other SROIs. Care is also required in accepting at face value the estimates reported given methodological issues that pertain to the current state of the art with respect to SROI. With these caveats in mind noted, the values reported for ACIs using the SROI approach are comparable with those from other SROI studies in other contexts including those as diverse as a first aid intervention [ 71 ], investment in urban greenways [ 72 ] and the provision of refuge services to those experiencing domestic violence [ 73 ] (a return on investment of £3.50-£4, £2.88-£5.81 and £4.94 respectively). Similarly, with respect to the study that adopted a cost-effectiveness approach, Coulton and colleagues (2015) reported a 64% probability of the intervention being cost-effective at a threshold of £30,000 [ 62 ]. Again, it is difficult to compare studies directly, but this is similar to that reported for interventions as diverse as a falls prevention initiative [ 74 ] and the treatment of depression using a collaborative approach [ 75 ] both in the UK. That the evidence base is meagre notwithstanding, there is, in other words, a prima facie case that ACIs are capable of offering value for money when targeted at older persons.

Our third finding relates to the state of the art with respect to SROIs in this area. Over the past 40 years, considerable time, effort and resources have been expended in the development of cost-effectiveness techniques in health and social care. While considerable heterogeneity can exist around their conduct, national guidance exists in many jurisdictions on the conduct of cost-effectiveness analyses (CEA) – such as the NICE reference case in the UK [ 76 ]– as well as in the reporting of these as set out in the CHEERS 2022 guidance [ 64 ]. This has helped raise the quality of published evaluations and the consistency with which they are reported. Despite the existence of a step-by-step guidance document on how to perform SROIs [ 77 ] which outlines how displacement effects, double counting, effect attribution and drop-off should be addressed, a significant body of work still remains to ensure that the methodology addresses a range of known biases in a robust manner. Where there is no comparator to the intervention being evaluated (as was the case in the SROIs reported here) it may be difficult to convince funders that the implicit incremental costs and benefits reported are indeed incremental and attributable to the intervention. Equally, where a comparator is present, greater consensus and standardisation is required regarding the identification, generation and application of, for example, financial proxies. Currently, SROI ratios combine value across a wide range of stakeholders, which is understandable if the objective is to capture all aspects of social benefit generated. This ratio, however, may not reflect the priorities and statutory responsibilities of healthcare funders. Whist all of the aforementioned issues can be addressed, investment is required to develop the SROI methodology further to more closely meet the needs of commissioning bodies.

Notwithstanding these challenges, social value analyses play a pivotal role within the procurement processes employed by government, local authorities and other non-departmental public bodies and should not be dismissed simply because the ‘burden of proof’ falls short of that required to secure remuneration within the health sector. As most SROIs are published in the grey literature, this means they often avoid peer scrutiny prior to publication and the potential quality assurance this can offer. It is noteworthy however that two of the SROIs included in this review [ 65 , 66 ] were published in the academic literature, suggesting that the academic community are engaging with this method which is to be applauded.

Moving forward, it is unlikely we will be able to meet all of the health and wellbeing needs of our ageing population solely in a primary or secondary care setting. New models of care are required, as are new models of funding to support interventions which can be delivered in non-healthcare settings. New hybrid models of evaluation will be required to provide robust economic evidence to assist in the allocation of scarce resources across health and non-healthcare settings; such evaluative frameworks must have robust theoretical underpinnings and be capable of delivering evidence from a non-clinical setting in a timely and cost-effective manner.

In the absence of a definitive evaluation framework for ACIs being currently available, we have a number of recommendations. First, and most importantly, all impact assessments should have a control group or credible counterfactual. This is currently not required when performing an SROI making it difficult to determine if all of the benefits ascribed to an intervention are in fact attributable. This recommendation is in line with the conclusion of a report by the London School of Economics [ 78 ] for the National Audit Office (NAO) which concluded that ‘any impact evaluation (and subsequent value for money calculation) requires construction of a counterfactual’. Second, a detailed technical appendix should accompany all impact assessments to allow independent review by a subject specialist. While this would assist peer review, it would allow providing greater transparency where peer review was not undertaken prior to publication. Furthermore, it would enable recalculation of SROI ratios to exclude ‘value’ attributable to stakeholders which are not relevant to a particular funder. Third, equity considerations should be addressed explicitly in all evaluations (this is currently not required in HTAs). Fourth, both costs and outcomes should be captured from a ‘broad’ perspective (adopting a ‘narrow’ healthcare perspective may underestimate the full economic impact), with non-healthcare sector costs being detailed as part of the analysis. Finally, data should be collected post-implementation to ensure that resources continue to be allocated efficiently.

As with any review, there are limitations which should be noted. A search of the grey literature was included as evaluations of applied public health interventions are not always reported in the academic literature. Systematically identifying grey literature and grey data can be problematic [ 79 , 80 , 81 , 82 , 83 ] as it is not collected, organised or stored in a consistent manner. Hence it is possible that we have not identified all relevant studies. Furthermore, as applied public health interventions can be performed in a non-healthcare setting we included SROIs in our review of economic evaluations. Current guidance on the systematic review of economic evaluations has been developed primarily for review of HTA as opposed to public health interventions and hence SROIs would be excluded, or if included would score poorly due to the inherent biases arising from no comparator or counterfactual being included.

This systematic review found that participation in group-based arts and creativity programmes was generally cost-effective and/or produced a positive return on investment whilst having a positive impact on older people’s physical, psychological, and social health and wellbeing outcomes. Unfortunately, the small number of studies identified, coupled with differences in methods used to assess economic impact hinders our ability to conclusively determine which types of art and creativity-based activities are more cost-effective or represent best value for money.

As well as the need for a greater focus on prevention of poor health as we age, new hybrid models of healthcare delivery are necessary to meet the needs of our ageing population. These models will integrate traditional medical care with other services such as home health aides (some of which may include artificial intelligence), telemedicine and social support networks. Alongside these, ACIs have the potential to provide a low cost, scalable, easily implementable and cost-effective solution to reduce the burden of illness in this age group and support healthy ageing.

Evidence on the cost-effectiveness of a range of ACIs is of utmost importance for policy and decision makers as it can both inform the development of policies that support the provision of ACIs in the context of ageing, but also identify the most cost-effective approaches for delivering such interventions. The development of hybrid models of evaluation, capable of capturing cost-effectiveness and social value, is becoming increasingly necessary as healthcare delivery for this age group moves beyond the realms of primary and secondary care and into the community. The development and refinement of such models will ensure a more comprehensive assessment of the impact of a diverse range of interventions providing a more nuanced understanding of the impact of an intervention. This will help inform decision making and ensure interventions are implemented in a cost-effective and socially beneficial manner.

Availability of data and materials

All data generated or analysed during this study are included in the published article and its supplementary information files.

United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2015 Revision, Key Findings and Advance Tables. Working Paper No. ESA/P/WP.241. 2015.

Office for National Statistics. Living longer: how our population is changing and why it matters. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/livinglongerhowourpopulationischangingandwhyitmatters/2018-08-13#how-do-incomes-of-older-people-compare-with-younger-ages . 2018. Accessed 07/12/2022

Dyakova M, Hamelmann C, Bellis MA, Besnier E, Grey CNB, Ashton K, Schwappach A, Clar C. Investment for health and well-being: a review of the social return on investment from public health policies to support implementing the Sustainable Development Goals by building on Health 2020 [Internet]. Copenhagen: WHO Regional Office for Europe; 2017.

Google Scholar  

Fancourt D, Finn S. What is the evidence on the role of the arts in improving health and well-being? A scoping review. Copenhagen: WHO Regional Office for Europe; 2019.

McQuade L, O’Sullivan R. Examining arts and creativity in later life and its impact on older people’s health and wellbeing: a systematic review of the evidence. Perspect Publ Health. 2023;0(0). https://doi.org/10.1177/17579139231157533

Skingley A, De’Ath S, Napleton L. Evaluation of Edna: arts and dance for older people. Work Older People. 2016;20(1):46–56.

Article   Google Scholar  

Brustio PR, Liubicich ME, Chiabrero M, et al. Dancing in the golden age: a study on physical function, quality of life, and social engagement. Geriatr Nurs. 2018;39(6):635–9.

Article   PubMed   Google Scholar  

Beauchet O, Bastien T, Mittelman M, et al. Participatory art-based activity, community-dwelling older adults and changes in health condition: results from a pre-post intervention, single-arm, prospective and longitudinal study. Maturitas. 2020;134:8–14.

Article   CAS   PubMed   Google Scholar  

Roswiyani R, Hiew CH, Witteman CLM, et al. Art activities and qigong exercise for the well-being of older adults in nursing homes in Indonesia: a randomized controlled trial. Aging Ment Health. 2020;24(10):1569–78.

Shanahan J, Bhriain ON, Morris ME, et al. Irish set dancing classes for people with Parkinson’s disease: the needs of participants and dance teachers. Complement Ther Med. 2016;27:12–7.

Garcia Gouvêa JA, Antunes MD, Bortolozzi F, et al. Impact of senior dance on emotional and motor parameters and quality of life of the elderly. Rev Rene. 2017;18(1):51–8.

Sun J, Zhang N, Buys N, et al. The role of Tai Chi, cultural dancing, playing a musical instrument and singing in the prevention of chronic disease in Chinese older adults: a mind–body meditative approach. Int J Ment Health Pr. 2013;15:227–39.

Fu MC, Belza B, Nguyen H, et al. Impact of group-singing on older adult health in senior living communities: a pilot study. Arch Gerontol Geriatr. 2018;76:138–46.

Feng L, Romero-Garcia R, Suckling J, et al. Effects of choral singing versus health education on cognitive decline and aging: a randomized controlled trial. Aging-us. 2020;12(24):24798–816.

Seinfeld S, Figueroa H, Ortiz-Gil J, et al. Effects of music learning and piano practice on cognitive function, mood and quality of life in older adults. Front Psychol. 2013;4:810.

Article   PubMed   PubMed Central   Google Scholar  

MacRitchie J, Breaden M, Milne AJ, et al. Cognitive, motor and social factors of music instrument training programs for older adults’ improved wellbeing. Front Psychol. 2020;10:2868.

Freeman WJI. A neurobiological role of music in social bonding. In: Wallin N, Merkur B, Brown S, editors. The origins of music. Cambridge: MIT Press; 2000. http://escholarship.org/uc/item/9025x8rt .

Huron D. Is music an evolutionary adaptation? Ann N Y Acad Sci. 2001;930(1):43–61. https://doi.org/10.1111/j.1749-6632.2001.tb05724.x .

Tarr B, Launay J, Dunbar RIM. Music and social bonding: “self–other” merging and neurohormonal mechanisms. Front Psychol. 2014;5:1096. https://doi.org/10.3389/fpsyg.2014.01096 .

Cain M, Lakhani A, Istvandity L. Short and long term outcomes for culturally and linguistically diverse (cald) and at-risk communities in participatory music programs: a systematic review. Arts Health. 2016;8(2):105–24. https://doi.org/10.1080/17533015.2015.1027934 .

Martin L, Oepen R, Bauer K, Nottensteiner A, Mergheim K, Gruber H, et al. Creative arts interventions for stress management and prevention – a systematic review. Behav Sci (Basel). 2018;8(2):pii:E28. https://doi.org/10.3390/bs8020028 .

Linnemann A, Wenzel M, Grammes J, Kubiak T, Nater UM. Music listening and stress in daily life: a matter of timing. Int J Behav Med. 2018;25(2):223–30. https://doi.org/10.1007/s12529-017-9697-5 .

Linnemann A, Strahler J, Nater UM. The stress-reducing effect of music listening varies depending on the social context. Psychoneuroendocrinology. 2016;72:97–105. https://doi.org/10.1016/j.psyneuen.2016.06.003 .

Panteleeva Y, Ceschi G, Glowinski D, Courvoisier DS, Grandjean DM. Music for anxiety? meta-analysis of anxiety reduction in non-clinical samples. Psychol Music. 2017;46(4):473–87. https://doi.org/10.1177/0305735617712424 .

Fancourt D, Tymoszuk U. Cultural engagement and incident depression in older adults: evidence from the English longitudinal study of ageing. Br J Psychiatry. 2018;214(4):225–9. https://doi.org/10.1192/bjp.2018.267 .

Balbag MA, Pedersen NL, Gatz M. Playing a musical instrument as a protective factor against dementia and cognitive impairment: a population-based twin study. Int J Alzheimer’s Dis. 2014;2014:836748. https://doi.org/10.1155/2014/836748 .

Porat S, Goukasian N, Hwang KS, Zanto T, Do T, Pierce J, et al. Dance experience and associations with cortical gray matter thickness in the aging population. Dement Geriatr Cogn Dis Extra. 2016;6(3):508–17. https://doi.org/10.1159/000449130 .

Federici A, Bellagamba S, Rocchi MBL. Does dance-based training improve balance in adult and young old subjects? a pilot randomized controlled trial. Aging Clin Exp Res. 2005;17(5):385–9 PMID: 16392413.

Alpert PT, Miller SK, Wallmann H, Havey R, Cross C, Chevalia T, et al. The effect of modified jazz dance on balance, cognition, and mood in older adults. J Am Acad Nurse Pract. 2009;21(2):108–15. https://doi.org/10.1111/j.1745-7599.2008.00392.x .

Jeon MY, Bark ES, Lee EG, Im JS, Jeong BS, Choe ES. The effects of a Korean traditional dance movement program in elderly women. Taehan Kanho Hakhoe Chi. 2005;35(7):126876 (in Korean). PMID: 16418553.

Eyigor S, Karapolat H, Durmaz B, Ibisoglu U, Cakir S. A randomized controlled trial of Turkish folklore dance on the physical performance, balance, depression and quality of life in older women. Arch Gerontol Geriatr. 2009;48(1):84–8. https://doi.org/10.1016/j.archger.2007.10.008 .

Noopud P, Suputtitada A, Khongprasert S, Kanungsukkasem V. Effects of Thai traditional dance on balance performance in daily life among older women. Aging Clin Exp Res. 2018;31(7):961–7. https://doi.org/10.1007/s40520-018-1040-8 .

Trombetti A, Hars M, Herrmann FR, Kressig RW, Ferrari S, Rizzoli R. Effect of musicbased multitask training on gait, balance, and fall risk in elderly people: a randomized controlled trial. Arch Intern Med. 2011;171(6):525–33. https://doi.org/10.1001/archinternmed.2010.446 .

Hyyppä MT, Mäki J, Impivaara O, Aromaa A. Individual-level measures of social capital as predictors of all-cause and cardiovascular mortality: a population-based prospective study of men and women in Finland. Eur J Epidemiol. 2007;22(9):589–97. https://doi.org/10.1007/s10654-007-9153-y .

Hyyppä MT, Mäki J, Impivaara O, Aromaa A. Leisure participation predicts survival: a population-based study in Finland. Health Promot Int. 2006;21(1):5–12. https://doi.org/10.1093/heapro/dai027 .

Lennartsson C, Silverstein M. Does engagement with life enhance survival of elderly people in Sweden? the role of social and leisure activities. J Gerontol B Psychol Sci Soc Sci. 2001;56(6):S335–42. https://doi.org/10.1093/geronb/56.6.s335 .

Sundquist K, Lindström M, Malmström M, Johansson SE, Sundquist J. Social participation and coronary heart disease: a follow-up study of 6900 women and men in Sweden. Soc Sci Med. 1982;58(3):615–22. https://doi.org/10.1016/s0277-9536(03)00229-6 .

Väänänen A, Murray M, Koskinen A, Vahtera J, Kouvonen A, Kivimäki M. Engagement in cultural activities and cause-specific mortality: prospective cohort study. Prev Med. 2009;49(2–3):142–7. https://doi.org/10.1016/j.ypmed.2009.06.026 .

Särkämö T, Soto D. Music listening after stroke: beneficial effects and potential neural mechanisms. Ann N Y Acad Sci. 2012;1252(1):266–81. https://doi.org/10.1111/j.1749-6632.2011.06405.x .

Särkämö T, Pihko E, Laitinen S, Forsblom A, Soinila S, Mikkonen M, et al. Music and speech listening enhance the recovery of early sensory processing after stroke. J Cogn Neurosci. 2010;22(12):2716–27. https://doi.org/10.1162/jocn.2009.21376 .

Särkämö T, Ripollés P, Vepsäläinen H, Autti T, Silvenno HM, Salli E, et al. Structural changes induced by daily music listening in the recovering brain after middle cerebral artery stroke: a voxel-based morphometry study. Front Hum Neurosci. 2014;8:245. https://doi.org/10.3389/fnhum.2014.00245 .

Särkämö T, Tervaniemi M, Laitinen S, Forsblom A, Soinila S, Mikkonen M, et al. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Brain. 2008;131(3):866–76. https://doi.org/10.1093/brain/awn013 .

Fancourt D, Steptoe A, Cadar D. Cultural engagement and cognitive reserve: museum attendance and dementia incidence over a 10-year period. Br J Psychiatry. 2018;213(5):661–3. https://doi.org/10.1192/bjp.2018.129 .

Fancourt D, Steptoe A, Cadar D. Cultural engagement predicts changes in cognitive function in older adults over a 10 year period: findings from the English longitudinal study of ageing. Sci Rep. 2018;8(1):10226. https://doi.org/10.1192/bjp.2018.129 .

All Party Parliamentary group on arts, health and wellbeing. Creative health: the arts for health and wellbeing. 2017.

van Mastrigt GA, Hiligsmann M, Arts JJ, Broos PH, Kleijnen J, Evers SM, Majoie MH. How to prepare a systematic review of economic evaluations for informing evidence-based healthcare decisions: a five-step approach (part 1/3). Expert Rev Pharmacoecon Outcomes Res. 2016;16(6):689–704. https://doi.org/10.1080/14737167.2016.1246960 . Epub 2016 Nov 2 PMID: 27805469.

Thielen FW, Van Mastrigt G, Burgers LT, Bramer WM, Majoie H, Evers S, Kleijnen J. How to prepare a systematic review of economic evaluations for clinical practice guidelines: database selection and search strategy development (part 2/3). Expert Rev Pharmacoecon Outcomes Res. 2016;16(6):705–21. https://doi.org/10.1080/14737167.2016.1246962 . Epub 2016 Nov 2 PMID: 27805466.

Wijnen B, Van Mastrigt G, Redekop WK, Majoie H, De Kinderen R, Evers S. How to prepare a systematic review of economic evaluations for informing evidence-based healthcare decisions: data extraction, risk of bias, and transferability (part 3/3). Expert Rev Pharmacoecon Outcomes Res. 2016;16(6):723–32. https://doi.org/10.1080/14737167.2016.1246961 . Epub 2016 Oct 21 PMID: 27762640.

Mandrik OL, Severens JLH, Bardach A, Ghabri S, Hamel C, Mathes T, Vale L, Wisløff T, Goldhaber-Fiebert JD. Critical appraisal of systematic reviews with costs and cost-effectiveness outcomes: an ISPOR good practices task force report. Value Health. 2021;24(4):463–72. https://doi.org/10.1016/j.jval.2021.01.002 . PMID: 33840423.

Kelly MP, McDaid D, Ludbrook A, Powell J: Economic appraisal of public health interventions. http://www.cawt.com/Site/11/Documents/Publications/Population%20Health/Economics%20of%20Health%20Improvement/Economic_appraisal_of_public_health_interventions.pdf

Weatherly H, Drummond M, Claxton K, Cookson R, Ferguson B, Godfrey C, Rice N, Sculpher M, Sowden A. Methods for assessing the cost-effectiveness of public health interventions: key challenges and recommendations. Health Policy. 2009;93(2–3):85–92. https://doi.org/10.1016/j.healthpol.2009.07.012 . Epub 2009 Aug 25 PMID: 19709773.

Payne K, McAllister M, Davies LM. Valuing the economic benefits of complex interventions: when maximising health is not sufficient. Health Econ. 2012. https://doi.org/10.1002/hec.2795 .

Edwards RT, Charles JM, Lloyd-Williams H. Public health economics: a systematic review of guidance for the economic evaluation of public health interventions and discussion of key methodological issues. BMC Public Health. 2013;24(13):1001. https://doi.org/10.1186/1471-2458-13-1001.PMID:24153037;PMCID:PMC4015185 .

Rethlefsen ML, Farrell AM, Osterhaus Trzasko LC, Brigham TJ. Librarian co-authors correlated with higher quality reported search strategies in general internal medicine systematic reviews. J Clin Epidemiol. 2015;68(6):617–26. https://doi.org/10.1016/j.jclinepi.2014.11.025 . Epub 2015 Feb 7 PMID: 25766056.

McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol. 2016;75:40–6. https://doi.org/10.1016/j.jclinepi.2016.01.021 . Epub 2016 Mar 19 PMID: 27005575.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. PLoS Med. 2008;6:e1000097. https://doi.org/10.1371/journal.pmed.1000097 .

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;21(339):b2700. https://doi.org/10.1136/bmj.b2700.PMID:19622552;PMCID:PMC2714672 .

Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. PLoS Med. 2009;6(7):e1000097 Evers S, Goossens M, De Vet H, et al. Criteria list for assessment of methodological quality of economic evaluations: consensus on health economic criteria. Int J Technol Assess Health Care. 2005;21(02):240–245.

Evers S, Goossens M, de Vet H, van Tulder M, Ament A. Criteria list for assessment of methodological quality of economic evaluations: Consensus on Health Economic Criteria. Int J Technol Assess Health Care. 2005;21(2):240–5 PMID: 15921065.

Hutchinson CL, Berndt A, Gilbert-Hunt S, George S, Ratcliffe J. Valuing the impact of health and social care programmes using social return on investment analysis: how have academics advanced the methodology? A protocol for a systematic review of peer-reviewed literature. BMJ Open. 2018;8(12):e022534. https://doi.org/10.1136/bmjopen-2018-022534 . PMID:30530579;PMCID:PMC6303612.

Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version 5.1. 0. Chichester: The Cochrane Collaboration; 2013.

Coulton S, Clift S, Skingley A, Rodriguez J. Effectiveness and cost-effectiveness of community singing on mental health-related quality of life of older people: randomised controlled trial. Br J Psychiatry. 2015;207(3):250–5. https://doi.org/10.1192/bjp.bp.113.129908 . Epub 2015 Jun 18 PMID: 26089304.

Johnson JK, Stewart AL, Acree M, Nápoles AM, Flatt JD, Max WB, Gregorich SE. A community choir intervention to promote well-being among diverse older adults: results from the community of voices trial. J Gerontol B Psychol Sci Soc Sci. 2020;75(3):549–59. https://doi.org/10.1093/geronb/gby132 . PMID:30412233;PMCID:PMC7328053.

Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S, CHEERS 2022 ISPOR Good Research Practices Task Force. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. Value Health. 2022;25(1):3–9. https://doi.org/10.1016/j.jval.2021.11.1351 . PMID: 35031096.

Bosco A, Schneider J, Broome E. The social value of the arts for care home residents in England: a social return on investment (SROI) analysis of the imagine arts programme. Maturitas. 2019;124:15–24. https://doi.org/10.1016/j.maturitas.2019.02.005 . Epub 2019 Mar 13 PMID: 31097173.

Jones C, Windle G, Edwards RT. Dementia and imagination: a social return on investment analysis framework for art activities for people living with dementia. Gerontologist. 2020;60(1):112–23. https://doi.org/10.1093/geront/gny147 . PMID: 30476114.

Social Value Lab and Impact Arts Craft Café: creative solutions to isolation and loneliness; Social return on investment. 2011. http://www.socialvaluelab.org.uk/wp-content/uploads/2013/05/CraftCafeSROI.pdf

MB associates. Make my day: the impact of Creative Caring in older people’s care homes. 2013. https://www.suffolkartlink.org.uk/wp-content/uploads/2014/10/CreativeCarersSROIReport_Nov2013.pdf

HACT. n.d. UK Social Value Bank. Retrieved December 11, 2023. from https://hact.org.uk/tools-and-services/uk-social-value-bank/ .

The Older Adults’ NHS and social care return on investment tool. Project report. Public health England. December 2019. Last accessed 27/03/2023.

British Red Cross – Valuing First Aid Education. 2018. https://socialvalueuk.org/wp-content/uploads/2018/12/Valuing-First-Aid-Education-Social-Return-on-Investment-Report-on-the-value-of-First-Aid-Education-Assured-Report.pdf . Accessed 17/02/2023

Hunter R, Dallat M, Tully M, O’Neill C, Heron L, Kee F. Social return on investment analysis of an urban greenway. Cities and Health. 2020. https://doi.org/10.1080/23748834.2020.1766783 .

NEF Consulting. Refuge: A social return on investment evaluation. 2016. https://socialvalueuk.org/wp-content/uploads/2017/04/Refuge-SROI-2016.pdf Accessed 17/02/2022

Corbacho B, Cockayne S, Fairhurst C, Hewitt CE, Hicks K, Kenan AM, Lamb SE, MacIntosh C, Menz HB, Redmond AC, Rodgers S, Scantlebury A, Watson J, Torgerson DJ, on behalf of the REFORM study. Cost-Effectiveness of a Multifaceted Podiatry Intervention for the Prevention of Falls in Older People: The REducing Falls with Orthoses and a Multifaceted Podiatry Intervention Trial Findings. Gerontology. 2018;64(5):503–12. https://doi.org/10.1159/000489171 . Epub 2018 Jun 26 PMID: 29945150.

Green C, Richards DA, Hill JJ, Gask L, Lovell K, Chew-Graham C, Bower P, Cape J, Pilling S, Araya R, Kessler D, Bland JM, Gilbody S, Lewis G, Manning C, Hughes-Morley A, Barkham M. Cost-effectiveness of collaborative care for depression in UK primary care: economic evaluation of a randomised controlled trial (CADET). PLoS ONE. 2014;9(8):e104225. https://doi.org/10.1371/journal.pone.0104225.PMID:25121991;PMCID:PMC4133193 .

National Institute for Health and Care Excellence (NICE). NICE health technology evaluations: the manual. 2022. Retrieved 27 March, 2023 from  https://www.nice.org.uk/process/pmg36/chapter/introduction-to-health-technology-evaluation

NEF Consulting. SSE – Beatrice SROI framework – guidance document. https://www.sse.com/media/svnn5jpk/sroi-methodology-guidance-nef-consulting.pdf . Accessed 17/02/2022

Gibbons S, McNally S, Overman H. Review of Government Evaluations: A report for the NAO. London: National Audit Office; 2013.

Turner AM, Liddy ED, Bradley J, Wheatley JA. Modeling public health interventions for improved access to the gray literature. J Med Libr Assoc. 2005;93(4):487–94 PMID: 16239945; PMCID: PMC1250325.

PubMed   PubMed Central   Google Scholar  

Benzies KM, Premji S, Hayden KA, Serrett K. State-of-the-evidence reviews: advantages and challenges of including grey literature. Worldviews Evid Based Nurs. 2006;3(2):55–61. https://doi.org/10.1111/j.1741-6787.2006.00051.x . PMID: 17040510.

Franks H, Hardiker NR, McGrath M, McQuarrie C. Public health interventions and behaviour change: reviewing the grey literature. Public Health. 2012;126(1):12–7. https://doi.org/10.1016/j.puhe.2011.09.023 . Epub 2011 Nov 29 PMID: 22130477.

Mahood Q, Van Eerd D, Irvin E. Searching for grey literature for systematic reviews: challenges and benefits. Res Synth Methods. 2014;5(3):221–34. https://doi.org/10.1002/jrsm.1106 . Epub 2013 Dec 6 PMID: 26052848.

Godin K, Stapleton J, Kirkpatrick SI, Hanning RM, Leatherdale ST. Applying systematic review search methods to the grey literature: a case study examining guidelines for school-based breakfast programs in Canada. Syst Rev. 2015;22(4):138. https://doi.org/10.1186/s13643-015-0125-0 . PMID:26494010;PMCID:PMC4619264.

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Acknowledgements

We would like to thank Ms. Louise Bradley (Information Resource Officer, Institute of Public Health) for her assistance in refining search strategies and literature search.

This study was supported by the Institute of Public Health (IPH), 200 South Circular Road, Dublin 8, Ireland, D08 NH90. This study was a collaboration between two health economists (GC, CO’N) and two members of staff from the funding organisation (LM, RO’S). Input from IPH staff was fundamental in defining the scope of work and research question, refining search terms and review and editing of the manuscript. Staff from IPH were not involved in quality assurance or review of papers included in the manuscript.

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LMcQ and ROS were involved in defining the scope of work, refining the research question, provision of subject specific (public health) context, review of search strategy, review & editing of manuscript. CON and GC were involved in refining the research question and search strategy, provision of health economics and systematic reviewing expertise, review of returned reports, original draft preparation, review, editing and submission of manuscript. All authors read and approved the final manuscript.

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Additional file 1.

: Table S1. Search strategy for electronic databases and grey literature.

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Crealey, G., McQuade, L., O’Sullivan, R. et al. Arts and creativity interventions for improving health and wellbeing in older adults: a systematic literature review of economic evaluation studies. BMC Public Health 23 , 2496 (2023). https://doi.org/10.1186/s12889-023-17369-x

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Received : 23 April 2023

Accepted : 28 November 2023

Published : 13 December 2023

DOI : https://doi.org/10.1186/s12889-023-17369-x

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