Review Manager 5.

2 Tutorial
for Diagnostic test accuracy reviews
September 2012

Welcome to the RevMan Diagnostic test accuracy (DTA) Tutorial. This tutorial is
designed to give Cochrane review authors an introduction to the process of writing a
Cochrane systematic review of the accuracy of diagnostic tests using RevMan.

The tutorial does not provide all the information necessary to write a Cochrane DTA
review, and does not address other types of Cochrane systematic reviews such as
reviews of intervention studies or overviews of reviews. For detailed instructions on
how to conduct a Cochrane DTA review, please refer to the Cochrane Handbook for
Diagnostic Test Accuracy Reviews, available from the following website
http://srdta.cochrane.org.

Later parts of this tutorial rely on activities completed in the earlier sections, so we
recommend you start working from the beginning. If you would like to skip ahead,
click on the section you would like to read in the Contents list. The approximate time
needed to complete this tutorial will be about three to four hours.

If you have technical questions regarding RevMan software, please contact the
Cochrane Information Management System team at ims.cochrane.org.net/revman.
Other questions related to preparing protocols or reviews in RevMan should be
directed to the relevant Cochrane Review Group.

About this tutorial

The tutorial for Cochrane diagnostic test accuracy reviews in RevMan 5 was developed by Mariska
Leeflang in 2010, with assistance from the Australasian Cochrane Centre and the UK and Continental
European Support Unit for diagnostic test accuracy reviews, and with funding from The Cochrane
Collaboration Steering Group. The tutorial was revised in February 2011 to incorporate new features
of RevMan 5.1 and in September 2012 for new features of RevMan 5.2. Please note that the results
reported in this tutorial are fictional and were created by the authors for teaching purposes only.

Note about using mouse right-clicks

Many of the functions in RevMan that involve selecting a button on the outline pane toolbar can also
be achieved by right-clicking the sub-headings in the outline pane and selecting the function from the
drop-down list.

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PART 1 – Getting started .................................................................................... 5
Opening your review.................................................................................................. 5
Setting up user details ............................................................................................... 6
The RevMan 5.2 interface .......................................................................................... 6
Saving a review .......................................................................................................... 8
Adding authors to a review ........................................................................................ 8
Accessing the Cochrane Handbook for Diagnostic Test Accuracy Reviews ............... 9
PART 2 – Working with text .............................................................................. 11
Adding text to a review ............................................................................................ 11
Formatting text ........................................................................................................ 11
Making changes to headings.................................................................................... 11
Adding notes ............................................................................................................ 12
Tracking changes in the text .................................................................................... 12
Checking your spelling ............................................................................................. 13
PART 3 – Adding studies and references ............................................................ 15
Adding studies to a review....................................................................................... 15
Adding references to a study ................................................................................... 15
Editing an existing reference ................................................................................... 17
Importing references from a text file ...................................................................... 18
Moving references ................................................................................................... 18
Adding links to references in the text ...................................................................... 19
Removing a link ........................................................................................................ 20
Adding multiple links automatically......................................................................... 20
PART 4 - Tables ................................................................................................ 21
Characteristics of included studies tables ............................................................... 21
Patient selection ...................................................................................................... 21
Index Test, Reference Standard, and Flow and Timing ........................................... 22
Editing the Characteristics of included studies table............................................... 22
Adding user-defined items....................................................................................... 23
Characteristics of excluded studies ......................................................................... 24
Adding Footnotes to tables...................................................................................... 25
Additional tables ...................................................................................................... 25
PART 5 - Data and analyses ............................................................................... 27
Adding tests ............................................................................................................. 27
Entering data by test ................................................................................................ 28
Entering data using the calculator ........................................................................... 29
Entering data by study ............................................................................................. 30
Assessment of methodological quality for two tests .............................................. 32
Covariates ................................................................................................................ 33
Analyses ................................................................................................................... 35
a. Changing Forest Plot properties .......................................................................... 36
b. Changing SROC Graph properties ........................................................................ 37
c. Entering Externally Calculated Parameters .......................................................... 38
Test Comparisons ..................................................................................................... 38

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 Paired Test Comparisons ......................................................................................... 40
Investigating heterogeneity ..................................................................................... 41
Adding a figure to your review ................................................................................ 42
Risk of bias and applicability concerns graph and summary ................................... 43
PART 6 – Finishing the review ........................................................................... 44
Summary of Findings tables ..................................................................................... 44
Adding an appendix ................................................................................................. 44
Validating a review................................................................................................... 44
Submitting a review for editorial approval .............................................................. 45
Appendix – To convert to QUADAS-2 from QUADAS ........................................... 46

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4
PART 1 – Getting started
Opening your review
All Cochrane reviews are stored in Archie, The Cochrane Collaboration’s central
server for managing documents and contacts details. When you have registered a
review with a Cochrane Review Group, they will set up a user account for you in
Archie. To work on your review, you will need to find your review online in Archie
and check it out into RevMan using the My Reviews button on the toolbar. Doing
this opens a new window which provides information on the location of your reviews
and what the next task for your review is. In this window you can check a review out
by selecting the title and pressing the Check Out button.

Before going ahead it is important to make sure that RevMan is currently in

‘Standard’ mode rather than ‘Non-Cochrane’ mode. ‘Non-Cochrane’ mode is a
preference that allows users to specify that they are using RevMan to author reviews
that will not be published in The Cochrane Library. In ‘Non-Cochrane’ mode, all
Cochrane-specific functions like check in/out and connection settings to Archie are
absent from the interface. To complete this tutorial you need to be in ‘Standard’
RevMan mode.

1. From Tools menu on the toolbar, select Preferences which will open the
Preferences window.
2. Under User mode on the General tab, confirm that the Non-Cochrane mode
option is NOT checked.
3. If the Non-Cochrane mode option is checked, uncheck it and press OK. A
warning will appear indicating that “Not all changes may take effect until you
restart the program”. Click OK, and Exit out of RevMan and restart it.
4. If the Non-Cochrane mode option is NOT checked, simply click OK.

For this tutorial we will use a sample review called ‘Laboratory tests for caffeine
addiction in PhD students’. Instead of checking the review out of Archie, it has been
provided as an additional file with RevMan 5.2.

1. From the File menu, select Open, or click the Open button on the toolbar.
2. Find the folder where RevMan was installed on your computer. If you are
using Windows and accepted the default installation location, this will be
C:\\Program Files\Review Manager 5. If you are using Mac OS or Linux, the
tutorial files are copied to a subfolder of your home directory named
‘RevMan tutorial’.
3. Open the doc folder, and then the tutorial folder.
4. Select the file ‘Laboratory tests for caffeine addiction in PhD students.rm5’.
5. Click Open.

Note: It is possible to create a new review in RevMan by selecting New from the File menu, or clicking
the New button on the toolbar. Be aware that if you create a review yourself, you cannot
check it into Archie or use it for publication in The Cochrane Library.

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Setting up user details
If you will be using RevMan regularly on the same computer, you may wish to enter
your user details (such as your name). RevMan will attach these user details to any
editing done using track changes so that co-authors and editors can easily identify
who has made the changes. Open your user details by selecting Preferences from
the Tools menu. Enter your name directly or click Choose to find your details in
Archie.

Note: You will need to set up RevMan access to Archie via the internet. In the Preferences window,
open the Connection tab. Click the Wizard button to set up your connection, or enter your
Archie user name and password directly and click the Test button to check the connection.
You may need to enter proxy server details. Consult the RevMan 5.2 Help or your local IT
support for more information.

The RevMan 5.2 interface

When a review is open in RevMan 5.2, you will see there are two separate window
panes that interact with each other as you navigate through the different sections of
a review. The pane on the left hand side shows the outline of a review. This is
referred to as the outline pane. The area on the right hand side shows all the
information contained in a review. This is referred to as the content pane. The
content pane will usually show the text of your review, but can also contain
additional tabs for results, figures, etc.

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In the outline pane, you can use the key icon next to each heading to expand and
collapse subheadings. In the content pane, use the symbol.

RevMan allows you to change the appearance of the interface by selecting

Preferences from the Tools menu and going to the Interface tab. The default Look
and Feel of the interface is Metal. All screen captures presented in this tutorial
display the Metal look and feel. It is also possible to set language and spelling
options in the Preferences window.

By default, your new review is at the protocol stage, indicating that you are planning
the methods for a review. Sections of a review that are not required at the protocol
stage (but will be needed later for your completed review) appear as inactive (light
grey) in both the outline pane and the content pane.

Note: You can tell the stage of a review by looking for the protocol or review icon at the top
left of the outline pane.

When you undertake a Cochrane review, the protocol must be completed and
submitted for publication before moving on to the review stage. For this tutorial, to
convert the file from the protocol stage to review stage, use the following directions:

1. Click the Properties button in the top-right of the content pane.

2. In the Properties window, select the General tab.
3. Note the automatically generated Version Number – this number will change
each time the review is checked into Archie. Note that you do not need a
separate Review Number unless your Review Group provides one.
4. Enter the Version Description ‘First draft’. When choosing a version
description, make sure it is brief and clearly indicates what’s different about
this draft, e.g. ‘Edited by [your initials]’ or ‘Methods section complete’.

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 5. For the Stage, select Full Review.
6. Click OK. Note that all of the section headings of the review are now
activated for inclusion (there are no light grey section headings).

Saving a review
When you have finished working on a review from Archie, we recommend that you
always save the review by checking it back into Archie using the Check In button
on the toolbar. This ensures the most recent version of your review is safely stored
and can always be accessed from Archie by your co-authors and editors.

We recommend that you do not keep saved reviews on your computer, to avoid
confusion with different versions. Be careful not to use a version of your review from
your computer if a more recent version is available in Archie. If for some reason you
do need to save a review to your computer, such as this tutorial review which is not
from Archie, go to the File menu and select Save As, or click the Save button on
the toolbar. You can open a saved review by going to the File menu and selecting
Open, or clicking the Open button on the toolbar.

RevMan also creates automatic backups of your review. See the Help menu for
information on retrieving a backup file.

Adding authors to a review

For a real review, your Review Group will add your name as an author of the review
when they create the file, along with any known co-authors. You may wish to add
additional authors later.

There are two ways to add authors to a review:

• Add an author based on their record in Archie – this option allows you to
add authors who are already listed in the Archie database. You will need to
have internet access and an Archie user account for this option.
• Add a local record (name only) that can be linked to Archie later – this
option allows you to add authors that are not yet listed in Archie.

1. In the content pane, click the icon next to the Review information heading
to show further subheadings.
2. Click the icon to open the Authors section. Note that three authors have
already been added to this review.
3. In the outline pane, click the key icon next to Review information.
4. Select the Authors heading.
5. Click the Add Author button on the outline pane toolbar to open the New
Author Wizard.
6. Select Add a local record (name only) that can be linked to Archie later. Click
Next.

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 7. Enter your name in the First Name and Family Name fields.
8. Click Finish. You will now see your name listed next to the other authors of
the review. Note that no affiliation is available for your name. Affiliations can
only be added from records in Archie.

Note: Many of the functions in RevMan which involve selecting a button on the outline pane
toolbar can also be achieved by right-clicking the sub-headings in the outline pane and
selecting the function from the drop-down list. For example, rather than clicking the Add
Author button on the outline pane toolbar to open the New Author Wizard, you can
also right-click the Author sub-heading and select Add Author from the drop-down list.

Under the author details in both the outline and content panes you will note that a
Contact person can be specified for the review. By default, this is the first author,
but another person (who may or may not be an author of the review) can be
nominated by selecting the Contact person heading in the outline pane and clicking
the Edit Contact Person button on the outline pane toolbar. The contact person
must be listed in Archie.

Note: To add new people to Archie or to make changes to contact details, please contact your Review
Group Co-ordinator.

Accessing the Cochrane Handbook for Diagnostic Test Accuracy Reviews

For detailed instructions on what to report in each section of your review, you can
refer to the Cochrane Handbook for Diagnostic Test Accuracy Reviews. This can be
accessed from the Help menu, or by clicking the Handbook button in the top
right-hand corner of the content pane, which will open a new window that will allow

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you to browse through all sections of the Handbook. A particular section of the
Handbook can be opened in the new window depending on which section of the
Main text you are working on.

1. In the outline pane, if it is not already expanded, click the key icon next to
the Main text heading.
2. Click on the word Abstract.
3. In the content pane, click the Handbook button (or right click and select
Handbook). Note that the Cochrane Handbook for Diagnostic Test Accuracy
Reviews window has opened at the section with guidance on what to write in
the abstract of the review.
4. Close the Cochrane Handbook for Diagnostic Test Accuracy Reviews
window.

Note: In February 2011, only Chapter 4 of the Cochrane Handbook for Diagnostic Test Accuracy
Reviews was available in RevMan. The other chapters are available through the following
webpage http://srdta.cochrane.org.

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PART 2 – Working with text
Adding text to a review
Text can be copied and pasted from a word processor document, imported as an
html file or typed directly into RevMan.

1. In the content pane, if it is not already expanded, click the icon next to the
Background heading.
2. Click the icon next to the Target condition being diagnosed heading. A
blank line will open under the heading.
3. Click to place the cursor in the blank line and type “Caffeine addiction is a
common problem that affects productivity of PhD students, mainly due to
too much talking at the coffee machine.”

Formatting text
RevMan text formatting options are available from the toolbar, including bold ,
italics , underline , superscript , subscript , and highlighting text similar
to most other word processing software. You cannot change the font or type size, as
these are standard for all Cochrane reviews.

The Insert Symbol button allows you to insert symbols into the text of the review,
including in tables and author names. You can also insert a non-breaking space.

RevMan also allows bulleted and numbered lists , including multi-level lists.

Making changes to headings

RevMan includes the standard headings for a complete Cochrane review, but new
headings can be added and some standard headings can be deactivated.

1. In the outline pane, click the key icon next to Main text to reveal the
subheadings.
2. Click the key icon next to Background.
3. Click the key icon next to Clinical pathway.
4. Any heading with the icon is optional and can be deactivated. Right-click
the Alternative tests subheading and select Deactivate Heading
(alternatively, select the heading Alternative test(s) then click the button
on the outline pane toolbar and select Deactivate Heading from the drop
down menu).
5. Note that the heading appears deactivated (light grey) in the outline pane
and the text of the heading has been removed from the content pane.
6. In the content pane, click to place the cursor at the end of the text in the
Target condition being diagnosed section and press Enter to create a new
line.
7. On the toolbar, you will see a drop-down box showing the text style currently
in use. By default, text is in the Normal style. Click the drop-down arrow and
select Heading 3.

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 8. Type the text ‘Reference standard’. Note that formatting of Heading 3 is bold
and italics.
9. Press Enter again. Note that the new blank line is in the Normal style again.

Adding notes
You can add notes to assist in drafting the review. These notes will not appear in the
published version of the review.

1. In the content pane, make sure the cursor is still in the Background section.
2. Click the Notes button on the outline pane toolbar (NOT the Notes button
in the content pane). This will open the Notes window.
3. Enter a note, ‘This text needs revision.’ You will see the user details you
entered in the Preferences window at the beginning of the tutorial appears
at the bottom of the Notes window.
4. Click the Close button to save the note and close the window.
5. A yellow Note icon appears next to the relevant heading in both the
content pane and outline pane.
6. To see all the notes for a review while you are working, go to the View menu
and select Notes. A separate window pane will appear below the content
pane showing the notes for each section.
7. In the content pane, click to place the cursor back in the Background section.
The notes area will automatically display the note you have entered in that
section.
8. Click the icon at the top left of the notes area to minimise it, or go to the
View menu and select Notes to close the notes pane.
9. In the content pane, click the Note icon to open the Notes window again.
10. Click Delete to delete the note.

Tracking changes in the text

RevMan has a Track Changes system to help you manage editing in the text.

1. From the Tools menu, select Track Changes, or click the Track Changes
button on the toolbar. Note that the Track Changes button is now activated.
2. In the content pane, go to the Background section and replace the word
‘problem’ with the word ‘condition’. The old text will appear in red with a line
through it, and the new text will appear in green.
3. In the same section of the review, change the word ‘at’ to ‘by’. Leave the
cursor in the text after your changes.
4. From the Tools menu, select Accept or Reject Changes. This will open the
Accept or Reject Changes window.
5. In the window you just opened, click the Find button with the arrow pointing
left to search backwards toward the beginning of your document.

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 6. The first change found will be the word ‘function’. The word will be
highlighted in the content pane. You may need to move the Accept or Reject
Changes window out of the way to see the highlighted section of text. Click
Accept to accept the change.
7. RevMan will automatically find the next change and highlight the relevant
text. Click Accept again to accept the deletion of the word ‘at’.
8. Reject the rest of the changes you made by clicking the Reject All button.
9. Click OK.
10. In the content pane, change the word ‘problem’ to ‘condition’ again.
11. Hover the mouse pointer over the change. A popup message will appear
showing the user details and when the change was made.
12. Right-click each change (both the added word and deleted word) and select
Accept Change.
13. Turn off the Track Changes feature by clicking the Track Changes button
on the toolbar.

Checking your spelling

RevMan can either check your spelling as you type, or check all the spelling in your
review at the one time.

1. From the Tools menu, select Preferences.

2. Select the Spell Checking tab.
3. Select which dictionaries you would like RevMan to use, including UK, US or
Canadian English. You can select more than one dictionary if you wish.

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 4. Click OK.
5. In the content pane, create a spelling mistake by deleting an ‘m’ from the
word ‘common’.
6. Open the Tools menu and select the Check Spelling option. This will open the
Check Spelling window.
7. Depending where your cursor was placed, RevMan may ask whether you wish
to continue checking from the beginning of the document. Click Yes.
8. RevMan will highlight the spelling mistake and suggest ‘common’ as the
correct spelling. Click Change.

Note: The Check Spelling tool cannot correct spelling errors in some sections of the review text, such
as author’s names and contact details or the Data and Analyses section.

9. A notice will appear to say that the spell check is complete. Click OK.
10. Click OK again to close the Check Spelling window.
11. To check spelling continuously while you type, go to the Tools menu and
select Check Spelling as You Type, or click the Check Spelling as You Type
button on the toolbar.
12. Delete the ‘m’ from ‘common’ again, and click to place the cursor elsewhere
in the text. The spelling mistake will be underlined in red.
13. To correct the word, right-click it and select the correct spelling from the
options available.

Note: The Check Spelling tool identifies the "s" in constructions like "Index Test(s)" and “Comparison
Test(s)” as spelling mistakes.

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PART 3 – Adding studies and references

There are two kinds of references that can be added to a review:

• References to studies – these are references to studies that have been either
included or excluded from your review. A study can have more than one
reference, for example if there has been more than one published paper, or if
you have received additional information from the study author.
• Other references – these are any other source you would like to cite in your
review, such as background articles, methodological references, software,
etc.

Adding studies to a review

When you are ready to add included and excluded studies to your review, you will
need to create a Study ID for each study, and then add the associated references. For
Cochrane reviews, the Study ID is usually the name of the lead author of the main
published paper and the year of publication. If you have more than one reference
with the same name and year, you can add a letter to the year to differentiate them
(e.g. Egberts 2001a, Egberts 2001b).

1. In the outline pane, click the key icon next to Studies and references.
2. Click the key icon next to the Reference to studies section. You will see
that there are already some studies included.
3. Select Included studies and click the Add Study button on the outline
pane toolbar. This will open the New Study Wizard.
4. Enter the Study ID ‘Dorlas 2006’ and click Next.
5. From the Data source drop-down list, choose Published and unpublished
data. Click Next.
6. The year the study was conducted will appear by default as ‘2006’. Click Next.
7. If your study has an ID number, such as a document ID, you can enter it here
by clicking the Add Identifier button, selecting an ID type from the drop-
down list, and entering the ID.
8. Click Next.
9. Select Add another study in the same section and click Finish.
10. Repeat steps 4-9 and add the following studies to the tutorial review:
Egberts 2001
Levelt 2007
Smit 2006
11. When you have added the details for the last study, instead of step 9, select
Nothing and click Finish.
12. In the outline pane, click the key symbol next to Included Studies to see
the new studies listed.

Adding references to a study

1. In the outline pane, select the Dorlas 2006 study.

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 2. Click the Add Reference button on the outline pane toolbar. This will open
the New Reference Wizard.
3. By default, the Reference Type is set to Journal article (click the drop-down
list to see the other options available). Click Next.
4. Enter the following details in the form provided (note that fields appearing in
bold are mandatory):
Authors: Dorlas S, Egberts D
English title: Questionnaires to measure caffeine addiction
Journal/book/source: Journal of Addictive Research
Date of publication: 2006
Volume: 15
Issue: 4
Pages: 567-71

Note: You can right-click in the Journal/book/source field and select Choose from list… to select
your journal from a list of titles. If your journal does not appear on this list, you can right-
click in the Journal/book/source field and select Edit custom journals list… which will open
a text file where you can create a custom list of journal titles. This text file will need to be
saved each time a new journal title is added to your custom list, and you can use this file to
copy the relevant journal title into the Journal/book/source field for each reference.

5. Click Next. As for a study, you will have the option to add an ID number for
the reference, such as a MEDLINE reference number.
6. Click Finish. The reference will now appear in the content pane. In the outline
pane, click the key symbol next to Dorlas 2006 to see the new reference
listed.

Note: To add an Other reference to your review, select Additional references in the outline pane and
follow steps 2 to 6 above. You will need to give your reference a Reference ID, which should
have the same format as a Study ID (first author and year of publication).

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Editing an existing reference

1. In the outline pane, double-click the reference listed under the Dorlas 2006
study (or right-click and select Edit Reference). This will open a new tab in the
content pane showing all the details you entered.
2. Open the Reference Type drop-down box and change the type from ‘Journal
article’ to ‘Book’. Note that the fields have changed and some rows are now
shaded. Shaded rows will not appear in your published review.
3. Change the reference information to the following (you need to scroll down
to see some of these fields):
Authors: Dorlas S, Egberts D
Journal/book/source: Measuring caffeine addiction
Date of publication: 2006
Publisher Name: Grinder Press
City of publication: London
4. At the bottom of the reference tab, note that the reference is displayed as it
will appear in the published review. Note that this display changes as you
make the changes to the reference. Check that the reference appears
correctly.

5. Go to the tab header and click the button next to the first author’s name to
close the reference tab (do not click the button at the top right corner as
this will close the review).

Note: For further details on how to enter different reference types, see the RevMan Help or the
Cochrane Style Guide, available from the Help menu.

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Importing references from a text file
If you have already entered your references in another program, you can avoid
typing them in again by importing them from a text file. A sample text file has been
provided with RevMan 5 for this tutorial.

Note: For details on how to generate a text file, see the help files in your reference management
software. RevMan can read text files created from most major reference management
software using the RIS format. You may need to check that you are using the right filter
when exporting your references to a text file.

1. Go to the File menu and select Import, then References. This will open the
Import References Wizard.
2. Click Next.
3. RevMan should automatically open the same folder we used to open the
sample review: c:\\program files\review manager 5\doc\tutorial. Select the
file ‘DTA Study References.txt’ and click Open.
4. You will see a preview of the text file. Click Next.
5. By default, RevMan Format is selected as the format of the text file (other
options include RIS or PubMed MEDLINE formats). Click Next.
6. By default, RevMan will save references to the Classification pending
references section, under Other References in the outline pane. References
in this section will not appear in the published review (for this reason they
are shown in grey). Click Next.
7. If you wish, you can assign different locations for each individual reference,
or exclude specific references from the text file while importing the rest. For
this tutorial, leave the settings as they are and click Finish.

8. RevMan will report that 8 references have been imported. Click OK.
9. In the outline pane, use the key icons to open the Other references section
and then the Classification pending references section. You will see the
references you imported.

Moving references
There are several ways to move references to the appropriate study.

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 1. In the outline pane, in the Classification pending references section, select
the reference Egberts 2001.
2. From the Edit menu, select Cut or click the Cut button on the toolbar.
3. Use the key icons to open the Included studies section, and open the
Egberts 2001 study. An [Empty] reference has been added here. To add a
reference manually, you can edit the empty reference using the instructions
in the previous section.
4. Select the Egberts 2001 study.
5. From the Edit menu, select Paste, or click the Paste button on the toolbar.
6. The reference will be deleted from the Classification pending references
section and added to the Egberts 2001 study. Note that the [Empty]
reference has gone.
7. Go to Classification pending references and right-click Gunnink 2003.
8. Select Move to, then Included studies. As there was no study with a name
matching the reference, RevMan will automatically create a new study in the
Included studies section with the ID Gunnink 2003.
9. Go to the Classification pending references section and select Kanis 2007.
10. Click and drag the reference to the Kanis 2007 study.
11. Repeat steps 1 to 6 and 10 to move the remaining references to the
corresponding studies.
12. In the outline pane, click the key icons to open the Included studies
section, and then open the Egberts 2001 study.
13. Select the first reference and double-click to open the reference tab.
14. In the content pane, check the This is the primary reference for the study
box.
15. In the outline pane, note that the book icon beside the primary reference
appears in black , and the icons beside the other references are grey .

Adding links to references in the text

Rather than typing citations in the text or including footnotes, RevMan allows you to
include active hyperlinks to references in the text of your review.

1. In the content pane, scroll up to find the Target condition being diagnosed
section.
2. Click to place the cursor after the word ‘machine’.
3. From the Format menu, select Insert Link, or click the Insert Link button
on the toolbar. This will open the Insert Link window.
4. From the list, select the study Gunnink 2003. Note that you can use this same
method to link to included and excluded studies, figures, tables, sections of
the review text and external web links.
5. Click OK. You will see a blue hyperlink to the reference appear in the text.
This link will be active after the review is published in The Cochrane Library.
6. Add a space before the link and parentheses ( ) before and after the link, so
that it appears as “…the coffee machine (Gunnink 2003).”

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Removing a link
To remove a link you have already inserted in a review, you can either delete it as
you would any other text, or use the Remove Link feature.

1. In the content pane, click to place the cursor in the link to Gunnink 2003.
2. Click the Remove Link button on the toolbar, or right-click and select
Remove Link. Note that the text is no longer blue.

Adding multiple links automatically

Instead of inserting one link at a time, RevMan can create all your links automatically
by searching through the text to identify studies and other references.

1. In the content pane, select the sentence in the Target condition being
diagnosed section, including the text ‘(Gunnink 2003)’.
2. From the Tools menu, select Find and Mark Links.
3. A notice will be displayed to let you know that one link has been created.
Click OK. You will notice that the blue reference link has again been created.

Note: If you do not select a section of text before using the Find and Mark Links tool, RevMan will
give you the option to check the whole review. Note that this tool will only search through
text that is expanded (that is, visible in the content pane). Click the icon next to a section
heading to expand and see the text.

20
PART 4 - Tables
Characteristics of included studies tables
Now that you have included references to studies in your review, you can add a
description of each study. This is done in the text of the review, and also in the
Characteristics of included studies table, which combines the characteristics of
included studies and the results from quality assessment.

The four domains—Patient Selection, Index Test, Reference Standard, and Flow and
Timing—are mandatory. All domains require a general description; this is the
Characteristics of Included studies part of the tables. All domains are assessed in
terms of risk of bias and the first three domains are also assessed in terms of
concerns regarding applicability.

When the review is published the tables are rendered separately. The study
characteristics table can be previewed for each study in RevMan by right clicking on
the study name and selecting View study characteristics.

Patient selection
The first domain to be completed is the Patient selection domain. The upper half of
the table refers to Risk of Bias, while the lower half refers to Concerns regarding
applicability.

1. In the outline pane, use the key icon to expand the Tables heading, then
the Characteristics of studies heading and the Characteristics of included
studies heading. You will see a list of the studies you have created.
2. Select the Dorlas 2006 study.
3. In the content pane, you will see the same study shown. Click the icon next
to Dorlas 2006 to show the Characteristics of included studies table.
4. Type or copy and paste the following text into the Patient sampling box:
“Cross-sectional design; single group with equal suspicion of caffeine
addiction; consecutive enrolment”.
5. The next step is to enter the Risk of Bias assessment for this study. The three
questions below the descriptive box are the signalling questions. The
question there under, in bold, is the overarching question for Risk of Bias in
this domain.
6. Set the three drop-down boxes for the signalling questions to Yes and the
drop-down box for the overarching question to Low risk.
7. Type or copy and paste the following text into the Patient characteristics and
setting box:
Sample size: 405 patients
Mean age: not reported; PhD students
Presentation: sleep deprivation, loss of concentration, hyperactivity.
Setting: Primary care; The Netherlands.
8. Set the drop-down box for the Concerns regarding applicability question to
Low concern.

21
Index Test, Reference Standard, and Flow and Timing
The same can be done for the other domains. Hereunder are some examples of what
can be put into the descriptive boxes.

Index and comparator

Index test is spectrometry; comparator is questionnaire.
tests
Target condition and Caffeine addiction, measured by coffee consumption in liters per
reference standard(s) day
Flow and timing Two weeks follow up. Three students withdrew; reasons not
explained.

Unlike the other domains, the Index test domain is assessed for each index test or
group of tests in the review. To enable assessment by test, the various index tests
should have been defined under Data tables by test. Therefore, we will come back to
that later, after we have added tests to the review (see Part 5, page 33).

Editing the Characteristics of included studies table

Signalling questions can be added or removed in each domain as appropriate for
each review. Additional domains cannot be created except a domain called
Comparative for specific comparative issues (in reviews that compare the accuracy of
tests) which do not fit in any of the other domains.

1. Click the Properties icon next to any of the headings of the Characteristics
of included studies table.
2. You will see a window with five tabs. It will open on a particular tab,
depending on next to which heading you clicked the Properties icon.
3. For example, on the Patient selection tab, you will find the three signalling
questions belonging to the Patient selection domain. All three questions

22
 have a tick symbol next to it, indicating it is included in the table by
default.
4. Only in very specific cases (see the Handbook for this), authors may decide
not to include one of the items in the table. Deactivate Was a case-control
design avoided by selecting it from the list and by clicking on the Activated
box, which then becomes deactivated.
5. Click ‘OK’. The signalling question has now been removed from the original
list of signalling questions for every study in your review. (Please note, that
you will lose any text that had already been entered in the description
column!)

Adding user-defined items

In some cases, it may be useful to add user-defined study characteristics. For
example, if you are assessing a commercially available device, it may be useful to
check for sponsoring.

1. In the content pane, find the Characteristics of included studies table

heading (you may need to click the icon).
2. Click the Properties icon next to the Characteristics of included studies
table heading in the main screen.
3. It opens now on the General tab. You can add a User Defined Field by ticking
the box next to User Defined 1 and enter your extra characteristic.

23
 4. Click ‘OK’. Your User defined field now appears at the bottom of the table,
just above the textbox for Notes.

5. Click again the Properties icon next to the Characteristics of included

studies table heading in the main screen and go to the Index test tab.
6. Click on the Add button in the Concerns regarding applicability section. A
new item will appear.
7. Enter the name of the new signalling question: ‘ Was the cut-off used
representative for the cut-off used in practice?’.Whenever you add a new
item to the table, make sure you phrase the question so that answering
"Yes" indicates low risk of bias or low concerns regarding applicability.
8. Click ‘OK’.
9. The Index test domain of each table will now include a row for the new
question. Set the new drop-down box to Yes, No or Unclear.

Note: For information on assessing the methodological quality and its relation with risk of bias, see
the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy, available from
http://srdta.cochrane.org/en/authors.html.

Characteristics of excluded studies

Studies identified in your search that met the exclusion criteria of the review may be
listed under Characteristics of excluded studies, along with the reason each study
was excluded. You do not need to list every study identified by your search, but it is
useful to list those which might appear to readers to meet your inclusion criteria.

1. In the outline pane, select Characteristics of excluded studies.

2. Click the Add Study button on the outline pane toolbar and enter the new
study ‘Bean 1988’. Click Next.
3. Select Published data only, and click Next.
4. Accept ‘1988’ as the year the study was conducted, and click Next.
5. Click Next without adding any identifiers.
6. Accept ‘Nothing’ as your next action, and click Finish. In the content pane,
you will see the Excluded studies section and the study you have created.

24
 7. In the outline pane, click the key icon next to Characteristics of excluded
studies.
8. Select the new study Bean 1988. In the content pane, you will see a table
under this study with the heading Reason for exclusion.
9. In the table, enter the text, ‘Coffee machine only contained decaf coffee.’

Note: Footnotes can be added below the Table for Characteristics of Excluded Studies.

Adding Footnotes to tables

In the content pane, below each tables section, there is a place to add footnotes for
these tables. To add Footnotes, click on the white space below the Caption heading
and type in some text.

Additional tables
Additional information can be included in table format either in the text of the
review, in an Appendix or as an Additional table. To add a table into the text of the
review:
1. In the content pane, scroll up to the Background section and place the cursor
in the Target condition being diagnosed section.
2. Click the Insert Table button on the toolbar. A 3x3 table will be created.
3. Right-click the top left cell. Note the table edit options.
4. Select Toggle Heading/Cell. The selected cell will be shaded, and any text
entered will appear in bold. Text can now be entered directly into the table.

25
To add an Additional table that will appear at the end of the published review:
1. In the outline pane, under the Tables heading, select Additional tables.
2. Click the Add Table button on the outline pane toolbar. This will open the
New Additional Table Wizard.
3. Enter the title, ‘Decaffeinated coffee: chemical information’.
4. Click Next.
5. Accept the default number of rows and columns and click Finish. In the
content pane, you will see the table in the Additional tables section. You can
now enter text directly into the table.
6. In the outline pane, click the key icon to see the new table listed under
Additional tables.

Note: Tables created in another program (e.g., Microsoft Word) can be copied and pasted into
RevMan 5.2. To do this, you need to copy the table to the clipboard in the other program (e.g., in
Microsoft Word, highlight the table and click ‘Copy’, then in RevMan 5.2, repeat steps 1-4 above and
at Step 5, select Paste in table copied from another program.

26
PART 5 - Data and analyses
Once you have described your included studies, you can begin analysing the results.
Before analysing the results, you will need to enter data and, if applicable,
covariates. Entering data can be done in two ways. You can enter them by test,
under Data tables by test. Using this option, you enter the data for one test at a time
as reported in each study. Alternatively, you can enter the data by study, under Data
tables by study. Using this option, you enter the data for one study at a time, for all
tests reported in that study. This may be advantageous when the included studies
analysed many tests.

When you have added included studies in your RevMan file, you will see the key icon
next to Data tables by study. That means that RevMan has listed all your included
studies under that heading.

Adding tests
The first step in analysing diagnostic accuracy data in RevMan is to enter the tests
that you are interested in. Reviews may include one or more tests.

1. In outline pane, select Data tables by test.

2. Click the Add Test button on the outline pane toolbar. This will open the
New Test Wizard.
3. Enter the Name ‘Spectrometry’ and, if applicable, the Full Name of the test
(for example, if you have different manufacturers for spectrometers). Then
click Next.
4. You can add a description of the test in the next pane. Click Finish. This will
open an empty Data Tables tab.
5. Repeat steps 1-4 to add another test called ‘Questionnaire’.

27
Entering data by test
When you are interested in only one or a few tests, or when you expect the included
studies to report the results of only one or a few tests, it will probably be easiest to
enter your data by test.

1. In the outline pane, click the key icon to see the new test(s) listed under
Data tables by test.
2. Select Spectrometry and click the Add Test Data button on the outline
pane toolbar. This will open the New Test Data Wizard.
3. You will now select the studies that report data for Spectrometry. By holding
down the Ctrl/Command-button on your computer, you can select multiple
studies at once.
4. Select the following studies:
Gunnink 2003
Havelaar 2005
Kanis 2007
Smit 2006
VanNelle 1999

5. Click Finish, this will open the Data Tables ready for you to enter the selected
studies listed. Beside each study is a row of cells ready for you to enter the
numbers of true positive results (TP), false positive results (FP), false negative
results (FN) and true negative results (TN).
6. Enter the following data into the table:

Study TP FP FN TN

Gunnink 2003 18 4 32 46

Havelaar 2005 22 17 1 38

Kanis 2007 60 87 16 371

28
 Smit 2006 8 8 4 59

VanNelle 1999 9 2 5 65

7. RevMan will automatically calculate the sensitivity and specificity (with 95%
confidence intervals) for each study. The results are also displayed in a forest
plot. The sensitivity and specificity for each study are shown as a blue square,
and with a horizontal line showing the confidence intervals.

Note: For those of you who are familiar with intervention reviews, note the following. There is no
pooled result shown for sensitivity and specificity, RevMan does not calculate weights for
the forest plots, and no measures of heterogeneity are given. For more details on why these
features are not provided, please refer to the Cochrane Handbook for Systematic Reviews of
Diagnostic Test Accuracy, available at http://srdta.cochrane.org.

8. At the bottom of the screen under the results table is space to enter
footnotes. In the results table, select the Kanis 2007 study. In the Footnote
field, enter the text ‘Unpublished data provided by author’.
9. At the top of the content pane, click the Text of review tab. Note that
RevMan has added a table with a brief summary of the results for this
outcome, including the number of studies and participants.

Entering data using the calculator

Another way to enter your data is to use the calculator. This is particularly useful
when you do not have the numbers of true and false positives and negatives, but you
do have sensitivity, specificity (or likelihood ratios) and the total numbers of people
with and without the target disease.

1. Select under Data tables by test the test called Questionnaire and click the
Add Test Data button on the outline pane toolbar. This will open the New
Test Data Wizard.

29
 2. Select the following studies that report data for Questionnaire and click
Finish:
Dorlas 2006
Egberts 2001
Gunnink 2003
Havelaar 2005
Levelt 2007
3. Select the first cell in the first row (Dorlas 2006) and click on the calculator
icon . A new window opens.
4. Enter 0.75 in the Sensitivity box. Note that RevMan will only recognize
numbers between 0 and 1, so you cannot enter 75%.
5. Enter 8 in the D+ box. D+ stands for ‘Diseased’. This means that there were in
total eight people with caffeine addiction included in the study.
6. RevMan will now automatically calculate TP and FN.
7. Enter 0.67 in the Specificity box and 91 in the D- box. D- stands for ‘Not
Diseased’. This means that there were in total 91 people without caffeine
addiction included in the study.
8. RevMan will now automatically calculate FP, TN and all other measures,
including positive and negative likelihood ratios. It also checks for
correctness. If the numbers seem to be correct (i.e. if the given parameters
can be used to calculate round numbers of TP, FP, FN, TN), the boxes appear
green. Otherwise the sensitivity box and/or specificity box will appear red.
9. Click ‘OK’. The cells in the first row will be filled with numbers and a forest
plot of sensitivity and specificity will be displayed.

Entering data by study

When you expect the included studies to report the results of many tests at one
time, you may want to enter your data tables by study.

1. In the outline pane, click the key icon to see the studies listed under Data
tables by study.

30
 2. Click the key icon next to Egberts 2001 to see the tests that are already
added to this study. Double-click on Egberts 2001 to open the data tables for
this study.
3. Enter these data into the table:

Study TP FP FN TN

Egberts 19 9 6 51
2001

4. In the outline pane, click the key icon next to Gunnink 2003 to see the tests
that are already added to this study. Double-click on Gunnink 2003 to open
the data tables for this study.
5. You will see that RevMan has already entered the data for Spectrometry,
taking the data you entered under Data tables by test.

6. Enter the data for the Questionnaire:

Study TP FP FN TN

Gunnink 2003 10 15 2 53

Havelaar 2005 74 54 26 246

Levelt 2007 9 23 1 51

Note: You can also enter the data by copying these from a spreadsheet. In that case, you select all the
cells containing TP, FP, FN, TN and copy those cells. Then you right-click on the first left-hand
cell in the RevMan data table and choose Paste. Make sure that the rows and columns in
your spreadsheet and in RevMan follow the same order!

31
Note: When you update a value in the data tables, make sure that you press Enter/Return
afterwards. If you do not press Enter, RevMan will not regard the number as really being
entered and will not update the matching forest plots.

Assessment of methodological quality for two tests

Unlike the other domains, the Index test domain is assessed for each index test or
group of tests in the review. RevMan allows you to add separate information for
each test, but in order to do that, the various index tests should have been defined
under Data tables by test.

1. In the content pane, select the Characteristics of included studies table

heading.
2. Click the Properties icon next to the Index Test heading.
3. By default ‘All tests’ is displayed in the Test Group area.
4. To assess the signalling question ‘If a threshold was used, was it pre-
specified?’ separately for both index tests included, select this item and click
the Add button next to the Test Group area.
5. A new test group with the label 'Test Group A' is created. Create the number
of groups that you require (by repeatedly clicking the Add button); in this
case we need two test groups, spectrometry and questionnaires.
6. You can modify the label of each (group of) test(s) and choose the test(s) that
should be part of the group from the list of tests that appears below by
ticking the box in front of each test. You can also choose the studies from the
list of studies that should be linked to the test group.
7. Tick the Spectrometry box and replace Test group A with Spectrometry. De-
select the studies from Levelt, Dorlas and Egberts.
8. Do the same for the questionnaires. De-select the studies from Kanis, Smit
and Van Nelle.
9. Click OK.
10. The properties window closes and the Index test domain for the test group is
added to the table. If you defined multiple test groups, there will be a domain
with signalling questions for each. Note there is only one descriptive text box
for all test groups.
11. You can also delete each test from each study after you have set up the table,
by clicking the Delete icon next to each test.

32
Covariates
It is possible to add covariates as well, for example, the cut off values of the tests
that are being assessed.

1. In outline pane under “Data and analyses”, right-click Covariates and choose
Add Covariate. This will open the New Covariate Wizard.
2. Enter the Name ‘Cut-off Value’ and click Next.
3. Select Test Level and click Next.
4. There are two types of covariates: Categorical or Continuous.
5. Select Continuous. For continuous covariates, you can leave the Default
Value blank or you can enter, for example, 0 for default.
6. Click Finish.
7. In the Data Tables (for both tests), a column will appear for Cut-off Value.
8. If you left the Default Value blank, you will see an empty column, otherwise,
this column will be filled with your default value.
9. Enter the following values in the tables (either via Data tables by test or Data
tables by study).

Study Test Cut-off Value

Gunnink 2003 Spectrometry 0.3
Havelaar 2005 Spectrometry 0.5
Kanis 2007 Spectrometry 0.5
Smit 2006 Spectrometry 0.4
VanNelle 1999 Spectrometry 0.5

33
10. Note that both Covariates appear in the Data Table of all included Tests. We
leave cut-off value for questionnaires blank.
11. For the questionnaire, we will add another covariate, called ‘Questionnaire
Type’.
12. In outline pane, right-click Covariates and select Add Covariate again.
13. Enter the Name ‘Questionnaire Type’ and click Next.
14. Select Test Level and click Next.
15. Select Categorical and click Next.
16. For categorical covariates, you must define the different categories. Click Add
to create a category.
17. Delete ‘New category’ and replace it with ‘Older List’.
18. Click Add to create the second category. Replace the name ‘New Category’
with ‘Newer List’.

19. Click Finish.

20. In the Data Tables (for both tests), a column will appear for Questionnaire
Type. In the Questionnaire data table, use the drop down menus to assign
the questionnaire types as follows:

Study Test Questionnaire Type

Dorlas 2006 Questionnaire Older List
Egberts 2001 Questionnaire Newer List
Gunnink 2003 Questionnaire Newer List
Havelaar 2005 Questionnaire Older List
Levelt 2007 Questionnaire Newer List

34
Note: Although you may wish to explore the effect of Risk of bias or Concerns regarding applicability
items, these need not to be entered as covariates. The signalling questions and the overall
judgments are already available as sources of heterogeneity.

Analyses
RevMan is not able to perform meta-analysis or calculate summary estimates for
DTA studies. You will need external software to do this. RevMan is capable of
graphical analysis of the data at hand, either on its own or with the input of
parameters from external software.

1. In outline pane, select Analyses.

2. Click the Add Analysis button on the outline pane toolbar. This will open
the New Analysis Wizard.
3. Enter the Name ‘Spectrometry’ and click Next.
4. Select Single test analysis, and then select Spectrometry from the list of
available tests. Click Next.

35
 5. Click Finish.
6. An Analysis pane will open, showing three different areas:
a. The Forest plot area
b. The SROC plot area
c. The Externally Calculated Parameters area, including the area in which
the lay-out of the sROC plot can be defined.

a. Changing Forest Plot properties

1. In the outline pane, click the key icon to see the analyses listed under
Analysis.
2. Click the Properties button in the top right corner. This will open the
Analysis Properties window.
3. Click the Forest Plot tab.
4. Select Cut-off Value as the Covariate Displayed on Forest Plot. Click Apply
and then OK. Note that a column is added to the forest plot.

36
b. Changing SROC Graph properties

1. Click the Properties button in the top right corner to open the Analysis
Properties window again.
2. Click the SROC Plot tab.
3. Select Sample Size as the Scale for size of points. Click Apply. Note that the
forms and size of the points in the graph have changed.

37
 4. Under Symmetry, select Asymmetric. Click Apply. Note that the shape of the
curve changed.
5. Click Apply. Click OK.
6. On the right hand side of the Analysis pane, in the area in which the lay-out
of the sROC plot can be defined, set the low end of the Specificity Range at
0.60 and the high end at 0.99. Note that the SROC curve covers a different
range in the plot.

c. Entering Externally Calculated Parameters

To obtain valid pooled estimates of sensitivity and specificity, and when statistical
testing is needed (e.g. to test whether the summary ROC curves of two tests
significantly differ), external software has to be used. The resulting parameters can
be entered here. Please consult the DTA Handbook or a statistician to explain how
these parameters should be used.

Test Comparisons
Most review questions will be comparative rather than looking at one specific test.

1. In outline pane, select Analyses.

2. Click the Add Analysis button on the outline pane toolbar. This will open the
New Analysis Wizard.

38
3. Enter the Name ‘Comparison’ and click Next.
4. Select Multiple tests analysis.
5. Select both Spectrometry and Questionnaire and click Next.
6. Click Finish.

7. After clicking finish, the Analysis pane occurs and again you will see three
different areas:
a. The Forest plot area: scroll down to see two forest plots, one for each
test.
b. The SROC plot area: two different symbols with two different colours are
now used. The black circles indicate the spectrometry studies and the red
diamonds indicate the questionnaire studies.
c. The Externally Calculated Parameters area: a drop-down menu appears
to enable you to enter the externally calculated parameters for each test
separately.

39
Paired Test Comparisons
RevMan enables you to restrict the Analyses to the data from studies that looked at
both tests together.

1. Click the Properties button in the top right corner to open the Analysis
Properties window.
2. Select Analyse paired data only.
3. Click OK.
4. While the two forest plots display all the data for each study, the SROC plot only
shows the studies that contain data for both tests, linked to each other by a solid
line.
5. The curves no longer reflect the data points displayed, and should be removed.
6. Click the Properties button, select the SROC plot tab and deselect Display
SROC curve(s) option.
7. Note that in one study, the questionnaire seems to have a much higher
sensitivity than spectrometry, while in the other study, spectrometry has a higher
sensitivity.

40
Investigating heterogeneity
RevMan allows you to investigate heterogeneity visually. You can examine whether
the accuracy of studies differ by certain characteristics of studies. A stratified
analysis of studies will be performed showing whether accuracy of studies differ by
subgroups of studies. In RevMan no formal testing will be performed to determine
whether results are significantly different. RevMan will only show a summary ROC
curve for each subgroup. The forest plots may show the values of both categorical
and continuous covariates, whereas the summary ROC plots will only be plotted for
categorical covariates.

1. In outline pane, select Analyses.

2. Click the Add Analysis button on the outline pane toolbar. This will open
the New Analysis Wizard.
3. Enter the Name ‘Effect of questionnaire type’ and click Next.
4. Select Investigate sources of heterogeneity, then select Questionnaires, click
Next, click Finish.
5. After clicking finish, the Analysis pane will appear, although at first there will
be no indication that heterogeneity has been taken into account. To address
the effect of different questionnaire types, click the Properties button in
the top right corner. This will open the Analysis Properties window.

41
 6. Open the tab Sources of heterogeneity and select Covariate.
7. Click on the drop down menu and select Questionnaire Type.
8. Click OK.
9. In the Externally Calculated Parameters area, a drop-down menu appears to
enable you to enter the externally calculated parameters for each covariate
separately.

Adding a figure to your review

A small number of key summary ROC plots and forest plots can be included as figures
in the text of your review, which will be published as a PDF. Forest plots for all
outcomes will still be accessible as additional data in (the full version of) your
published review.

1. In the outline pane, double-click the Spectrometry analysis to open the

Spectrometry tab in the content pane.
2. Click the Forest plot button or the SROC plot in the top right corner of
the Spectrometry tab. This will display the plots as they will appear in the
published review.
3. Click Add as Figure. This will open a new tab showing the forest plot, labelled
as Figure 1.
4. In the outline pane, click the key icon next to the Figures heading to see
that the figure has been added.
5. In the outline pane, click on the Spectrometry data table to return to the
Data Tables.
6. In the Gunnink study, change the number of true positives from 18 to 80.
7. Click on the Figure 1 tab again. Note that the numbers have been
automatically updated.
8. Click the Save As button in the top right corner of the Figure 1 tab. This
allows you to save the figure as a graphic file on your computer. Click Cancel.
9. Click the Text of Review tab. Scroll up to the Results section of your review.
10. Click the icon to open the Results section, and then the Findings section.

42
 11. Click to place the cursor in the Findings section.
12. Click the Insert Link button on the toolbar.
13. From the Insert Link To list, select Figure.
14. Select Figure 1 and click OK. A link to Figure 1 will now appear in the text of
the review. In the published version, a thumbnail image will appear.

Risk of bias and applicability concerns graph and summary

1. In the outline pane, select Figures.
2. Click the Add Figure button on the outline pane toolbar. This will open the
New Figure Wizard.
3. Select Risk of bias and applicability concerns graph and click Next.
4. Click Finish. RevMan will create a graphical representation of the judgments
entered in your Characteristics of Included Studies tables.
5. As you will see, there are no yellow bars to indicate an 'unclear' judgment.
This is because no reasons for our judgments have been entered in the
tables. RevMan interprets an unclear judgment with no reason given as "not
applicable", and removes these judgments from the tables in your published
review.
6. Repeat steps 1 and 2. This time select Risk of bias and applicability concerns
summary.
7. Click Next and then Finish. RevMan will create an alternative graphical
representation of the judgments in the Characteristics of Included Studies
tables. You can now add links to either of these figures in the text of the
review.

43
 PART 6 – Finishing the review
Summary of Findings tables
When your review is complete, you should add one or more tables to briefly
summarise your results. There is no fixed format for these tables in reviews of
diagnostic test accuracy. For more information on how to complete a summary of
findings table, see the Cochrane Handbook for Diagnostic Test Accuracy Reviews,
available from http://srdta.cochrane.org.

1. In the outline pane, use the key icon to expand the Tables heading, and
select Summary of Findings tables.
2. Click the Add Summary of Findings Table button on the outline pane
toolbar. This will open a 3 by 3 empty table, free to adjust as you like.
3. You can add rows and columns to this table by right-clicking on the table.
4. Select the top row of the table, right-click and select Merge Cells. A merged
top row can be used to state the review question and other information
needed to use the table as a stand-alone document.
5. The Summary of Findings table will be added to your review.

Adding an appendix
You can include more detailed information that is not essential to the main body of
your review in an appendix, such as detailed search strategies or statistical methods.

1. In the outline pane, select the Appendices heading (the last heading on the
list).
2. Click the Add Appendix button on the outline pane toolbar. This will open
the New Appendix Wizard.
3. Enter the Title ‘Detailed search strategies’.
4. Click Finish. In the content pane, the Appendices section will open and your
appendix title will be shown. You can now enter text or tables in the
appendix.

Validating a review
Before publication, every review should be validated to make sure all sections have
been completed and meet the requirements of The Cochrane Collaboration.

1. From the Tools menu, select Validate as You Type, or click the Validate as
You Type button on the toolbar. In the outline pane, any sections with
problems identified will be underlined.
2. Hover the mouse over a section underlined in red. A Validation error
message will appear. Validation errors must be corrected before publication.
3. Hover the mouse over a section underlined in blue. A Validation warning
message will appear. It is not compulsory to correct Validation warnings.
4. From the File menu, select Reports, and then Validation report. A report will
be displayed listing all the Validation errors and Validation warnings. You
can choose to copy, print or save this report.

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 5. Click OK.

Submitting a review for editorial approval

When you have completed all the remaining sections of the review, including the
Abstract, you will need to submit the review to your Cochrane Review Group for
editorial approval. You can select this option when checking the review into the
Archie database, and your Managing Editor will receive an automatic message
advising that the review is ready.

You will not be able to access your review during the editorial process.

When you have made all the changes requested and the review is ready to publish,
you and all your co-authors will need to sign the Licence for Publication Form,
available from the File menu under Reports.

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Appendix – To convert to QUADAS-2 from QUADAS

1. Click the Properties icon next to the 'Assessment of methodological

quality table' heading.
2. On the General tab click the button Switch to QUADAS-2.
3. A dialogue box will appear asking you to confirm that you want to switch to
QUADAS-2. The process cannot be undone so click Yes if you are sure
otherwise click No.

Data is not lost during the conversion process. The old QUADAS items and the
characteristics table will be converted as shown in the table below.

Study characteristics
RevMan 5.1 RevMan 5.2 – Text boxes for QUADAS-2 Domains
Study design Patient sampling
Participants Both fields in 5.1 merged into one called Patient characteristics and setting
Clinical features and setting
Index and comparator tests Index tests
Target condition and reference Target condition and reference standard(s)
standard(s)
Follow up Flow and timing
Notes Notes
User defined fields Notes
Methodological quality
QUADAS item QUADAS-2 signalling question QUADAS-2 Domain
Representative spectrum? Patient selection
Acceptable reference standard? Reference standard
Partial verification avoided? Flow and timing
Differential verification avoided? Did all patients receive the same Flow and timing
reference standard?
Incorporation avoided? Reference standard
Reference standard results Were the reference standard results Reference standard
blinded? interpreted without knowledge of the
results of the index test?
Index test results blinded? Were the index test results Index test
interpreted without knowledge of the
results of the reference standard?
Relevant clinical information? No related domain so added to
Notes field
Uninterpretable results reported? Flow and timing
Withdrawals explained? Flow and timing

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