4.4.9 Discussion

The aim of this section is to briefly summarize the main findings and then focus on the discussion of these results. Results should be discussed, compared and contrasted with what was already known from other sources, other than the review, usually at a minimum the literature mentioned in the background section, however, additional external literature may be discussed here in order to facilitate the understanding and positioning of the review results in a broader research and practice context. The applicability and generalizability of the review results should be discussed. The significance of the results should be discussed for individual studies and for meta-analyses. It is not enough to discuss the statistical significance of the results; the practical/clinical significance of the results should be discussed regardless of the statistical significance of the results. The minimum and maximum values for the scales of measurement or measurement instruments should be discussed and the values that are considered to represent the minimum important change from a clinical/practical point of view. 

This section should provide a presentation of the limitations of included studies and the limitations of the review process. Limitations of each included study (limitations in the design and conduct of the research, including risk of bias) should be discussed. Also, the limitations of entire set of included studies should be discussed in terms of common limitations (including risk of bias). All limitations, issues and problems noted in the review process related to the search, selection of study, critical appraisal, data extraction, and data synthesis, should be discussed. The impact of the limitations of the studies and of the review process on the applicability and generalizability of the results should be considered.