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Assessing the robustness of the synthesisWe assessed the quality of the included papers using the checklist by Dixon Woods and colleagues (box). We used specific criteria for each area to give a score out of 11; one reviewer (IJM) assessed the quality of each paper. The use of quality assessment when reviewing qualitative research has been debated owing to the lack of agreement among researchers about what criteria should be used, the multitude of possible qualitative methods, and the role of subjective judgment in analysis.16 We therefore did not exclude papers with low quality scores but used the scores to provide one indicator of the robustness of the synthesis.

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Once designs and fabrics are chosen, a prototype of the article using cheaper materials is created and then tried on a model to see what adjustments to the design need to be made. After final adjustments and fabric selections have been made, samples of the garment using the actual materials are sewn and then marketed to clothing retailers. Most designs are marketed at fashion and trade shows where retailers place orders that are then manufactured and distributed to stores.