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Best search strategies

This is an excerpt from Evidence-Based Practice for Rehabilitation Providers by David R. Dolbow,Hope Jervis Rademeyer.

Narrow and Broaden Your Search

There are several different strategies to limit or expand your search to find appropriate articles. These strategies may mean adjusting the search limits or modifying the specific search terms in different ways.

Search Limits

You can narrow your search by using search limits, which typically appear as a checklist within a database or search engine. Search limits are used to specify the search using one or more predefined criteria. Common search limits include article type, language, text avail-ability, and publication date. For example, to identify recent articles, you may limit your search to publications dated within the past 5 y. Search limits vary according to the database.

Truncation and Wildcard Searching

Truncation (i.e., stemming) is a common way to broaden your search by including different spellings and endings to words.²⁴ To do this, insert a truncation symbol at the end of the word. This will cause the search engine or database to return records that include any end-ing of the root word. Here are two examples:

respir* respire, respires, respiratory, respiration

time* timely, timeliness, times, timed, timer

If the root word is too short (e.g., plac*), it may return too many results (e.g., place, placed, placement, placing, placard, placid, etc.).

Wildcard searching is similar to truncation but a symbol is substituted for a letter of a word. Wildcards are useful if two words share the same meaning but have different spellings. Here are two examples:

fav!rite favorite or favourite

cance!ed cancelled or canceled

Common truncation and wildcard symbols are *, !, ?, and #. They may vary according to the database you have chosen to search.

Boolean Operations or Boolean Logic Methods

One way to broaden or narrow your search is to include Boolean operations, also known as Boolean Logic Methods (table 3.2, figure 3.2).^25,26 All databases use these terms, so it is useful to know what they are and how to apply them to your search.

• AND: This operator limits a search because it will look for the two search terms appearing together (e.g., rheumatoid arthritis AND assistive devices). A plus sign (“+”) can be used instead of the word AND.
• OR: This operator expands the search by presenting either of the two terms (e.g., assistive devices OR assistive technology). This operator is useful if there is a synonym for one word or other common terminology.
• NOT: This operator limits a search by removing a term from the search. For example, using “rheumatoid arthritis NOT osteoarthritis” would result in a search that looks for articles related to rheumatoid arthritis and excludes those articles related to osteoarthritis. A minus sign (“−”) can be used instead of the word NOT.

You can use all of these operations with three terms as well (e.g., “rheumatoid arthritis” AND “assistive devices” AND inflammation). However, depending on the Boolean operation you use, this may drastically narrow or expand your search.

Quotation marks are used to group words together (e.g., “spinal cord injury”) so that they are searched as one term. Parentheses group terms together so that more terms can be added to form a search. For example, (“patellofemoral pain” AND “platelet rich plasma”) will result in a search that groups these terms together. A search like (“patellofemoral pain” OR “meniscal tear”) will search for either of these two terms. Then, one or more terms are added to form the full search strategy. For example, (“patellofemoral pain” OR “meniscal tear”) AND “platelet rich plasma” will result in a search that finds one of the first two terms (“patellofemoral pain” OR “meniscal tear”) with the second term (“platelet rich plasma”).

Step 2: Execute the Search, Document the Search Strategy, and Refine and Rerun the Search

After you have designed a search strategy, the next step is to execute the search. With your initial search attempt, you may encounter several challenges. The search could return few or no results. Conversely, the search may return too many results. For these reasons, it is important to document your search strategy or save it within the search engine or database search if you are signed in and this feature is available. This way you can revisit to expand or narrow your search, change Boolean operators, use different keywords, include truncation, or implement alternative strategies that you have learned. Also, you must save your search strategy if you are conducting a systematic or scoping review (see chapter 9). The follow-ing sections present some examples of initial search strategies with a challenge identified and modified search strategies that address the challenge.

Example Google Scholar Search

In this example, the first search strategy shows a line-by-line breakdown of the terms included within each line of an advanced search. This is followed by the combined search query as it appears in the search box. The first strategy may seem better because there are fewer results. However, on closer examination, the results are not well aligned with the clinical question. By removing the NOT Boolean operator, we have expanded the search. Although 750 results may initially seem overwhelming, Google Scholar returns the most relevant and widely cited articles at the top of the list.²⁷ These articles are often highly cited as well.

First search strategy

stroke NOT “cerebral palsy”

AND pediatric OR child NOT adult

AND “constraint-induced movement therapy”

AND “pharmacologic intervention” OR medication

AND “upper extremity” OR “upper limb” OR arm

AND rehabilitation

AND randomized controlled trial

stroke NOT “cerebral palsy” AND pediatric OR child NOT adult AND “constraint-induced movement therapy” AND “pharmacologic intervention” OR medication AND “upper extremity” OR “upper limb” OR arm AND rehabilitation AND randomized controlled trial

• Retrieved: 57 results
• Potential issue: Irrelevant results as they relate to the clinical question

Refined search strategy

stroke AND pediatric OR child AND “constraint-induced movement therapy” AND “pharmacologic intervention” OR medication AND “upper extremity” OR “upper limb” OR arm AND rehabilitation AND randomized controlled trial

• Retrieved: 750 results

Example PubMed Search

By using this search strategy initially, two results are identified. These results include one review that discusses two RCTs and another that is a systematic review. However, neither article is available in full text without payment or institutional access. Therefore, a logical next step would be to search a database such as Web of Science. A comparable search conducted in Web of Science retrieved more results and provides direct access to full-text articles. From this point, it may also be useful to explore cited reference searching to identify additional relevant studies.

((( (stroke[MeSH Terms]) AND (“constraint-induced movement therapy-”[Title/Abstract])) AND (pediatric)) AND (upper extremity OR upper limb OR arm)) AND (controlled clinical trials, randomized[MeSH Terms])

• Retrieved: 2 results
• Potential issue: Too few results

Web of Science Search

(TS=(stroke)) AND ALL=(“constraint-induced movement therapy”) AND ALL= (pediatric) AND ALL=(upper extremity OR upper limb OR arm) AND ALL=; (randomized controlled trial)

• Retrieved: 14 results

Step 3: Select the Documents

It is important to follow a systematic process to select the final document or documents that will inform the answer to your clinical question or guide the approach used in patient care. This same approach is also applied when answering a research question.

1. Merge the search results. You can use reference management software to remove duplicate records from the same source, or from different databases, if you choose more than one for your search.²¹ This will leave you with a final list of records to review.
2. Review the titles and abstracts. This will enable you to include relevant records and exclude those that do not align with your clinical question.
3. Retrieve the full text of the record. If you do not have access to the full-text record through your institution or a paid subscription, sometimes it will be avail-able through the publisher, open access sources, or Google Scholar. You can also get the full text through the university interlibrary loan services between institutions. Another way to potentially get access to the full text is to send an email to the corresponding author or request access through a website such as ResearchGate.²⁸
4. Link together multiple reports of the same study. Check the authors, dates, number of participants, and other indicators to ensure you have not included the same report more than once. The same report may come from different locations or be published at different points in time. Make sure that you use the most current, relevant version.
5. Examine the full-text records. Make sure that the full text aligns with your clinical question and PICO.
6. Confer with peers. At this stage, aim to select one to three articles to present to your peers. Consider choosing peers from a different but related discipline, or those who might be part of your inter-disciplinary care team or allied health team. Ask for their perspectives about whether the information answers your clinical question. You could consider providing more articles or summarizing the information as time allows.
7. Decide which article you will use to answer your clinical question and apply it to your practice.

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