Review conclusions should help people make well-informed decisions about future healthcare research. The ‘Implications for research’ should comment on the need for further research, and the nature of the further research that would be most desirable. A format has been proposed for reporting research recommendations (‘EPICOT’), as follows (Brown 2006).
E (Evidence): What is the current evidence?
P (Population): Diagnosis, disease stage, co-morbidity, risk factor, sex, age, ethnic group, specific inclusion or exclusion criteria, clinical setting.
I (Intervention): Type, frequency, dose, duration, prognostic factor.
C (Comparison): Placebo, routine care, alternative treatment/management.
O (Outcome): Which clinical or patient-related outcomes will the researcher need to measure, improve, influence or accomplish? Which methods of measurement should be used?
T (Time stamp): Date of literature search or recommendation.
Other factors that might be considered in recommendations include the disease burden of the condition being addressed, the timeliness (e.g. length of follow-up, duration of intervention), and the study type that would best suit subsequent research (Brown 2006).
Cochrane review authors should ensure that they include the PICO aspects of this format. It is also helpful to note the study types, as well as any particular design features, that would best address the research question.
A review of compression stockings for prevention of deep vein thrombosis in airline passengers provides an example where there is some convincing evidence of a benefit of the intervention: “This review shows that the question of the effects on symptomless DVT of wearing versus not wearing compression stockings in the types of people studied in these trials should now be regarded as answered. Further research may be justified to investigate the relative effects of different strengths of stockings or of stockings compared to other preventative strategies. Further randomized trials to address the remaining uncertainty about the effects of wearing versus not wearing compression stockings on outcomes such as death, pulmonary embolus and symptomatic DVT would need to be large.” (Clarke 2006).
A review of therapeutic touch for anxiety disorder provides an example of the implications for research when no eligible studies had been found: “This review highlights the need for randomised controlled trials to evaluate the effectiveness of therapeutic touch in reducing anxiety symptoms in people diagnosed with anxiety disorders. Future trials need to be rigorous in design and delivery, with subsequent reporting to include high quality descriptions of all aspects of methodology to enable appraisal and interpretation of results.” (Robinson 2007).