literature review and studies

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

• Knowledge Base

Methodology

• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates, and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

Instantly correct all language mistakes in your text

Upload your document to correct all your mistakes in minutes

Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

Prevent plagiarism. Run a free check.

Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models, and methods?
• Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

Receive feedback on language, structure, and formatting

Professional editors proofread and edit your paper by focusing on:

• Academic style
• Vague sentences
• Style consistency

See an example

To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

Scribbr slides are free to use, customize, and distribute for educational purposes.

Open Google Slides Download PowerPoint

If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

McCombes, S. (2023, September 11). How to Write a Literature Review | Guide, Examples, & Templates. Scribbr. Retrieved July 30, 2024, from https://www.scribbr.com/dissertation/literature-review/

Is this article helpful?

Shona McCombes

Other students also liked, what is a theoretical framework | guide to organizing, what is a research methodology | steps & tips, how to write a research proposal | examples & templates, "i thought ai proofreading was useless but..".

I've been using Scribbr for years now and I know it's a service that won't disappoint. It does a good job spotting mistakes”

Purdue Online Writing Lab Purdue OWL® College of Liberal Arts

Writing a Literature Review

Welcome to the Purdue OWL

This page is brought to you by the OWL at Purdue University. When printing this page, you must include the entire legal notice.

Copyright ©1995-2018 by The Writing Lab & The OWL at Purdue and Purdue University. All rights reserved. This material may not be published, reproduced, broadcast, rewritten, or redistributed without permission. Use of this site constitutes acceptance of our terms and conditions of fair use.

A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically Evaluate: Mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

What is a Literature Review? How to Write It (with Examples)

A literature review is a critical analysis and synthesis of existing research on a particular topic. It provides an overview of the current state of knowledge, identifies gaps, and highlights key findings in the literature. 1 The purpose of a literature review is to situate your own research within the context of existing scholarship, demonstrating your understanding of the topic and showing how your work contributes to the ongoing conversation in the field. Learning how to write a literature review is a critical tool for successful research. Your ability to summarize and synthesize prior research pertaining to a certain topic demonstrates your grasp on the topic of study, and assists in the learning process. 

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 

How to write a good literature review 

• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• How to write a literature review faster with Paperpal? 
• Frequently asked questions 

What is a literature review?

A well-conducted literature review demonstrates the researcher’s familiarity with the existing literature, establishes the context for their own research, and contributes to scholarly conversations on the topic. One of the purposes of a literature review is also to help researchers avoid duplicating previous work and ensure that their research is informed by and builds upon the existing body of knowledge.

What is the purpose of literature review?

A literature review serves several important purposes within academic and research contexts. Here are some key objectives and functions of a literature review: 2  

1. Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 

2. Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field. 

Find academic papers related to your research topic faster. Try Research on Paperpal  

3. Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 

4. Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 

5. Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 

6. Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example

Let’s delve deeper with a literature review example: Let’s say your literature review is about the impact of climate change on biodiversity. You might format your literature review into sections such as the effects of climate change on habitat loss and species extinction, phenological changes, and marine biodiversity. Each section would then summarize and analyze relevant studies in those areas, highlighting key findings and identifying gaps in the research. The review would conclude by emphasizing the need for further research on specific aspects of the relationship between climate change and biodiversity. The following literature review template provides a glimpse into the recommended literature review structure and content, demonstrating how research findings are organized around specific themes within a broader topic. 

Literature Review on Climate Change Impacts on Biodiversity:

Climate change is a global phenomenon with far-reaching consequences, including significant impacts on biodiversity. This literature review synthesizes key findings from various studies: 

a. Habitat Loss and Species Extinction:

Climate change-induced alterations in temperature and precipitation patterns contribute to habitat loss, affecting numerous species (Thomas et al., 2004). The review discusses how these changes increase the risk of extinction, particularly for species with specific habitat requirements. 

b. Range Shifts and Phenological Changes:

Observations of range shifts and changes in the timing of biological events (phenology) are documented in response to changing climatic conditions (Parmesan & Yohe, 2003). These shifts affect ecosystems and may lead to mismatches between species and their resources. 

c. Ocean Acidification and Coral Reefs:

The review explores the impact of climate change on marine biodiversity, emphasizing ocean acidification’s threat to coral reefs (Hoegh-Guldberg et al., 2007). Changes in pH levels negatively affect coral calcification, disrupting the delicate balance of marine ecosystems. 

d. Adaptive Strategies and Conservation Efforts:

Recognizing the urgency of the situation, the literature review discusses various adaptive strategies adopted by species and conservation efforts aimed at mitigating the impacts of climate change on biodiversity (Hannah et al., 2007). It emphasizes the importance of interdisciplinary approaches for effective conservation planning. 

Strengthen your literature review with factual insights. Try Research on Paperpal for free!    

Writing a literature review involves summarizing and synthesizing existing research on a particular topic. A good literature review format should include the following elements. 

Introduction: The introduction sets the stage for your literature review, providing context and introducing the main focus of your review. 

• Opening Statement: Begin with a general statement about the broader topic and its significance in the field. 
• Scope and Purpose: Clearly define the scope of your literature review. Explain the specific research question or objective you aim to address. 
• Organizational Framework: Briefly outline the structure of your literature review, indicating how you will categorize and discuss the existing research. 
• Significance of the Study: Highlight why your literature review is important and how it contributes to the understanding of the chosen topic. 
• Thesis Statement: Conclude the introduction with a concise thesis statement that outlines the main argument or perspective you will develop in the body of the literature review. 

Body: The body of the literature review is where you provide a comprehensive analysis of existing literature, grouping studies based on themes, methodologies, or other relevant criteria. 

• Organize by Theme or Concept: Group studies that share common themes, concepts, or methodologies. Discuss each theme or concept in detail, summarizing key findings and identifying gaps or areas of disagreement. 
• Critical Analysis: Evaluate the strengths and weaknesses of each study. Discuss the methodologies used, the quality of evidence, and the overall contribution of each work to the understanding of the topic. 
• Synthesis of Findings: Synthesize the information from different studies to highlight trends, patterns, or areas of consensus in the literature. 
• Identification of Gaps: Discuss any gaps or limitations in the existing research and explain how your review contributes to filling these gaps. 
• Transition between Sections: Provide smooth transitions between different themes or concepts to maintain the flow of your literature review. 

Write and Cite as you go with Paperpal Research. Start now for free.   

Conclusion: The conclusion of your literature review should summarize the main findings, highlight the contributions of the review, and suggest avenues for future research. 

• Summary of Key Findings: Recap the main findings from the literature and restate how they contribute to your research question or objective. 
• Contributions to the Field: Discuss the overall contribution of your literature review to the existing knowledge in the field. 
• Implications and Applications: Explore the practical implications of the findings and suggest how they might impact future research or practice. 
• Recommendations for Future Research: Identify areas that require further investigation and propose potential directions for future research in the field. 
• Final Thoughts: Conclude with a final reflection on the importance of your literature review and its relevance to the broader academic community. 

Conducting a literature review

Conducting a literature review is an essential step in research that involves reviewing and analyzing existing literature on a specific topic. It’s important to know how to do a literature review effectively, so here are the steps to follow: 1  

Choose a Topic and Define the Research Question:

• Select a topic that is relevant to your field of study. 
• Clearly define your research question or objective. Determine what specific aspect of the topic do you want to explore? 

Decide on the Scope of Your Review:

• Determine the timeframe for your literature review. Are you focusing on recent developments, or do you want a historical overview? 
• Consider the geographical scope. Is your review global, or are you focusing on a specific region? 
• Define the inclusion and exclusion criteria. What types of sources will you include? Are there specific types of studies or publications you will exclude? 

Select Databases for Searches:

• Identify relevant databases for your field. Examples include PubMed, IEEE Xplore, Scopus, Web of Science, and Google Scholar. 
• Consider searching in library catalogs, institutional repositories, and specialized databases related to your topic. 

Conduct Searches and Keep Track:

• Develop a systematic search strategy using keywords, Boolean operators (AND, OR, NOT), and other search techniques. 
• Record and document your search strategy for transparency and replicability. 
• Keep track of the articles, including publication details, abstracts, and links. Use citation management tools like EndNote, Zotero, or Mendeley to organize your references. 

Review the Literature:

• Evaluate the relevance and quality of each source. Consider the methodology, sample size, and results of studies. 
• Organize the literature by themes or key concepts. Identify patterns, trends, and gaps in the existing research. 
• Summarize key findings and arguments from each source. Compare and contrast different perspectives. 
• Identify areas where there is a consensus in the literature and where there are conflicting opinions. 
• Provide critical analysis and synthesis of the literature. What are the strengths and weaknesses of existing research? 

Organize and Write Your Literature Review:

• Literature review outline should be based on themes, chronological order, or methodological approaches. 
• Write a clear and coherent narrative that synthesizes the information gathered. 
• Use proper citations for each source and ensure consistency in your citation style (APA, MLA, Chicago, etc.). 
• Conclude your literature review by summarizing key findings, identifying gaps, and suggesting areas for future research. 

Whether you’re exploring a new research field or finding new angles to develop an existing topic, sifting through hundreds of papers can take more time than you have to spare. But what if you could find science-backed insights with verified citations in seconds? That’s the power of Paperpal’s new Research feature!  

How to write a literature review faster with Paperpal?

Paperpal, an AI writing assistant, integrates powerful academic search capabilities within its writing platform. With the Research feature, you get 100% factual insights, with citations backed by 250M+ verified research articles, directly within your writing interface with the option to save relevant references in your Citation Library. By eliminating the need to switch tabs to find answers to all your research questions, Paperpal saves time and helps you stay focused on your writing.   

Here’s how to use the Research feature:  

• Ask a question: Get started with a new document on paperpal.com. Click on the “Research” feature and type your question in plain English. Paperpal will scour over 250 million research articles, including conference papers and preprints, to provide you with accurate insights and citations. 
• Review and Save: Paperpal summarizes the information, while citing sources and listing relevant reads. You can quickly scan the results to identify relevant references and save these directly to your built-in citations library for later access. 
• Cite with Confidence: Paperpal makes it easy to incorporate relevant citations and references into your writing, ensuring your arguments are well-supported by credible sources. This translates to a polished, well-researched literature review. 

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a good literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. By combining effortless research with an easy citation process, Paperpal Research streamlines the literature review process and empowers you to write faster and with more confidence. Try Paperpal Research now and see for yourself.  

Frequently asked questions

A literature review is a critical and comprehensive analysis of existing literature (published and unpublished works) on a specific topic or research question and provides a synthesis of the current state of knowledge in a particular field. A well-conducted literature review is crucial for researchers to build upon existing knowledge, avoid duplication of efforts, and contribute to the advancement of their field. It also helps researchers situate their work within a broader context and facilitates the development of a sound theoretical and conceptual framework for their studies.

Literature review is a crucial component of research writing, providing a solid background for a research paper’s investigation. The aim is to keep professionals up to date by providing an understanding of ongoing developments within a specific field, including research methods, and experimental techniques used in that field, and present that knowledge in the form of a written report. Also, the depth and breadth of the literature review emphasizes the credibility of the scholar in his or her field.  

Before writing a literature review, it’s essential to undertake several preparatory steps to ensure that your review is well-researched, organized, and focused. This includes choosing a topic of general interest to you and doing exploratory research on that topic, writing an annotated bibliography, and noting major points, especially those that relate to the position you have taken on the topic. 

Literature reviews and academic research papers are essential components of scholarly work but serve different purposes within the academic realm. 3 A literature review aims to provide a foundation for understanding the current state of research on a particular topic, identify gaps or controversies, and lay the groundwork for future research. Therefore, it draws heavily from existing academic sources, including books, journal articles, and other scholarly publications. In contrast, an academic research paper aims to present new knowledge, contribute to the academic discourse, and advance the understanding of a specific research question. Therefore, it involves a mix of existing literature (in the introduction and literature review sections) and original data or findings obtained through research methods. 

Literature reviews are essential components of academic and research papers, and various strategies can be employed to conduct them effectively. If you want to know how to write a literature review for a research paper, here are four common approaches that are often used by researchers.  Chronological Review: This strategy involves organizing the literature based on the chronological order of publication. It helps to trace the development of a topic over time, showing how ideas, theories, and research have evolved.  Thematic Review: Thematic reviews focus on identifying and analyzing themes or topics that cut across different studies. Instead of organizing the literature chronologically, it is grouped by key themes or concepts, allowing for a comprehensive exploration of various aspects of the topic.  Methodological Review: This strategy involves organizing the literature based on the research methods employed in different studies. It helps to highlight the strengths and weaknesses of various methodologies and allows the reader to evaluate the reliability and validity of the research findings.  Theoretical Review: A theoretical review examines the literature based on the theoretical frameworks used in different studies. This approach helps to identify the key theories that have been applied to the topic and assess their contributions to the understanding of the subject.  It’s important to note that these strategies are not mutually exclusive, and a literature review may combine elements of more than one approach. The choice of strategy depends on the research question, the nature of the literature available, and the goals of the review. Additionally, other strategies, such as integrative reviews or systematic reviews, may be employed depending on the specific requirements of the research.

The literature review format can vary depending on the specific publication guidelines. However, there are some common elements and structures that are often followed. Here is a general guideline for the format of a literature review:  Introduction:   Provide an overview of the topic.  Define the scope and purpose of the literature review.  State the research question or objective.  Body:   Organize the literature by themes, concepts, or chronology.  Critically analyze and evaluate each source.  Discuss the strengths and weaknesses of the studies.  Highlight any methodological limitations or biases.  Identify patterns, connections, or contradictions in the existing research.  Conclusion:   Summarize the key points discussed in the literature review.  Highlight the research gap.  Address the research question or objective stated in the introduction.  Highlight the contributions of the review and suggest directions for future research.

Both annotated bibliographies and literature reviews involve the examination of scholarly sources. While annotated bibliographies focus on individual sources with brief annotations, literature reviews provide a more in-depth, integrated, and comprehensive analysis of existing literature on a specific topic. The key differences are as follows: 

References 

• Denney, A. S., & Tewksbury, R. (2013). How to write a literature review.  Journal of criminal justice education ,  24 (2), 218-234. 
• Pan, M. L. (2016).  Preparing literature reviews: Qualitative and quantitative approaches . Taylor & Francis. 
• Cantero, C. (2019). How to write a literature review.  San José State University Writing Center . 

Paperpal is an AI writing assistant that help academics write better, faster with real-time suggestions for in-depth language and grammar correction. Trained on millions of research manuscripts enhanced by professional academic editors, Paperpal delivers human precision at machine speed.  

Try it for free or upgrade to  Paperpal Prime , which unlocks unlimited access to premium features like academic translation, paraphrasing, contextual synonyms, consistency checks and more. It’s like always having a professional academic editor by your side! Go beyond limitations and experience the future of academic writing.  Get Paperpal Prime now at just US$19 a month!

Related Reads:

• Empirical Research: A Comprehensive Guide for Academics 
• How to Write a Scientific Paper in 10 Steps 
• How Long Should a Chapter Be?
• How to Use Paperpal to Generate Emails & Cover Letters?

6 Tips for Post-Doc Researchers to Take Their Career to the Next Level

Self-plagiarism in research: what it is and how to avoid it, you may also like, the ai revolution: authors’ role in upholding academic..., the future of academia: how ai tools are..., how to write a research proposal: (with examples..., apa format: basic guide for researchers, how to choose a dissertation topic, how to write a phd research proposal, how to write an academic paragraph (step-by-step guide), five things authors need to know when using..., 7 best referencing tools and citation management software..., maintaining academic integrity with paperpal’s generative ai writing....

Harvey Cushing/John Hay Whitney Medical Library

• Collections
• Research Help

YSN Doctoral Programs: Steps in Conducting a Literature Review

• Biomedical Databases
• Global (Public Health) Databases
• Soc. Sci., History, and Law Databases
• Grey Literature
• Trials Registers
• Data and Statistics
• Public Policy
• Google Tips
• Recommended Books
• Steps in Conducting a Literature Review

What is a literature review?

A literature review is an integrated analysis -- not just a summary-- of scholarly writings and other relevant evidence related directly to your research question.  That is, it represents a synthesis of the evidence that provides background information on your topic and shows a association between the evidence and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment.  Rely heavily on the guidelines your instructor has given you.

Why is it important?

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Discovers relationships between research studies/ideas.
• Identifies major themes, concepts, and researchers on a topic.
• Identifies critical gaps and points of disagreement.
• Discusses further research questions that logically come out of the previous studies.

APA7 Style resources

APA Style Blog - for those harder to find answers

1. Choose a topic. Define your research question.

Your literature review should be guided by your central research question.  The literature represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way.

• Make sure your research question is not too broad or too narrow.  Is it manageable?
• Begin writing down terms that are related to your question. These will be useful for searches later.
• If you have the opportunity, discuss your topic with your professor and your class mates.

2. Decide on the scope of your review

How many studies do you need to look at? How comprehensive should it be? How many years should it cover? 

• This may depend on your assignment.  How many sources does the assignment require?

3. Select the databases you will use to conduct your searches.

Make a list of the databases you will search. 

Where to find databases:

• use the tabs on this guide
• Find other databases in the Nursing Information Resources web page
• More on the Medical Library web page
• ... and more on the Yale University Library web page

4. Conduct your searches to find the evidence. Keep track of your searches.

• Use the key words in your question, as well as synonyms for those words, as terms in your search. Use the database tutorials for help.
• Save the searches in the databases. This saves time when you want to redo, or modify, the searches. It is also helpful to use as a guide is the searches are not finding any useful results.
• Review the abstracts of research studies carefully. This will save you time.
• Use the bibliographies and references of research studies you find to locate others.
• Check with your professor, or a subject expert in the field, if you are missing any key works in the field.
• Ask your librarian for help at any time.
• Use a citation manager, such as EndNote as the repository for your citations. See the EndNote tutorials for help.

Review the literature

Some questions to help you analyze the research:

• What was the research question of the study you are reviewing? What were the authors trying to discover?
• Was the research funded by a source that could influence the findings?
• What were the research methodologies? Analyze its literature review, the samples and variables used, the results, and the conclusions.
• Does the research seem to be complete? Could it have been conducted more soundly? What further questions does it raise?
• If there are conflicting studies, why do you think that is?
• How are the authors viewed in the field? Has this study been cited? If so, how has it been analyzed?

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
• << Previous: Recommended Books
• Last Updated: Jun 20, 2024 9:08 AM
• URL: https://guides.library.yale.edu/YSNDoctoral

• UConn Library
• Literature Review: The What, Why and How-to Guide
• Introduction

Literature Review: The What, Why and How-to Guide — Introduction

• Getting Started
• How to Pick a Topic
• Strategies to Find Sources
• Evaluating Sources & Lit. Reviews
• Tips for Writing Literature Reviews
• Writing Literature Review: Useful Sites
• Citation Resources
• Other Academic Writings

What are Literature Reviews?

So, what is a literature review? "A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries." Taylor, D.  The literature review: A few tips on conducting it . University of Toronto Health Sciences Writing Centre.

Goals of Literature Reviews

What are the goals of creating a Literature Review?  A literature could be written to accomplish different aims:

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 

Baumeister, R. F., & Leary, M. R. (1997). Writing narrative literature reviews .  Review of General Psychology , 1 (3), 311-320.

What kinds of sources require a Literature Review?

• A research paper assigned in a course
• A thesis or dissertation
• A grant proposal
• An article intended for publication in a journal

All these instances require you to collect what has been written about your research topic so that you can demonstrate how your own research sheds new light on the topic.

Types of Literature Reviews

What kinds of literature reviews are written?

Narrative review: The purpose of this type of review is to describe the current state of the research on a specific topic/research and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weakness, and gaps are identified. The review ends with a conclusion section which summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.

• Example : Predictors and Outcomes of U.S. Quality Maternity Leave: A Review and Conceptual Framework:  10.1177/08948453211037398  

Systematic review : "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139). Nelson, L. K. (2013). Research in Communication Sciences and Disorders . Plural Publishing.

• Example : The effect of leave policies on increasing fertility: a systematic review:  10.1057/s41599-022-01270-w

Meta-analysis : "Meta-analysis is a method of reviewing research findings in a quantitative fashion by transforming the data from individual studies into what is called an effect size and then pooling and analyzing this information. The basic goal in meta-analysis is to explain why different outcomes have occurred in different studies." (p. 197). Roberts, M. C., & Ilardi, S. S. (2003). Handbook of Research Methods in Clinical Psychology . Blackwell Publishing.

• Example : Employment Instability and Fertility in Europe: A Meta-Analysis:  10.1215/00703370-9164737

Meta-synthesis : "Qualitative meta-synthesis is a type of qualitative study that uses as data the findings from other qualitative studies linked by the same or related topic." (p.312). Zimmer, L. (2006). Qualitative meta-synthesis: A question of dialoguing with texts .  Journal of Advanced Nursing , 53 (3), 311-318.

• Example : Women’s perspectives on career successes and barriers: A qualitative meta-synthesis:  10.1177/05390184221113735

Literature Reviews in the Health Sciences

• UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
• << Previous: Getting Started
• Next: How to Pick a Topic >>
• Last Updated: Sep 21, 2022 2:16 PM
• URL: https://guides.lib.uconn.edu/literaturereview

What Is A Literature Review?

A plain-language explainer (with examples).

By:  Derek Jansen (MBA) & Kerryn Warren (PhD) | June 2020 (Updated May 2023)

If you’re faced with writing a dissertation or thesis, chances are you’ve encountered the term “literature review” . If you’re on this page, you’re probably not 100% what the literature review is all about. The good news is that you’ve come to the right place.

Literature Review 101

• What (exactly) is a literature review
• What’s the purpose of the literature review chapter
• How to find high-quality resources
• How to structure your literature review chapter
• Example of an actual literature review

What is a literature review?

The word “literature review” can refer to two related things that are part of the broader literature review process. The first is the task of  reviewing the literature  – i.e. sourcing and reading through the existing research relating to your research topic. The second is the  actual chapter  that you write up in your dissertation, thesis or research project. Let’s look at each of them:

Reviewing the literature

The first step of any literature review is to hunt down and  read through the existing research  that’s relevant to your research topic. To do this, you’ll use a combination of tools (we’ll discuss some of these later) to find journal articles, books, ebooks, research reports, dissertations, theses and any other credible sources of information that relate to your topic. You’ll then  summarise and catalogue these  for easy reference when you write up your literature review chapter. 

The literature review chapter

The second step of the literature review is to write the actual literature review chapter (this is usually the second chapter in a typical dissertation or thesis structure ). At the simplest level, the literature review chapter is an  overview of the key literature  that’s relevant to your research topic. This chapter should provide a smooth-flowing discussion of what research has already been done, what is known, what is unknown and what is contested in relation to your research topic. So, you can think of it as an  integrated review of the state of knowledge  around your research topic. 

What’s the purpose of a literature review?

The literature review chapter has a few important functions within your dissertation, thesis or research project. Let’s take a look at these:

Purpose #1 – Demonstrate your topic knowledge

The first function of the literature review chapter is, quite simply, to show the reader (or marker) that you  know what you’re talking about . In other words, a good literature review chapter demonstrates that you’ve read the relevant existing research and understand what’s going on – who’s said what, what’s agreed upon, disagreed upon and so on. This needs to be  more than just a summary  of who said what – it needs to integrate the existing research to  show how it all fits together  and what’s missing (which leads us to purpose #2, next). 

Purpose #2 – Reveal the research gap that you’ll fill

The second function of the literature review chapter is to  show what’s currently missing  from the existing research, to lay the foundation for your own research topic. In other words, your literature review chapter needs to show that there are currently “missing pieces” in terms of the bigger puzzle, and that  your study will fill one of those research gaps . By doing this, you are showing that your research topic is original and will help contribute to the body of knowledge. In other words, the literature review helps justify your research topic.  

Purpose #3 – Lay the foundation for your conceptual framework

The third function of the literature review is to form the  basis for a conceptual framework . Not every research topic will necessarily have a conceptual framework, but if your topic does require one, it needs to be rooted in your literature review. 

For example, let’s say your research aims to identify the drivers of a certain outcome – the factors which contribute to burnout in office workers. In this case, you’d likely develop a conceptual framework which details the potential factors (e.g. long hours, excessive stress, etc), as well as the outcome (burnout). Those factors would need to emerge from the literature review chapter – they can’t just come from your gut! 

So, in this case, the literature review chapter would uncover each of the potential factors (based on previous studies about burnout), which would then be modelled into a framework. 

Purpose #4 – To inform your methodology

The fourth function of the literature review is to  inform the choice of methodology  for your own research. As we’ve  discussed on the Grad Coach blog , your choice of methodology will be heavily influenced by your research aims, objectives and questions . Given that you’ll be reviewing studies covering a topic close to yours, it makes sense that you could learn a lot from their (well-considered) methodologies.

So, when you’re reviewing the literature, you’ll need to  pay close attention to the research design , methodology and methods used in similar studies, and use these to inform your methodology. Quite often, you’ll be able to  “borrow” from previous studies . This is especially true for quantitative studies , as you can use previously tried and tested measures and scales. 

How do I find articles for my literature review?

Finding quality journal articles is essential to crafting a rock-solid literature review. As you probably already know, not all research is created equally, and so you need to make sure that your literature review is  built on credible research . 

We could write an entire post on how to find quality literature (actually, we have ), but a good starting point is Google Scholar . Google Scholar is essentially the academic equivalent of Google, using Google’s powerful search capabilities to find relevant journal articles and reports. It certainly doesn’t cover every possible resource, but it’s a very useful way to get started on your literature review journey, as it will very quickly give you a good indication of what the  most popular pieces of research  are in your field.

One downside of Google Scholar is that it’s merely a search engine – that is, it lists the articles, but oftentimes  it doesn’t host the articles . So you’ll often hit a paywall when clicking through to journal websites. 

Thankfully, your university should provide you with access to their library, so you can find the article titles using Google Scholar and then search for them by name in your university’s online library. Your university may also provide you with access to  ResearchGate , which is another great source for existing research. 

Remember, the correct search keywords will be super important to get the right information from the start. So, pay close attention to the keywords used in the journal articles you read and use those keywords to search for more articles. If you can’t find a spoon in the kitchen, you haven’t looked in the right drawer. 

Need a helping hand?

How should I structure my literature review?

Unfortunately, there’s no generic universal answer for this one. The structure of your literature review will depend largely on your topic area and your research aims and objectives.

You could potentially structure your literature review chapter according to theme, group, variables , chronologically or per concepts in your field of research. We explain the main approaches to structuring your literature review here . You can also download a copy of our free literature review template to help you establish an initial structure.

In general, it’s also a good idea to start wide (i.e. the big-picture-level) and then narrow down, ending your literature review close to your research questions . However, there’s no universal one “right way” to structure your literature review. The most important thing is not to discuss your sources one after the other like a list – as we touched on earlier, your literature review needs to synthesise the research , not summarise it .

Ultimately, you need to craft your literature review so that it conveys the most important information effectively – it needs to tell a logical story in a digestible way. It’s no use starting off with highly technical terms and then only explaining what these terms mean later. Always assume your reader is not a subject matter expert and hold their hand through a journe y of the literature while keeping the functions of the literature review chapter (which we discussed earlier) front of mind.

Example of a literature review

In the video below, we walk you through a high-quality literature review from a dissertation that earned full distinction. This will give you a clearer view of what a strong literature review looks like in practice and hopefully provide some inspiration for your own. 

Wrapping Up

In this post, we’ve (hopefully) answered the question, “ what is a literature review? “. We’ve also considered the purpose and functions of the literature review, as well as how to find literature and how to structure the literature review chapter. If you’re keen to learn more, check out the literature review section of the Grad Coach blog , as well as our detailed video post covering how to write a literature review . 

Psst… there’s more!

This post is an extract from our bestselling short course, Literature Review Bootcamp . If you want to work smart, you don't want to miss this .

16 Comments

Thanks for this review. It narrates what’s not been taught as tutors are always in a early to finish their classes.

Thanks for the kind words, Becky. Good luck with your literature review 🙂

This website is amazing, it really helps break everything down. Thank you, I would have been lost without it.

This is review is amazing. I benefited from it a lot and hope others visiting this website will benefit too.

Timothy T. Chol [email protected]

Thank you very much for the guiding in literature review I learn and benefited a lot this make my journey smooth I’ll recommend this site to my friends

This was so useful. Thank you so much.

Hi, Concept was explained nicely by both of you. Thanks a lot for sharing it. It will surely help research scholars to start their Research Journey.

The review is really helpful to me especially during this period of covid-19 pandemic when most universities in my country only offer online classes. Great stuff

Great Brief Explanation, thanks

So helpful to me as a student

GradCoach is a fantastic site with brilliant and modern minds behind it.. I spent weeks decoding the substantial academic Jargon and grounding my initial steps on the research process, which could be shortened to a couple of days through the Gradcoach. Thanks again!

This is an amazing talk. I paved way for myself as a researcher. Thank you GradCoach!

Well-presented overview of the literature!

This was brilliant. So clear. Thank you

Submit a Comment Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

• Print Friendly

Libraries | Research Guides

Literature reviews, what is a literature review, learning more about how to do a literature review.

• Planning the Review
• The Research Question
• Choosing Where to Search
• Organizing the Review
• Writing the Review

A literature review is a review and synthesis of existing research on a topic or research question. A literature review is meant to analyze the scholarly literature, make connections across writings and identify strengths, weaknesses, trends, and missing conversations. A literature review should address different aspects of a topic as it relates to your research question. A literature review goes beyond a description or summary of the literature you have read. 

• Sage Research Methods Core This link opens in a new window SAGE Research Methods supports research at all levels by providing material to guide users through every step of the research process. SAGE Research Methods is the ultimate methods library with more than 1000 books, reference works, journal articles, and instructional videos by world-leading academics from across the social sciences, including the largest collection of qualitative methods books available online from any scholarly publisher. – Publisher

• Next: Planning the Review >>
• Last Updated: Jul 8, 2024 11:22 AM
• URL: https://libguides.northwestern.edu/literaturereviews

Literature reviews as independent studies: guidelines for academic practice

• Original Paper
• Open access
• Published: 14 October 2022
• Volume 16 , pages 2577–2595, ( 2022 )

Cite this article

You have full access to this open access article

• Sascha Kraus   ORCID: orcid.org/0000-0003-4886-7482 1 , 2 ,
• Matthias Breier 3 ,
• Weng Marc Lim 4 , 8 , 22 ,
• Marina Dabić 5 , 6 ,
• Satish Kumar 7 , 8 ,
• Dominik Kanbach 9 , 10 ,
• Debmalya Mukherjee 11 ,
• Vincenzo Corvello 12 ,
• Juan Piñeiro-Chousa 13 ,
• Eric Liguori 14 ,
• Daniel Palacios-Marqués 15 ,
• Francesco Schiavone 16 , 17 ,
• Alberto Ferraris 18 , 21 ,
• Cristina Fernandes 19 , 20 &
• João J. Ferreira 19  

84k Accesses

340 Citations

4 Altmetric

Explore all metrics

Review articles or literature reviews are a critical part of scientific research. While numerous guides on literature reviews exist, these are often limited to the philosophy of review procedures, protocols, and nomenclatures, triggering non-parsimonious reporting and confusion due to overlapping similarities. To address the aforementioned limitations, we adopt a pragmatic approach to demystify and shape the academic practice of conducting literature reviews. We concentrate on the types, focuses, considerations, methods, and contributions of literature reviews as independent, standalone studies. As such, our article serves as an overview that scholars can rely upon to navigate the fundamental elements of literature reviews as standalone and independent studies, without getting entangled in the complexities of review procedures, protocols, and nomenclatures.

Similar content being viewed by others

Literature Reviews: An Overview of Systematic, Integrated, and Scoping Reviews

On being ‘systematic’ in literature reviews

Overview of the Integrative Review

Avoid common mistakes on your manuscript.

1 Introduction

A literature review – or a review article – is “a study that analyzes and synthesizes an existing body of literature by identifying, challenging, and advancing the building blocks of a theory through an examination of a body (or several bodies) of prior work (Post et al. 2020 , p. 352). Literature reviews as standalone pieces of work may allow researchers to enhance their understanding of prior work in their field, enabling them to more easily identify gaps in the body of literature and potential avenues for future research. More importantly, review articles may challenge established assumptions and norms of a given field or topic, recognize critical problems and factual errors, and stimulate future scientific conversations around that topic. Literature reviews Footnote 1 come in many different formats and purposes:

Some review articles conduct a critical evaluation of the literature, whereas others elect to adopt a more exploratory and descriptive approach.

Some reviews examine data, methodologies, and findings, whereas others look at constructs, themes, and theories.

Some reviews provide summaries by holistically synthesizing the existing research on a topic, whereas others adopt an integrative approach by assessing related and interdisciplinary work.

The number of review articles published as independent or standalone studies has been increasing over time. According to Scopus (i.e., search database ), reviews (i.e., document type ) were first published in journals (i.e., source type ) as independent studies in 1945, and they subsequently appeared in three digits yearly from the late 1980s to the late 1990s, four digits yearly from the early 2000s to the late 2010s, and five digits in the year 2021 (Fig.  1 ). This increase is indicative that reviewers and editors in business and management research alike see value and purpose in review articles to such a level that they are now commonly accepted as independent, standalone studies. This development is also reflected in the fact that some academic journals exclusively publish review articles (e.g., the Academy of Management Annals , or the  International Journal of Management Reviews ), and journals publishing in various fields often have special issues dedicated to literature reviews on certain topic areas (e.g., the Journal of Management and the Journal of International Business Studies ).

Full-year publication trend of review articles on Scopus (1945–2021)

One of the most important prerequisites of a high-quality review article is that the work follows an established methodology, systematically selects and analyzes articles, and periodically covers the field to identify latest developments (Snyder 2019 ). Additionally, it needs to be reproducible, well-evidenced, and transparent, resulting in a sample inclusive of all relevant and appropriate studies (Gusenbauer and Haddaway 2020; Hansen et al. 2021 ). This observation is in line with Palmatier et al. ( 2018 ), who state that review articles provide an important synthesis of findings and perspectives in a given body of knowledge. Snyder ( 2019 ) also reaffirmed this rationale, pointing out that review articles have the power to answer research questions beyond that which can be achieved in a single study. Ultimately, readers of review articles stand to gain a one-stop, state-of-the-art synthesis (Lim et al. 2022a ; Popli et al. 2022) that encapsulates critical insights through the process of re-interpreting, re-organizing, and re-connecting a body knowledge (Fan et al. 2022 ).

There are many reasons to conduct review articles. Kraus et al. ( 2020 ) explicitly mention the benefits of conducting systematic reviews by declaring that they often represent the first step in the context of larger research projects, such as doctoral dissertations. When carrying out work of this kind, it is important that a holistic overview of the current state of literature is achieved and embedded into a proper synthesis. This allows researchers to pinpoint relevant research gaps and adequately fit future conceptual or empirical studies into the state of the academic discussion (Kraus et al., 2021 ). A review article as an independent or standalone study is a viable option for any academic – especially young scholars, such as doctoral candidates – who wishes to delve into a specific topic for which a (recent) review article is not available.

The process of conducting a review article can be challenging, especially for novice scholars (Boell and Cecez-Kecmanovic 2015 ). Therefore, it is not surprising that numerous guides have been written in an attempt to improve the quality of review studies and support emerging scholars in their endeavors to have their work published. These guides for conducting review articles span a variety of academic fields, such as engineering education (Borrego et al. 2014 ), health sciences (Cajal et al. 2020 ), psychology (Laher and Hassem 2020 ), supply chain management (Durach et al. 2017 ), or business and entrepreneurship (Kraus et al. 2020 ; Tranfield et al. 2003 ) – the latter were among the first scholars to recognize the need to educate business/management scholars on the roles of review studies in assembling, ascertaining, and assessing the intellectual territory of a specific knowledge domain. Furthermore, they shed light on the stages (i.e., planning the review, conducting the review, reporting, and dissemination) and phases (i.e., identifying the need for a review, preparation of a proposal for a review, development of a review protocol, identification of research, selection of studies, study quality assessment, data extraction and monitoring progress, data synthesis, the report and recommendations, and getting evidence into practice) of conducting a systematic review. Other scholars have either adapted and/or developed new procedures (Kraus et al. 2020 ; Snyder 2019 ) or established review protocols such as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram (Moher et al. 2015 ). The latter provides a checklist that improves transparency and reproducibility, thus reducing questionable research practices. The declarative and procedural knowledge of a checklist allows users to derive value from (and, in some cases, produce) methodological literature reviews.

Two distinct and critical gaps or issues provide impetus for our article. First, while the endeavors of the named scholars are undoubtedly valuable contributions, they often encourage other scholars to explain the methodology of their review studies in a non-parsimonious way ( 1st issue ). This can become problematic if this information distracts and deprives scholars from providing richer review findings, particularly in instances in which publication outlets impose a strict page and/or word limit. More often than not, the early parts (i.e., stages/phases, such as needs, aims, and scope) of these procedures or protocols are explained in the introduction, but they tend to be reiterated in the methodology section due to the prescription of these procedures or protocols. Other parts of these procedures or protocols could also be reported more parsimoniously, for example, by filtering out documents, given that scientific databases (such as Scopus or Web of Science ) have since been upgraded to allow scholars to select and implement filtering criteria when conducting a search (i.e., criterion-by-criterion filtering may no longer be necessary). More often than not, the procedures or protocols of review studies can be signposted (e.g., bracket labeling) and disclosed in a sharp and succinct manner while maintaining transparency and replicability.

Other guides have been written to introduce review nomenclatures (i.e., names/naming) and their equivalent philosophical underpinnings. Palmatier et al. ( 2018 ) introduced three clearly but broadly defined nomenclatures of literature reviews as independent studies: domain-based reviews, theory-based reviews, and method-based reviews. However, such review nomenclatures can be confusing due to their overlapping similarities ( 2nd issue ). For example, Lim et al. ( 2022a ) highlighted their observation that the review nomenclatures associated with domain-based reviews could also be used for theory-based and method-based reviews.

The two aforementioned issues – i.e., the lack of a parsimonious understanding and the reporting of the review methodology , and the confusion emerging from review nomenclatures – are inarguably the unintended outcomes of diving into an advanced (i.e., higher level) understanding of literature review procedures, protocols, and nomenclatures from a philosophical perspective (i.e., underpinnings) without a foundational (i.e., basic level) understanding of the fundamental (i.e., core) elements of literature reviews from a pragmatic perspective. Our article aims to shed light on these issues and hopes to provide clarity for future scholarly endeavors.

Having a foundational understanding of literature reviews as independent studies is (i) necessary when addressing the aforementioned issues; (ii) important in reconciling and scaffolding our understanding, and (iii) relevant and timely due to the proliferation of literature reviews as independent studies. To contribute a solution toward addressing this gap , we aim to demystify review articles as independent studies from a pragmatic standpoint (i.e., practicality). To do so, we deliberately (i) move away from review procedures, protocols, and nomenclatures, and (ii) invest our attention in developing a parsimonious, scaffolded understanding of the fundamental elements (i.e., types, focuses, considerations, methods, and contributions) of review articles as independent studies.

Three contributions distinguish our article. It is worth noting that pragmatic guides (i.e., foundational knowledge), such as the present one, are not at odds with extant philosophical guides (i.e., advanced knowledge), but rather they complement them. Having a foundational knowledge of the fundamental elements of literature reviews as independent studies is valuable , as it can help scholars to (i) gain a good grasp of the fundamental elements of literature reviews as independent studies ( 1st contribution ), and (ii) mindfully adopt or adapt existing review procedures, protocols, and nomenclatures to better suit the circumstances of their reviews (e.g., choosing and developing a well-defined review nomenclature, and choosing and reporting on review considerations and steps more parsimoniously) ( 2nd contribution ). Therefore, this pragmatic guide serves as (iii) a foundational article (i.e., preparatory understanding) for literature reviews as independent studies ( 3rd contribution ). Following this, extant guides using a philosophical approach (i.e., advanced understanding) could be relied upon to make informed review decisions (e.g., adoption, adaptation) in response to the conventions of extant review procedures, protocols, and nomenclatures (Fig.  2 ).

Foundational and advanced understanding of literature reviews as independent studies

2 Fundamental elements of literature reviews as independent studies

A foundational understanding of literature reviews as independent studies can be acquired through the appreciation of five fundamental elements – i.e., types, focuses, considerations, methods, and contributions – which are illustrated in Fig.  3 and summarized in the following sections.

Fundamental elements of literature reviews as independent studies

There are two types of literature reviews as independent studies: systematic literature reviews ( SLRs ) and non-systematic literature reviews ( non-SLRs ). It is important to recognize that SLRs and non-SLRs are not review nomenclatures (i.e., names/naming) but rather review types (i.e., classifications).

In particular, SLRs are reviews carried out in a systematic way using an adopted or adapted procedure or protocol to guide data curation and analysis, thus enabling transparent disclosure and replicability (Lim et al. 2022a ; Kraus et al. 2020 ). Therefore, any review nomenclature guided by a systematic methodology is essentially an SLR. The origin of this type of literature review can be traced back to the evidence-based medicine movement in the early 1990s, with the objective being to overcome the issue of inconclusive findings in studies for medical treatments (Boell and Cecez-Kecmanovic 2015 ).

In contrast, non-SLRs are reviews conducted without any systematic procedure or protocol; instead, they weave together relevant literature based on the critical evaluations and (subjective) choices of the author(s) through a process of discovery and critique (e.g., pointing out contradictions and questioning assertions or beliefs); they are shaped by the exposure, expertise, and experience (i.e., the “3Es” in judgement calls) of the author(s). Therefore, non-SLRs are essentially critical reviews of the literature (Lim and Weissmann 2021 ).

2.2 Focuses

Unlike Palmatier et al. ( 2018 ) who considered domain-based reviews, theory-based reviews, and method-based reviews as review nomenclatures, we consider domain , theory , and method as three substantive focuses that can take center stage in literature reviews as independent studies. This is in line with our attempt to move away from review nomenclatures when providing a foundational understanding of literature reviews as independent studies.

A review that is domain-focused can examine: (i) a  concept (e.g., customer engagement; Lim et al. 2022b ; digital transformation; Kraus et al. 2021 ; home sharing; Lim et al. 2021 ; sharing economy; Lim 2020 ), (ii) a context (e.g., India; Mukherjee et al. 2022a ), (iii) a discipline (e.g., entrepreneurship; Ferreira et al. 2015 ; international business; Ghauri et al. 2021 ), (iv) a field (e.g., family business; Lahiri et al. 2020 ; Rovelli et al. 2021 ; female entrepreneurship; Ojong et al. 2021 ), or (v) an outlet (e.g., Journal of Business Research ; Donthu et al. 2020 ; Management International Review ; Mukherjee et al. 2021 ; Review of Managerial Science ; Mas-Tur et al. 2020 ), which typically offer broad, overarching insights.

Domain-focused hybrids , such as the between-domain hybrid (e.g., concept-discipline hybrid, such as digital transformation in business and management; Kraus et al. 2022 ; religion in business and entrepreneurship; Kumar et al. 2022a ; personality traits in entrepreneurship; Salmony and Kanbach 2022 ; and policy implications in HR and OB research; Aguinis et al., 2022 ) and the within-domain hybrid (e.g., the concept-concept hybrid, such as customer engagement and social media; Lim and Rasul 2022 ; and global business and organizational excellence; Lim 2022 ; and the discipline-discipline hybrid, such as neuromarketing; Lim 2018 ) are also common as they can provide finer-grained insights.

A review that is theory-focused can explore a standalone theory (e.g., theory of planned behavior; Duan and Jiang 2008 ), as well as a theory in conjunction with a domain , such as the concept-theory hybrid (e.g., behavioral control and theory of planned behavior; Lim and Weissmann 2021 ) and the theory-discipline hybrid (e.g., theory of planned behavior in hospitality, leisure, and tourism; Ulker-Demirel and Ciftci 2020 ), or a theory in conjunction with a method (e.g., theory of planned behavior and structural equation modeling).

A review that is method-focused can investigate a standalone method (e.g., structural equation modeling; Deng et al. 2018 ) or a method in conjunction with a domain , such as the method-discipline hybrid (e.g., fsQCA in business and management; Kumar et al. 2022b ).

2.3 Planning the review, critical considerations, and data collection

The considerations required for literature reviews as independent studies depend on their type: SLRs or non-SLRs.

For non-SLRs, scholars often rely on the 3Es (i.e., exposure, expertise, and experience) to provide a critical review of the literature. Scholars who embark on non-SLRs should be well versed with the literature they are dealing with. They should know the state of the literature (e.g., debatable, underexplored, and well-established knowledge areas) and how it needs to be deciphered (e.g., tenets and issues) and approached (e.g., reconciliation proposals and new pathways) to advance theory and practice. In this regard, non-SLRs follow a deductive reasoning approach, whereby scholars initially develop a set of coverage areas for reviewing a domain, theory, or method and subsequently draw on relevant literature to shed light and support scholarly contentions in each area.

For SLRs, scholars often rely on a set of criteria to provide a well-scoped (i.e., breadth and depth), structured (i.e., organized aspects), integrated (i.e., synthesized evidence) and interpreted/narrated (i.e., describing what has happened, how and why) systematic review of the literature. Footnote 2 In this regard, SLRs follow an inductive reasoning approach, whereby a set of criteria is established and implemented to develop a corpus of scholarly documents that scholars can review. They can then deliver a state-of-the-art overview, as well as a future agenda for a domain, theory, or method. Such criteria are often listed in philosophical guides on SLR procedures (e.g., Kraus et al. 2020 ; Snyder 2019 ) and protocols (e.g., PRISMA), and they may be adopted/adapted with justifications Footnote 3 . Based on their commonalities they can be summarized as follows:

Search database (e.g., “Scopus” and/or “Web of Science”) can be defined based on justified evidence (e.g., by the two being the largest scientific databases of scholarly articles that can provide on-demand bibliographic data or records; Pranckutė 2021 ). To avoid biased outcomes due to the scope covered by the selected database, researchers could utilize two or more different databases (Dabić et al. 2021 ).

Search keywords may be developed by reading scholarly documents and subsequently brainstorming with experts. The expanding number of databases, journals, periodicals, automated approaches, and semi-automated procedures that use text mining and machine learning can offer researchers the ability to source new, relevant research and forecast the citations of influential studies. This enables them to determine further relevant articles.

Boolean operators (e.g., AND, OR) should be strategically used in developing the  string   of search keywords (e.g., “engagement” AND “customer” OR “consumer” OR “business”). Furthermore, the correct and precise application of quotation marks is important but is very frequently sidestepped, resulting in incorrect selection processes and differentiated results.

Search period (e.g., between a specified period [e.g., 2000 to 2020] or up to the latest full year at the time or writing [e.g., up to 2021]) can be defined based on the justified scope of study (e.g., contemporary evolution versus historical trajectory).

Search field (e.g., “article title, abstract, keywords”) can be defined based on justified assumptions (e.g., it is assumed that the focus of relevant documents will be mentioned in the article title, abstract, and/or keywords).

Subject area (e.g., “business, management, and accounting”) can be defined based on justified principles (e.g., the focus of the review is on the marketing discipline, which is located under the “business, management, and accounting” subject area in Scopus).

Publication stage (e.g., “final”) can be defined based on justified grounds (e.g., enabling greater accuracy in replication).

Document type (e.g., “article” and/or “review”), which reflects the type of scientific/practical contributions (e.g., empirical, synthesis, thought), can be defined based on justified rationales (e.g., articles selected because they are peer-reviewed; editorials not selected because they are not peer-reviewed).

Source type (e.g., “journal”) can be defined based on justified reasons (e.g., journals selected because they publish finalized work; conference proceedings not selected because they are work in progress, and in business/management, they are usually not being considered as full-fledged “publications”).

Language (e.g., “English”) can be determined based on justified limitations (e.g., nowadays, there are not many reasons to use another language besides the academic lingua franca English). Different spellings should also be considered, as the literature may contain both American and British spelling variants (e.g., organization and organisation). Truncation and wildcards in searches are recommended to capture both sets of spellings. It is important to note that each database varies in its symbology.

Quality filtering (e.g., “A*” and “A” or “4*”, “4”, and “3”) can be defined based on justified motivations (e.g., the goal is to unpack the most originally and rigorously produced knowledge, which is the hallmark of premier journals, such as those ranked “A*” and “A” by the Australian Business Deans Council [ABDC] Journal Quality List [JQL] and rated “4*”, “4”, and “3” by the Chartered Association of Business Schools [CABS] Academic Journal Guide [AJG]).

Document relevance (i.e., within the focus of the review) can be defined based on justified judgement (e.g., for a review focusing on customer engagement, articles that mention customer engagement as a passing remark without actually investigating it would be excluded).

Others: Screening process should be accomplished by beginning with the deduction of duplicate results from other databases, tracked using abstract screening to exclude unfitting studies, and ending with the full-text screening of the remaining documents.

Others: Exclusion-inclusion criteria interpretation of the abstracts/articles is obligatory when deciding whether or not the articles dealt with the matter. This step could involve removing a huge percentage of initially recognized articles.

Others: Codebook building pertains to the development of a codebook of the main descriptors within a specific field. An inductive approach can be followed and, in this case, descriptors are not established beforehand. Instead, they are established through the analysis of the articles’ content. This procedure is made up of several stages: (i) the extraction of important content from titles, abstracts, and keywords; (ii) the classification of this content to form a reduced list of the core descriptors; and (iii) revising the codebook in iterations and combining similar categories, thus developing a short list of descriptors (López-Duarte et al. 2016 , p. 512; Dabić et al. 2015 ; Vlacic et al. 2021 ).

2.4 Methods

Various methods are used to analyze the pertinent literature. Often, scholars choose a method for corpus analysis before corpus curation. Knowing the analytical technique beforehand is useful, as it allows researchers to acquire and prepare the right data in the right format. This typically occurs when scholars have decided upon and justified pursuing a specific review nomenclature upfront (e.g., bibliometric reviews) based on the problem at hand (e.g., broad domain [outlet] with a large corpus [thousands of articles], such as a premier journal that has been publishing for decades) (Donthu et al. 2021 ). However, this may not be applicable in instances where (i) scholars do not curate a corpus of articles (non-SLRs), and (ii) scholars only know the size of the corpus of articles once that corpus is curated (SLRs). Therefore, scholars may wish to decide on a method of analyzing the literature depending on (i) whether they rely on a corpus of articles (i.e., yes or no), and (ii) the size of the corpus of articles that they rely on to review the literature (i.e., n  = 0 to ∞).

When analytical techniques (e.g., bibliometric analysis, critical analysis, meta-analysis) are decoupled from review nomenclatures (e.g., bibliometric reviews, critical reviews, meta-analytical reviews), we uncover a toolbox of the following methods for use when analyzing the literature:

Bibliometric analysis measures the literature and processes data by using algorithm, arithmetic, and statistics to analyze, explore, organize, and investigate large amounts of data. This enables scholars to identify and recognize potential “hidden patterns” that could help them during the literature review process. Bibliometrics allows scholars to objectively analyze a large corpus of articles (e.g., high hundreds or more) using quantitative techniques (Donthu et al. 2021 ). There are two overarching categories for bibliometric analysis: performance analysis and science mapping. Performance analysis enables scholars to assess the productivity (publication) and impact (citation) of the literature relating to a domain, method, or theory using various quantitative metrics (e.g., average citations per publication or year, h -index, g -index, i -index). Science mapping grants scholars the ability to map the literature in that domain, method, or theory based on bibliographic data (e.g., bibliographic coupling generates thematic clusters based on similarities in shared bibliographic data [e.g., references] among citing articles; co-citation analysis generates thematic clusters based on commonly cited articles; co-occurrence analysis generates thematic clusters based on bibliographic data [e.g., keywords] that commonly appear together; PageRank analysis generates thematic clusters based on articles that are commonly cited in highly cited articles; and topic modeling generates thematic clusters based on the natural language processing of bibliographic data [e.g., article title, abstract, and keywords]). Footnote 4 Given the advancement in algorithms and technology, reviews using bibliometric analysis are considered to be smart (Kraus et al. 2021 ) and technologically-empowered (Kumar et al. 2022b ) SLRs, in which a review has harnessed the benefits of (i) the machine learning of the bibliographic data of scholarly research from technologically-empowered scientific databases, and (ii) big data analytics involving various science mapping techniques (Kumar et al. 2022c ).

Content analysis allows scholars to analyze a small to medium corpus of articles (i.e., tens to low hundreds) using quantitative and qualitative techniques. From a quantitative perspective , scholars can objectively carry out a content analysis by quantifying a specific unit of analysis . A useful method of doing so involves adopting, adapting, or developing an organizing framework . For example, Lim et al. ( 2021 ) employed an organizing (ADO-TCM) framework to quantify content in academic literature based on: (i) the categories of knowledge; (ii) the relationships between antecedents, decisions, and outcomes; and (iii) the theories, contexts, and methods used to develop the understanding for (i) and (ii). The rapid evolution of software for content analysis allows scholars to carry out complex elaborations on the corpus of analyzed articles, so much so that the most recent software enables the semi-automatic development of an organizing framework (Ammirato et al. 2022 ). From a qualitative perspective , scholars can conduct a content analysis or, more specifically, a thematic analysis , by subjectively organizing the content into themes. For example, Creevey et al. ( 2022 ) reviewed the literature on social media and luxury, providing insights on five core themes (i.e., luxury brand strategy, luxury brand social media communications, luxury consumer attitudes and perceptions, engagement, and the influence of social media on brand performance-related outcomes) generated through a content (thematic) analysis. Systematic approaches for inductive concept development through qualitative research are similarly applied in literature reviews in an attempt to reduce the subjectivity of derived themes. Following the principles of the approach by Gioia et al. ( 2012 ), Korherr and Kanbach ( 2021 ) develop a taxonomy of human-related capabilities in big data analytics. Building on a sample of 75 studies for the literature review, 33 first-order concepts are identified. These are categorized into 15 second-order themes and are finally merged into five aggregate dimensions. Using the same procedure, Leemann and Kanbach ( 2022 ) identify 240 idiosyncratic dynamic capabilities in a sample of 34 studies for their literature review. They then categorize these into 19 dynamic sub-capabilities. The advancement of technology also makes it possible to conduct content analysis using computer assisted qualitative data analysis (CAQDA) software (e.g., ATLAS.ti, Nvivo, Quirkos) (Lim et al. 2022a ).

Critical analysis allows scholars to subjectively use their 3Es (i.e., exposure, expertise, and experience) to provide a critical evaluation of academic literature. This analysis is typically used in non-SLRs, and can be deployed in tandem with other analyses, such as bibliometric analysis and content analysis in SLRs, which are used to discuss consensual, contradictory, and underexplored areas of the literature. For SLRs, scholars are encouraged to engage in critical evaluations of the literature so that they can truly contribute to advancing theory and practice (Baker et al. 2022 ; Lim et al. 2022a ; Mukherjee et al. 2022b ).

Meta-analysis allows scholars to objectively establish a quantitative estimate of commonly studied relationships in the literature (Grewal et al. 2018 ). This analysis is typically employed in SLRs intending to reconcile a myriad of relationships (Lim et al. 2022a ). The relationships established are often made up of conflicting evidence (e.g., a positive or significant effect in one study, but a negative or non-significant effect in another study). However, through meta-analysis, scholars are able to identify potential factors (e.g., contexts or sociodemographic information) that may have led to the conflict.

Others: Multiple correspondence analysis helps to map the field, assessing the associations between qualitative content within a matrix of variables and cases. Homogeneity Analysis by Means of Alternating Least Squares ( HOMALS ) is also considered useful in allowing researchers to map out the intellectual structure of a variety of research fields (Gonzalez-Loureiro et al. 2015 ; Gonzalez-Louriero 2021; Obradović et al. 2021 ). HOMALS can be performed in R or used along with a matrix through SPSS software. In summary, the overall objective of this analysis is to discover a low dimensional representation of the original high dimensional space (i.e., the matrix of descriptors and articles). To measure the goodness of fit, a loss function is used. This function is used minimally, and the HOMALS algorithm is applied to the least squares loss functions in SPSS. This analysis provides a proximity map, in which articles and descriptors are shown in low-dimensional spaces (typically on two axes). Keywords are paired and each couple that appears together in a large number of articles is shown to be closer on the map and vice-versa.

When conducting a literature review, software solutions allow researchers to cover a broad range of variables, from built-in functions of statistical software packages to software orientated towards meta-analyses, and from commercial to open-source solutions. Personal preference plays a huge role, but the decision as to which software will be the most useful is entirely dependent on how complex the methods and the dataset are. Of all the commercial software providers, we have found the built-in functions of (i) R and VOSviewer most useful in performing bibliometric analysis (Aria and Cuccurullo 2017 ; R Core Team 2021 ; Van Eck and Waltman 2014 ) and (ii) Stata most useful in performing meta-analytical tasks.

Many different analytical tools have been used. These include simple document counting, citation analysis, word frequency analysis, cluster analysis, co-word analysis, and cooperation analysis (Daim et al. 2006 ). Software has also been produced for bibliometric analysis, such as the Thomson Data Analyzer (TDA), which Thomson Reuters created, and CiteSpace developed by Chen ( 2013 ). VOSviewer helps us to construct and visualize bibliometric networks, which can include articles, journals, authors, countries, and institutions, among others (Van Eck and Waltman 2014 ). These can be organized based on citations, co-citations, bibliographic coupling, or co-authorship relations. In addition, VOSviewer provides text mining functions, which can be used to facilitate a better understanding of co-occurrence networks with regards to the key terms taken from a body of scientific literature (Donthu et al. 2021 ; Wong 2018 ). Other frequently used tools include for bibliometric analysis include Bibliometrix/Biblioshiny in R, CitNetExplorer, and Gephi, among others.

2.5 Contributions

Well-conducted literature reviews may make multiple contributions to the literature as standalone, independent studies.

Generally, there are three primary contributions of literature reviews as independent studies: (i) to provide an overview of current knowledge in the domain, method, or theory, (ii) to provide an evaluation of knowledge progression in the domain, method, or theory, including the establishment of key knowledge, conflicting or inconclusive findings, and emerging and underexplored areas, and (iii) to provide a proposal for potential pathways for advancing knowledge in the domain, method, or theory (Lim et al. 2022a , p. 487). Developing theory through literature reviews can take many forms, including organizing and categorizing the literature, problematizing the literature, identifying and exposing contradictions, developing analogies and metaphors, and setting out new narratives and conceptualizations (Breslin and Gatrell 2020 ). Taken collectively, these contributions offer crystalized, evidence-based insights that both ‘mine’ and ‘prospect’ the literature, highlighting extant gaps and how they can be resolved (e.g., flags paradoxes or theoretical tensions, explaining why something has not been done, what the challenges are, and how these challenges can be overcome). These contributions can be derived through successful bibliometric analysis, content analysis, critical analysis, and meta-analysis.

Additionally, the deployment of specific methods can bring in further added value. For example, a performance analysis in a bibliometric analysis can contribute to: (i) objectively assessing and reporting research productivity and impact ; (ii) ascertaining reach for coverage claims ; (iii) identifying social dominance and hidden biases ; (iv) detecting anomalies ; and (v) evaluating ( equitable ) relative performance ; whereas science mapping in bibliometric analysis can contribute to: (i) objectively discovering thematic clusters of knowledge ; (ii) clarifying nomological networks ; (iii) mapping social patterns ; (iv) tracking evolutionary nuances ; and (v) recognizing knowledge gaps (Mukherjee et al. 2022b , p. 105).

3 Conclusion

Independent literature reviews will continue to be written as a result of their necessity, importance, relevance, and urgency when it comes to advancing knowledge (Lim et al. 2022a ; Mukherjee et al. 2022b ), and this can be seen in the increasing number of reviews being published over the last several years. Literature reviews advance academic discussion. Journal publications on various topics and subject areas are becoming more frequent sites for publication. This trend will only heighten the need for literature reviews. This article offers directions and control points that address the needs of three different stakeholder groups: producers (i.e., potential authors), evaluators (i.e., journal editors and reviewers), and users (i.e., new researchers looking to learn more about a particular methodological issue, and those teaching the next generation of scholars). Future producers will derive value from this article’s teachings on the different fundamental elements and methodological nuances of literature reviews. Procedural knowledge (i.e., using control points to assist in decision-making during the manuscript preparation phase) will also be of use. Evaluators will be able to make use of the procedural and declarative knowledge evident in control points as well. As previously outlined, the need to cultivate novelty within research on business and management practices is vital. Scholars must also be supported to choose not only safe mining approaches; they should also be encouraged to attempt more challenging and risky ventures. It is important to note that abstracts often seem to offer a lot of potential, stating that authors intend to make large conceptual contributions, broadening the horizons of the field.

Our article offers important insights also for practitioners. Noteworthily, our framework can support corporate managers in decomposing and better understanding literature reviews as ad-hoc and independent studies about specific topics that matter for their organization. For instance, practitioners can understand more easily what are the emerging trends within their domain of interest and make corporate decisions in line with such trends.

This article arises from an intentional decoupling from philosophy, in favor of adopting a more pragmatic approach. This approach can assist us in clarifying the fundamental elements of literature reviews as independent studies. Five fundamental elements must be considered: types, focuses, considerations, methods, and contributions. These elements offer a useful frame for scholars starting to work on a literature review. Overview articles (guides) such as ours are thus invaluable, as they equip scholars with a solid foundational understanding of the integral elements of a literature review. Scholars can then put these teachings into practice, armed with a better understanding of the philosophy that underpins the procedures, protocols, and nomenclatures of literature reviews as independent studies.

Data availability

Our manuscript has no associate data.

Our focus here is on standalone literature reviews in contrast with literature reviews that form the theoretical foundation for a research article.

Scoping reviews, structured reviews, integrative reviews, and interpretive/narrative reviews are commonly found in review nomenclature. However, the philosophy of these review nomenclatures essentially reflects what constitutes a good SLR. That is to say, a good SLR should be well scoped, structured, integrated, and interpreted/narrated. This observation reaffirms our position and the value of moving away from review nomenclatures to gain a foundational understanding of literature reviews as independent studies.

Given that many of these considerations can be implemented simultaneously in contemporary versions of scientific databases, scholars may choose to consolidate them into a single (or a few) step(s), where appropriate, so that they can be reported more parsimoniously. For a parsimonious but transparent and replicable exemplar, see Lim ( 2022 ).

Where keywords are present (e.g., author keywords or keywords derived from machine learning [e.g., natural language processing]), it is assumed that each keyword represents a specific meaning (e.g., topic [concept, context], method), and that a collection of keywords grouped under the same cluster represents a specific theme.

Aguinis H, Jensen SH, Kraus S (2022) Policy implications of organizational behavior and human resource management research. Acad Manage Perspect 36(3):1–22

Article   Google Scholar  

Ammirato S, Felicetti AM, Rogano D, Linzalone R, Corvello V (2022) Digitalising the systematic literature review process: The My SLR platform. Knowl Manage Res Pract. doi: https://doi.org/10.1080/14778238.2022.2041375

Aria M, Cuccurullo C (2017) bibliometrix: An R-tool for comprehensive science mapping analysis. J Informetrics 11(4):959–975

Baker WE, Mukherjee D, Perin MG (2022) Learning orientation and competitive advantage: A critical synthesis and future directions. J Bus Res 144:863–873

Boell SK, Cecez-Kecmanovic D (2015) On being ‘systematic’ in literature reviews. J Inform Technol 30:161–173

Borrego M, Foster MJ, Froyd JE (2014) Systematic literature reviews in engineering education and other developing interdisciplinary fields. J Eng Educ 103(1):45–76

Breslin D, Gatrell C (2020) Theorizing through literature reviews: The miner-prospector continuum. Organizational Res Methods. https://doi.org/10.1177/1094428120943288 (in press)

Cajal B, Jiménez R, Gervilla E, Montaño JJ (2020) Doing a systematic review in health sciences. Clínica y Salud 31(2):77–83

Chen C (2013) Mapping scientific frontiers: The quest for knowledge visualization. Springer Science & Business Media

Creevey D, Coughlan J, O’Connor C (2022) Social media and luxury: A systematic literature review. Int J Manage Reviews 24(1):99–129

Dabić M, González-Loureiro M, Harvey M (2015) Evolving research on expatriates: what is ‘known’after four decades (1970–2012). Int J Hum Resource Manage 26(3):316–337

Dabić M, Vlačić B, Kiessling T, Caputo A, Pellegrini M(2021) Serial entrepreneurs: A review of literature and guidance for future research.Journal of Small Business Management,1–36

Daim TU, Rueda G, Martin H, Gerdsri P (2006) Forecasting emerging technologies: Use of bibliometrics and patent analysis. Technol Forecast Soc Chang 73(8):981–1012

Deng L, Yang M, Marcoulides KM (2018) Structural equation modeling with many variables: A systematic review of issues and developments. Front Psychol 9:580

Donthu N, Kumar S, Pattnaik D (2020) Forty-five years of Journal of Business Research: A bibliometric analysis. J Bus Res 109:1–14

Donthu N, Kumar S, Mukherjee D, Pandey N, Lim WM (2021) How to conduct a bibliometric analysis: An overview and guidelines. J Bus Res 133:285–296

Duan W, Jiang G (2008) A review of the theory of planned behavior. Adv Psychol Sci 16(2):315–320

Google Scholar  

Durach CF, Kembro J, Wieland A (2017) A new paradigm for systematic literature reviews in supply chain management. J Supply Chain Manage 53(4):67–85

Fan D, Breslin D, Callahan JL, Szatt-White M (2022) Advancing literature review methodology through rigour, generativity, scope and transparency. Int J Manage Reviews 24(2):171–180

Ferreira MP, Reis NR, Miranda R (2015) Thirty years of entrepreneurship research published in top journals: Analysis of citations, co-citations and themes. J Global Entrepreneurship Res 5(1):1–22

Ghauri P, Strange R, Cooke FL (2021) Research on international business: The new realities. Int Bus Rev 30(2):101794

Gioia DA, Corley KG, Hamilton AL (2012) Seeking qualitative rigor in inductive research: Notes on the gioia methodology. Organizational Res Methods 16(1):15–31

Gonzalez-Loureiro M, Dabić M, Kiessling T (2015) Supply chain management as the key to a firm’s strategy in the global marketplace: Trends and research agenda. Int J Phys Distribution Logistics Manage 45(1/2):159–181. https://doi.org/10.1108/IJPDLM-05-2013-0124

Grewal D, Puccinelli N, Monroe KB (2018) Meta-analysis: Integrating accumulated knowledge. J Acad Mark Sci 46(1):9–30

Hansen C, Steinmetz H, Block J(2021) How to conduct a meta-analysis in eight steps: a practical guide.Management Review Quarterly,1–19

Korherr P, Kanbach DK (2021) Human-related capabilities in big data analytics: A taxonomy of human factors with impact on firm performance. RMS. https://doi.org/10.1007/s11846-021-00506-4 (in press)

Kraus S, Breier M, Dasí-Rodríguez S (2020) The art of crafting a systematic literature review in entrepreneurship research. Int Entrepreneurship Manage J 16(3):1023–1042

Kraus S, Durst S, Ferreira J, Veiga P, Kailer N, Weinmann A (2022) Digital transformation in business and management research: An overview of the current status quo. Int J Inf Manag 63:102466

Kraus S, Jones P, Kailer N, Weinmann A, Chaparro-Banegas N, Roig-Tierno N (2021) Digital transformation: An overview of the current state of the art of research. Sage Open 11(3):1–15

Kraus S, Mahto RV, Walsh ST (2021) The importance of literature reviews in small business and entrepreneurship research. J Small Bus Manage. https://doi.org/10.1080/00472778.2021.1955128 (in press)

Kumar S, Sahoo S, Lim WM, Dana LP (2022a) Religion as a social shaping force in entrepreneurship and business: Insights from a technology-empowered systematic literature review. Technol Forecast Soc Chang 175:121393

Kumar S, Sahoo S, Lim WM, Kraus S, Bamel U (2022b) Fuzzy-set qualitative comparative analysis (fsQCA) in business and management research: A contemporary overview. Technol Forecast Soc Chang 178:121599

Kumar S, Sharma D, Rao S, Lim WM, Mangla SK (2022c) Past, present, and future of sustainable finance: Insights from big data analytics through machine learning of scholarly research. Ann Oper Res. https://doi.org/10.1007/s10479-021-04410-8 (in press)

Laher S, Hassem T (2020) Doing systematic reviews in psychology. South Afr J Psychol 50(4):450–468

Leemann N, Kanbach DK (2022) Toward a taxonomy of dynamic capabilities – a systematic literature review. Manage Res Rev 45(4):486–501

Lahiri S, Mukherjee D, Peng MW (2020) Behind the internationalization of family SMEs: A strategy tripod synthesis. Glob Strategy J 10(4):813–838

Lim WM (2018) Demystifying neuromarketing. J Bus Res 91:205–220

Lim WM (2020) The sharing economy: A marketing perspective. Australasian Mark J 28(3):4–13

Lim WM (2022) Ushering a new era of Global Business and Organizational Excellence: Taking a leaf out of recent trends in the new normal. Global Bus Organizational Excellence 41(5):5–13

Lim WM, Rasul T (2022) Customer engagement and social media: Revisiting the past to inform the future. J Bus Res 148:325–342

Lim WM, Weissmann MA (2021) Toward a theory of behavioral control. J Strategic Mark. https://doi.org/10.1080/0965254X.2021.1890190 (in press)

Lim WM, Kumar S, Ali F (2022a) Advancing knowledge through literature reviews: ‘What’, ‘why’, and ‘how to contribute’. Serv Ind J 42(7–8):481–513

Lim WM, Rasul T, Kumar S, Ala M (2022b) Past, present, and future of customer engagement. J Bus Res 140:439–458

Lim WM, Yap SF, Makkar M (2021) Home sharing in marketing and tourism at a tipping point: What do we know, how do we know, and where should we be heading? J Bus Res 122:534–566

López-Duarte C, González-Loureiro M, Vidal-Suárez MM, González-Díaz B (2016) International strategic alliances and national culture: Mapping the field and developing a research agenda. J World Bus 51(4):511–524

Mas-Tur A, Kraus S, Brandtner M, Ewert R, Kürsten W (2020) Advances in management research: A bibliometric overview of the Review of Managerial Science. RMS 14(5):933–958

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Reviews 4(1):1–9

Mukherjee D, Kumar S, Donthu N, Pandey N (2021) Research published in Management International Review from 2006 to 2020: A bibliometric analysis and future directions. Manage Int Rev 61:599–642

Mukherjee D, Kumar S, Mukherjee D, Goyal K (2022a) Mapping five decades of international business and management research on India: A bibliometric analysis and future directions. J Bus Res 145:864–891

Mukherjee D, Lim WM, Kumar S, Donthu N (2022b) Guidelines for advancing theory and practice through bibliometric research. J Bus Res 148:101–115

Obradović T, Vlačić B, Dabić M (2021) Open innovation in the manufacturing industry: A review and research agenda. Technovation 102:102221

Ojong N, Simba A, Dana LP (2021) Female entrepreneurship in Africa: A review, trends, and future research directions. J Bus Res 132:233–248

Palmatier RW, Houston MB, Hulland J (2018) Review articles: Purpose, process, and structure. J Acad Mark Sci 46(1):1–5

Post C, Sarala R, Gatrell C, Prescott JE (2020) Advancing theory with review articles. J Manage Stud 57(2):351–376

Pranckutė R (2021) Web of Science (WoS) and Scopus: The titans of bibliographic information in today’s academic world. Publications 9(1):12

R Core Team (2021) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/ Accessed 20th July 2022

Rovelli P, Ferasso M, De Massis A, Kraus S(2021) Thirty years of research in family business journals: Status quo and future directions.Journal of Family Business Strategy,100422

Salmony FU, Kanbach DK (2022) Personality trait differences across types of entrepreneurs: a systematic literature review. RMS 16:713–749

Snyder H (2019) Literature review as a research methodology: An overview and guidelines. J Bus Res 104:333–339

Tranfield D, Denyer D, Smart P (2003) Towards a methodology for developing evidence-informed management knowledge by means of systematic review. Br J Manag 14(3):207–222

Ulker-Demirel E, Ciftci G (2020) A systematic literature review of the theory of planned behavior in tourism, leisure and hospitality management research. J Hospitality Tourism Manage 43:209–219

Van Eck NJ, Waltma L (2014) CitNetExplorer: A new software tool for analyzing and visualizing citation networks. J Informetrics 8(4):802–823

Vlačić B, Corbo L, Silva e, Dabić M (2021) The evolving role of artificial intelligence in marketing: A review and research agenda. J Bus Res 128:187–203

Wong D (2018) VOSviewer. Tech Serv Q 35(2):219–220. https://doi.org/10.1080/07317131.2018.1425352

Download references

Open access funding provided by Libera Università di Bolzano within the CRUI-CARE Agreement.

Author information

Authors and affiliations.

Faculty of Economics & Management, Free University of Bozen-Bolzano, Bolzano, Italy

Sascha Kraus

Department of Business Management, University of Johannesburg, Johannesburg, South Africa

School of Business, Lappeenranta University of Technology, Lappeenranta, Finland

Matthias Breier

Sunway University Business School, Sunway University, Sunway City, Malaysia

Weng Marc Lim

Faculty of Economics and Business, University of Zagreb, Zagreb, Croatia

Marina Dabić

School of Economics and Business, University of Ljubljana, Ljubljana, Slovenia

Department of Management Studies, Malaviya National Institute of Technology Jaipur, Jaipur, India

Satish Kumar

Faculty of Business, Design and Arts, Swinburne University of Technology, Kuching, Malaysia

Weng Marc Lim & Satish Kumar

Chair of Strategic Management and Digital Entrepreneurship, HHL Leipzig Graduate School of Management, Leipzig, Germany

Dominik Kanbach

School of Business, Woxsen University, Hyderabad, India

College of Business, The University of Akron, Akron, USA

Debmalya Mukherjee

Department of Engineering, University of Messina, Messina, Italy

Vincenzo Corvello

Department of Finance, Santiago de Compostela University, Santiago de Compostela, Spain

Juan Piñeiro-Chousa

Rowan University, Rohrer College of Business, Glassboro, NJ, USA

Eric Liguori

School of Engineering Design, Universidad Politécnica de Valencia, Valencia, Spain

Daniel Palacios-Marqués

Department of Management and Quantitative Studies, Parthenope University, Naples, Italy

Francesco Schiavone

Paris School of Business, Paris, France

Department of Management, University of Turin, Turin, Italy

Alberto Ferraris

Department of Management and Economics & NECE Research Unit in Business Sciences, University of Beira Interior, Covilha, Portugal

Cristina Fernandes & João J. Ferreira

Centre for Corporate Entrepreneurship and Innovation, Loughborough University, Loughborough, UK

Cristina Fernandes

Laboratory for International and Regional Economics, Graduate School of Economics and Management, Ural Federal University, Yekaterinburg, Russia

School of Business, Law and Entrepreneurship, Swinburne University of Technology, Hawthorn, Australia

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Sascha Kraus .

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Kraus, S., Breier, M., Lim, W.M. et al. Literature reviews as independent studies: guidelines for academic practice. Rev Manag Sci 16 , 2577–2595 (2022). https://doi.org/10.1007/s11846-022-00588-8

Download citation

Received : 15 August 2022

Accepted : 07 September 2022

Published : 14 October 2022

Issue Date : November 2022

DOI : https://doi.org/10.1007/s11846-022-00588-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Literature reviews
• Bibliometrics
• Meta Analysis
• Contributions

JEL classification

• Find a journal
• Publish with us
• Track your research

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Clinics (Sao Paulo)

Approaching literature review for academic purposes: The Literature Review Checklist

Debora f.b. leite.

I Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, SP, BR

II Universidade Federal de Pernambuco, Pernambuco, PE, BR

III Hospital das Clinicas, Universidade Federal de Pernambuco, Pernambuco, PE, BR

Maria Auxiliadora Soares Padilha

Jose g. cecatti.

A sophisticated literature review (LR) can result in a robust dissertation/thesis by scrutinizing the main problem examined by the academic study; anticipating research hypotheses, methods and results; and maintaining the interest of the audience in how the dissertation/thesis will provide solutions for the current gaps in a particular field. Unfortunately, little guidance is available on elaborating LRs, and writing an LR chapter is not a linear process. An LR translates students’ abilities in information literacy, the language domain, and critical writing. Students in postgraduate programs should be systematically trained in these skills. Therefore, this paper discusses the purposes of LRs in dissertations and theses. Second, the paper considers five steps for developing a review: defining the main topic, searching the literature, analyzing the results, writing the review and reflecting on the writing. Ultimately, this study proposes a twelve-item LR checklist. By clearly stating the desired achievements, this checklist allows Masters and Ph.D. students to continuously assess their own progress in elaborating an LR. Institutions aiming to strengthen students’ necessary skills in critical academic writing should also use this tool.

INTRODUCTION

Writing the literature review (LR) is often viewed as a difficult task that can be a point of writer’s block and procrastination ( 1 ) in postgraduate life. Disagreements on the definitions or classifications of LRs ( 2 ) may confuse students about their purpose and scope, as well as how to perform an LR. Interestingly, at many universities, the LR is still an important element in any academic work, despite the more recent trend of producing scientific articles rather than classical theses.

The LR is not an isolated section of the thesis/dissertation or a copy of the background section of a research proposal. It identifies the state-of-the-art knowledge in a particular field, clarifies information that is already known, elucidates implications of the problem being analyzed, links theory and practice ( 3 - 5 ), highlights gaps in the current literature, and places the dissertation/thesis within the research agenda of that field. Additionally, by writing the LR, postgraduate students will comprehend the structure of the subject and elaborate on their cognitive connections ( 3 ) while analyzing and synthesizing data with increasing maturity.

At the same time, the LR transforms the student and hints at the contents of other chapters for the reader. First, the LR explains the research question; second, it supports the hypothesis, objectives, and methods of the research project; and finally, it facilitates a description of the student’s interpretation of the results and his/her conclusions. For scholars, the LR is an introductory chapter ( 6 ). If it is well written, it demonstrates the student’s understanding of and maturity in a particular topic. A sound and sophisticated LR can indicate a robust dissertation/thesis.

A consensus on the best method to elaborate a dissertation/thesis has not been achieved. The LR can be a distinct chapter or included in different sections; it can be part of the introduction chapter, part of each research topic, or part of each published paper ( 7 ). However, scholars view the LR as an integral part of the main body of an academic work because it is intrinsically connected to other sections ( Figure 1 ) and is frequently present. The structure of the LR depends on the conventions of a particular discipline, the rules of the department, and the student’s and supervisor’s areas of expertise, needs and interests.

Interestingly, many postgraduate students choose to submit their LR to peer-reviewed journals. As LRs are critical evaluations of current knowledge, they are indeed publishable material, even in the form of narrative or systematic reviews. However, systematic reviews have specific patterns 1 ( 8 ) that may not entirely fit with the questions posed in the dissertation/thesis. Additionally, the scope of a systematic review may be too narrow, and the strict criteria for study inclusion may omit important information from the dissertation/thesis. Therefore, this essay discusses the definition of an LR is and methods to develop an LR in the context of an academic dissertation/thesis. Finally, we suggest a checklist to evaluate an LR.

WHAT IS A LITERATURE REVIEW IN A THESIS?

Conducting research and writing a dissertation/thesis translates rational thinking and enthusiasm ( 9 ). While a strong body of literature that instructs students on research methodology, data analysis and writing scientific papers exists, little guidance on performing LRs is available. The LR is a unique opportunity to assess and contrast various arguments and theories, not just summarize them. The research results should not be discussed within the LR, but the postgraduate student tends to write a comprehensive LR while reflecting on his or her own findings ( 10 ).

Many people believe that writing an LR is a lonely and linear process. Supervisors or the institutions assume that the Ph.D. student has mastered the relevant techniques and vocabulary associated with his/her subject and conducts a self-reflection about previously published findings. Indeed, while elaborating the LR, the student should aggregate diverse skills, which mainly rely on his/her own commitment to mastering them. Thus, less supervision should be required ( 11 ). However, the parameters described above might not currently be the case for many students ( 11 , 12 ), and the lack of formal and systematic training on writing LRs is an important concern ( 11 ).

An institutional environment devoted to active learning will provide students the opportunity to continuously reflect on LRs, which will form a dialogue between the postgraduate student and the current literature in a particular field ( 13 ). Postgraduate students will be interpreting studies by other researchers, and, according to Hart (1998) ( 3 ), the outcomes of the LR in a dissertation/thesis include the following:

• To identify what research has been performed and what topics require further investigation in a particular field of knowledge;
• To determine the context of the problem;
• To recognize the main methodologies and techniques that have been used in the past;
• To place the current research project within the historical, methodological and theoretical context of a particular field;
• To identify significant aspects of the topic;
• To elucidate the implications of the topic;
• To offer an alternative perspective;
• To discern how the studied subject is structured;
• To improve the student’s subject vocabulary in a particular field; and
• To characterize the links between theory and practice.

A sound LR translates the postgraduate student’s expertise in academic and scientific writing: it expresses his/her level of comfort with synthesizing ideas ( 11 ). The LR reveals how well the postgraduate student has proceeded in three domains: an effective literature search, the language domain, and critical writing.

Effective literature search

All students should be trained in gathering appropriate data for specific purposes, and information literacy skills are a cornerstone. These skills are defined as “an individual’s ability to know when they need information, to identify information that can help them address the issue or problem at hand, and to locate, evaluate, and use that information effectively” ( 14 ). Librarian support is of vital importance in coaching the appropriate use of Boolean logic (AND, OR, NOT) and other tools for highly efficient literature searches (e.g., quotation marks and truncation), as is the appropriate management of electronic databases.

Language domain

Academic writing must be concise and precise: unnecessary words distract the reader from the essential content ( 15 ). In this context, reading about issues distant from the research topic ( 16 ) may increase students’ general vocabulary and familiarity with grammar. Ultimately, reading diverse materials facilitates and encourages the writing process itself.

Critical writing

Critical judgment includes critical reading, thinking and writing. It supposes a student’s analytical reflection about what he/she has read. The student should delineate the basic elements of the topic, characterize the most relevant claims, identify relationships, and finally contrast those relationships ( 17 ). Each scientific document highlights the perspective of the author, and students will become more confident in judging the supporting evidence and underlying premises of a study and constructing their own counterargument as they read more articles. A paucity of integration or contradictory perspectives indicates lower levels of cognitive complexity ( 12 ).

Thus, while elaborating an LR, the postgraduate student should achieve the highest category of Bloom’s cognitive skills: evaluation ( 12 ). The writer should not only summarize data and understand each topic but also be able to make judgments based on objective criteria, compare resources and findings, identify discrepancies due to methodology, and construct his/her own argument ( 12 ). As a result, the student will be sufficiently confident to show his/her own voice .

Writing a consistent LR is an intense and complex activity that reveals the training and long-lasting academic skills of a writer. It is not a lonely or linear process. However, students are unlikely to be prepared to write an LR if they have not mastered the aforementioned domains ( 10 ). An institutional environment that supports student learning is crucial.

Different institutions employ distinct methods to promote students’ learning processes. First, many universities propose modules to develop behind the scenes activities that enhance self-reflection about general skills (e.g., the skills we have mastered and the skills we need to develop further), behaviors that should be incorporated (e.g., self-criticism about one’s own thoughts), and each student’s role in the advancement of his/her field. Lectures or workshops about LRs themselves are useful because they describe the purposes of the LR and how it fits into the whole picture of a student’s work. These activities may explain what type of discussion an LR must involve, the importance of defining the correct scope, the reasons to include a particular resource, and the main role of critical reading.

Some pedagogic services that promote a continuous improvement in study and academic skills are equally important. Examples include workshops about time management, the accomplishment of personal objectives, active learning, and foreign languages for nonnative speakers. Additionally, opportunities to converse with other students promotes an awareness of others’ experiences and difficulties. Ultimately, the supervisor’s role in providing feedback and setting deadlines is crucial in developing students’ abilities and in strengthening students’ writing quality ( 12 ).

HOW SHOULD A LITERATURE REVIEW BE DEVELOPED?

A consensus on the appropriate method for elaborating an LR is not available, but four main steps are generally accepted: defining the main topic, searching the literature, analyzing the results, and writing ( 6 ). We suggest a fifth step: reflecting on the information that has been written in previous publications ( Figure 2 ).

First step: Defining the main topic

Planning an LR is directly linked to the research main question of the thesis and occurs in parallel to students’ training in the three domains discussed above. The planning stage helps organize ideas, delimit the scope of the LR ( 11 ), and avoid the wasting of time in the process. Planning includes the following steps:

• Reflecting on the scope of the LR: postgraduate students will have assumptions about what material must be addressed and what information is not essential to an LR ( 13 , 18 ). Cooper’s Taxonomy of Literature Reviews 2 systematizes the writing process through six characteristics and nonmutually exclusive categories. The focus refers to the reviewer’s most important points of interest, while the goals concern what students want to achieve with the LR. The perspective assumes answers to the student’s own view of the LR and how he/she presents a particular issue. The coverage defines how comprehensive the student is in presenting the literature, and the organization determines the sequence of arguments. The audience is defined as the group for whom the LR is written.
• Designating sections and subsections: Headings and subheadings should be specific, explanatory and have a coherent sequence throughout the text ( 4 ). They simulate an inverted pyramid, with an increasing level of reflection and depth of argument.
• Identifying keywords: The relevant keywords for each LR section should be listed to guide the literature search. This list should mirror what Hart (1998) ( 3 ) advocates as subject vocabulary . The keywords will also be useful when the student is writing the LR since they guide the reader through the text.
• Delineating the time interval and language of documents to be retrieved in the second step. The most recently published documents should be considered, but relevant texts published before a predefined cutoff year can be included if they are classic documents in that field. Extra care should be employed when translating documents.

Second step: Searching the literature

The ability to gather adequate information from the literature must be addressed in postgraduate programs. Librarian support is important, particularly for accessing difficult texts. This step comprises the following components:

• Searching the literature itself: This process consists of defining which databases (electronic or dissertation/thesis repositories), official documents, and books will be searched and then actively conducting the search. Information literacy skills have a central role in this stage. While searching electronic databases, controlled vocabulary (e.g., Medical Subject Headings, or MeSH, for the PubMed database) or specific standardized syntax rules may need to be applied.

In addition, two other approaches are suggested. First, a review of the reference list of each document might be useful for identifying relevant publications to be included and important opinions to be assessed. This step is also relevant for referencing the original studies and leading authors in that field. Moreover, students can directly contact the experts on a particular topic to consult with them regarding their experience or use them as a source of additional unpublished documents.

Before submitting a dissertation/thesis, the electronic search strategy should be repeated. This process will ensure that the most recently published papers will be considered in the LR.

• Selecting documents for inclusion: Generally, the most recent literature will be included in the form of published peer-reviewed papers. Assess books and unpublished material, such as conference abstracts, academic texts and government reports, are also important to assess since the gray literature also offers valuable information. However, since these materials are not peer-reviewed, we recommend that they are carefully added to the LR.

This task is an important exercise in time management. First, students should read the title and abstract to understand whether that document suits their purposes, addresses the research question, and helps develop the topic of interest. Then, they should scan the full text, determine how it is structured, group it with similar documents, and verify whether other arguments might be considered ( 5 ).

Third step: Analyzing the results

Critical reading and thinking skills are important in this step. This step consists of the following components:

• Reading documents: The student may read various texts in depth according to LR sections and subsections ( defining the main topic ), which is not a passive activity ( 1 ). Some questions should be asked to practice critical analysis skills, as listed below. Is the research question evident and articulated with previous knowledge? What are the authors’ research goals and theoretical orientations, and how do they interact? Are the authors’ claims related to other scholars’ research? Do the authors consider different perspectives? Was the research project designed and conducted properly? Are the results and discussion plausible, and are they consistent with the research objectives and methodology? What are the strengths and limitations of this work? How do the authors support their findings? How does this work contribute to the current research topic? ( 1 , 19 )
• Taking notes: Students who systematically take notes on each document are more readily able to establish similarities or differences with other documents and to highlight personal observations. This approach reinforces the student’s ideas about the next step and helps develop his/her own academic voice ( 1 , 13 ). Voice recognition software ( 16 ), mind maps ( 5 ), flowcharts, tables, spreadsheets, personal comments on the referenced texts, and note-taking apps are all available tools for managing these observations, and the student him/herself should use the tool that best improves his/her learning. Additionally, when a student is considering submitting an LR to a peer-reviewed journal, notes should be taken on the activities performed in all five steps to ensure that they are able to be replicated.

Fourth step: Writing

The recognition of when a student is able and ready to write after a sufficient period of reading and thinking is likely a difficult task. Some students can produce a review in a single long work session. However, as discussed above, writing is not a linear process, and students do not need to write LRs according to a specific sequence of sections. Writing an LR is a time-consuming task, and some scholars believe that a period of at least six months is sufficient ( 6 ). An LR, and academic writing in general, expresses the writer’s proper thoughts, conclusions about others’ work ( 6 , 10 , 13 , 16 ), and decisions about methods to progress in the chosen field of knowledge. Thus, each student is expected to present a different learning and writing trajectory.

In this step, writing methods should be considered; then, editing, citing and correct referencing should complete this stage, at least temporarily. Freewriting techniques may be a good starting point for brainstorming ideas and improving the understanding of the information that has been read ( 1 ). Students should consider the following parameters when creating an agenda for writing the LR: two-hour writing blocks (at minimum), with prespecified tasks that are possible to complete in one section; short (minutes) and long breaks (days or weeks) to allow sufficient time for mental rest and reflection; and short- and long-term goals to motivate the writing itself ( 20 ). With increasing experience, this scheme can vary widely, and it is not a straightforward rule. Importantly, each discipline has a different way of writing ( 1 ), and each department has its own preferred styles for citations and references.

Fifth step: Reflecting on the writing

In this step, the postgraduate student should ask him/herself the same questions as in the analyzing the results step, which can take more time than anticipated. Ambiguities, repeated ideas, and a lack of coherence may not be noted when the student is immersed in the writing task for long periods. The whole effort will likely be a work in progress, and continuous refinements in the written material will occur once the writing process has begun.

LITERATURE REVIEW CHECKLIST

In contrast to review papers, the LR of a dissertation/thesis should not be a standalone piece or work. Instead, it should present the student as a scholar and should maintain the interest of the audience in how that dissertation/thesis will provide solutions for the current gaps in a particular field.

A checklist for evaluating an LR is convenient for students’ continuous academic development and research transparency: it clearly states the desired achievements for the LR of a dissertation/thesis. Here, we present an LR checklist developed from an LR scoring rubric ( 11 ). For a critical analysis of an LR, we maintain the five categories but offer twelve criteria that are not scaled ( Figure 3 ). The criteria all have the same importance and are not mutually exclusive.

First category: Coverage

1. justified criteria exist for the inclusion and exclusion of literature in the review.

This criterion builds on the main topic and areas covered by the LR ( 18 ). While experts may be confident in retrieving and selecting literature, postgraduate students must convince their audience about the adequacy of their search strategy and their reasons for intentionally selecting what material to cover ( 11 ). References from different fields of knowledge provide distinct perspective, but narrowing the scope of coverage may be important in areas with a large body of existing knowledge.

Second category: Synthesis

2. a critical examination of the state of the field exists.

A critical examination is an assessment of distinct aspects in the field ( 1 ) along with a constructive argument. It is not a negative critique but an expression of the student’s understanding of how other scholars have added to the topic ( 1 ), and the student should analyze and contextualize contradictory statements. A writer’s personal bias (beliefs or political involvement) have been shown to influence the structure and writing of a document; therefore, the cultural and paradigmatic background guide how the theories are revised and presented ( 13 ). However, an honest judgment is important when considering different perspectives.

3. The topic or problem is clearly placed in the context of the broader scholarly literature

The broader scholarly literature should be related to the chosen main topic for the LR ( how to develop the literature review section). The LR can cover the literature from one or more disciplines, depending on its scope, but it should always offer a new perspective. In addition, students should be careful in citing and referencing previous publications. As a rule, original studies and primary references should generally be included. Systematic and narrative reviews present summarized data, and it may be important to cite them, particularly for issues that should be understood but do not require a detailed description. Similarly, quotations highlight the exact statement from another publication. However, excessive referencing may disclose lower levels of analysis and synthesis by the student.

4. The LR is critically placed in the historical context of the field

Situating the LR in its historical context shows the level of comfort of the student in addressing a particular topic. Instead of only presenting statements and theories in a temporal approach, which occasionally follows a linear timeline, the LR should authentically characterize the student’s academic work in the state-of-art techniques in their particular field of knowledge. Thus, the LR should reinforce why the dissertation/thesis represents original work in the chosen research field.

5. Ambiguities in definitions are considered and resolved

Distinct theories on the same topic may exist in different disciplines, and one discipline may consider multiple concepts to explain one topic. These misunderstandings should be addressed and contemplated. The LR should not synthesize all theories or concepts at the same time. Although this approach might demonstrate in-depth reading on a particular topic, it can reveal a student’s inability to comprehend and synthesize his/her research problem.

6. Important variables and phenomena relevant to the topic are articulated

The LR is a unique opportunity to articulate ideas and arguments and to purpose new relationships between them ( 10 , 11 ). More importantly, a sound LR will outline to the audience how these important variables and phenomena will be addressed in the current academic work. Indeed, the LR should build a bidirectional link with the remaining sections and ground the connections between all of the sections ( Figure 1 ).

7. A synthesized new perspective on the literature has been established

The LR is a ‘creative inquiry’ ( 13 ) in which the student elaborates his/her own discourse, builds on previous knowledge in the field, and describes his/her own perspective while interpreting others’ work ( 13 , 17 ). Thus, students should articulate the current knowledge, not accept the results at face value ( 11 , 13 , 17 ), and improve their own cognitive abilities ( 12 ).

Third category: Methodology

8. the main methodologies and research techniques that have been used in the field are identified and their advantages and disadvantages are discussed.

The LR is expected to distinguish the research that has been completed from investigations that remain to be performed, address the benefits and limitations of the main methods applied to date, and consider the strategies for addressing the expected limitations described above. While placing his/her research within the methodological context of a particular topic, the LR will justify the methodology of the study and substantiate the student’s interpretations.

9. Ideas and theories in the field are related to research methodologies

The audience expects the writer to analyze and synthesize methodological approaches in the field. The findings should be explained according to the strengths and limitations of previous research methods, and students must avoid interpretations that are not supported by the analyzed literature. This criterion translates to the student’s comprehension of the applicability and types of answers provided by different research methodologies, even those using a quantitative or qualitative research approach.

Fourth category: Significance

10. the scholarly significance of the research problem is rationalized.

The LR is an introductory section of a dissertation/thesis and will present the postgraduate student as a scholar in a particular field ( 11 ). Therefore, the LR should discuss how the research problem is currently addressed in the discipline being investigated or in different disciplines, depending on the scope of the LR. The LR explains the academic paradigms in the topic of interest ( 13 ) and methods to advance the field from these starting points. However, an excess number of personal citations—whether referencing the student’s research or studies by his/her research team—may reflect a narrow literature search and a lack of comprehensive synthesis of ideas and arguments.

11. The practical significance of the research problem is rationalized

The practical significance indicates a student’s comprehensive understanding of research terminology (e.g., risk versus associated factor), methodology (e.g., efficacy versus effectiveness) and plausible interpretations in the context of the field. Notably, the academic argument about a topic may not always reflect the debate in real life terms. For example, using a quantitative approach in epidemiology, statistically significant differences between groups do not explain all of the factors involved in a particular problem ( 21 ). Therefore, excessive faith in p -values may reflect lower levels of critical evaluation of the context and implications of a research problem by the student.

Fifth category: Rhetoric

12. the lr was written with a coherent, clear structure that supported the review.

This category strictly relates to the language domain: the text should be coherent and presented in a logical sequence, regardless of which organizational ( 18 ) approach is chosen. The beginning of each section/subsection should state what themes will be addressed, paragraphs should be carefully linked to each other ( 10 ), and the first sentence of each paragraph should generally summarize the content. Additionally, the student’s statements are clear, sound, and linked to other scholars’ works, and precise and concise language that follows standardized writing conventions (e.g., in terms of active/passive voice and verb tenses) is used. Attention to grammar, such as orthography and punctuation, indicates prudence and supports a robust dissertation/thesis. Ultimately, all of these strategies provide fluency and consistency for the text.

Although the scoring rubric was initially proposed for postgraduate programs in education research, we are convinced that this checklist is a valuable tool for all academic areas. It enables the monitoring of students’ learning curves and a concentrated effort on any criteria that are not yet achieved. For institutions, the checklist is a guide to support supervisors’ feedback, improve students’ writing skills, and highlight the learning goals of each program. These criteria do not form a linear sequence, but ideally, all twelve achievements should be perceived in the LR.

CONCLUSIONS

A single correct method to classify, evaluate and guide the elaboration of an LR has not been established. In this essay, we have suggested directions for planning, structuring and critically evaluating an LR. The planning of the scope of an LR and approaches to complete it is a valuable effort, and the five steps represent a rational starting point. An institutional environment devoted to active learning will support students in continuously reflecting on LRs, which will form a dialogue between the writer and the current literature in a particular field ( 13 ).

The completion of an LR is a challenging and necessary process for understanding one’s own field of expertise. Knowledge is always transitory, but our responsibility as scholars is to provide a critical contribution to our field, allowing others to think through our work. Good researchers are grounded in sophisticated LRs, which reveal a writer’s training and long-lasting academic skills. We recommend using the LR checklist as a tool for strengthening the skills necessary for critical academic writing.

AUTHOR CONTRIBUTIONS

Leite DFB has initially conceived the idea and has written the first draft of this review. Padilha MAS and Cecatti JG have supervised data interpretation and critically reviewed the manuscript. All authors have read the draft and agreed with this submission. Authors are responsible for all aspects of this academic piece.

ACKNOWLEDGMENTS

We are grateful to all of the professors of the ‘Getting Started with Graduate Research and Generic Skills’ module at University College Cork, Cork, Ireland, for suggesting and supporting this article. Funding: DFBL has granted scholarship from Brazilian Federal Agency for Support and Evaluation of Graduate Education (CAPES) to take part of her Ph.D. studies in Ireland (process number 88881.134512/2016-01). There is no participation from sponsors on authors’ decision to write or to submit this manuscript.

No potential conflict of interest was reported.

1 The questions posed in systematic reviews usually follow the ‘PICOS’ acronym: Population, Intervention, Comparison, Outcomes, Study design.

2 In 1988, Cooper proposed a taxonomy that aims to facilitate students’ and institutions’ understanding of literature reviews. Six characteristics with specific categories are briefly described: Focus: research outcomes, research methodologies, theories, or practices and applications; Goals: integration (generalization, conflict resolution, and linguistic bridge-building), criticism, or identification of central issues; Perspective: neutral representation or espousal of a position; Coverage: exhaustive, exhaustive with selective citations, representative, central or pivotal; Organization: historical, conceptual, or methodological; and Audience: specialized scholars, general scholars, practitioners or policymakers, or the general public.

How to write a literature review introduction (+ examples)

The introduction to a literature review serves as your reader’s guide through your academic work and thought process. Explore the significance of literature review introductions in review papers, academic papers, essays, theses, and dissertations. We delve into the purpose and necessity of these introductions, explore the essential components of literature review introductions, and provide step-by-step guidance on how to craft your own, along with examples.

Why you need an introduction for a literature review

In academic writing , the introduction for a literature review is an indispensable component. Effective academic writing requires proper paragraph structuring to guide your reader through your argumentation. This includes providing an introduction to your literature review.

It is imperative to remember that you should never start sharing your findings abruptly. Even if there isn’t a dedicated introduction section .

When you need an introduction for a literature review

There are three main scenarios in which you need an introduction for a literature review:

What to include in a literature review introduction

It is crucial to customize the content and depth of your literature review introduction according to the specific format of your academic work.

Academic literature review paper

The introduction of an academic literature review paper, which does not rely on empirical data, often necessitates a more extensive introduction than the brief literature review introductions typically found in empirical papers. It should encompass:

Regular literature review section in an academic article or essay

In a standard 8000-word journal article, the literature review section typically spans between 750 and 1250 words. The first few sentences or the first paragraph within this section often serve as an introduction. It should encompass:

Introduction to a literature review chapter in thesis or dissertation

Some students choose to incorporate a brief introductory section at the beginning of each chapter, including the literature review chapter. Alternatively, others opt to seamlessly integrate the introduction into the initial sentences of the literature review itself. Both approaches are acceptable, provided that you incorporate the following elements:

Examples of literature review introductions

Example 1: an effective introduction for an academic literature review paper.

To begin, let’s delve into the introduction of an academic literature review paper. We will examine the paper “How does culture influence innovation? A systematic literature review”, which was published in 2018 in the journal Management Decision.

Example 2: An effective introduction to a literature review section in an academic paper

The second example represents a typical academic paper, encompassing not only a literature review section but also empirical data, a case study, and other elements. We will closely examine the introduction to the literature review section in the paper “The environmentalism of the subalterns: a case study of environmental activism in Eastern Kurdistan/Rojhelat”, which was published in 2021 in the journal Local Environment.

Thus, the author successfully introduces the literature review, from which point onward it dives into the main concept (‘subalternity’) of the research, and reviews the literature on socio-economic justice and environmental degradation.

Examples 3-5: Effective introductions to literature review chapters

Numerous universities offer online repositories where you can access theses and dissertations from previous years, serving as valuable sources of reference. Many of these repositories, however, may require you to log in through your university account. Nevertheless, a few open-access repositories are accessible to anyone, such as the one by the University of Manchester . It’s important to note though that copyright restrictions apply to these resources, just as they would with published papers.

Master’s thesis literature review introduction

Phd thesis literature review chapter introduction, phd thesis literature review introduction.

The last example is the doctoral thesis Metacognitive strategies and beliefs: Child correlates and early experiences Chan, K. Y. M. (Author). 31 Dec 2020 . The author clearly conducted a systematic literature review, commencing the review section with a discussion of the methodology and approach employed in locating and analyzing the selected records.

Steps to write your own literature review introduction

Master academia, get new content delivered directly to your inbox, the best answers to "what are your plans for the future", 10 tips for engaging your audience in academic writing, related articles, minor revisions: sample peer review comments and examples, sample emails to your thesis supervisor, co-authorship guidelines to successfully co-author a scientific paper, how to select a journal for publication as a phd student.

Research Methods

• Getting Started
• Literature Review Research
• Research Design
• Research Design By Discipline
• SAGE Research Methods
• Teaching with SAGE Research Methods

Literature Review

• What is a Literature Review?
• What is NOT a Literature Review?
• Purposes of a Literature Review
• Types of Literature Reviews
• Literature Reviews vs. Systematic Reviews
• Systematic vs. Meta-Analysis

Literature Review  is a comprehensive survey of the works published in a particular field of study or line of research, usually over a specific period of time, in the form of an in-depth, critical bibliographic essay or annotated list in which attention is drawn to the most significant works.

Also, we can define a literature review as the collected body of scholarly works related to a topic:

• Summarizes and analyzes previous research relevant to a topic
• Includes scholarly books and articles published in academic journals
• Can be an specific scholarly paper or a section in a research paper

The objective of a Literature Review is to find previous published scholarly works relevant to an specific topic

• Help gather ideas or information
• Keep up to date in current trends and findings
• Help develop new questions

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Helps focus your own research questions or problems
• Discovers relationships between research studies/ideas.
• Suggests unexplored ideas or populations
• Identifies major themes, concepts, and researchers on a topic.
• Tests assumptions; may help counter preconceived ideas and remove unconscious bias.
• Identifies critical gaps, points of disagreement, or potentially flawed methodology or theoretical approaches.
• Indicates potential directions for future research.

All content in this section is from Literature Review Research from Old Dominion University 

Keep in mind the following, a literature review is NOT:

Not an essay 

Not an annotated bibliography  in which you summarize each article that you have reviewed.  A literature review goes beyond basic summarizing to focus on the critical analysis of the reviewed works and their relationship to your research question.

Not a research paper   where you select resources to support one side of an issue versus another.  A lit review should explain and consider all sides of an argument in order to avoid bias, and areas of agreement and disagreement should be highlighted.

A literature review serves several purposes. For example, it

• provides thorough knowledge of previous studies; introduces seminal works.
• helps focus one’s own research topic.
• identifies a conceptual framework for one’s own research questions or problems; indicates potential directions for future research.
• suggests previously unused or underused methodologies, designs, quantitative and qualitative strategies.
• identifies gaps in previous studies; identifies flawed methodologies and/or theoretical approaches; avoids replication of mistakes.
• helps the researcher avoid repetition of earlier research.
• suggests unexplored populations.
• determines whether past studies agree or disagree; identifies controversy in the literature.
• tests assumptions; may help counter preconceived ideas and remove unconscious bias.

As Kennedy (2007) notes*, it is important to think of knowledge in a given field as consisting of three layers. First, there are the primary studies that researchers conduct and publish. Second are the reviews of those studies that summarize and offer new interpretations built from and often extending beyond the original studies. Third, there are the perceptions, conclusions, opinion, and interpretations that are shared informally that become part of the lore of field. In composing a literature review, it is important to note that it is often this third layer of knowledge that is cited as "true" even though it often has only a loose relationship to the primary studies and secondary literature reviews.

Given this, while literature reviews are designed to provide an overview and synthesis of pertinent sources you have explored, there are several approaches to how they can be done, depending upon the type of analysis underpinning your study. Listed below are definitions of types of literature reviews:

Argumentative Review      This form examines literature selectively in order to support or refute an argument, deeply imbedded assumption, or philosophical problem already established in the literature. The purpose is to develop a body of literature that establishes a contrarian viewpoint. Given the value-laden nature of some social science research [e.g., educational reform; immigration control], argumentative approaches to analyzing the literature can be a legitimate and important form of discourse. However, note that they can also introduce problems of bias when they are used to to make summary claims of the sort found in systematic reviews.

Integrative Review      Considered a form of research that reviews, critiques, and synthesizes representative literature on a topic in an integrated way such that new frameworks and perspectives on the topic are generated. The body of literature includes all studies that address related or identical hypotheses. A well-done integrative review meets the same standards as primary research in regard to clarity, rigor, and replication.

Historical Review      Few things rest in isolation from historical precedent. Historical reviews are focused on examining research throughout a period of time, often starting with the first time an issue, concept, theory, phenomena emerged in the literature, then tracing its evolution within the scholarship of a discipline. The purpose is to place research in a historical context to show familiarity with state-of-the-art developments and to identify the likely directions for future research.

Methodological Review      A review does not always focus on what someone said [content], but how they said it [method of analysis]. This approach provides a framework of understanding at different levels (i.e. those of theory, substantive fields, research approaches and data collection and analysis techniques), enables researchers to draw on a wide variety of knowledge ranging from the conceptual level to practical documents for use in fieldwork in the areas of ontological and epistemological consideration, quantitative and qualitative integration, sampling, interviewing, data collection and data analysis, and helps highlight many ethical issues which we should be aware of and consider as we go through our study.

Systematic Review      This form consists of an overview of existing evidence pertinent to a clearly formulated research question, which uses pre-specified and standardized methods to identify and critically appraise relevant research, and to collect, report, and analyse data from the studies that are included in the review. Typically it focuses on a very specific empirical question, often posed in a cause-and-effect form, such as "To what extent does A contribute to B?"

Theoretical Review      The purpose of this form is to concretely examine the corpus of theory that has accumulated in regard to an issue, concept, theory, phenomena. The theoretical literature review help establish what theories already exist, the relationships between them, to what degree the existing theories have been investigated, and to develop new hypotheses to be tested. Often this form is used to help establish a lack of appropriate theories or reveal that current theories are inadequate for explaining new or emerging research problems. The unit of analysis can focus on a theoretical concept or a whole theory or framework.

* Kennedy, Mary M. "Defining a Literature."  Educational Researcher  36 (April 2007): 139-147.

All content in this section is from The Literature Review created by Dr. Robert Larabee USC

Robinson, P. and Lowe, J. (2015),  Literature reviews vs systematic reviews.  Australian and New Zealand Journal of Public Health, 39: 103-103. doi: 10.1111/1753-6405.12393

What's in the name? The difference between a Systematic Review and a Literature Review, and why it matters . By Lynn Kysh from University of Southern California

Systematic review or meta-analysis?

A  systematic review  answers a defined research question by collecting and summarizing all empirical evidence that fits pre-specified eligibility criteria.

A  meta-analysis  is the use of statistical methods to summarize the results of these studies.

Systematic reviews, just like other research articles, can be of varying quality. They are a significant piece of work (the Centre for Reviews and Dissemination at York estimates that a team will take 9-24 months), and to be useful to other researchers and practitioners they should have:

• clearly stated objectives with pre-defined eligibility criteria for studies
• explicit, reproducible methodology
• a systematic search that attempts to identify all studies
• assessment of the validity of the findings of the included studies (e.g. risk of bias)
• systematic presentation, and synthesis, of the characteristics and findings of the included studies

Not all systematic reviews contain meta-analysis. 

Meta-analysis is the use of statistical methods to summarize the results of independent studies. By combining information from all relevant studies, meta-analysis can provide more precise estimates of the effects of health care than those derived from the individual studies included within a review.  More information on meta-analyses can be found in  Cochrane Handbook, Chapter 9 .

A meta-analysis goes beyond critique and integration and conducts secondary statistical analysis on the outcomes of similar studies.  It is a systematic review that uses quantitative methods to synthesize and summarize the results.

An advantage of a meta-analysis is the ability to be completely objective in evaluating research findings.  Not all topics, however, have sufficient research evidence to allow a meta-analysis to be conducted.  In that case, an integrative review is an appropriate strategy. 

Some of the content in this section is from Systematic reviews and meta-analyses: step by step guide created by Kate McAllister.

• << Previous: Getting Started
• Next: Research Design >>
• Last Updated: Jul 15, 2024 10:34 AM
• URL: https://guides.lib.udel.edu/researchmethods

• Resources Home 🏠
• Try SciSpace Copilot
• Search research papers
• Add Copilot Extension
• Try AI Detector
• Try Paraphraser
• Try Citation Generator
• April Papers
• June Papers
• July Papers

Types of Literature Review — A Guide for Researchers

Table of Contents

Researchers often face challenges when choosing the appropriate type of literature review for their study. Regardless of the type of research design and the topic of a research problem , they encounter numerous queries, including:

What is the right type of literature review my study demands?

• How do we gather the data?
• How to conduct one?
• How reliable are the review findings?
• How do we employ them in our research? And the list goes on.

If you’re also dealing with such a hefty questionnaire, this article is of help. Read through this piece of guide to get an exhaustive understanding of the different types of literature reviews and their step-by-step methodologies along with a dash of pros and cons discussed.

Heading from scratch!

What is a Literature Review?

A literature review provides a comprehensive overview of existing knowledge on a particular topic, which is quintessential to any research project. Researchers employ various literature reviews based on their research goals and methodologies. The review process involves assembling, critically evaluating, and synthesizing existing scientific publications relevant to the research question at hand. It serves multiple purposes, including identifying gaps in existing literature, providing theoretical background, and supporting the rationale for a research study.

What is the importance of a Literature review in research?

Literature review in research serves several key purposes, including:

• Background of the study: Provides proper context for the research. It helps researchers understand the historical development, theoretical perspectives, and key debates related to their research topic.
• Identification of research gaps: By reviewing existing literature, researchers can identify gaps or inconsistencies in knowledge, paving the way for new research questions and hypotheses relevant to their study.
• Theoretical framework development: Facilitates the development of theoretical frameworks by cultivating diverse perspectives and empirical findings. It helps researchers refine their conceptualizations and theoretical models.
• Methodological guidance: Offers methodological guidance by highlighting the documented research methods and techniques used in previous studies. It assists researchers in selecting appropriate research designs, data collection methods, and analytical tools.
• Quality assurance and upholding academic integrity: Conducting a thorough literature review demonstrates the rigor and scholarly integrity of the research. It ensures that researchers are aware of relevant studies and can accurately attribute ideas and findings to their original sources.

Types of Literature Review

Literature review plays a crucial role in guiding the research process , from providing the background of the study to research dissemination and contributing to the synthesis of the latest theoretical literature review findings in academia.

However, not all types of literature reviews are the same; they vary in terms of methodology, approach, and purpose. Let's have a look at the various types of literature reviews to gain a deeper understanding of their applications.

1. Narrative Literature Review

A narrative literature review, also known as a traditional literature review, involves analyzing and summarizing existing literature without adhering to a structured methodology. It typically provides a descriptive overview of key concepts, theories, and relevant findings of the research topic.

Unlike other types of literature reviews, narrative reviews reinforce a more traditional approach, emphasizing the interpretation and discussion of the research findings rather than strict adherence to methodological review criteria. It helps researchers explore diverse perspectives and insights based on the research topic and acts as preliminary work for further investigation.

Steps to Conduct a Narrative Literature Review

Source:- https://www.researchgate.net/figure/Steps-of-writing-a-narrative-review_fig1_354466408

Define the research question or topic:

The first step in conducting a narrative literature review is to clearly define the research question or topic of interest. Defining the scope and purpose of the review includes — What specific aspect of the topic do you want to explore? What are the main objectives of the research? Refine your research question based on the specific area you want to explore.

Conduct a thorough literature search

Once the research question is defined, you can conduct a comprehensive literature search. Explore and use relevant databases and search engines like SciSpace Discover to identify credible and pertinent, scholarly articles and publications.

Select relevant studies

Before choosing the right set of studies, it’s vital to determine inclusion (studies that should possess the required factors) and exclusion criteria for the literature and then carefully select papers. For example — Which studies or sources will be included based on relevance, quality, and publication date?

*Important (applies to all the reviews): Inclusion criteria are the factors a study must include (For example: Include only peer-reviewed articles published between 2022-2023, etc.). Exclusion criteria are the factors that wouldn’t be required for your search strategy (Example: exclude irrelevant papers, preprints, written in non-English, etc.)

Critically analyze the literature

Once the relevant studies are shortlisted, evaluate the methodology, findings, and limitations of each source and jot down key themes, patterns, and contradictions. You can use efficient AI tools to conduct a thorough literature review and analyze all the required information.

Synthesize and integrate the findings

Now, you can weave together the reviewed studies, underscoring significant findings such that new frameworks, contrasting viewpoints, and identifying knowledge gaps.

Discussion and conclusion

This is an important step before crafting a narrative review — summarize the main findings of the review and discuss their implications in the relevant field. For example — What are the practical implications for practitioners? What are the directions for future research for them?

Write a cohesive narrative review

Organize the review into coherent sections and structure your review logically, guiding the reader through the research landscape and offering valuable insights. Use clear and concise language to convey key points effectively.

Structure of Narrative Literature Review

A well-structured, narrative analysis or literature review typically includes the following components:

• Introduction: Provides an overview of the topic, objectives of the study, and rationale for the review.
• Background: Highlights relevant background information and establish the context for the review.
• Main Body: Indexes the literature into thematic sections or categories, discussing key findings, methodologies, and theoretical frameworks.
• Discussion: Analyze and synthesize the findings of the reviewed studies, stressing similarities, differences, and any gaps in the literature.
• Conclusion: Summarizes the main findings of the review, identifies implications for future research, and offers concluding remarks.

Pros and Cons of Narrative Literature Review

• Flexibility in methodology and doesn’t necessarily rely on structured methodologies
• Follows traditional approach and provides valuable and contextualized insights
• Suitable for exploring complex or interdisciplinary topics. For example — Climate change and human health, Cybersecurity and privacy in the digital age, and more
• Subjectivity in data selection and interpretation
• Potential for bias in the review process
• Lack of rigor compared to systematic reviews

Example of Well-Executed Narrative Literature Reviews

Paper title:  Examining Moral Injury in Clinical Practice: A Narrative Literature Review

Source: SciSpace

While narrative reviews offer flexibility, academic integrity remains paramount. So, ensure proper citation of all sources and maintain a transparent and factual approach throughout your critical narrative review, itself.

2. Systematic Review

A systematic literature review is one of the comprehensive types of literature review that follows a structured approach to assembling, analyzing, and synthesizing existing research relevant to a particular topic or question. It involves clearly defined criteria for exploring and choosing studies, as well as rigorous methods for evaluating the quality of relevant studies.

It plays a prominent role in evidence-based practice and decision-making across various domains, including healthcare, social sciences, education, health sciences, and more. By systematically investigating available literature, researchers can identify gaps in knowledge, evaluate the strength of evidence, and report future research directions.

Steps to Conduct Systematic Reviews

Source:- https://www.researchgate.net/figure/Steps-of-Systematic-Literature-Review_fig1_321422320

Here are the key steps involved in conducting a systematic literature review

Formulate a clear and focused research question

Clearly define the research question or objective of the review. It helps to centralize the literature search strategy and determine inclusion criteria for relevant studies.

Develop a thorough literature search strategy

Design a comprehensive search strategy to identify relevant studies. It involves scrutinizing scientific databases and all relevant articles in journals. Plus, seek suggestions from domain experts and review reference lists of relevant review articles.

Screening and selecting studies

Employ predefined inclusion and exclusion criteria to systematically screen the identified studies. This screening process also typically involves multiple reviewers independently assessing the eligibility of each study.

Data extraction

Extract key information from selected studies using standardized forms or protocols. It includes study characteristics, methods, results, and conclusions.

Critical appraisal

Evaluate the methodological quality and potential biases of included studies. Various tools (BMC medical research methodology) and criteria can be implemented for critical evaluation depending on the study design and research quetions .

Data synthesis

Analyze and synthesize review findings from individual studies to draw encompassing conclusions or identify overarching patterns and explore heterogeneity among studies.

Interpretation and conclusion

Interpret the findings about the research question, considering the strengths and limitations of the research evidence. Draw conclusions and implications for further research.

The final step — Report writing

Craft a detailed report of the systematic literature review adhering to the established guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). This ensures transparency and reproducibility of the review process.

By following these steps, a systematic literature review aims to provide a comprehensive and unbiased summary of existing evidence, help make informed decisions, and advance knowledge in the respective domain or field.

Structure of a systematic literature review

A well-structured systematic literature review typically consists of the following sections:

• Introduction: Provides background information on the research topic, outlines the review objectives, and enunciates the scope of the study.
• Methodology: Describes the literature search strategy, selection criteria, data extraction process, and other methods used for data synthesis, extraction, or other data analysis..
• Results: Presents the review findings, including a summary of the incorporated studies and their key findings.
• Discussion: Interprets the findings in light of the review objectives, discusses their implications, and identifies limitations or promising areas for future research.
• Conclusion: Summarizes the main review findings and provides suggestions based on the evidence presented in depth meta analysis.

*Important (applies to all the reviews): Remember, the specific structure of your literature review may vary depending on your topic, research question, and intended audience. However, adhering to a clear and logical hierarchy ensures your review effectively analyses and synthesizes knowledge and contributes valuable insights for readers.

Pros and Cons of Systematic Literature Review

• Adopts rigorous and transparent methodology
• Minimizes bias and enhances the reliability of the study
• Provides evidence-based insights
• Time and resource-intensive
• High dependency on the quality of available literature (literature research strategy should be accurate)
• Potential for publication bias

Example of Well-Executed Systematic Literature Review

Paper title: Systematic Reviews: Understanding the Best Evidence For Clinical Decision-making in Health Care: Pros and Cons.

Read this detailed article on how to use AI tools to conduct a systematic review for your research!

3. Scoping Literature Review

A scoping literature review is a methodological review type of literature review that adopts an iterative approach to systematically map the existing literature on a particular topic or research area. It involves identifying, selecting, and synthesizing relevant papers to provide an overview of the size and scope of available evidence. Scoping reviews are broader in scope and include a diverse range of study designs and methodologies especially focused on health services research.

The main purpose of a scoping literature review is to examine the extent, range, and nature of existing studies on a topic, thereby identifying gaps in research, inconsistencies, and areas for further investigation. Additionally, scoping reviews can help researchers identify suitable methodologies and formulate clinical recommendations. They also act as the frameworks for future systematic reviews or primary research studies.

Scoping reviews are primarily focused on —

• Emerging or evolving topics — where the research landscape is still growing or budding. Example — Whole Systems Approaches to Diet and Healthy Weight: A Scoping Review of Reviews .
• Broad and complex topics : With a vast amount of existing literature.
• Scenarios where a systematic review is not feasible: Due to limited resources or time constraints.

Steps to Conduct a Scoping Literature Review

While Scoping reviews are not as rigorous as systematic reviews, however, they still follow a structured approach. Here are the steps:

Identify the research question: Define the broad topic you want to explore.

Identify Relevant Studies: Conduct a comprehensive search of relevant literature using appropriate databases, keywords, and search strategies.

Select studies to be included in the review: Based on the inclusion and exclusion criteria, determine the appropriate studies to be included in the review.

Data extraction and charting : Extract relevant information from selected studies, such as year, author, main results, study characteristics, key findings, and methodological approaches.  However, it varies depending on the research question.

Collate, summarize, and report the results: Analyze and summarize the extracted data to identify key themes and trends. Then, present the findings of the scoping review in a clear and structured manner, following established guidelines and frameworks .

Structure of a Scoping Literature Review

A scoping literature review typically follows a structured format similar to a systematic review. It includes the following sections:

• Introduction: Introduce the research topic and objectives of the review, providing the historical context, and rationale for the study.
• Methods : Describe the methods used to conduct the review, including search strategies, study selection criteria, and data extraction procedures.
• Results: Present the findings of the review, including key themes, concepts, and patterns identified in the literature review.
• Discussion: Examine the implications of the findings, including strengths, limitations, and areas for further examination.
• Conclusion: Recapitulate the main findings of the review and their implications for future research, policy, or practice.

Pros and Cons of Scoping Literature Review

• Provides a comprehensive overview of existing literature
• Helps to identify gaps and areas for further research
• Suitable for exploring broad or complex research questions
• Doesn’t provide the depth of analysis offered by systematic reviews
• Subject to researcher bias in study selection and data extraction
• Requires careful consideration of literature search strategies and inclusion criteria to ensure comprehensiveness and validity.

In short, a scoping review helps map the literature on developing or emerging topics and identifying gaps. It might be considered as a step before conducting another type of review, such as a systematic review. Basically, acts as a precursor for other literature reviews.

Example of a Well-Executed Scoping Literature Review

Paper title: Health Chatbots in Africa Literature: A Scoping Review

Check out the key differences between Systematic and Scoping reviews — Evaluating literature review: systematic vs. scoping reviews

4. Integrative Literature Review

Integrative Literature Review (ILR) is a type of literature review that proposes a distinctive way to analyze and synthesize existing literature on a specific topic, providing a thorough understanding of research and identifying potential gaps for future research.

Unlike a systematic review, which emphasizes quantitative studies and follows strict inclusion criteria, an ILR embraces a more pliable approach. It works beyond simply summarizing findings — it critically analyzes, integrates, and interprets research from various methodologies (qualitative, quantitative, mixed methods) to provide a deeper understanding of the research landscape. ILRs provide a holistic and systematic overview of existing research, integrating findings from various methodologies. ILRs are ideal for exploring intricate research issues, examining manifold perspectives, and developing new research questions.

Steps to Conduct an Integrative Literature Review

• Identify the research question: Clearly define the research question or topic of interest as formulating a clear and focused research question is critical to leading the entire review process.
• Literature search strategy: Employ systematic search techniques to locate relevant literature across various databases and sources.
• Evaluate the quality of the included studies : Critically assess the methodology, rigor, and validity of each study by applying inclusion and exclusion criteria to filter and select studies aligned with the research objectives.
• Data Extraction: Extract relevant data from selected studies using a structured approach.
• Synthesize the findings : Thoroughly analyze the selected literature, identify key themes, and synthesize findings to derive noteworthy insights.
• Critical appraisal: Critically evaluate the quality and validity of qualitative research and included studies by using BMC medical research methodology.
• Interpret and present your findings: Discuss the purpose and implications of your analysis, spotlighting key insights and limitations. Organize and present the findings coherently and systematically.

Structure of an Integrative Literature Review

• Introduction : Provide an overview of the research topic and the purpose of the integrative review.
• Methods: Describe the opted literature search strategy, selection criteria, and data extraction process.
• Results: Present the synthesized findings, including key themes, patterns, and contradictions.
• Discussion: Interpret the findings about the research question, emphasizing implications for theory, practice, and prospective research.
• Conclusion: Summarize the main findings, limitations, and contributions of the integrative review.

Pros and Cons of Integrative Literature Review

• Informs evidence-based practice and policy to the relevant stakeholders of the research.
• Contributes to theory development and methodological advancement, especially in the healthcare arena.
• Integrates diverse perspectives and findings
• Time-consuming process due to the extensive literature search and synthesis
• Requires advanced analytical and critical thinking skills
• Potential for bias in study selection and interpretation
• The quality of included studies may vary, affecting the validity of the review

Example of Integrative Literature Reviews

Paper Title: An Integrative Literature Review: The Dual Impact of Technological Tools on Health and Technostress Among Older Workers

5. Rapid Literature Review

A Rapid Literature Review (RLR) is the fastest type of literature review which makes use of a streamlined approach for synthesizing literature summaries, offering a quicker and more focused alternative to traditional systematic reviews. Despite employing identical research methods, it often simplifies or omits specific steps to expedite the process. It allows researchers to gain valuable insights into current research trends and identify key findings within a shorter timeframe, often ranging from a few days to a few weeks — unlike traditional literature reviews, which may take months or even years to complete.

When to Consider a Rapid Literature Review?

• When time impediments demand a swift summary of existing research
• For emerging topics where the latest literature requires quick evaluation
• To report pilot studies or preliminary research before embarking on a comprehensive systematic review

Steps to Conduct a Rapid Literature Review

• Define the research question or topic of interest. A well-defined question guides the search process and helps researchers focus on relevant studies.
• Determine key databases and sources of relevant literature to ensure comprehensive coverage.
• Develop literature search strategies using appropriate keywords and filters to fetch a pool of potential scientific articles.
• Screen search results based on predefined inclusion and exclusion criteria.
• Extract and summarize relevant information from the above-preferred studies.
• Synthesize findings to identify key themes, patterns, or gaps in the literature.
• Prepare a concise report or a summary of the RLR findings.

Structure of a Rapid Literature Review

An effective structure of an RLR typically includes the following sections:

• Introduction: Briefly introduce the research topic and objectives of the RLR.
• Methodology: Describe the search strategy, inclusion and exclusion criteria, and data extraction process.
• Results: Present a summary of the findings, including key themes or patterns identified.
• Discussion: Interpret the findings, discuss implications, and highlight any limitations or areas for further research
• Conclusion: Summarize the key findings and their implications for practice or future research

Pros and Cons of Rapid Literature Review

• RLRs can be completed quickly, authorizing timely decision-making
• RLRs are a cost-effective approach since they require fewer resources compared to traditional literature reviews
• Offers great accessibility as RLRs provide prompt access to synthesized evidence for stakeholders
• RLRs are flexible as they can be easily adapted for various research contexts and objectives
• RLR reports are limited and restricted, not as in-depth as systematic reviews, and do not provide comprehensive coverage of the literature compared to traditional reviews.
• Susceptible to bias because of the expedited nature of RLRs. It would increase the chance of overlooking relevant studies or biases in the selection process.
• Due to time constraints, RLR findings might not be robust enough as compared to systematic reviews.

Example of a Well-Executed Rapid Literature Review

Paper Title: What Is the Impact of ChatGPT on Education? A Rapid Review of the Literature

A Summary of Literature Review Types

Tools and Resources for Conducting Different Types of Literature Reviews

Online scientific databases.

Platforms such as SciSpace , PubMed , Scopus , Elsevier , and Web of Science provide access to a vast array of scholarly literature, facilitating the search and data retrieval process.

Reference management software

Tools like SciSpace Citation Generator , EndNote, Zotero , and Mendeley assist researchers in organizing, annotating, and citing relevant literature, streamlining the review process altogether.

Automate Literature Review with AI tools

Automate the literature review process by using tools like SciSpace literature review which helps you compare and contrast multiple papers all on one screen in an easy-to-read matrix format. You can effortlessly analyze and interpret the review findings tailored to your study. It also supports the review in 75+ languages, making it more manageable even for non-English speakers.

Goes without saying — literature review plays a pivotal role in academic research to identify the current trends and provide insights to pave the way for future research endeavors. Different types of literature review has their own strengths and limitations, making them suitable for different research designs and contexts. Whether conducting a narrative review, systematic review, scoping review, integrative review, or rapid literature review, researchers must cautiously consider the objectives, resources, and the nature of the research topic.

If you’re currently working on a literature review and still adopting a manual and traditional approach, switch to the automated AI literature review workspace and transform your traditional literature review into a rapid one by extracting all the latest and relevant data for your research!

There you go!

Frequently Asked Questions

Narrative reviews give a general overview of a topic based on the author's knowledge. They may lack clear criteria and can be biased. On the other hand, systematic reviews aim to answer specific research questions by following strict methods. They're thorough but time-consuming.

A systematic review collects and analyzes existing research to provide an overview of a topic, while a meta-analysis statistically combines data from multiple studies to draw conclusions about the overall effect of an intervention or relationship between variables.

A systematic review thoroughly analyzes existing research on a specific topic using strict methods. In contrast, a scoping review offers a broader overview of the literature without evaluating individual studies in depth.

A systematic review thoroughly examines existing research using a rigorous process, while a rapid review provides a quicker summary of evidence, often by simplifying some of the systematic review steps to meet shorter timelines.

A systematic review carefully examines many studies on a single topic using specific guidelines. Conversely, an integrative review blends various types of research to provide a more comprehensive understanding of the topic.

You might also like

Boosting Citations: A Comparative Analysis of Graphical Abstract vs. Video Abstract

The Impact of Visual Abstracts on Boosting Citations

Introducing SciSpace’s Citation Booster To Increase Research Visibility

• Link to facebook
• Link to linkedin
• Link to twitter
• Link to youtube
• Writing Tips

What is the Purpose of a Literature Review?

4-minute read

• 23rd October 2023

If you’re writing a research paper or dissertation , then you’ll most likely need to include a comprehensive literature review . In this post, we’ll review the purpose of literature reviews, why they are so significant, and the specific elements to include in one. Literature reviews can:

1. Provide a foundation for current research.

2. Define key concepts and theories.

3. Demonstrate critical evaluation.

4. Show how research and methodologies have evolved.

5. Identify gaps in existing research.

6. Support your argument.

Keep reading to enter the exciting world of literature reviews!

What is a Literature Review?

A literature review is a critical summary and evaluation of the existing research (e.g., academic journal articles and books) on a specific topic. It is typically included as a separate section or chapter of a research paper or dissertation, serving as a contextual framework for a study. Literature reviews can vary in length depending on the subject and nature of the study, with most being about equal length to other sections or chapters included in the paper. Essentially, the literature review highlights previous studies in the context of your research and summarizes your insights in a structured, organized format. Next, let’s look at the overall purpose of a literature review.

Find this useful?

Subscribe to our newsletter and get writing tips from our editors straight to your inbox.

Literature reviews are considered an integral part of research across most academic subjects and fields. The primary purpose of a literature review in your study is to:

Provide a Foundation for Current Research

Since the literature review provides a comprehensive evaluation of the existing research, it serves as a solid foundation for your current study. It’s a way to contextualize your work and show how your research fits into the broader landscape of your specific area of study.  

Define Key Concepts and Theories

The literature review highlights the central theories and concepts that have arisen from previous research on your chosen topic. It gives your readers a more thorough understanding of the background of your study and why your research is particularly significant .

Demonstrate Critical Evaluation 

A comprehensive literature review shows your ability to critically analyze and evaluate a broad range of source material. And since you’re considering and acknowledging the contribution of key scholars alongside your own, it establishes your own credibility and knowledge.

Show How Research and Methodologies Have Evolved

Another purpose of literature reviews is to provide a historical perspective and demonstrate how research and methodologies have changed over time, especially as data collection methods and technology have advanced. And studying past methodologies allows you, as the researcher, to understand what did and did not work and apply that knowledge to your own research.  

Identify Gaps in Existing Research

Besides discussing current research and methodologies, the literature review should also address areas that are lacking in the existing literature. This helps further demonstrate the relevance of your own research by explaining why your study is necessary to fill the gaps.

Support Your Argument

A good literature review should provide evidence that supports your research questions and hypothesis. For example, your study may show that your research supports existing theories or builds on them in some way. Referencing previous related studies shows your work is grounded in established research and will ultimately be a contribution to the field.  

Literature Review Editing Services 

Ensure your literature review is polished and ready for submission by having it professionally proofread and edited by our expert team. Our literature review editing services will help your research stand out and make an impact. Not convinced yet? Send in your free sample today and see for yourself! 

Share this article:

Post A New Comment

Got content that needs a quick turnaround? Let us polish your work. Explore our editorial business services.

6-minute read

How to Write a Nonprofit Grant Proposal

If you’re seeking funding to support your charitable endeavors as a nonprofit organization, you’ll need...

9-minute read

How to Use Infographics to Boost Your Presentation

Is your content getting noticed? Capturing and maintaining an audience’s attention is a challenge when...

8-minute read

Why Interactive PDFs Are Better for Engagement

Are you looking to enhance engagement and captivate your audience through your professional documents? Interactive...

7-minute read

Seven Key Strategies for Voice Search Optimization

Voice search optimization is rapidly shaping the digital landscape, requiring content professionals to adapt their...

Five Creative Ways to Showcase Your Digital Portfolio

Are you a creative freelancer looking to make a lasting impression on potential clients or...

How to Ace Slack Messaging for Contractors and Freelancers

Effective professional communication is an important skill for contractors and freelancers navigating remote work environments....

Make sure your writing is the best it can be with our expert English proofreading and editing.

• Harvard Library
• Research Guides
• Faculty of Arts & Sciences Libraries

Finding and Reading Journal Articles

• Journal Articles: Why You Use Them

Why are articles so important to research?

• Subject Databases: Organizing Research Conversations
• Databases We Recommend For You
• Sources in the Disciplines
• Reading in the Disciplines

Journal articles are the academic's stock in trade, t he basic means of communicating research findings to an audience of one’s peers. That holds true across the disciplinary spectrum, so no matter where you land as a concentrator, you can expect to rely on them heavily. 

Regardless of the discipline, moreover,  journal articles perform an important knowledge-updating function .

Textbooks and handbooks and manuals will have a secondary function for chemists and physicists and biologists, of course. But in the sciences, articles are the standard and  preferred publication form. 

In the social sciences and humanities , where knowledge develops a little less rapidly or is driven less by issues of time-sensitivity , journal articles and books are more often used together.

Not all important and influential ideas warrant book-length studies, and some inquiry is just better suited to the size and scope and concentrated discussion that the article format offers.

Journal articles sometimes just present the most  appropriate  solution for communicating findings or making a convincing argument.  A 20-page article may perfectly fit a researcher's needs.  Sustaining that argument for 200 pages might be unnecessary -- or impossible.

The quality of a research article and the legitimacy of its findings are verified by other scholars, prior to publication, through a rigorous evaluation method called peer-review . This seal of approval by other scholars doesn't mean that an article is the best, or truest, or last word on a topic. If that were the case, research on lots of things would cease. Peer review simply means other experts believe the methods, the evidence, the conclusions of an article have met important standards of legitimacy, reliability, and intellectual honesty.

Searching the journal literature is part of being a responsible researcher at any level: professor, grad student, concentrator, first-year. Knowing why academic articles matter will help you make good decisions about what you find -- and what you choose to rely on in your work.

Think of journal articles as the way you tap into the ongoing scholarly conversation , as a way of testing the currency of  a finding, analysis, or argumentative position, and a way of bolstering the authority (or plausibility) of explanations you'll offer in the papers and projects you'll complete at Harvard. 

• Next: Subject Databases: Organizing Research Conversations >>

Except where otherwise noted, this work is subject to a Creative Commons Attribution 4.0 International License , which allows anyone to share and adapt our material as long as proper attribution is given. For details and exceptions, see the Harvard Library Copyright Policy ©2021 Presidents and Fellows of Harvard College.

• Open access
• Published: 31 July 2024

Clinical implications of the family history in patients with lung cancer: a systematic review of the literature and a new cross-sectional/prospective study design (FAHIC: lung)

• Fabrizio Citarella 1 , 2 ,
• Kazuki Takada 3 ,
• Priscilla Cascetta 4 ,
• Pierfilippo Crucitti 2 , 5 ,
• Roberta Petti 5 , 6 ,
• Bruno Vincenzi 1 , 2 ,
• Giuseppe Tonini 1 , 2 ,
• Francesco M. Venanzi 7 , 8 ,
• Alessandra Bulotta 7 , 8 ,
• Sara Oresti 7 , 8 ,
• Carlo Greco 2 , 9 ,
• Sara Ramella 2 , 9 ,
• Lucio Crinò 10 ,
• Angelo Delmonte 10 ,
• Roberto Ferrara 7 , 8 ,
• Massimo Di Maio 11 ,
• Fiorella Gurrieri 2 , 6 &
• Alessio Cortellini   ORCID: orcid.org/0000-0002-1209-5735 1 , 2 , 12  

Journal of Translational Medicine volume  22 , Article number:  714 ( 2024 ) Cite this article

21 Accesses

1 Altmetric

Metrics details

Compared to other malignancies, few studies have investigated the role of family history of cancer (FHC) in patients with lung cancer, yielding largely heterogeneous results. We performed a systematic literature review in accordance with PRISMA guidelines, searching the PubMed and Scopus databases from their inception to November 25, 2023, to identify studies reporting on the role of FHC in patients with lung cancer. A total of 53 articles were included, most with a retrospective design and encompassing a variety of geographical areas and ethnicities.

Thirty studies (56.6%) assessed patients with non-small cell lung cancer (NSCLC), while 17 studies (32.1%) assessed patients with mixed histologies. Overall, the rates of FHC ranged from 8.3 to 68.9%, and the rates of family history of lung cancer ranged from 2 to 46.8%. Twenty-seven studies investigated FHC as a potential risk factor for lung cancer, with more than half reporting an increased risk for subjects with FHC. Five studies reported on the potential role of FHC in determining clinical outcomes, and twelve studies examined the relationship between FHC and germline mutations. Notably, only one study reported a significantly increased rate of germline mutations, including ATM , BRCA2 , and TP53 , for patients with a family history of lung cancer compared to those without, but both groups had a low prevalence of mutations (< 1%).

The FAHIC—Lung (NCT06196424) is the first cross-sectional/prospective study specifically developed to identify FHC patterns and within-family clusters of other risk factors, including smoking, to guide patients with NSCLC to systematic genetic counseling. Acknowledging the largely heterogeneous results of our systematic review and considering the clinical implications of detecting pathogenic germline variants (PGVs), the FAHIC-lung study aims to identify patients potentially enriched with PGVs/likely PGVs to direct them to germline screening outside of the research setting.

Introduction

Familial aggregation and inherited predisposition have been increasingly investigated in multiple cancer types. In breast, ovarian, prostate, and colorectal malignancies, international guidelines recommend genetic counselling in patients showing risk criteria for syndromes of inherited susceptibility to cancer, as aggregations with other malignancies have been widely described within families of these patient populations [ 1 , 2 , 3 ].

With a predicted number of death of about 160 000 cases in 2023 in Europe and 127 070 in US [ 4 , 5 ], Non-Small Cell Lung Cancer (NSCLC) still remains a leading cause of cancer death worldwide. A positive smoking history represents the main risk factor [ 6 ], while environmental factors such as exposure to radon, asbestosis and air pollution have been linked to lung cancer among never smokers [ 7 , 8 , 9 ].

Few studies have investigated the impact of a positive family history of cancer (FHC) in patients with NSCLC, describing the malignancies that can occur among relatives of patients with NSCLC, while only few and rare genetic syndromes associated with inherited germline genetic mutations, such as the Li-Fraumeni, have been directly linked to lung cancer risk [ 10 ]. Most of the studies did not provide information on the potential within-family clusters of other risk factors, including exposure to tobacco smoking, environmental carcinogens, and other geographical/epidemiological factors. Additionally, retrospective approaches to this topic are heavily impacted by recall bias and misclassification [ 11 , 12 ].

To underline the importance and potential clinical implications of investigating family history of cancer (FHC) in patients with non-small cell lung cancer (NSCLC), a recent retrospective study conducted in a cohort of 7.788 patients with NSCLC, who underwent commercially available germline genetic testing and reported an FHC of 71%, found that pathogenic germline variants (PGVs) or likely PGVs were present in 14.9% of the cases. Additionally, 2.9% of the cases carried a single PGV in a gene associated with autosomal recessive inheritance. Among positive patients, 61.3% carried a PGV/likely PGV in DNA damage and response (DDR) genes, and 95.1% of them harbored a PGV in genes with potential clinical implications, including BRCA2 (2.8%), CHEK2 (2.1%), ATM (1.9%), TP53 (1.3%), BRCA1 (1.2%), and EGFR (1.0%) [ 13 ].

In this manuscript, we present the results of a systematic review of the available evidence on the role of FHC in patients with lung cancer, and the design of the FAHIC-lung study (NCT06196424), a cross-sectional study that aims to prospectively describe the FHC and the potential within-family distribution of smoking and other risk factors, to identify patients more likely to be carriers of PGVs or likely PGVs.

Systematic review—methods

Literature search strategy and study selection criteria.

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed and Scopus databases from their inception date to November 25, 2023, to identify potentially relevant articles. The search terms were “non-small cell lung cancer or NSCLC,” “family history,” “lung cancer,” and “risk.”

The inclusion criteria for the study selection were as follows: (1) patients diagnosed with NSCLC of any stage; (2) available information on the family history of cancer for the included population (e.g., prevalence and type of family history). The exclusion criteria were as follows: (1) lack of information on the family history of cancer; (2) studies not published in English; and (3) case reports.

As this study was a systematic review, ethical approval and informed consent were not required. The study protocol was registered in PROSPERO, an international prospective register of systematic reviews funded by the National Institute for Health Research (NIHR), with the registration code CRD4202450742 (available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024507422 ).

Data extraction and data synthesis

Two authors (F.C. and K.T.) performed the literature search and evaluated the eligibility of studies using the PICO (patients, interventions, comparison, and outcome) framework following the PRISMA criteria. Assuming a certain heterogeneity in the results, we adopted a textual narrative synthesis approach to summarize the included publications [ 14 ]. In view of that, we did not establish specific criteria for data synthesis (e.g., the minimum number of studies or level of consistency required for synthesis).

F.C. and T.K. independently reviewed and extracted data from the published papers, including first author, journal name, and year of publication. The prevalence (as a rate) of family history of cancer was summarized in a master table, along with the type of family history collected (e.g., lung-cancer specific vs. family history of any malignancy), study design, study population characteristics, smoking status of study participants and screened relatives (if available), primary tumor type (e.g., NSCLC, small cell lung cancer [SCLC], or others), number of patients included, and disease stage (e.g., early stage vs. advanced stage, if available). Study characteristics, context, and findings were summarized, and similarities/differences across studies were described in detail. Disagreements between the two authors (F.C. and K.T.) were discussed and resolved with a third independent author (A.C.).

Systematic review—results

We identified a total of 198 potentially relevant articles from the PubMed and Scopus online databases through an initial search strategy. After excluding 41 duplicate articles, we screened and reviewed the titles and abstracts of 157 articles, resulting in 54 being assessed for eligibility. Finally, a total of 53 articles were included in this systematic review. The flow diagram of the study selection process is shown in Fig.  1 while the whole search strategy with publications assessed at each step (identification, screening, eligibility and inclusion) is available as supplementary material (search strategy).

Flow diagram of the studies selection process according to the PRISMA guidelines

Overall, the vast majority of the studies had a retrospective design, with most of them being case–control or observational retrospective studies, with only one cross-sectional study [ 15 ] and one prospective study [ 16 ]. Study populations encompassed a variety of geographical areas/ethnicities, with 23 studies (43.4%) enrolling Asian patients, 13 studies (24.5%) enrolling patients with multiple ethnicities (all with a majority of white patients), 11 studies (20.7%) including non-specified ethnicities, and six studies (11.3%) including other populations. Even the included histology types showed heterogeneity, with 30 studies (56.6%) assessing patients with NSCLC, 17 studies (32.1%) assessing patients with a mixed type of lung cancer including small cell lung cancer (SCLC), four studies (7.5%) assessing other/unspecified types of lung cancer, one study (1.9%) assessing patients with adenocarcinoma, and one study (1.9%) assessing patients with EGFR -positive adenocarcinoma only.

FHC was collected through questionnaires in only three studies [ 17 , 18 , 19 ], while none of them used ad-hoc questionnaires specifically developed to collect FHC and the within-family distribution of other risk factors, including smoking. Twenty-five studies (47.2%) assessed family history (FH) by collecting all malignancies reported among relatives, 21 studies (39.6%) assessed FH of lung cancer, three studies (5.7%) assessed FHC and FH of lung cancer separately, three studies (5.7%) assessed FH of smoking-related and smoking-unrelated cancers, and two studies (3.8%) assessed FH of pre-specified types of cancer. The degree of relatedness ranged from first to second degree, although it was not reported for the majority of the included studies. One study reported on the smoking status among the relatives of study participants [ 20 ] and one study included the assessment of environmental factors (coal exposure) among the risk factors for lung cancer [ 21 ].

Overall, the rate of FHC in patients with lung cancer ranged from 8.3 [ 22 ] to 68.9% [ 20 ], while the rates of FH of lung cancer from 2 [ 23 ] to 46.8% [ 21 ]. Some studies enrolled cohorts of patients potentially enriched for FHC, such as 11 studies which assessed female patients only reporting FHC ranging from 7.7 [ 24 ] to 59.4% [ 25 ] and FH of lung cancer ranging from 6.2 [ 26 ] to 28% [ 27 ], four studies which specifically assessed never/light smoker patients only, reporting FHC ranging from 29.1 [ 28 ] to 68.9 [ 20 ], two studies assessing patients with small aggressive NSCLC, one study assessing male patients only, one study assessing smokers specifically, and one study assessing patients aged ≤ 45 years. A synoptic table with organization of results is available as supplementary file 1.

Studies investigating FHC as a risk factor for lung cancer

Overall, 27 studies investigated FHC as a potential risk factor for lung cancer (Table  1 ) [ 16 , 17 , 20 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. Six out of 11 studies (54.5%) that investigated the role of FHC as a whole or in pre-specified type of cancers reported an increased risk of developing lung cancer for patients with FHC, while 11 out of 16 studies (68.7%) that investigated the role of FH of lung cancer reported a significant association.

One study reported a more pronounced increased risk for women aged ≤ 45 years and a synergistic effect of smoking and FHC in increasing the risk of lung cancer [ 29 ], while another study reported that FH of lung cancer was specifically associated with an increased risk of early on set lung cancer (< 55 years old) [ 17 ]. One study that failed to demonstrate an association between FHC and lung cancer diagnosis, reported a significant effect for patients in whom at least one relative with cancer was diagnosed < 50 years of age [ 20 ], while one study that failed to demonstrate an association between FH of lung cancer and lung cancer risk, reported a significant effect for female patients only [ 42 ].

One study confirmed that FH of lung cancer was associated with risk of lung cancer in both the whole study population and among smokers [ 37 ], while another study reported that FH of lung cancer was more strongly associated with lung cancer risk in case of first/second degree of relatedness compared to collateral relatives [ 40 ].

Studies investigating the potential impact of FHC on clinical outcomes.

Five studies reported on the potential role of FHC in determining clinical outcomes (Table  2 ) [ 19 , 28 , 48 , 49 , 50 , 51 , 52 ]. One study reported no association between FH of lung cancer and outcomes [ 48 ], two studies reported a differential effect for FHC and FH of lung cancer [ 28 , 49 ] and one study reported a decreased risk of death for patients with FHC [ 50 ]. Similarly, one study reported improving outcomes from PD-1 immunotherapy with increasing burden of FHC [ 52 ].

Studies investigating associations between FHC and germline mutations.

Overall, 12 studies reported on the potential relationship between FHC and germline mutations (Table  3 ) [ 33 , 36 , 37 , 39 , 44 , 46 , 51 , 53 , 54 , 55 , 56 , 57 ]. Two studies did not show an enrichment of the germline mutations/polymorphisms of interest in patients with FHC [ 53 , 55 ], while three studies suggested a potential enrichment [ 46 , 54 , 57 ], with only one of them specifically reporting an increased rate of germline mutations including ATM, BRCA2 and TP53 for patients with family history of lung cancer compared to those with no FH [ 46 ]. Two studies reported a significant effect of the germline status in increasing the risk of lung cancer among patients with no FHC [ 33 , 36 ], while in three other studies the effect was independent of FHC [ 39 , 44 , 46 ]. One study showed a synergistic effect in increasing the risk of lung cancer of XRCC3/XRCC4 variants and FHC [ 37 ]. Two studies investigated the potential impact of germline polymorphisms on clinical outcomes, one showing an association between hOGG1 single nucleotide polymorphisms and worse survival specifically in patients without FHC [ 51 ], the other showing multifaceted effects of germline NOTCH4 polymorphisms depending on the FHC status [ 56 ].

Studies investigating associations between FHC and lung cancer somatic features.

Seven studies reported on the potential association between FHC and lung cancer somatic features (Table  4 ) [ 15 , 52 , 58 , 59 , 60 , 61 , 62 ]. Three studies did not confirm significant associations between FHC and somatic microsatellite instability status [ 58 ], somatic DDR genes status [ 52 ], or KRAS mutational status [ 59 ], while 2 studies reported a significant association between FHC and EGFR mutation [ 60 , 61 ]. In addition, another study reported an association between FHC and the occurrence of multiple somatic mutations in patients tested for multiple genes [ 62 ].

Studies investigating associations between FHC and other lung cancer features.

Nine studies included in this subgroup reported on associations between FHC and other lung cancer features (Table  5 ) [ 18 , 19 , 21 , 22 , 63 , 64 , 65 , 66 , 67 ]. One study reported a link between younger age at diagnosis female gender and FHC [ 63 ], one study reported an increased prevalence of FH of breast cancer among female patients with lung cancer [ 64 ], while another study reported a 10-years increasing trend over time for the prevalence of FHC [ 22 ]. Importantly, one study reported a significant association between FHC and smoking [ 19 ], while another study reported that FH of lung cancer was more frequent among young women, with synergistic effect with smoking and coil exposure in determining the younger age at diagnosis [ 21 ].

FAHIC lung—methods/design

Study design and objectives.

The FAHIC—Lung study (observational, prospective, multicenter study to investigate the family history of cancer in patients with non-small cell lung cancer) is a cross-sectional/prospective, observational, multicenter study. Consecutive patients with histologically diagnosed NSCLC will be enrolled, regardless of their age, TNM stage, smoking status, and other clinicopathologic characteristics. ClinicalTrials.gov identifier: NCT06196424.

The primary objective of the study is the identification of FHC patterns and within-family clusters of other risk factors to address patients with NSCLC for systematic genetic counseling for germline next-generation sequencing (NGS) testing to identify PGVs and likely PGVs. Secondary objectives include the description of clinicopathological and oncological characteristics of patients with NSCLC according to FHC patterns.

Patients’ family history will be carefully collected by investigators through a dedicated self-reported study questionnaire, which has been developed for the purpose of this study and validated by the genetic expert of the steering committee (F.G.) (Supplementary file 2). Study questionnaire will focus on: (1) family history of cancer; (2) type of tumors/primary tumor sites among relatives with history of cancer; (3) age at diagnosis among relatives with history of cancer; (4) biological sex of relatives with history of cancer; (5) exposure to tobacco smoking and smoking habits among relatives with history of cancer; (6) geographical origin of participants and relatives with history of cancer; (7) personal history of multiple malignancies; (8) potential professional and environmental exposure to carcinogens of participants and relatives with history of cancer; (9) ethnicity of both participants and relatives with history of cancer.

To minimize risks of recalling bias, patients will be followed up for four weeks through two study visits: the first study visit at enrolment and the follow-up study visit. During the first study visit all patient’s clinic-pathologic will be collected and study participants will be given the ad-hoc questionnaire, which will be returned to the study personnel at the follow-up study visit (Fig.  2 ).

FAHIC-lung study design diagram

The following clinic-pathologic characteristics will be collected: (1) smoking status (active/passive, package/year, total years of smoking); (2) Eastern Cooperative Oncology Group Performance Status (ECOG-PS); (3) age at diagnosis; (4) tumor histology; (5) tumor stage at diagnosis according to the 8th edition of TNM staging system; (6) ethnicity; (7) professional and environmental exposure to carcinogens; (8) programmed death ligand-1 tumor proportion score (PD—L1 TPS); (9) any available oncogenic drivers including EGFR, KRAS, BRAF, c-MET , mutations and ALK, ROS-1, RET, NTRK translocation/gene fusions; (10) personal history of other synchronous/metachronous primary malignancies.

The study plan includes an observational phase and an analytical phase:

Observational phase : after collecting participants’ questionnaires, we will first reconstruct patients’ family trees with additional information on how other potential risk factors, such as smoking history and exposure to professional/environmental carcinogens, segregate within the families with a history of cancer.

Analytical phase : once we have identified family clusters of malignancies and risk factors potentially associated with the highest risk of being carriers of germline PGVs or likely PGVs, we will proceed with the collection of blood samples for germline testing in a subgroup of patients. This will enable us to assess and compare the prevalence of PGVs/likely PGVs between patients more likely to be carriers and the control cohort. This approach aims to achieve a robust comparison, minimize systematic referrals to genetic counseling for all NSCLC patients, and optimize NGS testing requests outside the research setting. Considering the validity and comprehensiveness of high-throughput techniques in identifying PGVs/likely PGVs [ 68 ], we will assess the germline status of the groups of interest through whole exome sequencing (WES) after DNA extraction from blood samples in a two step analysis.

In the first step, the raw sequencing data (FASTQ files) will undergo bioinformatic processing. Mapping will be performed using a high-throughput aligner to ensure accurate alignment of the sequenced reads to the human genome. Variant calling will then be conducted to identify deviations from the reference genome. Filtering and annotation of these variants will focus on a pre-specified list of pre-specified genes known to be associated potentially associated with cancer (Supplementary file 3). This curated gene list will be used to prioritize PGVs/likely PGVs variants. Online tools will be utilized for variant prioritization, organizing the genes based on their correlation with lung cancer, thus enabling us to pinpoint the most relevant variants for further investigation.

In the second step, we aim to discover novel variants that may contribute to lung cancer predisposition. This phase involves a more exploratory analysis of the FASTQ data, looking beyond the known pathogenic variants. We will leverage the extensive genealogical data we have collected on the patients’ family histories to identify potential new genetic markers. The stored FASTQ files will be re-analyzed to detect previously unreported variants, incorporating bioinformatics tools and techniques for variant discovery. These include advanced algorithms for variant detection and annotation, as well as integrative approaches to assess the potential pathogenicity of novel variants. The integration of genealogical data will enhance our ability to correlate these novel variants with familial patterns of lung cancer, potentially uncovering new genetic predispositions. This comprehensive approach ensures that we maximize the utility of the sequencing data, providing a robust platform for both targeted and discovery-driven genetic analysis.

Participants selection

Inclusion Criteria include: (1) histopathological diagnosis of NSCLC (all stages); (2) age ≥ 18 years old; (3) signed written informed consent; (4) availability of familiar and/or personal anamnestic data of cancer. Exclusion Criteria include: (1) unavailability of familiar and/or personal anamnestic data of cancer; (2) patient’s refusal.

Statistical plan and sample size

The sample size of patients enrolled has been determined only for the observational phase of the study. This determination focuses on identifying patients who are more likely to be carriers of pathogenic germline variants (PGVs) or likely PGVs. This approach acknowledges the lack of information on the prevalence of germline PGVs/likely PGVs in patients with NSCLC who are not selected based on family history of cancer (FHC), as well as the limited knowledge regarding the potential characteristics that will define our group of interest. We hypothesized a prevalence of 10% of participants with an especially enriched family history of cancer to be directed to systematic germline testing; assuming a confidence level of 95% with a total width for the confidence interval of 0.1 (precision of ± 5%), the minimum number of subjects needed to properly describe the group of interest, following a binomial “exact” calculation of the sample size, is 175. To account for potential dropouts, we will enroll a minimum of 180 patients.

Descriptive statistics will be used as appropriate to report FHC data, the distribution of within-family other risk factors, and baseline clinicopathologic characteristics. Analyses will be performed using R-Studio software (R Core Team, 2021), and MedCalc® Statistical Software version 20 (MedCalc Software Ltd, Ostend, Belgium; https://www.medcalc.org ; 2021).

To the best of our knowledge, this is the first systematic review summarizing the available evidence on the role of FHC in patients with lung cancer, and the FAHIC-lung study (NCT06196424) is the first cross-sectional/prospective study specifically designed to identify patients with NSCLC more likely to be carrier of PGVs/likely PGVs, that should be systematically referred to genetic counselling and germline testing.

Our review shows that few studies have focused on the family history of cancer (FHC) in patients with lung cancer, resulting in overall heterogeneous results, beginning with the extremely wide range of FHC and family history of lung cancer rates. The category with the highest number of reports included studies assessing FHC as a potential risk factor for developing lung cancer. However, even in this category, the results were largely discordant, with a variety of different approaches and categorizations. Most of the included studies followed a retrospective approach, which is inherently associated with recall bias in collecting family history information, and none used questionnaires specifically designed to collect FHC. To mitigate this bias, we developed our ad-hoc study questionnaire, while the cross-sectional/prospective approach with the 4-week interval will allow study participants to gather and report FHC information as carefully as possible.

Something that set lung cancer apart from other malignancies, where the FHC has an established role in defining the probability of being a carrier of PGVs/likely PGVs, such as ovarian, breast, prostate, and colorectal cancer, is the role of smoking. As mentioned, smoking history represents the main risk factor for lung cancer [ 6 ], several evidence shows that passive smoking from family members can be a detrimental factor and that even the smoking habit can be “inherited”, with a sort of intergenerational transmission [ 69 , 70 ]. The FAHIC-lung questionnaire will allow us to mitigate this potential bias as well, collecting smoking habit information and environmental exposure to carcinogens among patients’ relatives with cancer.

More than a half of the studies that assessed FHC and FH of lung cancer as a potential risk factor for lung cancer concluded that FHC plays a detrimental role, with a potential synergistic effect with smoking, that seems even more pronounced among young/female patients. Our systematic review also suggests that younger patients, female, Asian, and never/light smokers may be especially enriched in FHC, although with no clear/conclusive results, while no somatic genomic feature seems to be significantly associated with FHC, except for EGFR mutations.

Recently, increasing attention has been focused on the study of germline mutations as risk factor for lung cancer, highlighting how DDR genes alterations can be found among patients with lung adenocarcinoma, even in the context of wider within-family primary tumors spectrums, including breast/pancreatic cancers or hematological malignancies [ 10 ]. Even in the context of TP53-associated genetic susceptibility, FHC is gaining a clearer role, to the point of recommending genetic counselling for patients with lung adenocarcinoma younger than 46 years old and with an especially enriched FHC or personal history of multiple primary tumors [ 71 ].

Importantly, in our systematic review only one of the studies that investigated the multifaceted role of germline mutations reported a significant enrichment among patients with FHC [ 46 ]. Rifkin and colleagues first reported a systematic review on the evidence linking germline mutations with lung cancer risk, then validated through a large case–control study of patients undergoing germline whole exome sequencing (WES) the significant association between lung cancer risk and ATM , BRCA2 and TP 53 pathogenetic/likely pathogenetic germline mutations [ 46 ]. However, despite the overall enrichment among controls, variant-based and gene-based analyses showed a low prevalence of germline PGV/likely PGV in both cases and controls [ 46 ]. In addition, they reported a higher rate of carriers among study participants with FH of lung cancer compared to those without, but with a very low overall prevalence (0.8% vs 0.7% for the combination of ATM/BRCA2/TP53 ) [ 46 ], suggesting that a simplified collection of FHC information is not enough to identify patients with the highest probability of being carriers and to properly optimize germ-line NGC access.

Among gene-specific susceptibility for lung cancer, EGFR -associated one needs a special mention. Genetic counselling is already recommended for patients with somatic EGFR positive NSCLC younger than 50 years, regardless of their family history [ 10 ], however, a proper syndromic EGFR -associated lung cancer should be suspected in the case of the novo EGFR T790M mutations, especially with a somatic variant allele frequency (VAF) ≥ 35% [ 10 , 72 ], with even more rare EGFR variants, such as V834L and V843I being increasingly recognized [ 73 , 74 ]. Lastly, we will have to consider the complexity related to the multifaceted role of multiple primary tumors. Beyond the consisting evidence linking DDR genes mutations to a personal history of multiple malignancies, recent studies reported on the potential role of pleiotropic loci in determining the risk of multiple malignancies [ 75 ].

Our study plan has, however, some limitations. First, we will have to rely on patients' ability and willingness to reconstruct their family history, therefore the recall bias will exert a certain effect despite the cross/sectional prospective approach. In addition, we have no strictly predefined definition of potential family clusters to be analyzed. However, we can anticipate that the identified group of interest will likely include young female patients with adenocarcinoma histology, never or light smokers, patients with EGFR mutations, patients with a history of multiple primary tumors, and patients with a high burden of family history. This high burden of family history is particularly expected to be enriched in non-smoking associated cancers, including lung cancer, and in the DDR-genes associated cancer spectrum, such as breast, ovarian, prostate, melanoma, and pancreatic cancers.To ensure a comprehensive analysis, we also plan to incorporate other factors collected through our detailed questionnaire. These factors include smoking habits of the patients, passive smoking exposure, working exposure to carcinogens, and smoking habits of family members. By evaluating these additional factors, we aim to identify within-family clusters of other risk factors. Specifically, we will focus on selecting patients without a history of passive smoking, identifying patients with a younger age at diagnosis among their relatives with cancer, and considering patients with low working exposure to carcinogens. Despite having these anticipations, we have deliberately chosen to adopt an unbiased approach without pre-established features to define patients for germline tests. Considering the very low prevalence of germline mutations reported so far [ 46 ], this strategy allows for a more comprehensive and inclusive analysis, ensuring that we do not overlook any potential associations or risk factors to unravel the complexity of FHC information and identify patients especially enriched in PGVs/likely PGVs. Furthermore, considering that this is an observational study, we decided to adopt a two steps approach, in order to identify patients at risk as a first step. This, to minimize the potential clinical implications for study participants and let their treating physicians refer them to genetic counseling as per their existing clinical practice. Once the group of interest will be identified, we will amend the protocol to collect blood samples and allocate fundings for germline testing. Lastly, we have to consider that the FAIHC lung study is being conducted in Italy, therefore the study population will mostly consist of white/Caucasian patients. Although this will prevent us from gathering broader information on the potential implications of different races, we will be able to focus and obtain reliable results on patients with European ancestry.

In the context of a worldwide progressive implementation of chest computed tomography based screening programs in subject with smoking history [ 76 ], and considering the initial evidence of the potential benefit of screening programs among never smokers and other subjects potentially enriched in FHC/PGVs [ 77 ], identifying patients with the highest risk of being carrier of PGVs/likely PGVs would be extremely important to develop dedicated preventing measures in non-smoker subjects. Considering the costs of commercially available germline NGS tests and the potential preventive, prognostic, and therapeutic implications of the detection of germline mutations related to familial cancers, we believe that establishing FHC patterns to identify a subgroup of patients especially enriched in PGVs to direct to germline screening outside of the research setting, would be extremely helpful in optimizing resources, spare time and eventually improve patients’ outcomes.

Data Availability

This systematic review does not involve the generation of new data. The data analyzed in this study are derived from publicly available studies and publications that are cited within the paper. All sources of data, including databases and search strategies used to identify relevant studies, are described in the Methods section. Readers interested in accessing the underlying data can refer to the referenced studies and publications for more detailed information. Due to data management regulations, individual patient-level data from the FAIHC-lung study are not available. However, inquiries from third parties can be directed to the corresponding author.

Guidelines Detail: https://www.nccn.org/guidelines/guidelines-detail .

Stjepanovic N, Moreira L, Carneiro F, et al. Hereditary gastrointestinal cancers: ESMO clinical practice guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 2019;30:1558–71.

Article   CAS   PubMed   Google Scholar  

Genetics of Prostate Cancer (PDQ ® )–Health Professional Version—NCI https://www.cancer.gov/types/prostate/hp/prostate-genetics-pdq .

Lung Cancer Statistics | How common is lung cancer? https://www.cancer.org/cancer/lung-cancer/about/key-statistics.html . Accessed 12 Mar 2023.

Malvezzi M, Santucci C, Boffetta P, et al. European cancer mortality predictions for the year 2023 with focus on lung cancer. Ann Oncol. 2023;34:410–9.

Steuer CE, Jegede OA, Dahlberg SE, et al. Smoking behavior in patients with early-stage NSCLC: a report from ECOG-ACRIN 1505 trial. J Thorac Oncol. 2021;16:960–7.

Article   PubMed   PubMed Central   Google Scholar  

Malhotra J, Malvezzi M, Negri E, et al. Risk factors for lung cancer worldwide. Eur Respir J. 2016;48:889–902.

Article   PubMed   Google Scholar  

Riudavets M, Garcia de Herreros M, Besse B, et al. Radon and lung cancer: current trends and future perspectives. Cancers. 2022;14:3142.

Article   CAS   PubMed   PubMed Central   Google Scholar  

A New Pathway from Air Pollution to Lung Cancer in Non-Smokers https://dailyreporter.esmo.org/esmo-congress-2022/research-advances-in-the-last-months/a-pathway-from-air-pollution-to-lung-cancer-in-non-smokers-has-been-identified .

Benusiglio PR, Fallet V, Sanchis-Borja M, et al. Lung cancer is also a hereditary disease. Eur Respir Rev. 2021;30: 210045.

Chang ET, Smedby KE, Hjalgrim H, et al. Reliability of self-reported family history of cancer in a large case-control study of lymphoma. J Natl Cancer Inst. 2006;98:61–8.

Murff HJ, Spigel DR, Syngal S. Does this patient have a family history of cancer? An evidence-based analysis of the accuracy of family cancer history. JAMA. 2004;292:1480–9.

Sorscher S, LoPiccolo J, Chen E, et al. Landscape of pathogenic germline variants in patients with lung cancer. JCO. 2022;40:388570–388570.

Article   Google Scholar  

Barnett-Page E, Thomas J. Methods for the synthesis of qualitative research: a critical review. BMC Med Res Methodol. 2009;9:59.

Lashkarizadeh M, Lashkarizadeh M, Nikian M, et al. The expression of HER2/neu in patients with lung cancer and its associated factors. Clin Respir J. 2023;17:90–5.

Tammemagi MC, Schmidt H, Martel S, et al. Participant selection for lung cancer screening by risk modelling (the Pan-Canadian early detection of lung cancer [PanCan] study): a single-arm, prospective study. Lancet Oncol. 2017;18:1523–31.

Cassidy A, Balsan J, Vesin A, et al. Cancer diagnosis in first-degree relatives and non-small cell lung cancer risk: results from a multi-centre case-control study in Europe. Eur J Cancer. 2009;45:3047–53.

Gaur P, Bhattacharya S, Kant S, et al. Hospital-based study on demographic, hematological, and biochemical profile of lung cancer patients. J Cancer Res Ther. 2020;16:839–42.

Isla D, Felip E, Viñolas N, et al. Lung cancer in women with a family history of cancer: the Spanish female-specific database WORLD07. Anticancer Res. 2016;36:6647–53.

Gorlova OY, Zhang Y, Schabath MB, et al. Never smokers and lung cancer risk: a case-control study of epidemiological factors. Int J Cancer. 2006;118:1798–804.

Chen Y, Li G, Lei Y, et al. Lung cancer family history and exposure to occupational/domestic coal combustion contribute to variations in clinicopathologic features and gene fusion patterns in non-small cell lung cancer. Thorac Cancer. 2019;10:695–707.

Zang R, Shi J-F, Lerut TE, et al. Ten-year trends of clinicopathologic features and surgical treatment of lung cancer in China. Ann Thorac Surg. 2020;109:389–95.

Tsugane S, Watanabe S, Sugimura H, et al. Smoking, occupation and family history in lung cancer patients under fifty years of age. Jpn J Clin Oncol. 1987;17:309–17.

CAS   PubMed   Google Scholar  

Chen K-Y, Hsiao C-F, Chang G-C, et al. Hormone replacement therapy and lung cancer risk in Chinese. Cancer. 2007;110:1768–75.

Titan AL, He H, Lui N, et al. The influence of hormone replacement therapy on lung cancer incidence and mortality. J Thorac Cardiovasc Surg. 2020;159:1546-1556.e4.

Jin K, Hung RJ, Thomas S, et al. Hormonal factors in association with lung cancer among Asian women: a pooled analysis from the international lung cancer consortium. Int J Cancer. 2021;148:2241–54.

Pathak A, Wenzlaff AS, Hyland PL, et al. Apoptosis-related single nucleotide polymorphisms and the risk of non-small cell lung cancer in women. J Cancer Ther Res. 2014;3:1.

Article   CAS   Google Scholar  

Lee Y, Jeon JH, Goh S-H, et al. The clinical impact of family history of cancer in female never-smoker lung adenocarcinoma. Lung Cancer. 2019;136:15–22.

Osann KE. Lung cancer in women: the importance of smoking, family history of cancer, and medical history of respiratory disease. Cancer Res. 1991;51:4893–7.

Schwartz AG, Wenzlaff AS, Prysak GM, et al. Reproductive factors, hormone use, estrogen receptor expression and risk of non small-cell lung cancer in women. J Clin Oncol. 2007;25:5785–92.

Tammemagi CM, Freedman MT, Church TR, et al. Factors associated with human small aggressive non small cell lung cancer. Cancer Epidemiol Biomarkers Prev. 2007;16:2082–9.

Cote ML, Yoo W, Wenzlaff AS, et al. Tobacco and estrogen metabolic polymorphisms and risk of non-small cell lung cancer in women. Carcinogenesis. 2009;30:626–35.

Hong Y-S, Kang H-J, Kwak J-Y, et al. Association between microRNA196a2 rs11614913 genotypes and the risk of non-small cell lung cancer in Korean population. J Prev Med Public Health. 2011;44:125–30.

Schwartz AG, Wenzlaff AS, Bock CH, et al. Admixture mapping of lung cancer in 1812 African-Americans. Carcinogenesis. 2011;32:312–7.

Sin DD, Tammemagi CM, Lam S, et al. Pro-surfactant protein B as a biomarker for lung cancer prediction. J Clin Oncol. 2013;31:4536–43.

Xu P, Liu L, Wang J, et al. Genetic variation in BCL2 3’-UTR was associated with lung cancer risk and prognosis in male Chinese population. PLoS ONE. 2013;8: e72197.

He F, Chang S-C, Wallar GM, et al. Association of XRCC3 and XRCC4 gene polymorphisms, family history of cancer and tobacco smoking with non-small-cell lung cancer in a Chinese population: a case-control study. J Hum Genet. 2013;58:679–85.

Yilmaz M, Kacan T, Sari I, et al. Lack of association between the MTHFRC677T polymorphism and lung cancer in a Turkish population. Asian Pac J Cancer Prev. 2014;15:6333–7.

Tian G, Wang M, Xu X. The role of NQO1 polymorphisms in the susceptibility and chemotherapy response of Chinese NSCLC patients. Cell Biochem Biophys. 2014;69:475–9.

Li J, Zhang M, Yang F, et al. High risk occupational exposure and family history were risk factors in young lung cancer in Chinese. Int J Clin Exp Med. 2016;9(12):23650–7.

Google Scholar  

White RW, Horvitz E. Evaluation of the feasibility of screening patients for early signs of lung carcinoma in web search logs. JAMA Oncol. 2017;3:398–401.

Warkentin MT, Tammemägi MC, Freedman MT, et al. Factors associated with small aggressive non-small cell lung cancers in the national lung screening trial: a validation study. JNCI Cancer Spectr. 2018;2:pkx010.

Brown D, Zingone A, Yu Y, et al. Relationship between circulating inflammation proteins and lung cancer diagnosis in the national lung screening trial. Cancer Epidemiol Biomarkers Prev. 2019;28:110–8.

Pineda Lancheros LE, Rojo Tolosa S, Gálvez Navas JM, et al. Effect of single nucleotide polymorphisms in the vitamin d metabolic pathway on susceptibility to non-small-cell lung cancer. Nutrients. 2022;14:4668.

Albano D, Dhamija A, Liao Y, et al. Lung cancer in nonsmokers—a risk factor analysis. Cancer Epidemiol. 2023;86: 102439.

Rifkin AS, Less EM, Wei J, et al. Association of reported candidate monogenic genes with lung cancer risk. Clin Lung Cancer. 2023;24:313–21.

Liu L, Yu H, Bai J, et al. Positive association of serum vitamin B6 levels with intrapulmonary lymph node and/or localized pleural metastases in non-small cell lung cancer: a retrospective study. Nutrients. 2023;15:2340.

Yang J, Li Y, Khoury T, et al. Relationships of hHpr1/p84/Thoc1 expression to clinicopathologic characteristics and prognosis in non-small cell lung cancer. Ann Clin Lab Sci. 2008;38:105–12.

CAS   PubMed   PubMed Central   Google Scholar  

Li N, Shao K, Chen Z, et al. The impact of positive cancer family history on the clinical features and outcome of patients with non-small cell lung cancer. Fam Cancer. 2011;10:331–6.

Li X, Pan X, Wang P, et al. Expression of ERCC1 mRNA in non-small cell lung cancer tissues and survival analysis of patients. Life Sci J. 2013;10(2):1926–31.

Su Y, Zhang H, Xu F, et al. DNA repair gene polymorphisms in relation to non-small cell lung cancer survival. Cell Physiol Biochem. 2015;36:1419–29.

Cortellini A, Giusti R, Filetti M, et al. High familial burden of cancer correlates with improved outcome from immunotherapy in patients with NSCLC independent of somatic DNA damage response gene status. J Hematol Oncol. 2022;15:9.

Tefre T, Børresen AL, Aamdal S, et al. Studies of the L-myc DNA polymorphism and relation to metastasis in Norwegian lung cancer patients. Br J Cancer. 1990;61:809–12.

Javid J, Mir R, Mirza M, et al. CC genotype of anti-apoptotic gene BCL-2 (-938 C/A) is an independent prognostic marker of unfavorable clinical outcome in patients with non-small-cell lung cancer. Clin Transl Oncol. 2015;17:289–95.

Liu Y, Kheradmand F, Davis CF, et al. Focused analysis of exome sequencing data for rare germline mutations in familial and sporadic lung cancer. J Thorac Oncol. 2016;11:52–61.

Xu Q, Lin D, Li X, et al. Association between single nucleotide polymorphisms of NOTCH signaling pathway-related genes and the prognosis of NSCLC. Cancer Manag Res. 2019;11:6895–905.

Liu M, Liu X, Suo P, et al. The contribution of hereditary cancer-related germline mutations to lung cancer susceptibility. Transl Lung Cancer Res. 2020;9:646–58.

Suzuki K, Ogura T, Yokose T, et al. Microsatellite instability in female non-small-cell lung cancer patients with familial clustering of malignancy. Br J Cancer. 1998;77:1003–8.

Yilmaz A, Mohamed N, Patterson KA, et al. Clinical and metabolic parameters in non-small cell lung carcinoma and colorectal cancer patients with and without KRAS mutations. Int J Environ Res Public Health. 2014;11:8645–60.

Cheng P-C, Cheng Y-C. Correlation between familial cancer history and epidermal growth factor receptor mutations in Taiwanese never smokers with non-small cell lung cancer: a case-control study. J Thorac Dis. 2015;7:281–7.

PubMed   PubMed Central   Google Scholar  

Hsu K-H, Tseng J-S, Wang C-L, et al. Higher frequency but random distribution of EGFR mutation subtypes in familial lung cancer patients. Oncotarget. 2016;7:53299–308.

Chang F, Zhang H, Chen C, et al. Concomitant genetic alterations are associated with plasma D-dimer level in patients with non-small-cell lung cancer. Future Oncol. 2022;18:679–90.

Ambrosone CB, Rao U, Michalek AM, et al. Lung cancer histologic types and family history of cancer. Analysis of histologic subtypes of 872 patients with primary lung cancer. Cancer. 1993;72:1192–8.

Tsuchiya M, Iwasaki M, Otani T, et al. Breast cancer in first-degree relatives and risk of lung cancer: assessment of the existence of gene sex interactions. Jpn J Clin Oncol. 2007;37:419–23.

Banik A, Schwarzer R, Pawlowska I, et al. Women with family cancer history are at risk for poorer physical quality of life and lower self-efficacy: a longitudinal study among men and women with non-small cell lung cancer. Health Qual Life Outcomes. 2017;15:62.

Chen P-H, Chuang J-H, Lu T-P, et al. Non-intubated versus intubated video-assisted thoracic surgery in patients aged 75 years and older: a propensity matching study. Front Surg. 2022;9: 880007.

Li Q, Wei X, Wang Y, et al. Pulmonary mucoepidermoid carcinoma in the Chinese population: a clinical characteristic and prognostic analysis. Front Oncol. 2022;12: 916906.

Parsons DW, Roy A, Yang Y, et al. Diagnostic yield of clinical tumor and germline whole-exome sequencing for children with solid tumors. JAMA Oncol. 2016;2:616–24.

Dwivedi S, Pathak R, Agarwalla R, et al. The intergenerational transmission of tobacco habit: role of parents and the family. J Family Med Prim Care. 2016;5:373–7.

Saari AJ, Kentala J, Mattila KJ. The smoking habit of a close friend or family member–how deep is the impact? A cross-sectional study. BMJ Open. 2014;4: e003218.

Bougeard G, Renaux-Petel M, Flaman J-M, et al. Revisiting Li-Fraumeni Syndrome from TP53 mutation carriers. J Clin Oncol. 2015;33:2345–52.

Oxnard GR, Chen R, Pharr JC, et al. Germline EGFR mutations and familial lung cancer. J Clin Oncol. 2023;41:5274–84.

van der Leest C, Wagner A, Pedrosa RM, et al: Novel EGFR V834L Germline Mutation Associated With Familial Lung Adenocarcinoma. JCO Precis Oncol 2:PO.17.00266, 2018

Ohtsuka K, Ohnishi H, Fujiwara M, et al: Predisposition to Lung Adenocarcinoma in a Family Harboring the Germline EGFR V843I Mutation. JCO Precis Oncol 3:PO.19.00104, 2019

Lu M, Zhang X, Chu Q, et al. Susceptibility genes associated with multiple primary cancers. Cancers. 2023;15:5788.

Passiglia F, Cinquini M, Bertolaccini L, et al. Benefits and harms of lung cancer screening by chest computed tomography: a systematic review and meta-analysis. J Clin Oncol. 2021;39:2574–85.

Triphuridet N, Zhang SS, Nagasaka M, et al. Low-dose computed tomography (LDCT) lung cancer screening in asian female never-smokers is as efficacious in detecting lung cancer as in Asian male ever-smokers: a systematic review and meta-analysis. J Thorac Oncol. 2023;18:698–717.

Download references

Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and affiliations.

Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy

Fabrizio Citarella, Bruno Vincenzi, Giuseppe Tonini & Alessio Cortellini

Department of Medicine and Surgery, Universitá Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy

Fabrizio Citarella, Pierfilippo Crucitti, Bruno Vincenzi, Giuseppe Tonini, Carlo Greco, Sara Ramella, Fiorella Gurrieri & Alessio Cortellini

Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan

Kazuki Takada

Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France

Priscilla Cascetta

Thoracic Surgery Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy

Pierfilippo Crucitti & Roberta Petti

Operative Research Unit of Medical Genetics, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 21, 00128, Rome, Italy

Roberta Petti & Fiorella Gurrieri

Università Vita-Salute San Raffaele, Milan, Italy

Francesco M. Venanzi, Alessandra Bulotta, Sara Oresti & Roberto Ferrara

Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy

Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy

Carlo Greco & Sara Ramella

Thoracic Oncology Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) “Dino Amadori”, Meldola, Italy

Lucio Crinò & Angelo Delmonte

Department of Oncology, Medical Oncology 1U, AOU Città della Salute e della Scienza di Torino, University of Turin, 10126, Turin, Italy

Massimo Di Maio

Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK

Alessio Cortellini

You can also search for this author in PubMed   Google Scholar

Contributions

All authors contributed to the publication according to the ICMJE guidelines for the authorship (study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision). All authors read and approved the submitted version of the manuscript (and any substantially modified version that involves the author's contribution to the study). Each author has agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

Corresponding author

Correspondence to Alessio Cortellini .

Ethics declarations

Ethics approval and consent to participate.

All the study procedures will follow the precepts of Good Clinical Practice and the declaration of Helsinki. The study was approved by the local ethical committees on human experimentation (Comitato Etico Territoriale Lazio AREA 2, registro sperimentazioni 27.23 CET 2 CBM, 12 Oct 2023).

Competing interests

Alessio Cortellini declares speaker’s fees from MSD, AstraZeneca, Pierre-Fabre, EISAI, Sanofi/REGENERON, and Roche (outside of the present work) and advisory board roles/grant for consultancies from MSD, BMS, AstraZeneca, Roche, OncoC4, IQVIA, Pierre-Fabre, EISAI, REGENERON, Sanofi/REGENERON, Ardelis Health, AlphaSight, Access Infinity (outside of the present work). He also declares travel support from MSD and Roche. Sara Ramella declares advisory board roles and grant consultancies from Astra Zeneca, MSD (Merk) and Roche (outside of the present work). All other authors declare no conflicts of interest associated with the present study.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Supplementary file 1., supplementary file 2., supplementary file 3., supplementary file 4., rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

Citarella, F., Takada, K., Cascetta, P. et al. Clinical implications of the family history in patients with lung cancer: a systematic review of the literature and a new cross-sectional/prospective study design (FAHIC: lung). J Transl Med 22 , 714 (2024). https://doi.org/10.1186/s12967-024-05538-4

Download citation

Received : 02 July 2024

Accepted : 24 July 2024

Published : 31 July 2024

DOI : https://doi.org/10.1186/s12967-024-05538-4

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Lung cancer
• Family history of cancer
• Germline screening

Journal of Translational Medicine

ISSN: 1479-5876

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

• Open access
• Published: 30 July 2024

Parapneumonic empyema in children: a scoping review of the literature

• Danilo Buonsenso   ORCID: orcid.org/0000-0001-8567-2639 1 ,
• Francesca Cusenza 2 ,
• Lucrezia Passadore 2 ,
• Francesca Bonanno 2 ,
• Carolina Calanca 2 ,
• Francesco Mariani 1 ,
• Carlotta Di Martino 3 ,
• Sonia Rasmi 2 &
• Susanna Esposito 2  

Italian Journal of Pediatrics volume  50 , Article number:  136 ( 2024 ) Cite this article

29 Accesses

Metrics details

Community-acquired pneumonia can lead to a serious complication called empyema, which refers to pus within the pleural space. While it poses a significant threat to morbidity, particularly in children, it is fortunately not associated with high mortality rates. However, determining the best course of management for children, including decisions regarding antibiotic selection, administration methods, and treatment duration, remains a topic of ongoing debate. This scoping review aims to map the existing literature on empyema in children, including types of studies, microbiology, therapies (both antimicrobial and surgical) and patient outcomes. We systematically searched PubMed and SCOPUS using the terms “pediatric” (encompassing children aged 0 to 18 years) and “pleural empyema” to identify all relevant studies published since 2000. This search adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR) checklist.

A total of 127 studies was included. Overall, 15 attempted to compare medical treatments (alone or in combination with pleural drainage or fibrinolysis) with more invasive surgical approaches, and six studies compared diverse surgical interventions. However, the diversity of study designs makes it difficult to derive firm conclusions on the optimal approach to pediatric empyema. The heterogeneity in inclusion criteria, pharmacological/surgical approaches and settings limit the ability to draw definitive conclusions. Overall, 78 out of 10,896 children (0.7%) included in the review died, with mortality being higher in Asia and Africa. Our scoping review highlights important gaps regarding several aspects of empyema in children, including specific serotypes of the most common bacteria involved in the etiology, the optimal pharmacological and surgical approach, and the potential benefits of newer antibiotics with optimal lung penetration. New trials, designed on a multi-country level a higher number of patients and more rigorous inclusion criteria and designs, should be urgently funded.

Introduction

Parapneumonic empyema, characterized by pus accumulation on the pleura, is a common local complication of childhood community-acquired pneumonia (CAP) [ 1 , 2 , 3 , 4 , 5 ]. While estimates suggest parapneumonic effusions develop in approximately 1 in every 100 to 150 children with CAP [ 6 , 7 ], hospitalized children with CAP may have a prevalence as high as 40% [ 8 ].

The primary causative agent of CAP is predominantly Streptococcus pneumoniae , and its incidence has demonstrated fluctuations over time [ 9 ]. Notably, there has been a significant global decrease in pneumococcal disease and mortality rates following the introduction of the heptavalent pneumococcal conjugate vaccine (PCV7), which targets serotypes 4, 6B, 9 V, 14, 18 C, 19 F, and 23 F, into routine childhood immunization schedules [ 10 ]. However, in subsequent years, the USA observed an uptick in pneumococcal empyema cases associated with serotypes not covered by PCV7 [ 11 ]. Following the transition from PCV7 to PCV13, which additionally includes pneumococcal serotypes 1, 3, 5, 6 A, 7 F, and 19 A, there has been a noteworthy reduction in the incidence and hospitalization rates related to empyema [ 12 ]. This shift to PCV13 is particularly significant given the strong correlation between parapneumonic empyema and pneumococcal serotype 1 [ 13 ]. Although other bacteria, such as group A Streptococcus and Staphylococcus aureus , are less commonly linked with CAP, they are potential bacterial pathogens associated with parapneumonic empyema [ 13 ].

The clinical manifestation of parapneumonic empyema closely resembles that of uncomplicated CAP [ 9 , 13 ]. Suspecting empyema is prudent in children experiencing prolonged fever (lasting 7 days or more) or those showing no improvement after 48–72 h of appropriate antibiotic therapy. Physical examination typically reveals reduced air entry and dullness to percussion [ 9 ]. Chest X-ray and/or pulmonary ultrasound are used to confirm suspected parapneumonic empyema. Ultrasound is particularly valuable due to its higher sensitivity compared to X-ray in assessing fluid collection extension and nature; additionally, it avoids radiation exposure for children. While thoracic computed tomography (CT) isn’t a first-line diagnostic tool for empyema, it may be warranted when diagnosis is unclear or malignancies are suspected, such as Burkitt’s lymphoma.

Treatment for parapneumonic empyema always includes empiric intravenous broad-spectrum antibiotic therapy targeting common bacteria like Streptococcus pneumoniae , Streptococcus pyogenes , and Staphylococcus aureus [ 5 , 14 ]. In cases of significant effusion (> 2 cm) or respiratory compromise, chest drainage is recommended [ 14 ]. Ultrasound-guided chest drainage is standard, often performed with children under sedation or general anesthesia. Intrapleural fibrinolytics, like urokinase, can expedite hospital discharge for cases with slow drainage or thick, loculated fluid [ 5 , 14 ]. Thoracic surgery should be considered in cases of antibiotic therapy failure, ineffective chest drainage, or inadequate response to fibrinolytics. However, current guidelines lack clear recommendations on the ideal surgical procedure, timing of intervention, duration of drainage and antibiotic therapy, transition to oral antibiotics, and how these factors influence outcomes. This scoping review aims to comprehensively outline the literature on study types, microbiology, therapeutic interventions (both antimicrobial and surgical), and outcomes of empyema in children since 2000.

Review questions

To address the lack of consensus on optimal treatment for pediatric parapneumonic empyema literature [ 15 ], this review primary focus will be to examine the existing literature on antibiotic and surgical interventions about pediatric empyema. This will include investigating the selection of first-line agents, appropriate dosages, routes of administration, and treatment durations. Furthermore, this review will address the following sub-questions:

What are the most commonly identified pathogens reported in literature?

What are the predominant outcomes and complication rates associated with empyema, as reported in the literature?

Which conservative or invasive treatments are most frequently reported, and which demonstrate improvements in outcomes and reduced length of stay?

The protocol for this review has been published prospectively and can be accessed at https://osf.io/9wkma/ .

Inclusion criteria

This review encompasses studies involving children and adolescents (under 18 years old) who have received a confirmed diagnosis of empyema, defined by the presence of pus within the pleural cavity. Diagnosis of empyema is established through the identification of pus, positive Gram’s stain, culture, or nucleic-acid amplification tests in the pleural fluid. Only studies explicitly mentioning the performance of microbiological investigations, administration of antimicrobial and surgical treatments, as well as outcomes (at least until discharge), have been included.

The primary focus of this review is to comprehensively examine all aspects of empyema, with particular attention given to treatment options. Due to the severity of the condition, articles involving non-hospitalized patients were not anticipated, thus only inpatient studies have been considered.

To capture a broad range of evidence, this review includes randomized controlled trials, non-randomized controlled trials and all observational studies, (prospective and retrospective, including case-control, cohort, and cross-sectional studies, as well as small case series or single case reports).

Search strategy

The search was conducted by one reviewer. It began in April 2023, using the bibliographic databases PubMed and SCOPUS. We limited our search to English-language articles published between January 1, 2000, to March 31, 2023. The search strategy incorporated a combination of keywords and their synonyms, including “pediatric,” “empyema,” and “treatment.” The PubMed search strategy is accessible in the supplementary data section of this protocol; the terms used in this search were adjusted for use with other bibliographic databases.

Following the search, studies were exported to Rayyan. Initially, one author screened for duplicates. Subsequently, titles and/or abstracts of retrieved studies were independently screened by two reviewers to identify potentially relevant studies for inclusion in the review. Full texts of potentially eligible studies were then retrieved and independently assessed for eligibility by two reviewers. Each researcher was blinded to the decision of the other. Any discrepancies regarding study eligibility were resolved through discussion and, if necessary, consultation with a third reviewer.

Studies failing to meet the inclusion criteria were excluded, and a table detailing the reasons for exclusion was included in the final manuscript. The results of the search were reported using the PRISMA flow diagram.

Data extraction was performed independently by two review authors, each using a separate Excel spreadsheet. Each researcher remained blinded to the other’s decisions. In cases of discordance, disagreements were identified and resolved through discussion (with involvement of a third author if needed).

An Excel file was utilized to store extracted data, which included the following when available:

Study details: title, author, year of publication, study type, number of patients, geographic location.

Participant characteristics: sample size, nationality, age, socio-economic status, comorbidities.

Clinical manifestations: fever duration, cough with mucus, dyspnea, chest pain, and others.

Imaging findings: lung involvement type on chest X-rays, lung ultrasound (US), CT scans, or MRI.

Details of antimicrobial treatments administered during empyema (e.g., duration, antibiotics used).

Adjunctive treatments and their durations during empyema (e.g., steroids, other immunomodulatory medications).

Surgical interventions and their durations during empyema (e.g., drainage, thoracoscopy, surgical resection).

Outcomes (e.g., death, survival, survival with sequelae, type of sequelae).

Data analysis and presentation

To present our findings, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist, as detailed in the supplementary material. A narrative synthesis was conducted to summarize the results obtained from the studies included in the review, providing our interpretation of the findings. Special attention was given to antimicrobial and surgical therapies, with a focus on the frequency of antibiotic selection, efficacy, and treatment duration. more than 100 records were included after the initial selection process, preference was given to original articles and those published within the last 5 years.

Tables and charts were employed to concisely summarize both the characteristics of included studies and essential clinical, diagnostic, treatment, and outcome data. Various tables and figures were compiled to outline the types of studies and their primary findings, covering microbiology, therapies, and outcomes. Additionally, we emphasized areas for future research to address existing gaps in knowledge.

Patient and public involvement

Patient and public involvement was not directly incorporated into this review. However, the primary inquiries that motivated our research project were influenced by public dialogues initiated by family associations in the media. These conversations underscored the significance of gaining a deeper understanding of how empyema can be identified earlier in the disease progression, prior to clinical deterioration becoming uncontrollable. Additionally, they raised questions about the potential for preventing empyema if it arises as a complication of a previously undetected and untreated lung infection.

Characteristics of available literature

We reviewed literature published between January 2000 to January 2023 and identified 127 articles in our systematic review. Figure  1 shows the included studies according to PRISMA flowchart. The majority of studies were observational studies (93), 77 retrospective and 16 prospective, 20 case series, 9 randomized clinical trials and 5 case series. Geographically, most studies originated from Asia, Europe and North America, with a minority from low-income countries. Interestingly, Fig.  2 reveals a slight increase in publications on pediatric empyema over the last decade.

PRISMA flowchart of included studies

Temporal distribution of studies on pediatric empyema

Microbiology of empyema

All 127 studies in our scoping review assessed microbiological etiology of empyema. Microbiological examinations were performed on either pleural fluid or biological samples obtained from bronchoalveolar lavage, blood culture, or a combination of two or more of these samples. Overall, 2% ( n  = 2) of the studies, despite investigating the microbiological etiology, did not provide quantitative results or the percentage of patients for each pathogen. Another 2% ( n  = 2) of the studies did not report microbiological results in the specific text. Moreover, 6% ( n  = 9) of the studies reported that the examined microbiological samples yielded negative results. Finally, 90% ( n  = 114) of the studies specified the pathogen by reporting the number of patients with positive results.

In the 114 studies where the microbiological diagnosis of empyema was specified, various etiological agents were implicated. Streptococcus pneumoniae was highlighted in patients from 92 studies, group A Streptococcus in 42, and Staphylococcus aureus in 91 (Fig.  3 ). In 80 studies, other microorganisms implicated were reported, different from those previously mentioned, including: Haemophilus influenzae , Streptococcus anginosus , Streptococcus viridans , Escherichia coli , Neisseria spp , Klebsiella pneumoniae , Pseudomonas aeruginosa , Fusobacterium necrophorum , coagulase-negative Staphylococcus , Enterococcus spp., Enterobacter aerogenes , Enterobacter cloacae , and influenza A, as well as fungi. Notably, 107 studies documented negative microbiological results.

Description of bacteria involved in the pathogenesis of empyema

Antibiotic treatment

Details on medical therapy were available only in 71 out of the 127 included studies. In 30 cases out of 71, the molecule used was not specified. Of the studies reporting specific antibiotics, the rest of them was mentioned as follows, often administered in combination: in 73.1% ( n  = 30 studies) Ceftriaxone was the most frequent, followed by Vancomycin 46.3% ( n  = 19), Amoxicillin-Clavulanic acid, 41.4% ( n  = 17), Clindamycin 41.4% ( n  = 17), Linezolid 17% ( n  = 7) and Teicoplanin 4.8% ( n  = 2). Furthermore, no studies compared the effectiveness of different antibiotic classes, single vs. combination therapies, or explored variations in treatment durations and administration routes (fully intravenous vs. partial intravenous vs. fully oral).

Surgical management

The studies employed various surgical approaches, as detailed in Fig.  4 . Pleural drainage was the most frequent procedure, reported in 123 studies (97%), intrapleural fibrinolysis in 73 (58%), video-assisted thoracoscopy surgery (VATS) in 79 (62%), surgical treatments as lung decortication or lobectomy in 51 (40%). In 26 studies (20%), all types of surgical techniques were performed, mostly in Europe and Asia, while in 18 (14%) only pleural drainage and in 3 (2%) only VATS was conducted. The remaining studies involved combinations of various surgical techniques. Most studies originated from Asia, Europe and North America, and the application of surgical techniques displayed significant geographical variability.

Surgical treatments performedin studies on pediatric empyema

It’s noteworthy that VATS procedures became more prelevant from 2019 onwards, whereas their use was less consistent in earlier years. Similarly, the use of fibrinolysis primarily began after 2012.

Treatment comparisons

Fifteen studies tried to compare medical treatments (alone or in combination with pleural drainage or fibrinolosis) with more invasive surgical approaches, and 6 studies that compared diverse surgical intervetions. Nearly half of these studies originated from Asia.

To assess the safest and most effective tratmente, these studies employed various criteria, which exhibited significant heterogeneity between studies.

Interestingly, most studies considered the total duration of hospitalization as a marker of treatment severity and, indirectly, treatment success.

However, the different inclusion criteria, diverse pharmacological/surgical approaches and study settings, do not allow to reach firm conclusions. Table  1 summarizes the main findings from those studies that attempted to perform specific therapeutic comparisons [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ].

Mortality data was reported in 100 out of 127 studies. Two studies did not mention mortality in outcome (2/127). Among the studies reporting mortality (25/127), the mortality rate was below the 5% of the sample size (21/25) and under 15% in the rest of cases (4/25). Overall, 78 deaths occurred among the 10,896 children (0.7%) included in the review.

Focusing on the region, mortality was predominantly in developing countries (19/25); the majority were conducted in Asia, while the highest percentages of mortality related to sample size (up to 10% of the sample size) were recorded in studies conducted in Africa.

This scoping review mapped the existing literature on pediatric empyema published over the past 23 years. To the best of our knowledge, this represents the most extensive description of current knowledge in the topic. Overall, we have found that evidence on the topic is still inconclusive and difficult to translate into rigorous guidelines. Aetiologies are frequently reported, with a probable role of molecular assays in improving microbe detection. As expected, S. pneumoniae , Group A Streptococcus and S. aureus are the most frequent pathogens. However, gaps remain: the serotypes of S. pneumoniae are rarely reported, as well as children’ vaccination status. Therefore, the real burden of S. pneumoniae serotype 3 in empyema in vaccinated children remains unclear, as current vaccines may offer/provide lower protection against it [ 38 ]. Studies have in fact described vaccine breakthrough cases of serotype 3 complicated pneumonia in vaccinated children [ 38 ]. Additionally, the distinction between methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) is seldom reported, even though their pathogenicity might differ. Finally, M. pneumoniae was rarely identified as a leading pathogen.

Currently, there are no rigorous guidelines concerning antibiotic treatment for pediatric empyema, and the literature still appears lacking solid scientific evidence, which is why pediatricians relies mainly on expert opinions. It is common to start with empirical broad-spectrum antibiotics which can be switched to narrow-spectrum following examination culture and susceptibility testing also considering local antibiotic resistance. However, while this is what is usually suggested, in routine practice there is confusion in terms of number of drugs, routes and length of antibiotic therapies, as well as optimal surgical approaches.

In general, we observed that the most common performed surgical treatment was pleural drainage, while the less performed one was open surgery, reserved for the most severe cases. Video-assisted thoracoscopic surgery (VATS) and fibrinolysis were performed almost equally. However, the studies included patients with diverse characteristics and employed different criteria for inclusion. Additionally, the causative organisms were often unknown, making it difficult to translate these findings directly into routine clinical practice-. Specifically, a recent ongoing systematic review and meta-analysis, which continuously updates its findings, compared various treatment approaches for pediatric empyema management. This review revealed that therapies such as fibrinolytic therapy, (VATS), and thoracotomy were linked to shorter hospital stays compared to chest tube drainage alone [ 39 ]. However, is it important to acknowledge that assessing hospital length of stay can be subjective, potentially limiting the generalizability of these findings. Notably, short- and long-term morbidity rates were similar across different treatment options, and mortality rates were low across all interventions, consistent with the outcomes observed in our study. In addition, inclusion criteria for the diagnosis of empyema varied. Some studies included biochemical findings in the pleural fluid, while others considered loculations on imaging. However, interpreting pleural fluid loculations can be subjective, and lung ultrasound might be a more reliable imaging tool for this purpose [ 40 ], which however has only recently been significantly implemented in pediatric practice [ 41 ]. Small studies conducted by expert pediatricians in the field found that lung ultrasound seems to be very sensitive in predicting empyema, and may guide therapeutic choices. However, there are currently no trials to evaluate whether children diagnosed with lung ultrasound and given to different pharmacological arms may benefit from one intervention over another.

Importantly, another limitation in the interpretation of available literature is the absence of clinical trials comparing antibiotic therapies while having a fixed surgical intervention, nor trials comparing surgical approaches while having fixed antibiotic therapies. As such, it is challenging to understand the impact of each drug, or surgical intervention, on the patient’s improvement. Our review identified that children often undergo multiple antibiotic treatments due to an apparent lack of clinical response to pharmacological treatment. However, in many cases, it is possible that persistence of fever may not to be attributed to the lack of pharmacological efficacy but could simply be due to the persistence of inflammation. As such, multiple antibiotics are frequently administered, whereas a single effective antibiotic paired with a single effective surgical approach may suffice. The absence of bacteria-specific trials makes it difficult to provide clear treatment recommendations. Also, a recent brief review from the European Society of Pediatric Infectious Disease provides reasonable options rather than defined indications [ 42 ], and also five of the major international societies have similar but still different recommendations [ 43 , 44 , 45 , 46 , 47 ]. Of note, only a few studies have described the role of newer drugs with optimal lung penetration such as linezolid, yet with no trials available.

Importantly, despite the mentioned limitations of the available literature and uncertainties about optimal management, mortality in children with empyema is overall low. However, significant differences have been highlighted between high and low-to-middle income countries. Such differences may be multifactorial, both associated with availability of healthcare resources like intensive care units and surgery, but also pathogen- (e.g., multidrug resistance in specific countries) and host- (e.g., malnutrition, genetics, delay in diagnosis due to socioeconomic issues) related factors. Such differences would need more studies to better understand this point and reduce inequalities in children’s outcomes.

Conclusions

Despite an increase in pediatric empyema research over the past two decades, a significant gap exists in high quality clinical trials. This hinders to fully understand the disease and the optimal surgical approach. While some existing surgical trials suggest potential benefits for fibrinolysis in terms of safety, costs and success rates, the best antibiotic regimen remain unclear. Future well-designed trials should aim to investigate different antibiotics (including newer ones with optimal lung penetration) accompanied by fixed surgical approaches, as well as different surgical interventions accompanied by optimal antibiotic therapies.

Data availability

available upon request to the corresponding author.

Abbreviations

Community-acquired pneumonia

Pneumococcal conjugate vaccine

Computed tomography

Methicillin-susceptible S. aureus

methicillin-resistant S. aureus

Video-assisted thoracoscopic surgery

Maffey A, Colom A, Venialgo C, Acastello E, Garrido P, Cozzani H, Eguiguren C, Teper A. Clinical, functional, and radiological outcome in children with pleural empyema. Pediatr Pulmonol. 2019;54(5):525–30.

Article   PubMed   Google Scholar  

Krenke K, Sadowy E, Podsiadły E, Hryniewicz W, Demkow U, Kulus M. Etiology of parapneumonic effusion and pleural empyema in children. The role of conventional and molecular microbiological tests. Respir Med. 2016;116:28–33.

Article   PubMed   PubMed Central   Google Scholar  

Zhang X, Zhang H. Microbiological characteristics and outcomes of children with pleural empyema admitted to a tertiary hospital in southeast China, 2009–2018. Turk J Pediatr. 2021;63(6):994–1003.

Article   CAS   PubMed   Google Scholar  

Liese JG, Schoen C, van der Linden M, Lehmann L, Goettler D, Keller S, Maier A, Segerer F, Rose MA, Streng A. Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010–2017: a nationwide surveillance study. Clin Microbiol Infect. 2019;25(7):857–64.

Pabary R, Balfour-Lynn IM. Complicated pneumonia in children. Breathe (Sheff). 2013;9:210–22.

Article   Google Scholar  

Sonnappa S, Jaffe A. Treatment approaches for empyema in children. Paediatr Respir Rev. 2007;8:164–70.

Chonmaitree T, Powell KR. Parapneumonic pleural effusion and empyema in children. Review of a 19-year experience, 1962–1980. Clin Pediatr (Phila). 1983;22(6):414–9.

Hamm H, Light RW. Parapneumonic effusion and empyema. Eur Respir J. 1997;10(5):1150–6.

de Benedictis FM, Kerem E, Chang AB, Colin AA, Zar HJ, Bush A. Complicated pneumonia in children. Lancet. 2020;396(10253):786–98.

Fitzwater SP, Chandran A, Santosham M, Johnson HL. The worldwide impact of the seven-valent pneumococcal conjugate vaccine. Pediatr Infect Dis J. 2012;31:501–08.

Byington CL, Korgenski K, Daly J, Ampofo K, Pavia A, Mason EO. Impact of the pneumococcal conjugate vaccine on pneumococcal parapneumonic empyema. Pediatr Infect Dis J. 2006;25:250–4.

Wiese AD, Griffin MR, Zhu Y, Mitchel EF Jr, Grijalva CG. Changes in empyema among U.S. children in the pneumococcal conjugate vaccine era. Vaccine. 2016;34(50):6243–9.

Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, Thomson A, British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011;66(Suppl 2):ii1–23.

Balfour-Lynn IM, Abrahamson E, Cohen G. Et alBTS guidelines for the management of pleural infection in children. Thorax. 2005;60:i1–21.

Hafen GM, Grenzbach AC, Moeller A, Rochat MK. Lack of concordance in parapneumonic effusion management in children in central Europe. Pediatr Pulmonol. 2016;51(4):411–7.

Yeap E, Nataraja RM, Roseby R, McCullagh A, Pacilli M. Factors affecting outcome following video-assisted thoracoscopic surgery for Empyema in Children: experience from a large Tertiary referring Centre. J Laparoendosc Adv Surg Tech A. 2019;29(10):1276–80.

Meyer Sauteur PM, Burkhard A, Moehrlen U, Relly C, Kellenberger C, Ruoss K, Berger C. Pleural tap-guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in children: a single-Center Cohort Study. J Clin Med. 2019;8(5):698.

Kafle SP, Koirala N, Amad E, Rauniyar LP. Bhatta, Mukesh. Empyema Thoracis in children: a five-year analysis from a Tertiary Care Center in Eastern Nepal. J Nepal Paediatr Soc 2022;42 Issue 1:51–6.

Ibarra Rodríguez MR, Garrido Pérez JI, Rueda FV, Murcia Pascual FJ, Wiesner Torres SR, Paredes Esteban RM. Fibrinolysis versus thoracoscopy: comparison of results in empyema management in the child. Ann Thorac Med. 2022;17(3):145–50.

Gautam A, Wiseman G, Legg R, Lindsay D, Puvvadi R, Rathnamma BM, Stalewski H, Norton R, White AV. Management of Pediatric thoracic empyema in the North Queensland Region of Australia and Impact of a local evidence-based Treatment Guideline. Pediatr Infect Dis J. 2022;41(1):1–5.

Balci AE, Eren S, Ulkü R, Eren MN. Management of multiloculated empyema thoracis in children: thoracotomy versus fibrinolytic treatment. Eur J Cardiothorac Surg. 2002;22(4):595–8.

Chan PW, Crawford O, Wallis C, Dinwiddie R. Treatment of pleural empyema. J Paediatr Child Health. 2000;36(4):375–7.

Shankar KR, Kenny SE, Okoye BO, Carty HM, Lloyd DA, Losty PD. Evolving experience in the management of empyema thoracis. Acta Paediatr. 2000;89(4):417–20.

Schultz KD, Fan LL, Pinsky J, Ochoa L, Smith EO, Kaplan SL, Brandt ML. The changing face of pleural empyemas in children: epidemiology and management. Pediatrics. 2004;113(6):1735–40.

Eroğlu E, Tekant G, Erdoğan E, Kuruoğlu S, Emir H, Sarimurat N, Yeker D. Evolving experience in the management of pleural empyema. Eur J Pediatr Surg. 2004;14(2):75–8.

Kalfa N, Allal H, Montes-Tapia F, Lopez M, Forgues D, Guibal MP, Counil F, Galifer RB. Ideal timing of thoracoscopic decortication and drainage for empyema in children. Surg Endosc. 2004;18(3):472–7.

Saleem AF, Shaikh AS, Khan RS, Khan F, Faruque AV, Khan MA. Empyema Thoracis in children: clinical presentation, management and complications. J Coll Physicians Surg Pak. 2014;24(8):573–6.

PubMed   Google Scholar  

Wong KS, Lin TY, Huang YC, Chang LY, Lai SH. Scoring system for empyema thoracis and help in management. Indian J Pediatr. 2005;72(12):1025–8.

Sonnappa S, Cohen G, Owens CM, van Doorn C, Cairns J, Stanojevic S, Elliott MJ, Jaffé A. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med. 2006;174(2):221–7.

Khalil BA, Corbett PA, Jones MO, Baillie CT, Southern K, Losty PD, Kenny SE. Less is best? The impact of urokinase as the first line management of empyema thoracis. Pediatr Surg Int. 2007;23(2):129–33. https://doi.org/10.1007/s00383-006-1806-5 . Epub 2006 Sep 30.

Chen JS, Huang KC, Chen YC, Hsu HH, Kuo SW, Huang PM, Lee JM, Lee YC. Pediatric empyema: outcome analysis of thoracoscopic management. J Thorac Cardiovasc Surg. 2009;137(5):1195–9.

St Peter SD, Tsao K, Spilde TL, Keckler SJ, Harrison C, Jackson MA, Sharp SW, Andrews WS, Rivard DC, Morello FP, Holcomb GW 3rd, Ostlie DJ. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg. 2009;44(1):106 – 11; discussion 111. Erratum in: J Pediatr Surg. 2009;44(9):1865. Rivard, Doug C [added]; Morello, Frank P [added].

Atalay Sahina F, Meteroglua S, Erena C, Erenc, Yusuf Celikb. Evaluation of management of postpneumonic empyema thoracis in children. Annals Pediatr Surg. 2013;9:131–5.

Grisaru-Soen G, Eisenstadt M, Paret G, Schwartz D, Keller N, Nagar H, Reif S. Pediatric parapneumonic empyema: risk factors, clinical characteristics, microbiology, and management. Pediatr Emerg Care. 2013;29(4):425–9.

Budusan A, Paraian I, Zamora D. Surgical management of complicated parapneumonic pleural effusion in children. Clujul Med. 2013;86(3):266–9. Epub 2013 Aug 5.

PubMed   PubMed Central   Google Scholar  

Timuçin Alar C, Özçelik S, Onat. Zerrin Özçelik, Emin Sırrı Bayar. Treatment of pediatric parapneumonic empyemas with pulmonary cavitary lesions. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2013;21(1):84–8.

Google Scholar  

Singh RK, Gurudutta AV, Chandrasekar S, Thomas A. Empyema in Children - Is Primary VATS the Preferred Strategy. J Nepal Paediatr Soc. 2020;40(3):197–201.

Silva-Costa C, Gomes-Silva J, Pinho MD, Friães A, Ramirez M, Melo-Cristino J. Continued vaccine breakthrough cases of serotype 3 complicated pneumonia in Vaccinated Children, Portugal (2016–2019). Microbiol Spectr. 2022;10(4):e0107722.

Fernandez Elviro C, Longcroft-Harris B, Allin E, Leache L, Woo K, Bone JN, Pawliuk C, Tarabishi J, Carwana M, Wright M, Nama N. InsightScope Team. Conservative and Surgical modalities in the management of Pediatric Parapneumonic Effusion and Empyema: a living systematic review and network Meta-analysis. Chest. 2023;164(5):1125–38.

Buonsenso D, Tomà P, Scateni S, Curatola A, Morello R, Valentini P, Ferro V, D’Andrea ML, Pirozzi N, Musolino AM. Lung ultrasound findings in pediatric community-acquired pneumonia requiring surgical procedures: a two-center prospective study. Pediatr Radiol. 2020;50(11):1560–9.

Musolino AM, Tomà P, De Rose C, Pitaro E, Boccuzzi E, De Santis R, Morello R, Supino MC, Villani A, Valentini P, Buonsenso D. Ten years of Pediatric Lung Ultrasound: a narrative review. Front Physiol. 2022;12:721951.

Forster J, Paul P, Liese J. Current management of Pediatric Parapneumonic Pleural effusions and Pleural Empyema. Pediatr Infect Dis J. 2023;42(11):e407–10.

Bradley JS, Byington CL, Shah SS, PediatricvInfectious Diseases Society and the Infectious Diseases Society of America, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the pediatric infectious diseases society and the infectious diseases society of America. Clin Infect Dis. 2011;53:e25–76.

Shen KR, Bribriesco A, Crabtree T, et al. The American Association for thoracic surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg. 2017;153:e129–e146.

Balfour-Lynn IM, Abrahamson E, Cohen G, et al. BTS guidelines for the management of pleural infection in children. Thorax. 2005;60:i1–21

Ried M, Graml J, Großer C, et al. [Para- and postpneumonic pleural empyema: current treatment strategies in children and adults]. Zentralbl Chir. 2015;140:S22–S28.

Strachan R, Gulliver T, Martin A, et al. Paediatric empyema thoracis: recommendations for management: position statement from the Thoracic Society of Australia and New Zealand. 2019.

Download references

Acknowledgements

Not applicable.

The publication of this manuscript was supported by the Laboratory for Clinical Pediatric Research, University of Parma, Parma, Italy (PED-2023-12).

Author information

Authors and affiliations.

Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

Danilo Buonsenso & Francesco Mariani

Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy

Francesca Cusenza, Lucrezia Passadore, Francesca Bonanno, Carolina Calanca, Sonia Rasmi & Susanna Esposito

Medicine and Surgery, Catholic University of Rome, Rome, Italy

Carlotta Di Martino

You can also search for this author in PubMed   Google Scholar

Contributions

DB and SE conceptualized the study. FC, LP, FB, CC, SR were responsible for the whole screening process and data extraction. FM was responsible for the development of the review process and supervision of steps and implementation of Ryaan a.i. platform. CDM was responsible for English revision of the final version of the manuscript. DB and SMRE supervised and coordinated the team. DB, FC, LP, FB, CC, SR, CDM drafted the initial draft. All authors saw and approved the final version of the manuscript. All the authors approved the final version of the manuscript.

Corresponding author

Correspondence to Danilo Buonsenso .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Buonsenso, D., Cusenza, F., Passadore, L. et al. Parapneumonic empyema in children: a scoping review of the literature. Ital J Pediatr 50 , 136 (2024). https://doi.org/10.1186/s13052-024-01701-1

Download citation

Received : 21 May 2024

Accepted : 16 July 2024

Published : 30 July 2024

DOI : https://doi.org/10.1186/s13052-024-01701-1

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Antibiotics

Italian Journal of Pediatrics

ISSN: 1824-7288

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

• Open access
• Published: 31 July 2024

Ozone therapy in musculoskeletal medicine: a comprehensive review

• Madhan Jeyaraman   ORCID: orcid.org/0000-0002-9045-9493 1 ,
• Naveen Jeyaraman   ORCID: orcid.org/0000-0002-4362-3326 1 ,
• Swaminathan Ramasubramanian   ORCID: orcid.org/0000-0001-8845-8427 2 ,
• Sangeetha Balaji   ORCID: orcid.org/0000-0002-1566-1333 2 ,
• Arulkumar Nallakumarasamy   ORCID: orcid.org/0000-0002-2445-2883 3 ,
• Bishnu Prasad Patro   ORCID: orcid.org/0000-0001-9497-9624 4 &
• Filippo Migliorini   ORCID: orcid.org/0000-0001-7220-1221 5 , 6 , 7  

European Journal of Medical Research volume  29 , Article number:  398 ( 2024 ) Cite this article

64 Accesses

1 Altmetric

Metrics details

Musculoskeletal disorders encompass a wide range of conditions that impact the bones, joints, muscles, and connective tissues within the body. Despite the ongoing debate on toxicity and administration, ozone demonstrated promise in managing several musculoskeletal disorders, modulating pain and inflammation. A literature search was conducted. The research design, methods, findings, and conclusions of the studies were then examined to evaluate the physiological effects, clinical application, controversies, and safety of the application of ozone in musculoskeletal medicine. Ozone application demonstrates considerable therapeutic applications in the management of musculoskeletal disorders, including fractures, osteoarthritis, and chronic pain syndromes. Despite these advantages, studies have raised concerns regarding its potential toxicity and emphasized the importance of adhering to stringent administration protocols to ensure safety. Additionally, heterogeneities in patient reactions and hazards from oxidizing agents were observed. Given its anti-inflammatory and analgesic qualities, ozone therapy holds potential in the management of several musculoskeletal disorders. Additional high-quality research with long follow-up is required to refine indications, efficacy and safety profile. Finally, for wider clinical acceptability and utilization, the development of international recommendations is essential.

Introduction

Ozone therapy is an innovative modality which gained growing attention in medical science, especially in musculoskeletal medicine [ 1 ]. Administered as a mixture of oxygen and ozone gases, it stimulates physiological responses, particularly anti-inflammatory and analgesic effects [ 2 , 3 ]. By doing so, ozone therapy is administered in various acute and chronic musculoskeletal disorders such as fractures [ 4 , 5 , 6 ], osteoarthritis (OA) [ 7 , 8 , 9 , 10 ], low back ache [ 11 , 12 ], osteomyelitis [ 13 , 14 , 15 , 16 ], and chronic pain syndromes [ 17 , 18 , 19 ]. Beyond orthopaedic applications, ozone therapy has shown potential in treating conditions such as chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME) using different modalities such as ozonated water, ozone oil, and ozone gas [ 20 , 21 , 22 , 23 , 24 ]. Tailored routes of administration, ranging from enteral ozonated oil [ingestion], enteral ozonated water [ingestion], parenteral oxygen/ozone gas mixture [intramuscular, subcutaneous, intratonsillar, intrathecal, intraperitoneal, periganglionic, intraforaminal, paravertebral, intra-articular, intradiscal, oral submucous, supralaminar, epidural, penile, and intravenous], parenteral ozonated water [intra-tumoral], systemic [minor autohemotherapy (MiAH), major autohemotherapy (MAH), extracorporeal blood oxygenation and ozonation (EBOO), intravenous, and rectal insufflation], topical ozonated water [wound wash, ozonized balneotherapy, mouth wash, irrigation (nasal, sinus, otological, vaginal, intrauterine, intestinal, and intravesical), and sauna therapy, topical oxygen/ozone gas mixture [insufflation (ontological, intrafistula, intrauterine, and intravesical) and hyperbaric bagging], topical ozonated oil [embrocation and inhalation], and topical ozonated saline solution [wound wash, mouth wash, irrigation (saline, ontological, vaginal, intrauterine, and intravesical)], highlight its versatility [ 18 , 25 , 26 , 27 ]. In orthopaedic practice, intramuscular, subcutaneous, intrathecal, periganglionic, intraforaminal, paravertebral, intra-articular, intradiscal, oral submucous, supralaminar, epidural, intravenous routes are used. However, besides its therapeutic potential, concerns about ozone toxicity and the importance of adhering to safe administration protocols cannot be overlooked [ 21 , 25 , 26 , 28 ]. Prolonged inhalation of tropospheric ozone has been linked to detrimental impacts on the respiratory system and vital organs, inducing chronic oxidative stress and inflammation across multiple organs [ 29 ]. However, in controlled therapeutic settings, ozone therapy has demonstrated calculated oxidative stress induction, which activates therapeutic benefits without resulting in acute or chronic toxicity [ 29 ]. Caution is warranted to ensure that ozone doses do not surpass the blood’s antioxidant capacity to prevent potential toxicity [ 30 ]. While ozone therapy has the potential to enhance erythrocyte characteristics, correct hypoxia in diseases, and increase ATP levels through glycolysis activation, precise application is essential to avoid toxicity concerns [ 30 ]. The existing evidence is divided between its clinical benefits and potential risks as an oxidizing agent, further nuanced by variability in patient responses [ 28 ]. Despite its environmental implications as a pollutant, when administered under controlled conditions, ozone therapeutic potential in musculoskeletal conditions, including OA and herniated discs, is documented [ 20 , 25 , 26 ]. Therefore, ozone therapy emerges as a potent yet intricate intervention, necessitating further in-depth scientific scrutiny.

Numerous studies have explored ozone therapy, yet discrepancies persist, yielding variable results. Existing literature on ozone therapy reveals research gaps: limited comparative studies between treatments, unclear safety and effectiveness in various musculoskeletal conditions and insufficient understanding of anti-inflammatory effects [ 3 , 18 , 31 ]. Reviews frequently concentrate on specialized areas, prompting the necessity for a comprehensive review to address lacunae. In light of these controversies, this review critically evaluates the current evidence on the utilization of ozone in musculoskeletal disorders.

Effects of ozone

Ozone therapy, with its multifaceted therapeutic capacities, has demonstrated notable physiological effects across various medical arenas. Its primary mechanism centres on enhancing tissue oxygenation, an indispensable component of cellular metabolism, by augmenting oxygen delivery to hypoxic tissues, thereby fostering optimal conditions for metabolic and repair processes [ 20 , 26 , 32 ]. For systemic administration of ozone, such as in major autohemotherapy (MAH), the concentration range should fall within 10–40 μg/mL, with 10–20 μg/mL of blood considered biologically relevant. It is advisable to administer a total ozone amount of 500–1000 μg per 50 mL of blood during MAH treatment. This induces the production of pharmacologically active hydroxy hydroperoxides, referred to as “ozone peroxides” [ 15 , 25 ]. These compounds play a pivotal role in modulating endogenous antioxidant systems, particularly through interactions with the glutathione system [ 15 ]. A salient feature of ozone therapy is its proficiency in managing oxidative stress (Fig.  1 ), amplifying cellular antioxidant mechanisms while tempering the formation of reactive oxygen species (ROS) [ 3 , 33 ]. Specifically, ozone engages with cysteine residues and glutathione, catalysing signal processes that support the bioregulation of enzymatic antioxidants [ 15 ]. This aptitude for oxidative stress modulation is important in conditions marked by persistent inflammation and immune system anomalies [ 3 , 17 ]. Notably, ozone moderates inflammation by curtailing pro-inflammatory cytokines, such as interleukin 6 (IL-6), and simultaneously promotes anabolic activity, as evident by elevated insulin-like growth factor 1 (IGF-1) levels [ 33 , 34 ]. In addition, ozone therapy exerts a regulatory effect on key transcription factors: it activates Nrf2, endorsing antioxidant and anti-inflammatory responses, while concurrently inhibiting NF-kB, integral in inflammation regulation [ 18 , 33 , 35 , 36 ]. The therapy also modulates the synthesis of prostaglandins, impacts bradykinin release [ 26 ], and optimizes immune functions, particularly enhancing the activity of macrophages pivotal to immune reactions [ 3 , 17 ]. From a tissue repair and angiogenesis standpoint, ozone therapy stimulates the expression of proteins such as collagen I, α-SMA, and TGF-β1, facilitating fibroblast activity [ 22 ]. It also upregulates growth factors, including vascular endothelial growth factor (VEGF) and transforming growth factor-beta (TGF-β), fostering enhanced tissue regeneration [ 23 , 33 ]. Moreover, the activation of cellular signalling pathways like the PI3K/Akt/mTOR axis underscores its role in promoting the epithelial–mesenchymal transition (EMT) process [ 22 , 37 ].

Physiological effects of ozone

Clinically, ozone therapy has been effective in pain management, addressing conditions such as low back pain [ 18 ] and rotator cuff calcific tendinitis [ 38 ] (Fig. 2 ). Its influence extends to ameliorating microcirculatory disturbances seen in bone necrosis [ 1 ] and positively adjusting serum physiological markers, including total antioxidant capacity and lactate dehydrogenase [ 14 ], alongside inflammatory markers like the erythrocyte sedimentation rate [ 13 ]. The nuanced mechanisms of action underlying ozone therapy, ranging from improved oxygenation and oxidative stress modulation to anti-inflammatory effects, immune system enhancements, and tissue repair, validate its rising interest as a potential adjunctive treatment for several medical conditions. Its multifaceted physiological interactions render it an asset in contemporary clinical practice.

Applications of metamizole in musculoskeletal medicine

Clinical applications of ozone in orthopaedics

Fracture non-union posed challenges in orthopaedic medicine, prompting the exploration of novel approaches [ 39 ]. In this context, ozone therapy garnered attention for its potential to enhance bone healing. Experimental studies using animal models, especially those with critical size defects, have demonstrated its efficacy. Duman et al. documented improved aspects of bone healing in a rat femoral fracture model with ozone therapy, noting enhanced union, bone formation, and bone marrow organization [ 40 ]. These findings align with those of Irban et al., who observed increased periosteal thickness and trabecular formation, thereby solidifying ozone therapy prospective role in bone regeneration [ 41 ]. These preclinical insights are bolstered by clinical evidence underscoring the therapy benefits. Shah et al. detailed a case wherein ozone therapy expedited wound healing and infection resolution over a tibial area, resulting in the patient regained ability to walk within 20 months [ 42 ]. Beyond fracture healing, ozone therapy has demonstrated effectiveness in pain management. Sconza et al. identified a comparable efficacy between ozone therapy and hyaluronic acid injections for knee OA pain alleviation and functional improvement [ 8 ]. Additionally, in comparison with low-level laser therapy, ozone therapy evidenced superior performance in promoting bone formation in rat calvarial defects [ 5 ]. Irban et al. conducted a comprehensive examination revealing ozone therapy profound impact on bone healing. Beyond the observed increase in periosteal thickness and trabecular areas, there was a marked elevation in vital growth factors and proteins, such as VEGF, β-catenin, and TGF-β, in the ozone-administered group versus the control [ 41 ]. Nevertheless, while the existing evidence is promising, it is crucial to address the current methodological limitations. Bennett et al. systematic review highlighted concerns regarding the quality of studies on the prevention or treatment of fracture non-union, pinpointing issues like lack of method standardization, inconsistent outcome measures, and inadequate reporting, which currently hampers the feasibility of meta-analyses [ 4 ].

Osteoarthritis

The advent of ozone therapy modalities, specifically O 2 –O 3 therapy and oxygen–ozone therapy (OOT), has significantly enriched the therapeutic spectrum for knee OA. These interventions, recognized for their ability to modulate oxidative stress and suppress pro-inflammatory cytokines, offer pain relief and functional enhancement in patients with knee OA [ 3 , 43 , 44 ]. Ozone therapy yields outcomes in pain, stiffness, and overall function comparable to the traditionally favoured hyaluronic acid injections [ 8 ]. Fernandez et al. observed its effectiveness through intra-articular injections for knee OA, resulting in symptomatic relief and improved physical function [ 33 ]. Comparative trials, such as those juxtaposing the efficacy of ozone prolotherapy and intra-articular hypertonic saline, found both modalities to be therapeutically analogous [ 45 ]. Periodic intra-articular ozone injections have been advocated for their consistent pain amelioration, joint function enhancement, and overall quality of life improvement, alongside a commendable safety profile [ 10 ]. These favourable findings merit a balanced perspective. A systematic review of randomized controlled trials (RCTs) pinpointed the generally subpar methodological quality in the prevailing research on this topic [ 4 ]. A previous review on OOT for knee OA reinforced this finding, suggesting that while short to medium-term results were encouraging, the included RCTs exhibited discernible methodological constraints [ 8 ]. When juxtaposing ozone therapy with hyaluronic acid injections, both modalities manifested significant advancements in pain, stiffness, and function across various time points, including 1, 3, and 6 months of follow-ups [ 46 ]. The anti-inflammatory and anabolic attributes of ozone therapy have garnered notable attention. Fernandez-Cuadros et al. documented reductions in inflammatory markers such as interleukin-6 (IL-6), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and uric acid, coupled with pain alleviation and functional improvements spanning all grades of knee OA [ 33 ]. Farpour et al. findings echoed this, revealing that both ozone prolotherapy and intra-articular hypertonic saline injections offered parallel therapeutic benefits [ 45 ]. Moreover, a specific RCT highlighted the potential of weekly ozone injections over 8 weeks, emphasizing discernible pain reduction, improved joint functionality, and enhanced life quality [ 10 ]. While the prevailing literature accentuates the prospective benefits of ozone therapy in knee OA management, it simultaneously underscores methodological inadequacies in the current research landscape. To unequivocally establish ozone therapy standing as an efficacious knee OA treatment, there is an undeniable need for comprehensive, multicentre RCTs with extended follow-ups to corroborate its long-term benefits and reliability.

Osteonecrosis of the femoral head

Ozone therapy has emerged as a promising alternative in treating osteonecrosis of the femoral head, especially for patients unresponsive to traditional therapeutic approaches. The therapy effectiveness is rooted in its capacity to promote neovascularization and immunoregulation, both pivotal for repairing hypoxic-ischaemic necrosis in the femoral head [ 1 , 47 ]. Elucidating the molecular underpinnings of this treatment, An et al. highlighted the influence of differentially expressed genes, suggesting that individualized ozone therapy regimens, tailored to specific molecular markers, could be developed [ 1 ]. Complementary findings by An et al. showcased the augmented benefits of conjoining intra-articular O 2 –O 3 hip injections with O 3 -AHT (autohemotherapy). Such a combination not only ameliorated enduring pain, but also aided in mitigating bone marrow oedema across diverse stages of osteonecrosis of the femoral head. Importantly, differential clinical outcomes between patients responsive and non-responsive to ozone therapy underscored the significance of immunoregulatory pathways, particularly spotlighting the impact of mitotically active lymphocytes in modulating treatment efficacy [ 1 ]. Branching out from osteonecrosis of the femoral head, the therapeutic scope of ozone therapy has been assessed in other conditions like avascular bisphosphonate-induced jaw osteonecrosis [ 48 , 49 , 50 , 51 ]. Agrillo et al. indicated that over half of the participants experienced full lesion healing and symptom abatement, with another 30% witnessing substantial lesion diminution and symptom relief. Even though lesions persisted relatively unchanged in 16% of the patients, they still reported some alleviation in symptoms, suggesting that ozone therapy might be an effective alternative to more invasive interventions, such as bone ablation surgery, particularly for bisphosphonate-induced related jaw osteonecrosis cases [ 51 ].

Osteomyelitis

Ozone therapy potential as a treatment for osteomyelitis, a challenging bone infection often unyielding to conventional modalities, has garnered increasing attention in both clinical and preclinical domains. Yasheng et al. demonstrated the effectiveness of a treatment approach combining ozonated water lavage, physiological saline irrigation, and vacuum-sealed drainage for chronic osteomyelitis. This regimen yielded significant bacterial clearance and stimulated granulation tissue formation, attesting to ozone therapy potential as a reliable intervention [ 16 ]. Further, Shetty et al. highlighted its adaptability in specialized cases, showcasing its efficacy in neonatal mandibular osteomyelitis when combined with intravenous vancomycin antibiotics. The route of ozone administration involves the local application of ozonated water to the lesional site. The ozonated water is prepared by infusing three cycles of ozonated gas into 100 mL of saline over a 24-h p24 hours [ 52 ]. Animal studies bolster these clinical observations. Bilge et al., using a rat osteomyelitis model, noted improved histopathological parameters, suggesting ozone therapy has potent anti-inflammatory attributes [ 14 ]. Focusing on inflammatory markers, Nabi et al. reported the therapy positive impact on indices like the erythrocyte sedimentation rate, documenting a commendable 86.66% recovery in a patient cohort [ 13 ]. This line of exploration aligns with Shah et al. emphasis on ozone inherent disinfectant and antibacterial properties, positioning it as a beneficial option for extensive orthopaedic conditions, including osteomyelitis [ 42 ]. Furthermore, ozone therapy role extends to conditions such as bisphosphonate-related jaw osteonecrosis. Agrillo et al. evidenced complete healing in a significant patient proportion and substantial symptom relief in others [ 51 ]. An RCT delving into ozone therapy for chronic osteomyelitis showed the treatment group exhibiting marginally improved recovery rates and inflammatory indices, without notable adverse events, although the observed difference was not statistically significant [ 13 ].

Adhesive capsulitis

Recent randomized controlled trials have sought to discern the optimal treatment strategy for adhesive capsulitis of the shoulder. Foula et al. compared the therapeutic merits of ultrasound-guided intra-articular injections, specifically contrasting ozone, steroid, and pulsed radiofrequency. The equipment utilized in the study employed platelet-rich fibrin (PRF) generators, which emit oscillating pulses spanning a frequency range of 420–500 kHz. These pulses have an amplitude of 45 V and a duration of 20 ms, followed by a silent period lasting 480 ms. Their results indicated the superior long-term efficacy of pulsed radiofrequency in symptom alleviation compared to its counterparts, ozone and steroid injections [ 53 ]. Another study echoed the benefits of these ultrasound-guided intra-articular injections in treating shoulder adhesive capsulitis. It documented marked improvements in pain, disability, range of motion (ROM), and inflammation across all intervention groups. Notably, visual analogue scale (VAS) scores during movement exhibited significant enhancements from the second week onward, persisting through the fourth and eighth weeks for all interventions. The steroid group, in particular, showed early improvements with VAS scores at rest enhancing from the initial week. ROM and the Shoulder Pain and Disability Index (SPADI) scores also reported progress from the second week. Moreover, consistent reductions in inflammatory markers, intercellular adhesion molecule-1 (ICAM-1), and high-sensitivity C-reactive protein (hs-CRP), were observed across the groups [ 53 ]. While both studies validate the efficacy of ultrasound-guided intra-articular injections in managing adhesive capsulitis symptoms, Foula et al. findings distinctly spotlight pulsed radiofrequency advantage for sustained symptom relief [ 53 ]. Concurrently, the subsequent study provides a more holistic perspective, underscoring the significant short-term benefits of both ozone and steroid injections, in addition to pulsed radiofrequency. Thus, pulsed radiofrequency stands out for its long-term therapeutic potential. Still, all modalities, including ozone and steroids, remain significant contenders in the short-term therapeutic landscape for adhesive capsulitis of the shoulder.

Tendinopathies

Ozone therapy is progressively gaining prominence in managing various musculoskeletal conditions, especially tendinopathies [ 20 , 38 , 54 , 55 , 56 ]. Hidalgo-Tallon et al., spotlighted the therapy efficacy in treating subacromial tendinopathy, illustrating its advantage over mesotherapy and steroid injections [ 2 ]. Complementary research by Dong et al. [ 38 ] and Atar et al. [ 56 ] further substantiated these findings, suggesting ozone therapy potential in managing conditions like rotator cuff calcific tendinitis and chronic supraspinatus tendinopathy. These studies suggest that ozone injections are comparable to corticosteroid injections in alleviating symptoms. Further broadening the scope of ozone therapy, the modality matches corticosteroid injections in delivering significant relief from chronic plantar fasciitis [ 55 ]. This not only accentuates ozone therapy versatility, but also positions it as a potent alternative to established treatments. In the realm of sports medicine, the ozone therapy utility is becoming apparent. Hidalgo-Tallon et al. showcased ozone therapy benefits in managing hamstring injuries among professional athletes, noting pronounced pain reduction and functional improvements [ 57 ]. Seyam et al. highlighted positive outcomes from ultrasound-guided ozone therapy for partial supraspinatus tendon tears [ 20 ]. Furthermore, with an emphasis on compassionate care and treatment-resistant cases, Hidalgo-Tallon et al. proposed ozone therapy as an invaluable tool [ 2 ]. While ongoing research is geared towards elucidating ozone therapy comprehensive efficacy relative to corticosteroid injections in treating rotator cuff calcific tendinitis, definitive outcomes remain anticipated [ 38 ]. Additionally, animal studies such as the one by Gurger et al. spotlight the augmented effect of combining ozone therapy with platelet-rich plasma (PRP) on tendon-to-bone healing. This particular study revealed the duo potential in enhancing biomechanical strength, collagen fibre continuity, and alignment, thus hinting at the possibility of using ozonized PRP as a biological catalyst in tendon healing processes [ 58 ]. Lastly, Atar et al. randomized controlled trial buttressed the comparable therapeutic potency of ozone and corticosteroid injections for chronic supraspinatus tendinopathy in terms of pain relief, life quality, and functionality, though emphasizing the need for extended studies to gauge long-term outcomes [ 56 ].

Rheumatic pathologies

Ozone therapy has emerged as a noteworthy intervention in the realm of rheumatic diseases, driven primarily by its capacities to modulate oxidative stress and attenuate pro-inflammatory cytokines [ 3 ]. Rheumatoid arthritis stands as a significant context where ozone therapy is increasingly being validated for methotrexate (MTX) efficacy for clinical response and improves cellular redox balance [ 59 , 60 , 61 ]. In animal models induced by Freund complete adjuvant and another experimental model, studies by Bozbas et al. and Zhao et al., respectively, observed marked attenuation of symptoms, histopathological signs of inflammation, and reductions in pro-inflammatory cytokines [ 62 , 63 ]. Furthermore, Patel et al. postulate the potential dual application of ozone therapy, both as a primary treatment and synergistically alongside stem cell therapy or natural medicines [ 64 ]. Complementing its standalone utility, ozone therapy demonstrates promise as an adjunctive approach in conventional treatment protocols for rheumatoid arthritis. Fernandez et al. explored its potential combined with methotrexate (MTX), finding enhanced therapeutic outcomes of MTX in rheumatoid arthritis [ 61 ]. This combined approach not only mitigated disease activity, but also reinforced the antioxidant system, accentuating ozone therapeutic complementarity [ 61 ]. Beyond rheumatoid arthritis, the application spectrum of ozone therapy expands to other rheumatic conditions. Studies by Seyam et al. and Tartari et al. also spotlighted ozone therapy role in modulating oxidative damage in systemic sclerosis and its potential applicability in systemic autoimmune rheumatic diseases via cytokine profile adjustments [ 20 , 60 ]. However, nuances exist in the broader application of ozone. Zhao et al. study pointed to a correlation between fine particulate matter (PM2.5) exposure and systemic autoimmune rheumatic diseases, yet did not firmly link ozone exposure with the onset of these diseases [ 63 ]. While another study affirmed ozone therapy benefits in reducing inflammation and arthritis severity in an animal model with rheumatoid arthritis, the alterations in oxidative stress markers remained statistically inconclusive [ 62 ].

Chronic pain syndromes

Ozone therapy has solidified its position as an effective therapeutic modality in managing an array of chronic pain conditions. Particularly, intramuscular injections of the O 2 –O 3 mixture have shown significant efficacy in alleviating cervicobrachial pain, with discernible reductions in VAS pain scores [ 65 , 66 ]. Parallel to this, intramuscular paravertebral lumbar injections of the mixture have proven fruitful in addressing low back pain, as reflected by reductions in VAS scores and enhancements in the Oswestry Disability Index (ODI) scores [ 11 ]. This is further substantiated by studies by Andrade et al. and Biazzo et al., which emphasize the minimally invasive and effective nature of ozone therapy in lumbar pain management [ 11 , 12 ]. A meta-analysis considering ozone therapy role in lumbar pain underscores its therapeutic potential but also signals the necessity for caution due to the high or uncertain risk of bias in some of the assessed trials [ 12 ]. Beyond specific pain syndromes, ozone therapy exhibits broader mechanisms, such as oxygenation, immune modulation, and anti-inflammatory action, and has been applied to other chronic conditions like ME/CFS and CFS [ 17 , 67 , 68 , 69 ]. Furthermore, its efficacy has been observed to be comparable, if not superior, to standard treatments in Pain Units, especially when conventional therapies fall short [ 2 ]. The treatment adaptability was further highlighted in a case report detailing its successful application in an 11-year-old with Complex Regional Pain Syndrome and pseudo-seizures, marking a full remission post-intervention [ 17 ]. Delving into synergistic applications, Patel presented the intriguing prospect of combining ozone therapy with stem cell interventions, particularly for rheumatoid arthritis. However, this proposal is nascent and requires in-depth exploration for both safety and effectiveness [ 64 ]. While ozone therapy therapeutic potential is increasingly acknowledged, there exists a clear mandate for more robust scientific investigation. Tartari et al. emphasize the need for clarity in indications, protocol optimization, and pinpointing the patient demographics most likely to benefit [ 60 ]. Thus, despite the growing advocacy for ozone therapy as a versatile and efficient treatment modality in chronic pain management, its broad clinical application demands further empirical rigour.

Fibromyalgia

Ozone therapy has emerged as a viable therapeutic option in addressing chronic conditions marked by fatigue and musculoskeletal pain, particularly myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) [ 67 , 68 , 69 , 70 ] and fibromyalgia [ 71 , 72 , 73 , 74 ]. In patients with ME/CFS, oxygen–ozone autohemotherapy (O 2 –O 3 -AHT) has been linked to significant clinical advantages. After O 2 –O 3 -AHT, approximately 43.5% of participants experienced a marked reduction in fatigue symptoms, with these benefits persisting for at least 3 months across diverse demographics [ 68 ]. The therapy impact on ME/CFS extends beyond symptom alleviation, showing potential in modulating metabolic pathways, oxidative stress, antioxidant systems, and immune and inflammatory responses [ 67 ]. Simultaneously, for fibromyalgia, a condition which shares many symptomatic parallels with ME/CFS, rectal insufflation ozone therapy has shown significant therapeutic potential [ 66 ]. Hidalgo-Tallon et al. observed substantial improvements in fibromyalgia patients’ physical symptoms, as reflected by decreased Fibromyalgia Impact Questionnaire scores within the initial 4 weeks of intervention [ 66 ]. In addition to physical improvements, the therapy also positively influenced psychological parameters, evident from reduced depression scores and enhanced Physical Summary Scores on the SF-12 questionnaire [ 66 ]. Subsequent research has affirmed these findings, with notable reductions in fatigue and psychological distress in fibromyalgia patients post-ozone therapy [ 25 , 41 ]. While transient meteorism was occasionally reported, the side effects did not negate the overall beneficial outcomes of the therapy [ 66 ]. Furthermore, in a distinct study focusing on CFS, an impressive 70% of patients reported significant symptom alleviation, with the treatment presenting no major adverse effects [ 67 ]. Collectively, ozone therapy, whether through O 2 –O 3 -AHT or rectal insufflation, provides a robust therapeutic approach to the comprehensive challenges presented by ME/CFS and fibromyalgia. The therapy multifaceted mechanisms of action, coupled with its evident safety profile [ 67 , 68 , 69 ], advocate for its consideration, especially for patients who have found limited relief with other treatments [ 69 ].

Miscellaneous

Ozone therapy has been identified as a versatile therapeutic modality, demonstrating efficacy across diverse medical conditions. For avascular bisphosphonate-related jaw osteonecrosis, approximately 54% of patients achieved complete lesion healing following an average treatment duration of 6.5 months, suggesting its potential in managing such conditions [ 51 ]. Furthermore, ozone therapy has demonstrated longer-lasting symptom relief for chronic plantar fasciitis compared to corticosteroids [ 55 ].

In orthopaedics, ozone therapy has been examined for its benefits in a range of conditions, from temporomandibular joint disorders to low back pain and carpal tunnel syndrome [ 8 , 11 , 15 ]. Its application has also been extended to chronic wound and ulcer management. Topical and injected ozone treatments have enhanced wound healing by reducing inflammation, facilitating rapid wound closure, and promoting angiogenesis and fibroblast proliferation, as evident from animal studies [ 22 , 23 ]. Case studies and systematic reviews, such as those by Fitzpatrick et al. and Romary et al., highlight the efficacy of ozone therapy in promoting wound healing, especially in chronic wound scenarios [ 24 , 75 ]. Particularly for diabetic foot ulcers, ozone therapy has been credited for reducing wound size and amputation rates [ 76 , 77 , 78 , 79 , 80 ].

The mechanistic attributes of ozone therapy in tissue repair have also been explored. Studies highlight its role in promoting fibroblast migration, stimulating epithelial–mesenchymal transition via the PI3K/Akt/mTOR pathway, and augmenting angiogenesis [ 22 , 23 ]. A notable case study indicated the potential of combined ozone therapy in promoting the healing of extensive tibial wounds, enhancing the patient mobility [ 42 ]. In sports medicine, ozone therapy has proven valuable in managing injuries such as those in professional athletes with hamstring injuries, resulting in diminished pain, improved mobility, and enhanced perfusion [ 57 , 77 , 78 ]. Its safety and effectiveness are also corroborated by systematic reviews in pain medicine for conditions like knee OA [ 2 ]. The significant research findings and merits and de-merits of ozone therapy for various musculoskeletal conditions are jotted in Tables 1 and 2 , respectively.

Complications of ozone therapy

Ozone therapy, increasingly recognized in the scientific literature for its therapeutic potential, has demonstrated a commendable safety profile across various clinical applications when administered following established guidelines and employing an atoxic system. Clinical trials predominantly document mild and self-limiting adverse effects such as abdominal distension, lower limb hypoesthesia, and transient pain exacerbation, which typically resolve without necessitating extensive medical intervention [ 4 , 21 , 25 , 26 , 66 ]. Specifically, within the realm of musculoskeletal disorders, ozone therapy, in conditions like knee OA, has showcased a safety profile commensurate with hyaluronic acid injections, with both modalities yielding only mild, transient adverse events [ 33 , 46 ]. This safety spectrum further extends to osteomyelitis, as evidenced in a rat model study, wherein ozone therapy augmented antioxidant mechanisms devoid of adverse reactions [ 14 ]. In treating chronic wounds and ulcers, studies have reiterated the minimal risk profile of ozone therapy, emphasizing its efficacy in wound healing [ 80 ]. Nonetheless, potential complications arising from specific administration methods, such as the use of polyvinyl chloride (PVC) auto-transfusion bags contaminated with excessive citrate–phosphate–dextrose (CPD), warrant vigilance [ 21 ]. Puncture accidents during therapy and risks in populations like the elderly or those with decompensated conditions merit careful consideration [ 10 , 12 ].

Contraindications to ozone therapy are unambiguously defined, encompassing conditions like latent hypoglycaemia, hyperthyroidism, favism (due to G-6PD deficiency), pregnancy, and sickle cell anaemia. The use of angiotensin-converting enzyme (ACE) inhibitors also mandates caution with ozone therapy [ 20 , 21 ]. These contraindications are rooted in potential risks such as the prospect of hemolysis in G-6PD deficiency, mutagenic concerns during early pregnancy, and asthmatic hypersensitivity.

Prolonged exposure to ozone may adversely affect the respiratory system, fostering the release of deleterious compounds into the bloodstream and potentially resulting in multiorgan damage [ 81 ]. Cells with deficient antioxidant activity are especially vulnerable to mutagenic alterations with sustained ozone exposure [ 82 ]. High concentrations of ozone can induce DNA oxidation and exhibit genotoxic effects [ 83 ]. Within the pulmonary milieu, ozone interaction with unsaturated fatty acids can yield lipid ozonation products, engendering lipid peroxidation, perturbed membrane permeability, and subsequent activation of inflammatory mediators [ 84 ]. When ozone commingles with nitrogen dioxide (NO 2 ), the ensuing photochemical smog can intensify detrimental effects. Fortunately, antioxidants like vitamins E and C, along with anti-inflammatory agents like indomethacin, can serve as protective countermeasures against such adversities [ 20 , 21 ].

Limitations of ozone therapy

Ozone therapy, emerging as a promising therapeutic modality across diverse medical conditions, including osteonecrosis of the femoral head (ONFH) and orthopaedic disorders, has garnered considerable attention. Despite promising clinical observations [ 1 , 5 , 20 , 28 , 51 , 69 ], the present study has methodological challenges which negatively impact the robustness of the findings. Notably, the prevalence of studies with small sample sizes underscores the imperative for investigations with expansive patient cohorts and prolonged follow-ups to affirm these preliminary insights [ 20 , 46 , 69 , 80 ]. The methodological quality of much extant research tempers the interpretability of results. A significant portion of these studies exhibit a high or uncertain risk of bias [ 8 , 12 ], highlighting the exigency for methodologically rigorous investigations to validate the therapeutic potential of ozone therapy [ 2 ]. A marked inconsistency in treatment protocols, as underscored by Fernandez-Cuadros et al. regarding knee OA [ 33 ], underlines the need for standardized approaches. Such consistency can lay the foundation for evidence-based guidelines, fostering the safe and efficacious deployment of ozone therapy in clinical contexts. A paramount lacuna in our current comprehension pertains to the elucidation of the exact biological and physiological mechanisms underpinning ozone therapy effects. This knowledge gap is accentuated in conditions like ONFH, where hypotheses around ozone role in neovascularization and immunoregulation remain speculative [ 1 ]. Sire et al. further highlight the necessity to broaden the research spectrum to encompass additional musculoskeletal disorders, enriching our understanding of ozone therapy applications in orthopaedics [ 18 ]. Deciphering these mechanisms is pivotal to refine and optimize treatment protocols. While the promise of ozone therapy in contexts such as wound healing in diabetic foot ulcers is evident [ 80 , 85 ], the call for high-quality randomized controlled trials (RCTs) reverberates, especially when venturing beyond specific wound types. This is emblematic of the overarching need for comprehensive, methodologically sound trials which shed light on ozone therapy influence on inflammatory mediators and its broader clinical implications [ 3 ]. Despite ozone therapy prospective benefits, it encounters significant barriers to its mainstream medical integration, most prominently the absence of FDA approval and a paucity of evidence corroborating its expansive efficacy [ 17 , 86 , 87 ]. Overcoming these challenges demands the undertaking of well-constructed research studies, adhering to rigorous scientific paradigms. By redressing these research inadequacies, the scientific community can proffer compelling evidence which vindicates the place of ozone therapy in contemporary healthcare, emphasizing its efficacy and safety vis-à-vis conventional treatments [ 24 , 75 , 80 ].

Level of evidence of ozone in orthopaedics

In this paper, the cited evidence is classified according to the Oxford Centre for Evidence-based Medicine hierarchy. Foremost, Level 2 evidence, encompassing randomized controlled trials (RCTs) and systematic reviews with meta-analyses, offers the most robust validation. This calibre of evidence prominently features in discussions on osteoarthritis, osteomyelitis, tendinopathies, rheumatic pathologies, and chronic pain syndromes. The methodological rigour of Level 2 studies engenders heightened confidence in the outcomes they present as mentioned in Table  3 . Subsequently, Level 3 evidence, characterized by non-randomized controlled trials and case–control studies, emerges in contexts such as avascular necrosis, osteomyelitis, adhesive capsulitis, chronic pain syndromes, and fibromyalgia. Though not mirroring the exacting standards of Level 2 research, these Level 3 studies furnish indispensable foundational knowledge, potentially guiding subsequent, more rigorous investigations.

Lastly, a solitary study, a systematic review assessing preclinical therapies for fracture non-union, is identified as Level 4 evidence. While systematic reviews are typically accorded a higher evidential standing, the specific methodological approach of this review positions it within the Level 4 category. In summary, the literature predominantly aligns with Level 2 and Level 3 evidence, reflecting a considerable degree of scientific rigour. The limited representation of Level 4 evidence, confined to a single systematic review of fractures, accentuates the depth of the findings while simultaneously highlighting domains warranting further high-level research to corroborate assertions across diverse medical contexts.

Future prospective

The advancement of ozone therapy scientific foundation in orthopaedics demands stringent, meticulously designed randomized controlled trials with expanded sample sizes and prolonged follow-up periods [ 4 , 8 , 11 , 15 , 22 ]. Such studies should prioritize consistent, objective outcome measures to elevate their methodological quality, enabling a clearer comparison of various treatments [ 4 ]. It is essential that research impartially delineates the pros and cons of ozone therapy. A focal area of inquiry should be the interplay between constant oxidative stress and the episodic acute stress invoked by ozone treatments, a realm presently marked by uncertainty [ 40 ]. Deepening our comprehension of the molecular underpinnings guiding therapeutic responses is pivotal, not only to academic discourse but also in refining and personalizing treatment regimens for specific orthopaedic afflictions [ 1 , 28 , 65 , 85 ]. For the therapy to achieve broader clinical acceptance, the establishment of standardized guidelines is paramount. These guidelines would encapsulate the best practices for ozone administration, thereby ensuring uniformity in therapeutic approaches and the consequent predictability of clinical outcomes [ 66 ]. The identification of differentially expressed genes between positive responders and non-responders to ozone therapy can offer insights into predicting therapeutic outcomes, facilitating a more personalized therapeutic strategy [ 1 ]. Research endeavours should encompass a detailed exploration of optimal dosages, session frequencies, and treatment durations, ensuring maximized therapeutic potential across varied orthopaedic conditions [ 3 , 66 ]. Furthermore, expansive multicentre prospective studies can enhance the validation of ozone therapy’s therapeutic and safety profiles, extending its reach to broader patient demographics with a multitude of clinical conditions [ 1 , 52 , 88 , 89 , 90 , 91 , 92 ]. Emphasis should also be placed on examining the specific impacts of topical ozone treatments, such as ozonated water and oils, which currently lack comprehensive evaluation in human studies [ 75 ]. The fortification of ozone therapy’s role in orthopaedics necessitates a multifaceted research approach. This encompasses the execution of rigorous trials, a deeper investigation into molecular mechanisms, and the formulation of standardized treatment protocols. Through such integrated efforts, the orthopaedic community can establish a solid evidence base, ensuring the effective and reliable clinical integration of ozone therapy.

Ozone therapy, with its multifaceted potential, is steadily gaining prominence across diverse clinical domains, notably within orthopaedics. At the physiological level, the therapy exhibits attributes crucial for orthopaedic interventions, including enhanced tissue oxygenation, modulation of oxidative stress, and anti-inflammatory properties. Such mechanisms provide potential relief in conditions such as knee OA, chronic osteomyelitis, and various chronic pain syndromes, positioning ozone therapy as a valuable adjunct or alternative when conventional treatments fall short. While the merits are evident, a comprehensive endorsement of ozone therapy in mainstream clinical practice awaits a more robust body of evidence. The imperative lies in rigorous research endeavours, particularly well-executed randomized controlled trials, to address current methodological limitations. Comprehensive studies must also delve into the precise mechanisms underpinning ozone therapy therapeutic impacts. Alongside this, the establishment of standardized treatment guidelines will be vital for its broader clinical acceptance and application. Until consolidated evidence emerges, clinicians should approach ozone therapy with circumspection, calibrating its use based on individual patient needs and clinical contexts. In essence, while ozone therapy offers considerable promise for a myriad of orthopaedic conditions, the onus is on the scientific community to further elucidate its efficacy, refine its application, and ascertain its safety profile.

Availability of data and materials

The datasets generated during and/or analysed during the current study are available throughout the manuscript.

An J-X, Wu G-P, Niu K, Wei Y-P, Liu H, Gao X-Y, et al. Treatment of femoral head osteonecrosis with ozone therapy: pilot trial of a new therapeutic approach. Pain Physician. 2022;25:E43–54.

PubMed   Google Scholar  

Hidalgo-Tallón FJ, Torres-Morera LM, Baeza-Noci J, Carrillo-Izquierdo MD, Pinto-Bonilla R. Updated review on ozone therapy in pain medicine. Front Physiol. 2022;13: 840623.

Article   PubMed   PubMed Central   Google Scholar  

de Sire A, Marotta N, Ferrillo M, Agostini F, Sconza C, Lippi L, et al. Oxygen–ozone therapy for reducing pro-inflammatory cytokines serum levels in musculoskeletal and temporomandibular disorders: a comprehensive review. Int J Mol Sci. 2022;23:2528.

Bennett PM, Stewart SK, Dretzke J, Bem D, Penn-Barwell JG. Preclinical therapies to prevent or treat fracture non-union: a systematic review. PLoS ONE. 2018;13: e0201077.

Kazancioglu HO, Ezirganli S, Aydin MS. Effects of laser and ozone therapies on bone healing in the calvarial defects. J Craniofac Surg. 2013;24:2141–6.

Article   PubMed   Google Scholar  

Irban A, Uslu S, Gereli A, Aydinlar EI, Karyemez PE, Luleci N, et al. The effect of ozone therapy on experimental bone fracture healing in rats [abstract]. J Ozone Ther. 2019;3:29.

Article   Google Scholar  

Feng X, Beiping L. Therapeutic efficacy of ozone injection into the knee for the osteoarthritis patient along with oral celecoxib and glucosamine. J Clin Diagn Res. 2017;11:UC01–3.

CAS   PubMed   PubMed Central   Google Scholar  

Sconza C, Respizzi S, Virelli L, Vandenbulcke F, Iacono F, Kon E, et al. Oxygen–ozone therapy for the treatment of knee osteoarthritis: a systematic review of randomized controlled trials. Arthrosc J Arthrosc Relat Surg. 2020;36:277–86.

Aliyev D, Akkemik U, Asik I. Efficacy of an intra-articular ozone injection for chronic knee pain due to osteoarthritis. Altern Ther Health Med. 2023;29:24–8.

Lopes De Jesus CC, Dos Santos FC, De Jesus LMOB, Monteiro I, SantAna MSSC, Trevisani VFM. Comparison between intra-articular ozone and placebo in the treatment of knee osteoarthritis: a randomized, double-blinded, placebo-controlled study. PLoS ONE. 2017;12: e0179185.

Biazzo A, Corriero AS, Confalonieri N. Intramuscular oxygen–ozone therapy in the treatment of low back pain. Acta Bio Medica Atenei Parmensis. 2018;89:41–6.

De Andrade RR, De Oliveira-Neto OB, Barbosa LT, Santos IO, De Sousa-Rodrigues CF, Barbosa FT. Effectiveness of ozone therapy compared to other therapies for low back pain: a systematic review with meta-analysis of randomized clinical trials. Braz J Anesthesiol. 2019;69:493–501 ( English Edition ).

Nabi BN, Sedighinejad A, Mirbolouk AR, Farzi F, Haghighi M, Atrkarroushan Z, et al. The effectiveness of ozone therapy in chronic osteomyelitis: a randomized controlled clinical trial. Arch Clin Infect Dis. 2018;13: e61320.

Google Scholar  

Bilge A, Öztürk Ö, Adali Y, Üstebay S. Could ozone treatment be a promising alternative for osteomyelitis? An experimental study. Acta Ortop Bras. 2018;26:67–71.

Viebahn-Hänsler R, León Fernández OS, Fahmy Z. Ozone in medicine: the low-dose ozone concept—guidelines and treatment strategies. Ozone Sci Eng. 2012;34:408–24.

Yasheng T, Mijiti A, Yushan M, Liu Z, Liu Y, Yusufu A. Ozonated water lavage and physiological saline irrigation combined with vacuum-sealed drainage in the treatment of 18 cases of chronic osteomyelitis. J Int Med Res. 2021;49:0300060521999530.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Rowen RJ, Robins H. Ozone therapy for complex regional pain syndrome: review and case report. Curr Pain Headache Rep. 2019;23:41.

De Sire A, Agostini F, Lippi L, Mangone M, Marchese S, Cisari C, et al. Oxygen–ozone therapy in the rehabilitation field: state of the art on mechanisms of action, safety and effectiveness in patients with musculoskeletal disorders. Biomolecules. 2021;11:356.

Alebouyeh M-R, Morsali SF, Zojaji F, Ebrahimi SA, Ahani A, Antar A. Refractory complex regional pain syndrome: a case report and review of literature. Anesth Pain Med. 2023;13: e135286.

Seyam O, Smith N, Reid I, Gandhi J, Jiang W, Khan S. Clinical utility of ozone therapy for musculoskeletal disorders. Med Gas Res. 2018;8:103.

Bocci V. The potential toxicity of ozone: side effects and contraindications of ozonetherapy. In: Ozone. Dordrecht: Springer; 2010. p. 75–84.

Chapter   Google Scholar  

Xiao W, Tang H, Wu M, Liao Y, Li K, Li L, et al. Ozone oil promotes wound healing by increasing the migration of fibroblasts via PI3K/Akt/mTOR signaling pathway. Biosci Rep. 2017;37:BSR20170658.

Pchepiorka R, Moreira MS, Lascane NADS, Catalani LH, Allegrini S Jr, De Lima NB, et al. Effect of ozone therapy on wound healing in the buccal mucosa of rats. Arch Oral Biol. 2020;119: 104889.

Article   CAS   PubMed   Google Scholar  

Fitzpatrick E, Holland OJ, Vanderlelie JJ. Ozone therapy for the treatment of chronic wounds: a systematic review. Int Wound J. 2018;15:633–44.

Serra MEG, Baeza-Noci J, Mendes Abdala CV, Luvisotto MM, Bertol CD, Anzolin AP. The role of ozone treatment as integrative medicine. An evidence and gap map. Front Public Health. 2023;10:1112296.

Akkawi I. Ozone therapy for musculoskeletal disorders Current concepts. Acta Biomed. 2020;91(4):e2020191.

Bocci V. How is ozone administered? Ozone. 2010. https://doi.org/10.1007/978-90-481-9234-2_5 .

Article   PubMed Central   Google Scholar  

Re L, Mawsouf MN, Menéndez S, León OS, Sánchez GM, Hernández F. Ozone therapy: clinical and basic evidence of its therapeutic potential. Arch Med Res. 2008;39:17–26.

Bocci VA. Tropospheric ozone toxicity vs. usefulness of ozone therapy. Arch Med Res. 2007;38:265–7.

Bocci V. Ozone as Janus: this controversial gas can be either toxic or medically useful. Mediat Inflamm. 2004;13:3–11.

Article   CAS   Google Scholar  

Li Q, Qi X, Zhang Z. Intra-articular oxygen–ozone versus hyaluronic acid in knee osteoarthritis: a meta-analysis of randomized controlled trials. Int J Surg. 2018;58:3–10.

Sagai M, Bocci V. Mechanisms of action involved in ozone therapy: is healing induced via a mild oxidative stress? Med Gas Res. 2011;1:29.

Fernández-Cuadros ME, Pérez-Moro OS, Albaladejo-Florín MJ, Tobar-Izquierdo MM, Magaña-Sánchez A, Jiménez-Cuevas P, et al. Intra articular ozone modulates inflammation and has anabolic effect on knee osteoarthritis: IL-6 and IGF-1 as pro-inflammatory and anabolic biomarkers. Processes. 2022;10:138.

Travagli V, Iorio EL. The biological and molecular action of ozone and its derivatives: state-of-the-art, enhanced scenarios, and quality insights. Int J Mol Sci. 2023;24:8465.

Galiè M, Covi V, Tabaracci G, Malatesta M. The role of Nrf2 in the antioxidant cellular response to medical ozone exposure. Int J Mol Sci. 2019;20:4009.

Viebahn-Haensler R, León Fernández OS. Ozone in medicine. The low-dose ozone concept and its basic biochemical mechanisms of action in chronic inflammatory diseases. Int J Mol Sci. 2021;22:7890.

Xu W, Yang Z, Lu N. A new role for the PI3K/Akt signaling pathway in the epithelial–mesenchymal transition. Cell Adhes Migr. 2015;9:317–24.

Dong J, Zhang L, Jia H, Zhu Y, Xiang R, Li P. Effects of adjuvant application of corticosteroid and ozone after ultrasound-guided puncture and lavage for the treatment of rotator cuff calcific tendinitis: study protocol for a non-inferiority randomized controlled trial. Trials. 2023;24:375.

Stewart S. Fracture non-union: a review of clinical challenges and future research needs. Malays Orthop J. 2019;13:1–10.

Duman IG, Davul S, Gokce H, Gonenci R, Özden R, Uruc V. Effects of gaseous ozone treatment on bone regeneration in femoral defect model in rats. J Hard Tissue Biol. 2017;26:7–12.

Irban A, Uslu S, Gereli A, Aydinlar EI, Karyemez PE, Luleci N, et al. The effect of ozone therapy on experimental bone fracture healing in rats. Int Res J Public Environ Health. 2015. https://doi.org/10.15739/irjpeh.034 .

Shah P, Shyam AK, Shah S. Adjuvant combined ozone therapy for extensive wound over tibia. IJOO. 2011;45:376–9.

Vaillant JD, Fraga A, Díaz MT, Mallok A, Viebahn-Hänsler R, Fahmy Z, et al. Ozone oxidative postconditioning ameliorates joint damage and decreases pro-inflammatory cytokine levels and oxidative stress in PG/PS-induced arthritis in rats. Eur J Pharmacol. 2013;714:318–24.

Sun P, Xu W, Zhao X, Zhang C, Lin X, Gong M, et al. Ozone induces autophagy by activating PPARγ/mTOR in rat chondrocytes treated with IL-1β. J Orthop Surg Res. 2022;17:351.

Farpour HR, Ashraf A, Hosseini SS. The efficacy of ozone prolotherapy compared to intra-articular hypertonic saline injection in reducing pain and improving the function of patients with knee osteoarthritis: a randomized clinical trial. Evid-Based Complement Altern Med. 2021;2021:1–7.

Sconza C, Di Matteo B, Queirazza P, Dina A, Amenta R, Respizzi S, et al. Ozone therapy versus hyaluronic acid injections for pain relief in patients with knee osteoarthritis: preliminary findings on molecular and clinical outcomes from a randomized controlled trial. IJMS. 2023;24:8788.

Iliakis E, Bonetti M, Iliakis A. Osteonecrosis of the femoral head: could oxygen–ozone therapy became a treatment option? J Ozone Ther. 2015;1(1).1-7.

Sacco R, Leeson R, Nissan J, Olate S, Bettoni Cruz de Castro CH, Acocella A, et al. A systematic review of oxygen therapy for the management of medication-related osteonecrosis of the jaw (MRONJ). Appl Sci. 2019;9:1026.

Ripamonti CI, Cislaghi E, Mariani L, Maniezzo M. Efficacy and safety of medical ozone (O 3 ) delivered in oil suspension applications for the treatment of osteonecrosis of the jaw in patients with bone metastases treated with bisphosphonates: preliminary results of a phase I–II study. Oral Oncol. 2011;47:185–90.

Di Fede O, Del Gaizo C, Panzarella V, La Mantia G, Tozzo P, Di Grigoli A, et al. Ozone infiltration for osteonecrosis of the jaw therapy: a case series. J Clin Med. 2022;11:5307.

Agrillo A, Ungari C, Filiaci F, Priore P, Iannetti G. Ozone therapy in the treatment of avascular bisphosphonate-related jaw osteonecrosis. J Craniofac Surg. 2007;18:1071–5.

Shetty L, Channe S, Londhe U, Bongulwar R. Potential use of local ozone therapy for neonatal mandibular osteomyelitis. World J Dent. 2018;9:343–4.

Foula AS, Sabry LS, Elmulla AF, Kamel MA, Hozien AI. Ultrasound-guided shoulder intraarticular ozone injection versus pulsed radiofrequency application for shoulder adhesive capsulitis: a randomized controlled trial. Pain Physician. 2023;26(4):E329.

Kizilkaya V, Uruc V, Levent A, Kanat O, Yildizgoren MT, Dogramaci Y, et al. Effectiveness of ozone therapy on tendon healing: an experimental study in generated Achilles tendon injury model in rats. J Hard Tissue Biol. 2018;27:309–14.

Babaei-Ghazani A, Karimi N, Forogh B, Madani SP, Ebadi S, Fadavi HR, et al. Comparison of ultrasound-guided local ozone (O 2 –O 3 ) injection vs corticosteroid injection in the treatment of chronic plantar fasciitis: a randomized clinical trial. Pain Med. 2019;20:314–22.

Atar MÖ, Korkmaz N, Aslan SG, Tezen Ö, Köylü SU, Demir Y, et al. Comparison of ultrasound-guided subacromial corticosteroid and ozone (O 2 –O 3 ) injections in the treatment of chronic rotator cuff tendinopathy: a randomized clinical trial. Korean J Pain. 2023;36:128–36.

Hidalgo-Tallón FJ, Pinto-Bonilla R, Baeza-Noci J, Menéndez-Cepero S, Cabizosu A. Medical ozone on hamstring injury in a professional athlete assessed by thermography: a clinical case report. BJR Case Rep. 2023;9:20220078.

PubMed   PubMed Central   Google Scholar  

Gurger M, Once G, Yilmaz E, Demir S, Calik I, Say Y, et al. The effect of the platelet-rich plasma and ozone therapy on tendon-to-bone healing in the rabbit rotator cuff repair model. J Orthop Surg Res. 2021;16:202.

Bozbaş GT, Yilmaz M, Paşaoğlu E, Gürer G, İvgin R, Demirci B. Effect of ozone in Freund’s complete adjuvant-induced arthritis. Arch Rheumatol. 2018;33:137–42.

Tartari APS, Moreira FF, Pereira MCDS, Carraro E, Cidral-Filho FJ, Salgado AI, et al. Anti-inflammatory effect of ozone therapy in an experimental model of rheumatoid arthritis. Inflammation. 2020;43:985–93.

León Fernández OS, Viebahn-Haensler R, Cabreja GL, Espinosa IS, Matos YH, Roche LD, et al. Medical ozone increases methotrexate clinical response and improves cellular redox balance in patients with rheumatoid arthritis. Eur J Pharmacol. 2016;789:313–8.

Taşçı BG. Effect of ozone in Freund’s complete adjuvant-induced arthritis. Arch Rheumatol. 2018;33:137–42.

Zhao N, Smargiassi A, Jean S, Gamache P, Laouan-Sidi E-A, Chen H, et al. Long-term exposure to fine particulate matter and ozone and the onset of systemic autoimmune rheumatic diseases: an open cohort study in Quebec, Canada. Arthritis Res Ther. 2022;24:151.

[PDF] Ozone and stem cell a possible cure for Rheumatoid Arthritis | Semantic Scholar. https://www.semanticscholar.org/paper/Ozone-and-stem-cell-a-possible-cure-for-Rheumatoid-Nd-Cht/710b110e67457449bf0fca17e1056db608ddf32d . Accessed 9 Oct 2023.

Rania V, Marcianò G, Casarella A, Vocca C, Palleria C, Calabria E, et al. Oxygen–ozone therapy in cervicobrachial pain: a real-life experience. JCM. 2022;12:248.

Hidalgo-Tallón J, Menéndez-Cepero S, Vilchez JS, Rodríguez-López CM, Calandre EP. Ozone therapy as add-on treatment in fibromyalgia management by rectal insufflation: an open-label pilot study. J Altern Complement Med. 2013;19:238–42.

Tirelli U, Cirrito C, Pavanello M. Oxygen–ozone therapy is an effective therapy in chronic fatigue syndrome: results in 100 patients. BJSTR. 2019;21:15890–2.

Tirelli U, Franzini M, Valdenassi L, Pandolfi S, Berretta M, Ricevuti G, et al. Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) greatly improved fatigue symptoms when treated with oxygen–ozone autohemotherapy. J Clin Med. 2021;11:29.

Tirelli U, Cirrito C, Pavanello M. Ozone therapy is an effective therapy in chronic fatigue syndrome: result of an Italian study in 65 patients. Ozone Ther. 2018. https://doi.org/10.4081/ozone.2018.7812 .

Chirumbolo S, Valdenassi L, Franzini M, Pandolfi S, Ricevuti G, Tirelli U. Male vs. female differences in responding to oxygen–ozone autohemotherapy (O 2 –O 3 -AHT) in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). J Clin Med. 2022;11:173.

Tirelli U, Cirrito C, Pavanello M. Ozone therapy in 40 patients with fibromyalgia: an effective therapy. Ozone Ther. 2018. https://doi.org/10.4081/ozone.2018.7969 .

Gazioğlu Türkyılmaz G, Rumeli Ş, Bakır M. Effects of major ozone autohemotherapy on physical functionality and quality of life in fibromyalgia syndrome: a prospective cross-sectional study. Altern Ther Health Med. 2021;27:8–12.

Sucuoğlu H, Soydaş N. Efficacy of ozone therapy as an add-on treatment in fibromyalgia: a randomized double-blind placebo-controlled study. J Back Musculoskelet Rehabil. 2023;36:357–66.

Tirelli U, Cirrito C, Pavanello M, Piasentin C, Lleshi A, Taibi R. Ozone therapy in 65 patients with fibromyalgia: an effective therapy. Eur Rev Med Pharmacol Sci. 2019;23:1786–8.

CAS   PubMed   Google Scholar  

Romary DJ, Landsberger SA, Bradner KN, Ramirez M, Leon BR. Liquid ozone therapies for the treatment of epithelial wounds: a systematic review and meta-analysis. Int Wound J. 2023;20:1235–52.

Faraji N, Goli R, Choobianzali B, Bahrami S, Sadeghian A, Sepehrnia N, et al. Ozone therapy as an alternative method for the treatment of diabetic foot ulcer: a case report. J Med Case Rep. 2021;15:234.

Astasio-Picado Á, Babiano AÁ, López-Sánchez M, Lozano RR, Cobos-Moreno P, Gómez-Martín B. Use of ozone therapy in diabetic foot ulcers. J Pers Med. 2023;13:1439.

Kushmakov R, Gandhi J, Seyam O, Jiang W, Joshi G, Smith NL, et al. Ozone therapy for diabetic foot. Med Gas Res. 2018;8:111–5.

Izadi M, Kheirjou R, Mohammadpour R, Aliyoldashi MH, Moghadam SJ, Khorvash F, et al. Efficacy of comprehensive ozone therapy in diabetic foot ulcer healing. Diabetes Metab Syndr. 2019;13:822–5.

Wen Q, Liu D, Wang X, Zhang Y, Fang S, Qiu X, et al. A systematic review of ozone therapy for treating chronically refractory wounds and ulcers. Int Wound J. 2022;19:853–70.

Kim S-Y, Kim E, Kim WJ. Health effects of ozone on respiratory diseases. Tuberc Respir Dis. 2020;83(Suppl 1):S6–11.

Lobo V, Patil A, Phatak A, Chandra N. Free radicals, antioxidants and functional foods: impact on human health. Pharmacogn Rev. 2010;4:118–26.

Palli D, Sera F, Giovannelli L, Masala G, Grechi D, Bendinelli B, et al. Environmental ozone exposure and oxidative DNA damage in adult residents of Florence. Italy Environ Pollut. 2009;157:1521–5.

Ballinger CA, Cueto R, Squadrito G, Coffin JF, Velsor LW, Pryor WA, et al. Antioxidant-mediated augmentation of ozone-induced membrane oxidation. Free Radic Biol Med. 2005;38:515–26.

Manoto SL, Maepa MJ, Motaung SK. Medical ozone therapy as a potential treatment modality for regeneration of damaged articular cartilage in osteoarthritis. Saudi J Biol Sci. 2018;25:672–9.

Secondary direct food additives permitted in food for human consumption (21 CFR 173.5-173.405). | FAOLEX. https://www.fao.org/faolex/results/details/en/c/LEX-FAOC156335/ . Accessed 14 Nov 2023.

Grangeat AM, de LA Erario M. The use of medical ozone in chronic intervertebral disc degeneration can be an etiological and conservative treatment. Int J Mol Sci. 2023;24:6538.

El Meligy OA, Elemam NM, Talaat IM. Ozone therapy in medicine and dentistry: a review of the literature. Dent J. 2023;11:187.

Bocci V, Zanardi I, Borrelli E, Travagli V. Reliable and effective oxygen–ozone therapy at a crossroads with ozonated saline infusion and ozone rectal insufflation. J Pharm Pharmacol. 2012;64:482–9.

Shah M, Captain J, Vaidya V, Kulkarni A, Valsangkar K, Nair PMK, et al. Safety and efficacy of ozone therapy in mild to moderate COVID-19 patients: a phase 1/11 randomized control trial (SEOT study). Int Immunopharmacol. 2021;91: 107301.

Epelle EI, Macfarlane A, Cusack M, Burns A, Okolie JA, Mackay W, et al. Ozone application in different industries: a review of recent developments. Chem Eng J. 2023;454: 140188.

Steppan J, Meaders T, Muto M, Murphy KJ. A metaanalysis of the effectiveness and safety of ozone treatments for herniated lumbar discs. J Vasc Interv Radiol. 2010;21:534–48.

Download references

Acknowledgements

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and affiliations.

Department of Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, Tamil Nadu, 600077, India

Madhan Jeyaraman & Naveen Jeyaraman

Department of Orthopaedics, Government Medical College, Omandurar Government Estate, Chennai, Tamil Nadu, 600002, India

Swaminathan Ramasubramanian & Sangeetha Balaji

Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)–Karaikal, Puducherry, 605006, India

Arulkumar Nallakumarasamy

Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India

Bishnu Prasad Patro

Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany

Filippo Migliorini

Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy

Department of Life Sciences, Health, and Health Professions, Link Campus University, Rome, Italy

You can also search for this author in PubMed   Google Scholar

Contributions

MJ: conception and design, drafting (original and revision); MJ, FM: supervision, drafting (revision); MJ, FM: drafting (revision); NJ, SB, SR, AN, BPP: drafting (original). All authors have agreed to the final version to be published and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Filippo Migliorini .

Ethics declarations

Ethics approval and consent to participate.

This study complies with ethical standards. Registration and protocol: the present review was not registered.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have any competing interests in this article.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Jeyaraman, M., Jeyaraman, N., Ramasubramanian, S. et al. Ozone therapy in musculoskeletal medicine: a comprehensive review. Eur J Med Res 29 , 398 (2024). https://doi.org/10.1186/s40001-024-01976-4

Download citation

Received : 28 November 2023

Accepted : 14 July 2024

Published : 31 July 2024

DOI : https://doi.org/10.1186/s40001-024-01976-4

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Orthopaedics
• Traumatology
• Musculoskeletal medicine

European Journal of Medical Research

ISSN: 2047-783X

• Submission enquiries: [email protected]
• General enquiries: [email protected]

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• For authors
• Browse by collection
• BMJ Journals

You are here

• Volume 14, Issue 7
• False claims of equivalence in the neurosurgical trauma literature: prevalence and associated factors—a systematic review protocol
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• http://orcid.org/0000-0001-7816-3051 André Luiz Freitas Oliveira Júnior 1 ,
• http://orcid.org/0000-0002-2001-6793 João Vitor Miranda Porto Oliveira 1 ,
• Angelos G Kolias 2 ,
• Wellingson S Paiva 3 ,
• http://orcid.org/0000-0002-5092-6595 Davi Jorge Fontoura Solla 4
• 1 Bahiana School of Medicine and Public Health , Salvador , Brazil
• 2 Division of Neurosurgery , University of Cambridge , Cambridge , UK
• 3 Division of Neurosurgery , University of São Paulo , São Paulo , Brazil
• 4 Department of Neurosciences and Behaviour Sciences , University of São Paulo , Ribeirao Preto , Brazil
• Correspondence to Dr André Luiz Freitas Oliveira Júnior; Andreluizfojr{at}gmail.com

Introduction Research quality within the neurosurgical field remains suboptimal. Therefore, many studies published in the neurosurgical literature lack enough statistical power to establish the presence or absence of clinically important differences between treatment arms. The field of neurotrauma deals with additional challenges, with fewer financial incentives and restricted resources in low-income and middle-income countries with the highest burden of neurotrauma diseases. In this systematic review, we aim to estimate the prevalence of false claims of equivalence in the neurosurgical trauma literature and identify its predictive factors.

Methods and analysis The Preferred Reporting Items for Systematic Review and Meta-Analyses recommendations were followed. Randomised clinical trials that enrolled only traumatic brain injury patients and investigated any type of intervention (surgical or non-surgical) will be eligible for inclusion. The MEDLINE/PubMed database will be searched for articles in English published from January 1960 to July 2020 in 15 top-ranked journals. A false claim of equivalence will be identified by insufficient power to detect a clinically meaningful effect: for categorical outcomes, a difference of at least 25% and 50%, and for continuous outcomes, a Cohen’s d of at least 0.5 and 0.8. Using the number of patients in each treatment arm and the minimum effect sizes to be detected, the power of each study will be calculated with the assumption of a two-tailed alpha that equals 0.05. Standardised differences between the groups with and without a false claim of equivalence will be calculated, and the variables with a standardised difference equal or above 0.2 and 0.5 will be considered weakly and strongly associated with false claims of equivalence, respectively. The data analysis will be blinded to the authors and institutions of the studies.

Ethics and dissemination This study will not involve primary data collection. Therefore, formal ethical approval will not be required. The final systematic review will be published in a peer-reviewed journal and presented at appropriate conferences.

• NEUROSURGERY
• TRAUMA MANAGEMENT
• Neurosurgery
• Neurological injury
• NEUROPATHOLOGY
• Clinical trials

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/ .

https://doi.org/10.1136/bmjopen-2020-044794

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

STRENGTHS AND LIMITATIONS OF THIS STUDY

This is the first systematic review to evaluate the prevalence of false claims of equivalence in the neurosurgical trauma literature and its associated factors.

The knowledge generated from this study may inform recommendations to enhance the neurosurgical research quality.

Due to the exclusion of non-randomised clinical trials and observational studies, as well as other journals that are not top ranked within the field, the results of this study may not be fully generalisable.

But considering that randomised clinical trials, compared with other study designs, usually are better planned and conducted, besides being published in journals with more rigorous peer review, our results may be conservative and thus strengthened.

Introduction

Reviews have shown that the quantity and the quality of clinical trials in neurosurgery remain suboptimal. 1–4 Among the main limitations, the following are highlighted: absence of sample size calculation, limited sample size, single-centre recruitment and incomplete subject follow-up. 2 3 Therefore, many studies published in the neurosurgical literature lack enough statistical power to establish the presence or absence of clinically important differences between treatment arms. 1 2 5–9

The field of neurotrauma deals with additional challenges. Compared with other neurosurgical subspecialties, there is less financial incentive for neurotrauma research development, in part due to its disproportionately higher incidence in low-income and middle-income countries (LMICs) compared with high-income countries (HICs). The highest burden of neurotrauma diseases lies in LMIC with about 90% of global injury-related deaths, but these countries tend to lack adequate resources for qualified scientific production. 10 Paradoxically, most of the high-quality studies looking at traumatic brain injury (TBI) are funded and conducted by HIC institutions, and less than 5% of 6708 published reports had a LMIC affiliation. 11 12 Few initiatives are in progress to improve global neurotrauma care and research, such as the Global Health Research Group on Neurotrauma, funded by the National Institute for Health Research. 11

More than 50% of neurotrauma clinical trials have recruited less than 100 subjects, and the median total sample size is around 70 subjects. 3–5 Besides a higher odd of false discoveries, insufficient statistical power is associated with false claims of equivalence. 3 In this systematic review, we aim to estimate the prevalence of false claims of equivalence in the neurosurgical trauma literature and identify its predictive factors.

Methods and analysis

Protocol and registration.

This systematic review and meta-analysis will be reported following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.

Eligibility criteria

Published randomised clinical trials (RCTs) that enrolled only TBI patients and investigated any type of intervention (surgical or non-surgical) will be eligible for inclusion. The following journals were selected for screening based on the impact factor and importance to the neurosurgical trauma literature: New England Journal of Medicine (NEJM); Lancet ; Lancet Neurology ; Journal of the American Medical Association (JAMA); JAMA Neurology ; Journal of Neurology, Neurosurgery and Psychiatry (JNNP); Neurosurgery ; Journal of Neurosurgery ; Neurosurgical Focus ; World Neurosurgery ; Acta Neurochirurgica ; Journal of Neurotrauma ; Intensive Care Medicine ; Critical Care ; and Neurocritical Care . For RCT with multiple publications, only the reporting of the primary outcome was considered. Considering that randomised clinical trials, compared with other study designs, usually are better planned and conducted, besides being published in journals with more rigorous peer review, we believe these criteria will strengthen our results.

Information sources and search strategy

The MEDLINE/PubMed database will be searched for articles in English published from January 1960 to July 2020. The descriptors (((((Traumatic brain injury[Title/Abstract]) OR (TBI[Title/Abstract])) OR (Brain trauma[Title/Abstract])) OR (Brain concussion[Title/Abstract])) OR (Brain contusion[Title/Abstract])) OR (head trauma[Title/Abstract]) OR (head injury[Title/Abstract]) OR (brain injury[Title/Abstract]) will be used. The filter ‘Randomised clinical trials’ will be applied.

Study selection

The search strategy aims to achieve a sample of RCTs published in the neurosurgical trauma literature from which negative trials could be selected. Negative trials will be defined as those that concluded equivalent outcomes (either dichotomous or continuous) in the treatment arms by explicitly stating it (eg, ‘there was no statistically significant difference between the groups’). Otherwise, positive trials will be used as controls. Only the primary outcome intention to treat analysis will be considered, identified by a clear statement of the authors in the methods section or a clear primary focus of the article. If no clear primary outcome can be identified, the neurological/functional outcome or death, hierarchically, will be considered the outcome of interest. All articles’ titles and abstracts were screened by two authors (ALFOJR and JVMPO) for eligibility. The selected articles will be adjudicated by a third author (DJFS), and disagreements will be resolved by consensus. Additional studies identified in the reference section of the selected articles can be included if the eligibility criteria are fulfilled. No RCT studies, as well as no TBI works, will be excluded.

Data collection and analysis

Data will be abstracted and recorded on a standardised form regarding the following: journal, year of publication, study country (high income or low and middle income), first and last author affiliations (neurosurgery or other), the presence of a statistician among the authors, single-centre or multicentre trial, type of trial design (superiority, non-inferiority or equivalence), the presence of a priori sample size and power calculation, type of TBI (mild, moderate and severe), setting (prehospital or intrahospital), intervention (surgical, drug or other), allocation concealment and blinding, number of patients, follow-up period, the event rates in the two treatment arms, the presence of a post hoc power calculation, the discussion of lack of power as a limitation, funding (industry, independent or none) and conflict of interest (when explicitly stated). The full text of the included articles will be systematically reviewed by two authors (ALFOJR and JVMPO). The interobserver agreement and the κ- statistic will be calculated. Disagreements will be resolved by a third author (DJFS). The data analysis will be blinded to the authors and institutions of the study.

The primary outcome will be the prevalence of false claim of equivalence in neurosurgical literature. A false claim of equivalence will be identified by insufficient power to detect a clinically meaningful effect, which will be defined under two scenarios for each type of outcome as follows: for categorical outcomes, a difference of at least 25% and 50% between the two groups given the control group baseline event rate, and for continuous outcomes, a Cohen’s d of at least 0.5 and 0.8 (between groups) given the control group outcome values. Using the number of patients in each treatment arm and the minimum effect sizes to be detected, the power of each study will be calculated with the assumption of a two-tailed alpha that equals 0.05.

Traditional descriptive statistics will be used to present the included RCT characteristics. Standardised differences between the groups with and without a false claim of equivalence will be calculated as proposed by Yang and Dalton. 13 The variables with a standardised difference equal or above 0.2 and 0.5 will be considered weakly and strongly associated with false claims of equivalence, respectively. All analyses will be conducted with the SPSS software (IBM Corp. SPSS Statistics for Windows, V.24.0. Armonk, NY).

Risk of bias in individual studies

The entire text of each included paper will be evaluated in a structured fashion for prespecified attributes. The second version of the Cochrane risk-of-bias tool (RoB 2) for randomised trials will be used. 14 RoB 2 is structured into a fixed set of domains of bias, focusing on different aspects of trial design, conduct and reporting. Within each domain, a series of questions (signalling questions) aim to elicit information about features of the trial that are relevant to risk of bias. A proposed judgement about the risk of bias arising from each domain is generated by an algorithm, based on answers to the signalling questions. Judgement can be ‘low’ or ‘high’ risk of bias or can express ‘some concerns’.

Ethics and dissemination

This study will not involve primary data collection. Therefore, formal ethical approval will not be required. The final systematic review will be published in a peer-reviewed journal and presented at appropriate conferences. This protocol may be adapted for the analysis of other innovative surgical and invasive procedures.

Ethics statements

Patient consent for publication.

Not applicable.

• Kiehna EN ,
• Starke RM ,
• Pouratian N , et al
• Tatsioni A ,
• Polyzoidis K , et al
• Mansouri A ,
• Shin SM , et al
• Schöller K ,
• Tonn JC , et al
• Coburn M , et al
• Dimick JB ,
• Diener-West M ,
• Sundaresan N ,
• Voorhies R ,
• Kwok KL , et al
• Kreiter KT ,
• Howard G , et al
• Rattani A ,
• Gupta S , et al
• Kolias AG ,
• Rubiano AM ,
• Figaji A , et al
• Servadei F ,
• Tropeano MP ,
• Spaggiari R , et al
• Sterne JAC ,
• Savović J ,
• Page MJ , et al

X @davisolla

Contributors DJFS conceived the research idea. DJFS, ALFOJR and JVPMO designed and drafted the study protocol. AGK and WSP made critical review of the study protocol and edited the final manuscript.

Funding Drs Solla, Kolias, and Paiva are supported by the NIHR Global Health Research Group on Neurotrauma, which was commissioned by the National Institute for Health Research (NIHR) using UK aid from the UK Government (project 16/137/105). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Angelos Kolias is supported by a Clinical Lectureship, School of Clinical Medicine, University of Cambridge and the Royal College of Surgeons of England.

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

Read the full text or download the PDF:

Information

• Author Services

Initiatives

You are accessing a machine-readable page. In order to be human-readable, please install an RSS reader.

All articles published by MDPI are made immediately available worldwide under an open access license. No special permission is required to reuse all or part of the article published by MDPI, including figures and tables. For articles published under an open access Creative Common CC BY license, any part of the article may be reused without permission provided that the original article is clearly cited. For more information, please refer to https://www.mdpi.com/openaccess .

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive positive feedback from the reviewers.

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

Original Submission Date Received: .

• Active Journals
• Find a Journal
• Proceedings Series
• For Authors
• For Reviewers
• For Editors
• For Librarians
• For Publishers
• For Societies
• For Conference Organizers
• Open Access Policy
• Institutional Open Access Program
• Special Issues Guidelines
• Editorial Process
• Research and Publication Ethics
• Article Processing Charges
• Testimonials
• Preprints.org
• SciProfiles
• Encyclopedia

Article Menu

• Subscribe SciFeed
• Recommended Articles
• Google Scholar
• on Google Scholar
• Table of Contents

Find support for a specific problem in the support section of our website.

Please let us know what you think of our products and services.

Visit our dedicated information section to learn more about MDPI.

JSmol Viewer

Technique variables associated with fast bowling performance: a systematic-narrative review.

1. Introduction

2. materials and methods, 2.1. search strategy, 2.2. quality assessment scale, 3.1. study characteristics, 3.2. biomechanical variables studied, 4. discussion, 4.1. performance parameters associated with fast bowling performance, 4.1.1. run-up and pre-delivery stride, 4.1.2. delivery phase, 4.1.3. rear leg kinematics, 4.1.4. front leg kinematics, 4.1.5. trunk, pelvis and centre-of-mass kinematics, 4.1.6. bowling arm and shoulder kinematics, 4.1.7. segmental sequencing, 4.1.8. bowling delivery length, accuracy and type, 4.1.9. inter and intra-individual analyses, 5. limitations and future directions, 6. conclusions, author contributions, conflicts of interest.

• Petersen, C.; Pyne, D.; Portus, M.; Cordy, J.; Dawson, B. Analysis of performance at the 2007 Cricket World Cup. Int. J. Perform. Anal. Sport 2008 , 8 , 1–8. [ Google Scholar ] [ CrossRef ]
• Worthington, P.; King, M.; Ranson, C. Relationships between fast bowling technique and ball release speed in cricket. J. Appl. Biomech. 2013 , 29 , 78–84. [ Google Scholar ] [ CrossRef ]
• Ferdinands, R.E.; Sinclair, P.J.; Stuelcken, M.C.; Greene, A. Rear leg kinematics and kinetics in cricket fast bowling. Sport. Technol. 2014 , 7 , 52–61. [ Google Scholar ] [ CrossRef ]
• Hurrion, P.D.; Dyson, R.; Hale, T. Simultaneous measurement of back and front foot ground reaction forces during the same delivery stride of the fast-medium bowler. J. Sports Sci. 2000 , 18 , 993–997. [ Google Scholar ] [ CrossRef ]
• Spratford, W.; Kenneally-Dabrowski, C.; Byrne, S.; Hicks, A.; Portus, M. Does stride length play a role in cricket fast bowling performance outcomes? An observational, cross-sectional study. Int. J. Sports Sci. Coach. 2016 , 11 , 655–661. [ Google Scholar ] [ CrossRef ]
• Ferdinands, R.E.D.; Kersting, U.G.; Marshall, R.N. Kinematic and kinetic energy analysis of segmental sequencing in cricket fast bowling. Sport. Technol. 2013 , 6 , 10–21. [ Google Scholar ] [ CrossRef ]
• Portus, M.R.; Sinclair, P.J.; Burke, S.T.; Moore, D.J.; Farhart, P.J. Cricket fast bowling performance and technique and the influence of selected physical factors during an 8-over spell. J. Sports Sci. 2000 , 18 , 999–1011. [ Google Scholar ] [ CrossRef ]
• Ferdinands, R.; Marshall, R.N.; Kersting, U. Centre of mass kinematics of fast bowling in cricket. Sport. Biomech. 2010 , 9 , 139–152. [ Google Scholar ] [ CrossRef ]
• Glazier, P.S.; Worthington, P.J. The impact of centre of mass kinematics and ground reaction forces o ball release speeds in cricket fast bowling. Sport. Technol. 2014 , 7 , 4–11. [ Google Scholar ] [ CrossRef ]
• Middleton, K.J.; Mills, P.M.; Elliott, B.C.; Alderson, J.A. The association between lower limb biomechanics and ball release speed in cricket fast bowlers: A comparison of high-performance and amateur competitors. Sport. Biomech. 2016 , 3141 , 357–369. [ Google Scholar ] [ CrossRef ]
• Wormgoor, S.; Harden, L.; McKinon, W. Anthropometric, biomechanical, and isokinetic strength predictors of ball release speed in high-performance cricket fast bowlers. J. Sports Sci. 2010 , 28 , 957–965. [ Google Scholar ] [ CrossRef ]
• Zhang, Y.; Unka, J.; Liu, G. Contributions of joint rotations to ball release speed during cricket bowling: A three-dimensional kinematic analysis. J. Sports Sci. 2011 , 29 , 1293–1300. [ Google Scholar ] [ CrossRef ]
• Felton, P.J.; Lister, S.L.; Worthington, P.J.; King, M.A. Comparison of biomechanical characteristics between male and female elite fast bowlers. J. Sports Sci. 2019 , 37 , 665–670. [ Google Scholar ] [ CrossRef ]
• Liberati, A.; Altman, D.G.; Tetzlaff, J.; Mulrow, C.; Gøtzsche, P.C.; Ioannidis, J.P.A.; Clarke, M.; Devereaux, P.J.; Kleijnen, J.; Moher, D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J. Clin. Epidemiol. 2009 , 62 , e1–e34. [ Google Scholar ] [ CrossRef ]
• Downes, M.J.; Brennan, M.L.; Williams, H.C.; Dean, R.S. Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open 2016 , 6 , e011458. [ Google Scholar ] [ CrossRef ]
• Portus, M.R.; Mason, B.R.; Elliott, B.C.; Pfitzner, M.C.; Done, R.P. Technique factors related to ball release speed and trunk injuries in high performance cricket fast bowlers. Sport. Biomech. 2004 , 3 , 263–284. [ Google Scholar ] [ CrossRef ]
• Salter, C.W.; Sinclair, P.J.; Portus, M.R. The associations between fast bowling technique and ball release speed: A pilot study of the within-bowler and between-bowler approaches. J. Sports Sci. 2007 , 25 , 1279–1285. [ Google Scholar ] [ CrossRef ]
• Phillips, E.; Portus, M.; Davids, K.; Renshaw, I. Performance accuracy and functional variability in elite and developing fast bowlers. J. Sci. Med. Sport. 2012 , 15 , 182–188. [ Google Scholar ] [ CrossRef ]
• Loram, L.C.; McKinon, W.; Wormgoor, S.; Rogers, G.G.; Nowak, I.; Harden, L.M. Determinants of ball release speed in schoolboy fast-medium bowlers in cricket. J. Sports Med. Phys. Fitness 2005 , 45 , 483–490. [ Google Scholar ]
• King, M.A.; Worthington, P.J.; Ranson, C.A. Does maximising ball speed in cricket fast bowling necessitate higher ground reaction forces? J. Sports Sci. 2016 , 34 , 707–712. [ Google Scholar ] [ CrossRef ]
• Feros, S.A.; Young, W.B.; O’Brien, B.J. Relationship between selected physical qualities, bowling kinematics, and pace bowling skill in club-standard cricketers. J. Strength. Cond. Res. 2019 , 33 , 2812–2825. [ Google Scholar ] [ CrossRef ]
• Kiely, N.; Rodriguez, L.P.; Watsford, M.; Reddin, T.; Hardy, S.; Duffield, R. The influence of technique and physical capacity on ball release speed in cricket fast-bowling. J. Sports Sci. 2021 , 39 , 2361–2369. [ Google Scholar ] [ CrossRef ]
• Bartlett, R.M.; Stockill, N.P.; Elliott, B.C.; Burnett, A.F. The biomechanics of fast bowling in men’s cricket: A review. J. Sports Sci. 1996 , 14 , 403–424. [ Google Scholar ] [ CrossRef ]
• McNamara, D.J.; Gabbett, T.J.; Chapman, P.; Naughton, G.; Farhart, P. Variability of PlayerLoad, bowling velocity, and performance execution in fast bowlers across repeated bowling spells. Int. J. Sports Physiol. Perform. 2015 , 10 , 1009–1014. [ Google Scholar ] [ CrossRef ]
• Felton, P.; King, M. Optimising individual performance in cricket fast bowling. ISBS Proc. Arch. 2017 , 35 , 23. [ Google Scholar ]
• Mullineaux, D.R.; Bartlett, R.M.; Bennett, S. Research design and statistics in biomechanics and motor control. J. Sport. Sci. 2001 , 19 , 739–760. [ Google Scholar ] [ CrossRef ]

Click here to enlarge figure

Share and Cite

Bhandurge, S.; Alway, P.; Allen, S.; Blenkinsop, G.; King, M. Technique Variables Associated with Fast Bowling Performance: A Systematic-Narrative Review. Appl. Sci. 2024 , 14 , 6752. https://doi.org/10.3390/app14156752

Bhandurge S, Alway P, Allen S, Blenkinsop G, King M. Technique Variables Associated with Fast Bowling Performance: A Systematic-Narrative Review. Applied Sciences . 2024; 14(15):6752. https://doi.org/10.3390/app14156752

Bhandurge, Shruti, Peter Alway, Sam Allen, Glen Blenkinsop, and Mark King. 2024. "Technique Variables Associated with Fast Bowling Performance: A Systematic-Narrative Review" Applied Sciences 14, no. 15: 6752. https://doi.org/10.3390/app14156752

Article Metrics

Article access statistics, further information, mdpi initiatives, follow mdpi.

Subscribe to receive issue release notifications and newsletters from MDPI journals