Extract from Our Module

Cochrane Neuromuscular Disease Group

Update Policy(current version 12 August 2014 [minor revisions])

Authors of Cochrane reviews agree to maintain their reviews in the light of new evidence, comments and criticism and other developments, and to update the review at least once every two years, or, if requested, transfer responsibility for maintaining the review to others as agreed with the editorial team of their review group.

A request to agree a timetable for undertaking the update will be sent to a review team every 20 months by the managing editor. The review should be updated at least every two years, or sooner if there is new evidence that is likely to substantially alter the conclusions of the review.

We will then send the results of updated searches of the NMD Group register, MEDLINE and EMBASE (we will search from the date the last search was undertaken to the present date). However, as authors are often aware of work ongoing in their field, we ask them to also monitor the literature themselves and to contact the editorial base if they are aware that a new trial relevant to their review is due to be, or has been published and should be considered for inclusion in the review. This may prompt a need for an earlier update if there is new evidence that is likely to substantially alter the conclusions of the review.

If an author is not able to continue to maintain their review, they should inform the managing editor at the earliest opportunity. This will minimise delays in keeping the review up to date. We can then investigate alternative authors to take on the update. If one of the authors on the original review is unwilling to lead on the update, they may have a research fellow or junior colleague in their department who would like to develop their systematic reviewing skills and is willing to get involved. Alternatively, the review group may be able to identify a new contact author, or team to take on the update.

Procedure for updates

The managing editor will contact the review team every 20 months to discuss a timetable for updating. She will then request updated searches from the trials search co-ordinator who will send these onto the authors.

On receipt of the search results, the contact author should then:

Circulate the updated searches to his/her co- authors. At least 2 authors should independently screen the updated searches.

If no new relevant trials are found:

The authors should check that they are happy that the existing text of the review

still represents the best evidence. They should consider whether any new non-randomised evidence has been published which should be added to the background/discussion section of the review, or any relevant Cochrane reviews.

The authors should:
Check that the Trials Search Co-ordinators have updated the date of search in the search strategies section. If incorrect please contact the editorial base for revision.
Authors are required to search for ongoing trials using ClinicalTrials.gov and WHO ICTRP ( as a minimum, and include the date searched in the review. The strategy/strategies need to be included in a separate appendix exactly as used. Add any ongoing trials to the ongoing trials section of the references
Include a note of the number of hits from each database at the start of the Results of the search section of the Results. The group’s TSC will provide figures for the databases she has searched. Revise numbers of identified, screened and excluded studies if relevantin the Description of Studies section.
Alter the Plain Language summary, Abstract background and Background sectionsby adding a sentence that this is an updated review and that an updated search was undertaken in which no new studies were found.
Revise the plain language summary according to Cochrane PLEACS guidance ( The editorial base can assist with language if necessary, but authors should add headings and include all mandatory elements.
Add two events in the What’s new section in the review information: one ‘updated’ indicating that the review has been updated with a new search but no new relevant studies were found. The other ‘New citation: conclusions not changed’ or ‘New citation: conclusions changed’. All updates are new citations. Finally they should alter the date the review was assessed as up to date, which is the same as the date of the earliest database search.
Incorporate the new risk of bias assessments and complete a Risk of bias table for existing studies from earlier versions of the review, following the guidance in Chapter 8 of the Cochrane Handbook if this has not already been completed.
Updates with included RCTs should in most circumstances include a ‘Summary of findings’ table following guidance in Chapters 11 and 12 of the Cochrane Handbook and . The software for producing a Summary of findings table can be found at: See Getting Started - the help files within GRADEpro are also useful. Please consult the Managing Editor to check whether a ‘Summary of findings’ table is needed, or for assistance.
Any changes in methods should be noted in the ‘Differences between protocol and review’ section.

If potentially relevant trials are found in the updated searches:

The full text of any potentially relevant new trials should be obtained for independent assessment by at least 2 authors.

A data extraction form should be used for the assessment of new trials. This may be the original data extraction form. However, if important new outcomes are included in the new evidence then the data extraction form may need to be modified to incorporate these. It may also be necessary to revisit the original trial evidence to see if data for these additional outcomes can also be extracted. The new trials must be assessed as vigorously as in the first version of the review, including the description of studies and methodological quality. All the comparison tables, risk of bias assessments, description of studies section, results section, discussion, abstract, plain language summary and conclusions should be revised.

Authors should consider any need for a change in research question and selection criteria of the review: eg addition of a new outcome or comparison, adding a newly specified subgroup analysis following improved methods for categorizing the condition.

Authors should consider changes to methodology: egsince January 2009 we have asked authors updating reviews to include a ‘Risk of bias’ assessment of currently-included studies and any newly identified studies. A‘Summary of findings’ table is also usuallyrequired for updates that have included studies. Data extraction forms will need to be modified accordingly. An example of data extraction form incorporating the new risk of bias assessments is available from the editorial base. Any changes in methodology should be noted in the ‘Differences between protocol and review’ section.

The new evidence should be incorporated into the review in the following ways:

Check that the TSC has updated the dates in the ‘Search methods for identification of studies’ section. If incorrect please contact the editorial base for revision.
Authors are required to search for ongoing trials using ClinicalTrials.gov and WHO ICTRP ( as a minimum, and include the date of search in the review. The strategy/strategies need to be included in a separate appendix exactly as used. Add any ongoing trials to the ongoing trials section of the references
Include a note of the number of hits from each database at the start of the Results of the search section of the Results. The group’s TSC will provide figures for the databases she has searched. Indicate how many new references were identified in the ‘Description of studies’ section and incorporate key trial characteristics from the new studies into this section. It is helpful but not compulsory to complete a PRISMA diagram to illustrate the study selection process.
Add the references to new studies to the ‘References to included studies’ or ‘Reference to excluded studies’ as appropriate.
Incorporate information on risk of bias from the new trials that meet your inclusion criteria and complete a risk of bias table using the 2008 methodology for those studies already included.
Incorporate the new studies that meet your inclusion criteria into the table of comparisons and Results sections if appropriate. Note that the ‘Effects of interventions’ section of the Results should be organised by comparison and then by outcome.
Add the new studies to the Table of Included studies, or Table of Excluded studies and to any additional tables (for example Risk of Bias table).
Update the Results, Discussion and Conclusions
Updates with included RCTs should in most circumstances include a ‘Summary of findings’ table following guidance in Chapters 11 and 12 of the Cochrane Handbook. The software for producing a Summary of findings table can be found at: See Getting Startedfor instructions,and the help files are also useful. Please consult the Managing Editor to check whether a ‘Summary of findings’ table is needed, or for assistance.
Create two eventsin the What’s new section at the head of the review Updated, and ‘New citation conclusions changed’ or ‘New citation: conclusions not changed’ - this creates a ‘publication flag’ for the review on the Cochrane library.
Update the Abstract and Plain Language Summary - revise the plain language summary according to Cochrane PLEACS guidance ( The editorial base can assist with language if necessary, but authors should add headings and include all mandatory elements.
Alter the date review was assessed as being up to date. This is the same as the date of search.

When an updated review is submitted to the editorial base, the extent of the update (eg whether major changes have been made to the review with the inclusion of new studies or whether the update only involved a search for new trials which found no new data) will be discussed by the editorial team. If the alterations are significant, the updated review will be submitted to the same editorial process as the original review before being approved for publication and submitted to the Cochrane Library. The update may need revising following peer review.

All authors are required to submit online Conflict of interest forms online and the Declaration of interest statement in the review should be updated accordingly. In their form, authors should also mention any involvement in studies that are or might be eligible for inclusion in the review (in section 4), along with financial conflicts. A new Licence for publication form will also be required from all authors before publication. These forms are now submitted via Archie and require user names and passwords. Authors cited on the review should be those who have contributed in some way to the review. If the original authors of the review have not contributed to the update, they should be removed from the list of authors and their contribution to developing the original review should be mentioned in the Contribution of authors section and Acknowledgments. The original review (and original authors) should be referenced in ‘Other published versions of this review’ in RevMan.

Separate citations on MEDLINE will appear for the original version of the Cochrane review, and any subsequent updates, so both the authors of the original review, and any new reviewers or review teams who take on an update will have a separate MEDLINE citation.

Out-of-datereviews and protocols

The Group has adopted the Cochrane Collaboration policy with regard to updating reviews and protocols.

Reviews must be updated and published in the Cochrane Library within 30 issues (two and a half years maximum) of the Cochrane Library from the date of their original publication or last update (or a reason why an update has not been completed should be added).

Protocols must be published as reviews within 30 issues of first being published in the Cochrane Library.

If no progress is made in updating the review, within 30 issues of first publication (or last update) the editorial base will advise authors of the intention to withdraw the review from the Cochrane Library.

Contact reviewers, who currently receive a copy of each issue of the Cochrane Library on CD ROM, will not receive their copies until the review has been updated.

Feedback

Authors of reviews who receive feedback or a comment on their review through the ‘Feedback' facility on the Cochrane Library are required to address the comment within three months and reply to the criticism editor of the group. This may involve adjustments or changes to the review. Once the criticism editor is satisfied that the authors have satisfactorily responded to the comment, both the comment and response will be published with the review. If the review requires significant changes in the light of such comments, it will be subject to the same editorial process as an updated review.