the literature review should occur

• 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

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Writing a Literature Review

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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.

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 Collection 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

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How To Write A Literature Review - A Complete Guide

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A literature review is much more than just another section in your research paper. It forms the very foundation of your research. It is a formal piece of writing where you analyze the existing theoretical framework, principles, and assumptions and use that as a base to shape your approach to the research question.

Curating and drafting a solid literature review section not only lends more credibility to your research paper but also makes your research tighter and better focused. But, writing literature reviews is a difficult task. It requires extensive reading, plus you have to consider market trends and technological and political changes, which tend to change in the blink of an eye.

Now streamline your literature review process with the help of SciSpace Copilot. With this AI research assistant, you can efficiently synthesize and analyze a vast amount of information, identify key themes and trends, and uncover gaps in the existing research. Get real-time explanations, summaries, and answers to your questions for the paper you're reviewing, making navigating and understanding the complex literature landscape easier.

In this comprehensive guide, we will explore everything from the definition of a literature review, its appropriate length, various types of literature reviews, and how to write one.

What is a literature review?

A literature review is a collation of survey, research, critical evaluation, and assessment of the existing literature in a preferred domain.

Eminent researcher and academic Arlene Fink, in her book Conducting Research Literature Reviews , defines it as the following:

“A literature review surveys books, scholarly articles, and any other sources relevant to a particular issue, area of research, or theory, and by so doing, provides a description, summary, and critical evaluation of these works in relation to the research problem being investigated.

Literature reviews are designed to provide an overview of sources you have explored while researching a particular topic, and to demonstrate to your readers how your research fits within a larger field of study.”

Simply put, a literature review can be defined as a critical discussion of relevant pre-existing research around your research question and carving out a definitive place for your study in the existing body of knowledge. Literature reviews can be presented in multiple ways: a section of an article, the whole research paper itself, or a chapter of your thesis.

A literature review does function as a summary of sources, but it also allows you to analyze further, interpret, and examine the stated theories, methods, viewpoints, and, of course, the gaps in the existing content.

As an author, you can discuss and interpret the research question and its various aspects and debate your adopted methods to support the claim.

What is the purpose of a literature review?

A literature review is meant to help your readers understand the relevance of your research question and where it fits within the existing body of knowledge. As a researcher, you should use it to set the context, build your argument, and establish the need for your study.

What is the importance of a literature review?

The literature review is a critical part of research papers because it helps you:

• Gain an in-depth understanding of your research question and the surrounding area
• Convey that you have a thorough understanding of your research area and are up-to-date with the latest changes and advancements
• Establish how your research is connected or builds on the existing body of knowledge and how it could contribute to further research
• Elaborate on the validity and suitability of your theoretical framework and research methodology
• Identify and highlight gaps and shortcomings in the existing body of knowledge and how things need to change
• Convey to readers how your study is different or how it contributes to the research area

How long should a literature review be?

Ideally, the literature review should take up 15%-40% of the total length of your manuscript. So, if you have a 10,000-word research paper, the minimum word count could be 1500.

Your literature review format depends heavily on the kind of manuscript you are writing — an entire chapter in case of doctoral theses, a part of the introductory section in a research article, to a full-fledged review article that examines the previously published research on a topic.

Another determining factor is the type of research you are doing. The literature review section tends to be longer for secondary research projects than primary research projects.

What are the different types of literature reviews?

All literature reviews are not the same. There are a variety of possible approaches that you can take. It all depends on the type of research you are pursuing.

Here are the different types of literature reviews:

Argumentative review

It is called an argumentative review when you carefully present literature that only supports or counters a specific argument or premise to establish a viewpoint.

Integrative review

It is a type of literature review focused on building a comprehensive understanding of a topic by combining available theoretical frameworks and empirical evidence.

Methodological review

This approach delves into the ''how'' and the ''what" of the research question —  you cannot look at the outcome in isolation; you should also review the methodology used.

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 collect, report, and analyze data from the studies included in the review.

Meta-analysis review

Meta-analysis uses 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 than those derived from the individual studies included within a review.

Historical review

Historical literature reviews focus on examining research throughout a period, often starting with the first time an issue, concept, theory, or phenomenon 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 identify future research's likely directions.

Theoretical Review

This form aims to examine the corpus of theory accumulated regarding an issue, concept, theory, and phenomenon. The theoretical literature review helps to establish what theories exist, the relationships between them, the degree the existing approaches have been investigated, and to develop new hypotheses to be tested.

Scoping Review

The Scoping Review is often used at the beginning of an article, dissertation, or research proposal. It is conducted before the research to highlight gaps in the existing body of knowledge and explains why the project should be greenlit.

State-of-the-Art Review

The State-of-the-Art review is conducted periodically, focusing on the most recent research. It describes what is currently known, understood, or agreed upon regarding the research topic and highlights where there are still disagreements.

Can you use the first person in a literature review?

When writing literature reviews, you should avoid the usage of first-person pronouns. It means that instead of "I argue that" or "we argue that," the appropriate expression would be "this research paper argues that."

Do you need an abstract for a literature review?

Ideally, yes. It is always good to have a condensed summary that is self-contained and independent of the rest of your review. As for how to draft one, you can follow the same fundamental idea when preparing an abstract for a literature review. It should also include:

• The research topic and your motivation behind selecting it
• A one-sentence thesis statement
• An explanation of the kinds of literature featured in the review
• Summary of what you've learned
• Conclusions you drew from the literature you reviewed
• Potential implications and future scope for research

Here's an example of the abstract of a literature review

Is a literature review written in the past tense?

Yes, the literature review should ideally be written in the past tense. You should not use the present or future tense when writing one. The exceptions are when you have statements describing events that happened earlier than the literature you are reviewing or events that are currently occurring; then, you can use the past perfect or present perfect tenses.

How many sources for a literature review?

There are multiple approaches to deciding how many sources to include in a literature review section. The first approach would be to look level you are at as a researcher. For instance, a doctoral thesis might need 60+ sources. In contrast, you might only need to refer to 5-15 sources at the undergraduate level.

The second approach is based on the kind of literature review you are doing — whether it is merely a chapter of your paper or if it is a self-contained paper in itself. When it is just a chapter, sources should equal the total number of pages in your article's body. In the second scenario, you need at least three times as many sources as there are pages in your work.

Quick tips on how to write a literature review

To know how to write a literature review, you must clearly understand its impact and role in establishing your work as substantive research material.

You need to follow the below-mentioned steps, to write a literature review:

• Outline the purpose behind the literature review
• Search relevant literature
• Examine and assess the relevant resources
• Discover connections by drawing deep insights from the resources
• Structure planning to write a good literature review

1. Outline and identify the purpose of  a literature review

As a first step on how to write a literature review, you must know what the research question or topic is and what shape you want your literature review to take. Ensure you understand the research topic inside out, or else seek clarifications. You must be able to the answer below questions before you start:

• How many sources do I need to include?
• What kind of sources should I analyze?
• How much should I critically evaluate each source?
• Should I summarize, synthesize or offer a critique of the sources?
• Do I need to include any background information or definitions?

Additionally, you should know that the narrower your research topic is, the swifter it will be for you to restrict the number of sources to be analyzed.

2. Search relevant literature

Dig deeper into search engines to discover what has already been published around your chosen topic. Make sure you thoroughly go through appropriate reference sources like books, reports, journal articles, government docs, and web-based resources.

You must prepare a list of keywords and their different variations. You can start your search from any library’s catalog, provided you are an active member of that institution. The exact keywords can be extended to widen your research over other databases and academic search engines like:

• Google Scholar
• Microsoft Academic
• Science.gov

Besides, it is not advisable to go through every resource word by word. Alternatively, what you can do is you can start by reading the abstract and then decide whether that source is relevant to your research or not.

Additionally, you must spend surplus time assessing the quality and relevance of resources. It would help if you tried preparing a list of citations to ensure that there lies no repetition of authors, publications, or articles in the literature review.

3. Examine and assess the sources

It is nearly impossible for you to go through every detail in the research article. So rather than trying to fetch every detail, you have to analyze and decide which research sources resemble closest and appear relevant to your chosen domain.

While analyzing the sources, you should look to find out answers to questions like:

• What question or problem has the author been describing and debating?
• What is the definition of critical aspects?
• How well the theories, approach, and methodology have been explained?
• Whether the research theory used some conventional or new innovative approach?
• How relevant are the key findings of the work?
• In what ways does it relate to other sources on the same topic?
• What challenges does this research paper pose to the existing theory
• What are the possible contributions or benefits it adds to the subject domain?

Be always mindful that you refer only to credible and authentic resources. It would be best if you always take references from different publications to validate your theory.

Always keep track of important information or data you can present in your literature review right from the beginning. It will help steer your path from any threats of plagiarism and also make it easier to curate an annotated bibliography or reference section.

4. Discover connections

At this stage, you must start deciding on the argument and structure of your literature review. To accomplish this, you must discover and identify the relations and connections between various resources while drafting your abstract.

A few aspects that you should be aware of while writing a literature review include:

• Rise to prominence: Theories and methods that have gained reputation and supporters over time.
• Constant scrutiny: Concepts or theories that repeatedly went under examination.
• Contradictions and conflicts: Theories, both the supporting and the contradictory ones, for the research topic.
• Knowledge gaps: What exactly does it fail to address, and how to bridge them with further research?
• Influential resources: Significant research projects available that have been upheld as milestones or perhaps, something that can modify the current trends

Once you join the dots between various past research works, it will be easier for you to draw a conclusion and identify your contribution to the existing knowledge base.

5. Structure planning to write a good literature review

There exist different ways towards planning and executing the structure of a literature review. The format of a literature review varies and depends upon the length of the research.

Like any other research paper, the literature review format must contain three sections: introduction, body, and conclusion. The goals and objectives of the research question determine what goes inside these three sections.

Nevertheless, a good literature review can be structured according to the chronological, thematic, methodological, or theoretical framework approach.

Literature review samples

1. Standalone

2. As a section of a research paper

How SciSpace Discover makes literature review a breeze?

SciSpace Discover is a one-stop solution to do an effective literature search and get barrier-free access to scientific knowledge. It is an excellent repository where you can find millions of only peer-reviewed articles and full-text PDF files. Here’s more on how you can use it:

Find the right information

Find what you want quickly and easily with comprehensive search filters that let you narrow down papers according to PDF availability, year of publishing, document type, and affiliated institution. Moreover, you can sort the results based on the publishing date, citation count, and relevance.

Assess credibility of papers quickly

When doing the literature review, it is critical to establish the quality of your sources. They form the foundation of your research. SciSpace Discover helps you assess the quality of a source by providing an overview of its references, citations, and performance metrics.

Get the complete picture in no time

SciSpace Discover’s personalized suggestion engine helps you stay on course and get the complete picture of the topic from one place. Every time you visit an article page, it provides you links to related papers. Besides that, it helps you understand what’s trending, who are the top authors, and who are the leading publishers on a topic.

Make referring sources super easy

To ensure you don't lose track of your sources, you must start noting down your references when doing the literature review. SciSpace Discover makes this step effortless. Click the 'cite' button on an article page, and you will receive preloaded citation text in multiple styles — all you've to do is copy-paste it into your manuscript.

Final tips on how to write a literature review

A massive chunk of time and effort is required to write a good literature review. But, if you go about it systematically, you'll be able to save a ton of time and build a solid foundation for your research.

We hope this guide has helped you answer several key questions you have about writing literature reviews.

Would you like to explore SciSpace Discover and kick off your literature search right away? You can get started here .

Frequently Asked Questions (FAQs)

1. how to start a literature review.

• What questions do you want to answer?

• What sources do you need to answer these questions?

• What information do these sources contain?

• How can you use this information to answer your questions?

2. What to include in a literature review?

• A brief background of the problem or issue

• What has previously been done to address the problem or issue

• A description of what you will do in your project

• How this study will contribute to research on the subject

3. Why literature review is important?

The literature review is an important part of any research project because it allows the writer to look at previous studies on a topic and determine existing gaps in the literature, as well as what has already been done. It will also help them to choose the most appropriate method for their own study.

4. How to cite a literature review in APA format?

To cite a literature review in APA style, you need to provide the author's name, the title of the article, and the year of publication. For example: Patel, A. B., & Stokes, G. S. (2012). The relationship between personality and intelligence: A meta-analysis of longitudinal research. Personality and Individual Differences, 53(1), 16-21

5. What are the components of a literature review?

• A brief introduction to the topic, including its background and context. The introduction should also include a rationale for why the study is being conducted and what it will accomplish.

• A description of the methodologies used in the study. This can include information about data collection methods, sample size, and statistical analyses.

• A presentation of the findings in an organized format that helps readers follow along with the author's conclusions.

6. What are common errors in writing literature review?

• Not spending enough time to critically evaluate the relevance of resources, observations and conclusions.

• Totally relying on secondary data while ignoring primary data.

• Letting your personal bias seep into your interpretation of existing literature.

• No detailed explanation of the procedure to discover and identify an appropriate literature review.

7. What are the 5 C's of writing literature review?

• Cite - the sources you utilized and referenced in your research.

• Compare - existing arguments, hypotheses, methodologies, and conclusions found in the knowledge base.

• Contrast - the arguments, topics, methodologies, approaches, and disputes that may be found in the literature.

• Critique - the literature and describe the ideas and opinions you find more convincing and why.

• Connect - the various studies you reviewed in your research.

8. How many sources should a literature review have?

When it is just a chapter, sources should equal the total number of pages in your article's body. if it is a self-contained paper in itself, you need at least three times as many sources as there are pages in your work.

9. Can literature review have diagrams?

• To represent an abstract idea or concept

• To explain the steps of a process or procedure

• To help readers understand the relationships between different concepts

10. How old should sources be in a literature review?

Sources for a literature review should be as current as possible or not older than ten years. The only exception to this rule is if you are reviewing a historical topic and need to use older sources.

11. What are the types of literature review?

• Argumentative review

• Integrative review

• Methodological review

• Systematic review

• Meta-analysis review

• Historical review

• Theoretical review

• Scoping review

• State-of-the-Art review

12. Is a literature review mandatory?

Yes. Literature review is a mandatory part of any research project. It is a critical step in the process that allows you to establish the scope of your research, and provide a background for the rest of your work.

But before you go,

• Six Online Tools for Easy Literature Review
• Evaluating literature review: systematic vs. scoping reviews
• Systematic Approaches to a Successful Literature Review
• Writing Integrative Literature Reviews: Guidelines and Examples

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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.
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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: 
• 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  

• 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. 
• 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. 
• 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. 
• 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. 
• 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. 
• 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. 

How to write a good literature review

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. 

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. 

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 literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. 

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 . 

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Literature Reviews

Steps in the literature review process.

• What is a literature review?
• Define your research question
• Determine inclusion and exclusion criteria
• Choose databases and search
• Review Results
• Synthesize Results
• Analyze Results
• Librarian Support
• You may need to some exploratory searching of the literature to get a sense of scope, to determine whether you need to narrow or broaden your focus
• Identify databases that provide the most relevant sources, and identify relevant terms (controlled vocabularies) to add to your search strategy
• Finalize your research question
• Think about relevant dates, geographies (and languages), methods, and conflicting points of view
• Conduct searches in the published literature via the identified databases
• Check to see if this topic has been covered in other discipline's databases
• Examine the citations of on-point articles for keywords, authors, and previous research (via references) and cited reference searching.
• Save your search results in a citation management tool (such as Zotero, Mendeley or EndNote)
• De-duplicate your search results
• Make sure that you've found the seminal pieces -- they have been cited many times, and their work is considered foundational 
• Check with your professor or a librarian to make sure your search has been comprehensive
• Evaluate the strengths and weaknesses of individual sources and evaluate for bias, methodologies, and thoroughness
• Group your results in to an organizational structure that will support why your research needs to be done, or that provides the answer to your research question  
• Develop your conclusions
• Are there gaps in the literature?
• Where has significant research taken place, and who has done it?
• Is there consensus or debate on this topic?
• Which methodological approaches work best?
• For example: Background, Current Practices, Critics and Proponents, Where/How this study will fit in 
• Organize your citations and focus on your research question and pertinent studies
• Compile your bibliography

Note: The first four steps are the best points at which to contact a librarian. Your librarian can help you determine the best databases to use for your topic, assess scope, and formulate a search strategy.

Videos Tutorials about Literature Reviews

This 4.5 minute video from Academic Education Materials has a Creative Commons License and a British narrator.

Recommended Reading

• Last Updated: Oct 26, 2022 2:49 PM
• URL: https://guides.lib.utexas.edu/literaturereviews

How To Structure Your Literature Review

3 options to help structure your chapter.

By: Amy Rommelspacher (PhD) | Reviewer: Dr Eunice Rautenbach | November 2020 (Updated May 2023)

Writing the literature review chapter can seem pretty daunting when you’re piecing together your dissertation or thesis. As  we’ve discussed before , a good literature review needs to achieve a few very important objectives – it should:

• Demonstrate your knowledge of the research topic
• Identify the gaps in the literature and show how your research links to these
• Provide the foundation for your conceptual framework (if you have one)
• Inform your own  methodology and research design

To achieve this, your literature review needs a well-thought-out structure . Get the structure of your literature review chapter wrong and you’ll struggle to achieve these objectives. Don’t worry though – in this post, we’ll look at how to structure your literature review for maximum impact (and marks!).

But wait – is this the right time?

Deciding on the structure of your literature review should come towards the end of the literature review process – after you have collected and digested the literature, but before you start writing the chapter. 

In other words, you need to first develop a rich understanding of the literature before you even attempt to map out a structure. There’s no use trying to develop a structure before you’ve fully wrapped your head around the existing research.

Equally importantly, you need to have a structure in place before you start writing , or your literature review will most likely end up a rambling, disjointed mess. 

Importantly, don’t feel that once you’ve defined a structure you can’t iterate on it. It’s perfectly natural to adjust as you engage in the writing process. As we’ve discussed before , writing is a way of developing your thinking, so it’s quite common for your thinking to change – and therefore, for your chapter structure to change – as you write. 

Need a helping hand?

Like any other chapter in your thesis or dissertation, your literature review needs to have a clear, logical structure. At a minimum, it should have three essential components – an  introduction , a  body   and a  conclusion . 

Let’s take a closer look at each of these.

1: The Introduction Section

Just like any good introduction, the introduction section of your literature review should introduce the purpose and layout (organisation) of the chapter. In other words, your introduction needs to give the reader a taste of what’s to come, and how you’re going to lay that out. Essentially, you should provide the reader with a high-level roadmap of your chapter to give them a taste of the journey that lies ahead.

Here’s an example of the layout visualised in a literature review introduction:

Your introduction should also outline your topic (including any tricky terminology or jargon) and provide an explanation of the scope of your literature review – in other words, what you  will   and  won’t   be covering (the delimitations ). This helps ringfence your review and achieve a clear focus . The clearer and narrower your focus, the deeper you can dive into the topic (which is typically where the magic lies). 

Depending on the nature of your project, you could also present your stance or point of view at this stage. In other words, after grappling with the literature you’ll have an opinion about what the trends and concerns are in the field as well as what’s lacking. The introduction section can then present these ideas so that it is clear to examiners that you’re aware of how your research connects with existing knowledge .

2: The Body Section

The body of your literature review is the centre of your work. This is where you’ll present, analyse, evaluate and synthesise the existing research. In other words, this is where you’re going to earn (or lose) the most marks. Therefore, it’s important to carefully think about how you will organise your discussion to present it in a clear way. 

The body of your literature review should do just as the description of this chapter suggests. It should “review” the literature – in other words, identify, analyse, and synthesise it. So, when thinking about structuring your literature review, you need to think about which structural approach will provide the best “review” for your specific type of research and objectives (we’ll get to this shortly).

There are (broadly speaking)  three options  for organising your literature review.

Option 1: Chronological (according to date)

Organising the literature chronologically is one of the simplest ways to structure your literature review. You start with what was published first and work your way through the literature until you reach the work published most recently. Pretty straightforward.

The benefit of this option is that it makes it easy to discuss the developments and debates in the field as they emerged over time. Organising your literature chronologically also allows you to highlight how specific articles or pieces of work might have changed the course of the field – in other words, which research has had the most impact . Therefore, this approach is very useful when your research is aimed at understanding how the topic has unfolded over time and is often used by scholars in the field of history. That said, this approach can be utilised by anyone that wants to explore change over time .

For example , if a student of politics is investigating how the understanding of democracy has evolved over time, they could use the chronological approach to provide a narrative that demonstrates how this understanding has changed through the ages.

Here are some questions you can ask yourself to help you structure your literature review chronologically.

• What is the earliest literature published relating to this topic?
• How has the field changed over time? Why?
• What are the most recent discoveries/theories?

In some ways, chronology plays a part whichever way you decide to structure your literature review, because you will always, to a certain extent, be analysing how the literature has developed. However, with the chronological approach, the emphasis is very firmly on how the discussion has evolved over time , as opposed to how all the literature links together (which we’ll discuss next ).

Option 2: Thematic (grouped by theme)

The thematic approach to structuring a literature review means organising your literature by theme or category – for example, by independent variables (i.e. factors that have an impact on a specific outcome).

As you’ve been collecting and synthesising literature , you’ll likely have started seeing some themes or patterns emerging. You can then use these themes or patterns as a structure for your body discussion. The thematic approach is the most common approach and is useful for structuring literature reviews in most fields.

For example, if you were researching which factors contributed towards people trusting an organisation, you might find themes such as consumers’ perceptions of an organisation’s competence, benevolence and integrity. Structuring your literature review thematically would mean structuring your literature review’s body section to discuss each of these themes, one section at a time.

Here are some questions to ask yourself when structuring your literature review by themes:

• Are there any patterns that have come to light in the literature?
• What are the central themes and categories used by the researchers?
• Do I have enough evidence of these themes?

PS – you can see an example of a thematically structured literature review in our literature review sample walkthrough video here.

Option 3: Methodological

The methodological option is a way of structuring your literature review by the research methodologies used . In other words, organising your discussion based on the angle from which each piece of research was approached – for example, qualitative , quantitative or mixed  methodologies.

Structuring your literature review by methodology can be useful if you are drawing research from a variety of disciplines and are critiquing different methodologies. The point of this approach is to question  how  existing research has been conducted, as opposed to  what  the conclusions and/or findings the research were.

For example, a sociologist might centre their research around critiquing specific fieldwork practices. Their literature review will then be a summary of the fieldwork methodologies used by different studies.

Here are some questions you can ask yourself when structuring your literature review according to methodology:

• Which methodologies have been utilised in this field?
• Which methodology is the most popular (and why)?
• What are the strengths and weaknesses of the various methodologies?
• How can the existing methodologies inform my own methodology?

3: The Conclusion Section

Once you’ve completed the body section of your literature review using one of the structural approaches we discussed above, you’ll need to “wrap up” your literature review and pull all the pieces together to set the direction for the rest of your dissertation or thesis.

The conclusion is where you’ll present the key findings of your literature review. In this section, you should emphasise the research that is especially important to your research questions and highlight the gaps that exist in the literature. Based on this, you need to make it clear what you will add to the literature – in other words, justify your own research by showing how it will help fill one or more of the gaps you just identified.

Last but not least, if it’s your intention to develop a conceptual framework for your dissertation or thesis, the conclusion section is a good place to present this.

Example: Thematically Structured Review

In the video below, we unpack a literature review chapter so that you can see an example of a thematically structure review in practice.

Let’s Recap

In this article, we’ve  discussed how to structure your literature review for maximum impact. Here’s a quick recap of what  you need to keep in mind when deciding on your literature review structure:

• Just like other chapters, your literature review needs a clear introduction , body and conclusion .
• The introduction section should provide an overview of what you will discuss in your literature review.
• The body section of your literature review can be organised by chronology , theme or methodology . The right structural approach depends on what you’re trying to achieve with your research.
• The conclusion section should draw together the key findings of your literature review and link them to your research questions.

If you’re ready to get started, be sure to download our free literature review template to fast-track your chapter outline.

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 .

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27 Comments

Great work. This is exactly what I was looking for and helps a lot together with your previous post on literature review. One last thing is missing: a link to a great literature chapter of an journal article (maybe with comments of the different sections in this review chapter). Do you know any great literature review chapters?

I agree with you Marin… A great piece

I agree with Marin. This would be quite helpful if you annotate a nicely structured literature from previously published research articles.

Awesome article for my research.

I thank you immensely for this wonderful guide

It is indeed thought and supportive work for the futurist researcher and students

Very educative and good time to get guide. Thank you

Great work, very insightful. Thank you.

Thanks for this wonderful presentation. My question is that do I put all the variables into a single conceptual framework or each hypothesis will have it own conceptual framework?

Thank you very much, very helpful

This is very educative and precise . Thank you very much for dropping this kind of write up .

Pheeww, so damn helpful, thank you for this informative piece.

I’m doing a research project topic ; stool analysis for parasitic worm (enteric) worm, how do I structure it, thanks.

comprehensive explanation. Help us by pasting the URL of some good “literature review” for better understanding.

great piece. thanks for the awesome explanation. it is really worth sharing. I have a little question, if anyone can help me out, which of the options in the body of literature can be best fit if you are writing an architectural thesis that deals with design?

I am doing a research on nanofluids how can l structure it?

Beautifully clear.nThank you!

Lucid! Thankyou!

Brilliant work, well understood, many thanks

I like how this was so clear with simple language 😊😊 thank you so much 😊 for these information 😊

Insightful. I was struggling to come up with a sensible literature review but this has been really helpful. Thank you!

You have given thought-provoking information about the review of the literature.

Thank you. It has made my own research better and to impart your work to students I teach

I learnt a lot from this teaching. It’s a great piece.

I am doing research on EFL teacher motivation for his/her job. How Can I structure it? Is there any detailed template, additional to this?

You are so cool! I do not think I’ve read through something like this before. So nice to find somebody with some genuine thoughts on this issue. Seriously.. thank you for starting this up. This site is one thing that is required on the internet, someone with a little originality!

I’m asked to do conceptual, theoretical and empirical literature, and i just don’t know how to structure it

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Neal Haddaway

October 19th, 2020, 8 common problems with literature reviews and how to fix them.

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Literature reviews are an integral part of the process and communication of scientific research. Whilst systematic reviews have become regarded as the highest standard of evidence synthesis, many literature reviews fall short of these standards and may end up presenting biased or incorrect conclusions. In this post, Neal Haddaway highlights 8 common problems with literature review methods, provides examples for each and provides practical solutions for ways to mitigate them.

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Researchers regularly review the literature – it’s an integral part of day-to-day research: finding relevant research, reading and digesting the main findings, summarising across papers, and making conclusions about the evidence base as a whole. However, there is a fundamental difference between brief, narrative approaches to summarising a selection of studies and attempting to reliably and comprehensively summarise an evidence base to support decision-making in policy and practice.

So-called ‘evidence-informed decision-making’ (EIDM) relies on rigorous systematic approaches to synthesising the evidence. Systematic review has become the highest standard of evidence synthesis and is well established in the pipeline from research to practice in the field of health . Systematic reviews must include a suite of specifically designed methods for the conduct and reporting of all synthesis activities (planning, searching, screening, appraising, extracting data, qualitative/quantitative/mixed methods synthesis, writing; e.g. see the Cochrane Handbook ). The method has been widely adapted into other fields, including environment (the Collaboration for Environmental Evidence ) and social policy (the Campbell Collaboration ).

Despite the growing interest in systematic reviews, traditional approaches to reviewing the literature continue to persist in contemporary publications across disciplines. These reviews, some of which are incorrectly referred to as ‘systematic’ reviews, may be susceptible to bias and as a result, may end up providing incorrect conclusions. This is of particular concern when reviews address key policy- and practice- relevant questions, such as the ongoing COVID-19 pandemic or climate change.

These limitations with traditional literature review approaches could be improved relatively easily with a few key procedures; some of them not prohibitively costly in terms of skill, time or resources.

In our recent paper in Nature Ecology and Evolution , we highlight 8 common problems with traditional literature review methods, provide examples for each from the field of environmental management and ecology, and provide practical solutions for ways to mitigate them.

There is a lack of awareness and appreciation of the methods needed to ensure systematic reviews are as free from bias and as reliable as possible: demonstrated by recent, flawed, high-profile reviews. We call on review authors to conduct more rigorous reviews, on editors and peer-reviewers to gate-keep more strictly, and the community of methodologists to better support the broader research community. Only by working together can we build and maintain a strong system of rigorous, evidence-informed decision-making in conservation and environmental management.

Note: This article gives the views of the authors, and not the position of the LSE Impact Blog, nor of the London School of Economics. Please review our  comments policy  if you have any concerns on posting a comment below

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About the author

Neal Haddaway is a Senior Research Fellow at the Stockholm Environment Institute, a Humboldt Research Fellow at the Mercator Research Institute on Global Commons and Climate Change, and a Research Associate at the Africa Centre for Evidence. He researches evidence synthesis methodology and conducts systematic reviews and maps in the field of sustainability and environmental science. His main research interests focus on improving the transparency, efficiency and reliability of evidence synthesis as a methodology and supporting evidence synthesis in resource constrained contexts. He co-founded and coordinates the Evidence Synthesis Hackathon (www.eshackathon.org) and is the leader of the Collaboration for Environmental Evidence centre at SEI. @nealhaddaway

Why is mission creep a problem and not a legitimate response to an unexpected finding in the literature? Surely the crucial points are that the review’s scope is stated clearly and implemented rigorously, not when the scope was finalised.

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#9. Most of them are terribly boring. Which is why I teach students how to make them engaging…and useful.

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• Published: 26 April 2024

A Systematic review of the factors that affect soccer players’ short-passing ability—based on the Loughborough Soccer Passing Test

• Bihan Wang 1   na1 ,
• Bin Wan 1   na1 ,
• Shu Chen 1 ,
• Yu Zhang 1 ,
• Xiaorong Bai 2 ,
• Wensheng Xiao 2 ,
• Changfa Tang 1 &
• Bo Long 1  

BMC Sports Science, Medicine and Rehabilitation volume  16 , Article number:  96 ( 2024 ) Cite this article

66 Accesses

Metrics details

This study synthesizes evidence from the Loughborough Passing Test to evaluate the short-passing ability of soccer players and summarizes the reported variables that affect this ability to provide support for the development and improvement of short-passing abilities in soccer players.

In this systematic review using the PRISMA guidelines, a comprehensive search was conducted in Web of Science, PubMed, and EBSCOhost from inception to July 2023 to identify relevant articles from the accessible literature. Only studies that used the Loughborough test to assess athletes' short-passing ability were included. The quality of the included studies was independently assessed by two reviewers using the PEDro scale, and two authors independently completed the data extraction.

Based on the type of intervention or influencing factor, ten studies investigated training, nine studies investigated fatigue, nine studies investigated supplement intake, and five studies investigated other factors.

Evidence indicates that fitness training, small-sided games training, and warm-up training have positive effects on athletes' short-passing ability, high-intensity special-position training and water intake have no discernible impact, mental and muscular exhaustion have a significantly negative effect, and the effect of nutritional ergogenic aid intake is not yet clear. Future research should examine more elements that can affect soccer players' short-passing ability.

Trial registration

https://inplasy.com/ ., identifier: INPLASY20237.

Peer Review reports

Introduction

Soccer is a game of skills and strategy, and one of the most crucial techniques is short passing [ 1 , 2 , 3 ]. A player's ability to make short passes is important for the team to initiate offense and control the pace of the game. Soccer players can more effectively control the game by strategically use their short passing ability. Making multiple quick, short passes in succession can speed up the game, complete the attacking strategy, and increase pressure on the defence of the opposition, which can provide scoring opportunities [ 4 ]. According to a study, most goals are preceded by short passes [ 5 ].

Players who use short-passing techniques in the game must decide on the pass's timing, strength, and direction under time and space constraints based on the placement of teammates and opponents on the field. However, the conventional short-passing ability assessment employs a single short-passing ability test. The most striking feature of this type of test is that it is performed in a relatively static environment with a short pass to a target or teammate at a known distance and direction; therefore, only motion patterns are shown throughout the test, and it has limited ecological validity [ 6 , 7 , 8 , 9 ]. This type of test cannot be used to effectively evaluate the short-pass technique of athletes with different levels of competitive ability [ 10 , 11 , 12 ]. In contrast to conventional short-passing ability tests, the Loughborough Soccer Passing Test (LSPT), as shown in Fig.  1 , as a multitask test, has advantages in the evaluation of athletes' short passes: it requires participants to remember the relative orientation of the target, process oral information for quick decision-making, squelch potential errors, and make flexible cognitive transitions while using their short-passing ability. As a result, the LSPT is consistent with the shifting circumstances of soccer matches [ 12 , 13 ]. The LSPT procedure is manageable and requires subjects to pass the ball 16 times while surrounded by a rectangular bench. Each bench has a colourful metal strip or coloured cardboard (0.6 × 0.3 m) that can be utilized as a target area to make an effective pass in one of four randomly selected colour sequences. Subjects must complete 16 brief passes of the test as quickly and accurately as they can. Time-related metrics are used to define LSPT scores, including execution time (the amount of time needed to complete 16 passes), penalty time (the amount of time added for mistakes, including incorrect passes and sluggish performance), and total time (execution time plus penalty time). All LSPT time values are inversely correlated with a player's short-passing ability in soccer (a player with a lower LSPT time value has greater short-passing ability). The LSPT is currently used in research on athlete selection in Australia [ 14 ], the Netherlands [ 15 ], and France [ 16 ]. Several studies have shown that the LSPT has good retest reliability and good discriminant validity for players of different sport levels, ages, and genders [ 12 , 17 ].

Layout of the LSPT [ 12 , 18 ]

Regrettably, despite its importance, there is no systematic review of short-passing abilities or the factors that influence them. Systematic reviews of soccer skills have been conducted on most or all skills or overall athletic performance [ 19 , 20 , 21 ], but there is a lack of systematic reviews of specific soccer skills. Due to the importance of short-passing abilities, there is a great need for a more comprehensive analysis of the research on soccer players' short-passing abilities to statistically synthesize the various findings and to examine the factors that affect soccer players' short-passing abilities. The purpose of this paper is to review and analyse research on the factors that affect the short-passing ability of soccer players to contribute to improvements in soccer players’ short-passing ability.

This systematic review used the PRISMA guidelines [ 22 ] and was registered in the International Platform for Registered Programs for Systematic Reviews and Meta-Analyses (INPLASY); https://inplasy.com , INPLASY202370041.

Search strategy

A comprehensive, electronic search of the literature was conducted without data restrictions in Web of Science, PubMed, and EBSCOhost on July 10, 2023, using a search strategy developed by two authors (WBH and XWS). The keyword combinations used were: (("Pass" OR "Skill" OR "Technology" OR "Technique" OR "Art" OR "Performance" OR "Ability" OR "Capacity") AND ("Soccer" OR "Football") AND ("LSPT" OR "Loughborough Soccer Passing Test")). Additionally, the researchers explored Google Scholar and the reference lists of the included studies for potential papers that could meet the inclusion criteria for additional related citations.

Eligibility criteria

The overall, intervention, comparison, outcome, and study design (PICOS) criteria were the inclusion criteria for this study, as detailed in Table 1 . Studies were included if they met the following requirements: 1. football players were the subjects of the study; 2. the paper must include at least one study that aimed to assess the effect of a factor or an intervention on the short-passing ability of soccer players; 3. the method used to assess the short-passing ability of the subjects of the study must have been LSPT. Regardless of the factor that influences a soccer player's short-passing ability, any study that met the above three requirements was included in this systematic review.

Studies that met the following criteria were excluded: 1. conferences, overviews, newsletters, book reviews, and studies that were not supported by data and were not analysed statistically; 2. studies that did not quantitatively evaluate the short-passing abilities of the subjects or evaluated them without using the LSPT; 3. studies that did not apply to the vast majority of soccer players, such as the effect of a particular religious practice on the short-passing ability of a soccer player of that religion or the effect of a certain factor on the short-passing ability of a soccer player with a disability.

Study selection

The following procedure was used to choose the papers. First, prior to importing the studies into EndNote X9 to check for duplication, an experienced librarian assisted with the search strategy by putting key phrases into the three major databases to search for articles. Second, to find pertinent research, two independent reviewers (WBH and XWS) examined the titles and abstracts of all identified papers in accordance with the inclusion and exclusion criteria of the study.

Data extraction

Two independent reviewers (WBH and XWS) completed the data extraction. Any disputes were explored further. When necessary, a third reviewer (BXR) participated until consensus was reached. The records included (1) the author and year of publication; (2) the study design; (3) participant characteristics, namely, age, sex, and athletic level; (4) the characteristics of the intervention; and (5) the final research outcomes.

Quality assessment

Two authors (WBH and XWS) independently utilized the PEDro scale, with disagreements resolved by a third rater (BXR). The eligibility criteria in the scale were not included in the total score, as they were related to external validity. The total PEDro score ranges from 0 to 10. The higher the score, the better the methodological quality. A score of 8 to 10 indicates a study of excellent methodological quality, 5 to 7 is considered to indicate good quality, 3 to 4 is considered a study of average quality, and values less than 3 points are considered to indicate fair quality. A score lower than 3 is considered a poor-quality study [ 23 ].

As shown in Fig. 2 , the electronic search of the relevant databases yielded 147 potentially relevant articles (54 from Web of Science, 30 from PubMed, and 63 from EBSCOhost), while an additional five studies were found through Google Scholar and references. The titles and abstracts of 65 publications were evaluated for conformity after duplicates were eliminated ( n = 87). After 17 items were deleted at the title and abstract levels, the remaining 48 articles were read. Following this reading, an additional 15 publications were excluded, and 33 studies that met all the inclusion criteria for the systematic review were retained. The characteristics of the included studies are detailed in Table 2 .

PRISMA flow chart of the study selection process

Demographic characteristics

The pertinent details of the studies are presented in Table 2 . The age of the players ranged from 8 to 25.5 ± 5.2 years. With regard to the players’ gender, most of the studies reported male players, two studies examined female players [ 41 , 42 ], and only one study reported on male and female players [ 52 ].

Intervention characteristics

For ease of generalization and induction, other factors included motivation, soccer field, verbal interaction, visual observation, and salbutamol intake; these are presented in Fig. 3 . Of the 33 included studies, 24 were one-time intervention studies and 9 were long-term intervention studies. Interventions/influencing factors included training ( n = 10), fatigue ( n = 9), supplement intake ( n = 9), and other factors ( n = 5). The ten papers on the influence of training on football players' short-passing ability included fitness training ( n = 4), small-sided games training ( n = 2), warm-up training ( n = 3) and high-intensity position-specific training ( n = 1). The 9 papers on the effect of fatigue on short-passing ability in soccer players included mental fatigue ( n = 5) and muscle fatigue ( n = 4). The 9 papers on the effect of supplement intake on short-passing ability in soccer players included water intake ( n = 2) and nutritional ergogenic aid intake ( n = 7). The five papers on other factors that influence football players' short-passing ability included motivation ( n = 1), verbal interaction ( n = 1), football field ( n = 1), visual observation ( n = 1) and salbutamol intake ( n = 1).

Influence Factor Chart of Short-passing Skill of Soccer Players

Among the studies ( n = 10) on the effects of training on short-passing ability in soccer players, with the exception of two one-time intervention studies [ 30 , 32 ], 1) all studies explicitly reported the total duration of the intervention, with the shortest being 5 days [ 31 ] and the longest being 22 weeks [ 25 ]; 2) most of the studies explicitly reported the duration of each intervention, with the shortest being 16 minutes [ 33 ] and the longest being 98 minutes [ 25 ] and only two studies failing to explicitly report the duration of each intervention [ 27 , 31 ]; 3) all studies explicitly reported the frequency of intervention, which was once a day in one study [ 31 ], twice a week in three studies [ 28 , 29 , 33 ], three times a week in two studies [ 26 , 27 ], between 2 times a week and 4 times a week in one study [ 25 ], and 2 times in the first week and 3 times in weeks 2 to 4 in one study [ 24 ]. In the studies in which fatigue affected the short-passing ability of soccer players ( n = 9), all reported in detail the intervention protocols used. In terms of mental fatigue, four studies used the Stroop task [ 18 , 34 , 35 , 37 ], one study used Brain It On software [ 36 ], one study used the LSPT random order and clockwise order tasks in addition to the Stroop task [ 18 ], and four studies performed muscle training [ 38 ], soccer matches [ 39 ], high-intensity interval training [ 40 ], and resistance training [ 41 ]. In studies on the effects of supplement intake on short-passing ability in soccer players ( n = 9), 1) all studies reported the intake dose of supplements; 2) all studies explicitly reported the type of supplement ingested, including water, carbohydrate solution, caffeine solution, and carbohydrate caffeine solution (i.e., carbohydrate solution mixed with caffeine solution). In two studies only water was ingested [ 42 , 43 ], in three studies only carbohydrate solutions were ingested [ 44 , 45 , 48 ], two studies used only caffeine solution [ 46 , 50 ], carbohydrate solutions and carbohydrate caffeine solutions were ingested in one study [ 47 ], and carbohydrate solution, caffeine solution, and carbohydrate caffeine solution were ingested in one study [ 49 ]. All other studies of factors that affect short-passing ability in soccer players ( n = 5) provided a clear description or explicit definition of the substance or method of intervention.

Study quality assessment

The quality of the studies is presented in Table 3 . The PEDro checklist was used to assess the quality of the included studies. The results showed that eight studies received a score of 3 or 4, indicating average quality, and 18 studies scored 5 to 7 points, which was considered good quality. Moreover, seven studies had scores ranging from 8 to 10 points and were considered to have excellent methodological quality.

Outcome and measures

The results of the current study were divided into groups based on the various interventions and influencing factors that were found to have an impact on soccer players' short-passing ability.

The effect of training on the short-passing ability of soccer players

Fitness training.

Four studies examined the impact of fitness training on soccer players' short-passing abilities [ 24 , 25 , 26 , 27 ]. The fitness training methods included aerobic interval training [ 24 ], skill combined with agility training [ 25 ], balance training [ 26 ], and strength combined with endurance training [ 27 ]. The subjects included amateur players [ 26 ], youth players [ 24 ], players with five years of experience [ 27 ], and regional sub-elite players [ 25 ]. The results of these studies demonstrate that fitness training improves soccer players' short-passing abilities and is more effective than the training methods used in the control groups of the respective studies.

Small-sided games training

This review comprises two studies that examined the impact of small-sided games training on soccer players' short-passing abilities [ 28 , 29 ]. The participants included amateur players [ 29 ] and professional players [ 28 ]. Both studies found that small-field match training improved short-passing ability in soccer players and demonstrated that small-field match training was more effective than repetitive sprint training and conventional aerobic interval training, respectively, which were used by their control groups.

Warm-up training

The influence of warm-up training on soccer players' short-passing abilities was examined in three studies [ 30 , 31 , 32 ]. One of these studies examined pre-match warm-up training, while the other two explored halftime rewarm-up training. These studies used four warm-up training methods, including passing warm-up training [ 30 ], foam axle rolling training [ 32 ], leg press training, and small-sided games training [ 30 ]. The participants included non-elite players [ 31 ] and professional players [ 30 , 32 ]. Of the four training methods, foam axle rolling training [ 32 ] and leg press training [ 30 ] performed during halftime did not significantly affect players’ short-passing ability, while the remaining two warm-up training methods positively affected players’ short-passing ability [ 30 , 31 ].

High-intensity special-position training

Only one study included in this systematic review presented inferences about the effect of high-intensity special position training on soccer players' short-passing abilities [ 33 ]. The participants in this study were national youth events and professional soccer training services. This study revealed no improvement in short-passing ability after high-intensity special-position training [ 33 ].

The effect of fatigue on the short-passing ability of soccer players

Mental fatigue.

This review included five studies that examined the impact of mental fatigue on soccer players' short-passing abilities [ 18 , 34 , 35 , 36 , 37 ]. The participants included youth players [ 36 ], trained players [ 18 ], players competing at the national level [ 37 ], and professional players [ 34 , 35 ]. These five studies revealed a significant negative impact of mental weariness on soccer players' short-passing abilities.

Muscle fatigue

This systematic review comprised four studies that examined how soccer players' short-passing abilities were affected by muscular exhaustion [ 38 , 39 , 40 , 41 ]. Importantly, two of the studies provided indirect confirmation rather than directly investigating how muscular exhaustion affects soccer players' short-passing abilities [ 40 , 41 ]. The participants included college soccer players [ 38 ], high-level competition players [ 40 ], professional elites, sub-elite players [ 41 ], and professional footballers [ 39 ]. These four studies demonstrated that muscle exhaustion can significantly impair soccer players' short-passing abilities.

The effect of supplement intake on short-passing ability in soccer players

Water intake.

This review included two trials that examined the impact of water intake on soccer players' short-passing abilities [ 42 , 43 ]. The participants included semi-professional players [ 43 ] and professional players [ 42 ]. The intake of water had no discernible impact on players' ability to produce short passes in both experiments.

Nutrition ergogenic aid intake

This review comprised seven trials to confirm the impact of nutrition ergogenic aid intake use on football players' short passing ability [ 44 , 45 , 46 , 47 , 48 , 49 , 50 ]. The subjects included semi-professional players, ex-professional players or players who had reached at least college 1st/2nd team standards [ 44 ], semi-professional or non-professional players from college teams [ 45 ], regional top league players [ 46 ], class players [ 47 ], college players [ 48 , 49 ], and casual players [ 50 ]. Only two studies reported a significant positive effect on players' short-passing ability when they ingested a carbohydrate solution [ 48 ] or a caffeine solution [ 46 ]. The results of the remaining five studies indicated that the ingestion of a carbohydrate solution, a caffeine solution, or a carbohydrate caffeine solution did not have a significant effect on players' short-passing ability [ 44 , 45 , 47 , 49 , 50 ].

This review included five studies that examined additional variables that influenced soccer players' short-passing abilities [ 51 , 52 , 53 , 54 , 55 ]. The participants included amateur players [ 51 ], amateur student players [ 52 ], top players in school soccer games [ 53 ], soccer academy high-level players, soccer academy low-level players [ 54 ] and professional junior soccer players [ 55 ]. In five studies, motivation [ 51 ] and verbal interaction [ 52 ] were reported to positively influence players' short-passing ability. O’Meagher et al. (2022) reported no significant difference in players' short-passing ability between grass and artificial turf. One study reported the important effect of visual observation on players' short-passing ability [ 54 ]. Another study showed that salbutamol intake did not have a significant effect on players' short-passing ability [ 55 ].

The growth and performance of soccer players’ technical and tactical skills depend on their level of fitness. The four studies that examined how short-passing abilities in soccer players were affected by fitness training all concluded that players could benefit from the training techniques used in their studies, which included aerobic interval training [ 24 ], strength and endurance training [ 27 ], skill and agility training [ 25 ], and balance training [ 26 ]. This means that a player's short-passing ability benefits not only from technical training but also from fitness training. The training techniques employed in these studies involve only a portion of the fitness training approach, including endurance training, balance training, and strength training. Some studies support the findings of earlier research that showed that fitness training can enhance athletes' abilities [ 56 , 57 , 58 ]. In fact, the same rationale that supports the positive effects of fitness training on athletes' specialized skills in other sports likely applies to the short-passing abilities of soccer players. In addition to athletes’ mastery of the technique itself, athletes’ physical attributes are crucial to the use of the skill. For instance, an athlete's balance directly influences the mass of the short passing, which is a dynamic unilateral technical movement [ 59 , 60 ], especially when a game-time physical altercation with the opponent occurs. Future studies should examine the effects of various fitness training programmes on soccer players' short-passing abilities.

Soccer training for small-sided games is referred to as skill-based match training [ 61 ] or match-based training [ 62 ] and is typically played on a smaller pitch. According to the two included studies on the impact of small-sided games training on soccer players' short-passing ability [ 28 , 29 ], small-sided games training considerably enhances players' short-passing ability. Small-sided games training simulates the athletic demands, physiological intensity, and technical requirements of a soccer game. Compared with traditional short-passing practice (e.g., one-on-one passing, multiple passes to each other), small-sided games training forces players to use short passes more frequently under increased defensive pressure and reduced field size due to the limitations of the rules. In other words, small-sided games training allows players more opportunities to use and practice short passes under time and space pressure [ 62 , 63 ]. This may also explain why small-sided games training improves soccer players' short-passing ability more significantly than traditional short-passing training or other training methods. This means that coaches and players can use small-sided games training drills to improve short passes in real scenarios that are more similar to games.

Soccer training before a game is essential. In recent years, researchers have examined various warm-up training strategies, such as rewarming up during the game's halftime break and conventional pregame warm-up training, as the methods and means of warm-up training have become more varied. In comparison to a ball size of five, Burcak's (2015) study found that pre-match warm-up training with a ball size of four had a positive effect on players' short-passing ability. In a randomized crossover experiment, Zois et al. (2013) discovered that practising for a small-sided game during halftime increased players' short-passing ability. In contrast, the halftime leg press drill had little impact on players' short-passing ability. Similarly, randomized crossover research by Kaya et al. (2021) revealed that halftime foam-axis rolling drills had no positive impact on players' short-passing ability [ 64 , 65 ]. Nevertheless, due to the lower intensity, foam-axis rolling training and leg press training during halftime tend to reduce muscle temperature in athletes who have recently concluded a game's first half. Based on these findings, athletes may decide to maintain their muscular temperature by engaging in rewarming exercises during halftime. However, it is crucial to remember that each player must be evaluated individually. If a player is extremely exhausted at halftime, rewarming up for training may worsen his or her short passing ability and athletic performance.

Soccer players who engage in high-intensity position-specific training practise the skill most pertinent to their position at a high level (90% HRmax) [ 33 ]. Compared to the impact of small-sided games training on soccer players' short-passing abilities, this produces the opposite outcome. Due to the limitations of the field size, small-sided games training may offer more possibilities for practising short-passing techniques. High-intensity position-specific training, in contrast, includes many additional elements and requires less time to improve short-passing ability. This indicates that high-intensity special-position training is used by coaches and players to enhance short passing, which is an unwise choice.

According to one definition, mental tiredness is a psychobiological condition marked by feelings of exhaustion that can occur during or after prolonged periods of perceived exertion [ 66 , 67 ]. The five studies in this paper on the effect of psychological exhaustion on soccer players' short-passing abilities all concluded that psychological exhaustion may be detrimental to these abilities [ 18 , 34 , 35 , 36 , 37 ]. This suggests that coaches and players should pay increased attention to this easily overlooked factor that affects short-passing ability. According to Filipas et al. (2021), mental fatigue has a significant negative impact on U18 players' short-passing abilities as well as a negative, albeit nonsignificant, impact on U14 and U16 players' short-passing abilities; total LSPT times are 7.4% (U14) and 4.2% (U16) greater than the control group. Smith et al. (2017) also performed more thorough statistical analyses using the LSPT penalty time rule. In contrast to players who are not mentally weary, mentally fatigued players targeted errors substantially more and completed passes significantly less frequently. These findings confirm earlier studies suggesting that mental weariness impairs athletes' performance [ 66 , 68 , 69 ]. According to some research, mental weariness can impair a player's ability to concentrate, lengthen reaction times for cognitive activities, and increase a player's risk of making mistakes when using short-passing techniques [ 70 ]. When using short-passing abilities in soccer, players must maintain a high degree of focus and accurate perception to allow them to make the right choices in a highly dynamic environment and under time and space pressures. As a result, athletes should try to prevent developing premature mental tiredness. Cognitive tasks that require considerable energy typically lead to mental weariness [ 71 ]. Therefore, to avoid premature mental fatigue, players should be wary of high levels of pregame cognitive demands (e.g., excessive use of cell phones, tablets, and video games, as well as prolonged cognitive skill training).

Short inter-match recovery times (halftime) and high neuromuscular demands during soccer matches may result in muscle fatigue during the game, decreasing players' abilities and fitness, which may have an impact on match performance [ 72 ]. Researchers of soccer have paid close attention to the impact of muscular fatigue on short-passing ability, one of the skills most often employed by players in games. Two studies directly reported significant negative effects of muscle fatigue on soccer players' short-passing ability [ 38 , 39 ], and two other studies provided indirect support that short-passing ability can have significant negative effects on soccer players. After high-intensity interval training, Draganidis et al. (2013) reported that professional sub-elite players' short-passing abilities deteriorated, and Lyons et al. (2021) found that high-level players' short-passing abilities deteriorated. These findings provide circumstantial evidence that players with short-passing abilities can suffer from muscle exhaustion resulting from persistent dynamic exercise and resistance training [ 73 , 74 ].

These results are consistent with those from earlier investigations. In fact, numerous studies have documented losses in athletic ability and performance that occur as players approach a state of muscular tiredness [ 75 , 76 ], and one study reported that after fatigue training, a considerable drop occurred in shooting scores [ 77 ]. Soccer players’ short-passing abilities might suffer from muscle exhaustion, perhaps as a result of a reduction in muscle functioning capacity [ 78 , 79 ], which decreases the stability and accuracy of a player's passes. The decrease in players' short-passing ability caused by completing short bursts of high-intensity activity at the same absolute workload is also related to players' physical quality [ 39 ]. Therefore, in actual daily training, to prevent premature muscle fatigue from impairing short-passing ability in play, players should enhance their physical training and practice.

The effect of supplement intake on the short-passing ability of soccer players

During a game, soccer players exert both mental and physical effort. Under extreme physical and mental strain, the body is susceptible to water loss and mental exhaustion. Reduced endurance and cognitive function can result from dehydration in athletes with up to 2% body weight loss during exercise [ 80 , 81 ]. Two variables may cause a player's ability to pass short passes to gradually deteriorate throughout sports: dehydration and inadequate water intake. To keep players' short-passing ability or slow down its decline, several studies have tried feeding them a specific volume of water. However, neither of the experiments presented in this study revealed a significant impact of water intake on players' short-passing abilities [ 42 , 43 ]. These findings suggest that soccer players cannot rely on drinking water during a game to prevent a decrease in short-passing ability.

Nutritional ergogenic aid intake

The nutritional ergogenic aid intake is anything that enhances athletic performance. It can be a nutrient, a nutrient metabolite, a food extract (from a plant), or something that is typically present in other items (i.e., caffeine or carbohydrates) [ 82 ]. Carbohydrate solution, caffeine solution, and carbohydrate and caffeine solution were utilized in the seven studies that examined the impact of the nutritional ergogenic aid intake on soccer players' short-passing abilities. O'Reilly et al. (2013) and Foskett et al. (2009) reported that ingesting a carbohydrate solution or a caffeine solution significantly improved players' short-passing ability. The other five studies found no evidence that ingesting a carbohydrate solution, a caffeine solution, or a carbohydrate and caffeine solution significantly improved players' short-passing abilities [ 44 , 45 , 47 , 49 , 50 ]. Three studies indicate that players' short pass ability is positively impacted by nutritional ergogenic supplement intake, but these findings also indicate that this relationship is not statistically significant [ 44 , 45 , 50 ]. Therefore, the impact of nutritional ergogenic aid intake on soccer players' short-passing abilities is unclear and requires additional explanation. In fact, the effects of nutritional ergogenic aid intake on athletes' skills have been similarly ambiguous in other investigations. For instance, Stuart et al. (2005) [ 83 ] reported that rugby players who swallowed a caffeine solution had a 10% increase in passing accuracy on the exam. However, rugby players took the same dose of caffeine solution in the study by Assi and Bottoms (2014), and the findings revealed no appreciable impact on test-passing accuracy [ 84 ]. Belenky et al. (2005) [ 85 ] claimed that ingesting a caffeinated solution enhanced shooting ability, although other studies have demonstrated that doing so did not significantly enhance this ability [ 86 , 87 ]. Therefore, football players are advised to not employ nutritional ergogenic aid intake to maintain their short-passing abilities or to halt their decline. Future research should confirm these findings with additional randomized, double-blind crossover experiments. Future research is necessary to determine the potential impact of other commonly used nutritional ergogenic aids, such as creatine, L-carnitine, protein, and amino acid supplements, on football players' short pass ability.

Other factors affecting short-passing ability in soccer players

The five studies that were evaluated in this section of the paper examined five underappreciated or overlooked factors that may affect soccer players' short-passing abilities [ 51 , 52 , 53 , 54 , 55 ]. Barte et al. (2019) reported that various methods of motivating worn-out players while at rest improve athletes' short-passing abilities. This suggests that motivating players makes practical sense for improving short passes, which provides support for coaches who are accustomed to motivating players. Khalifa et al. (2020) suggested that talking to teammates during halftime can improve short-passing abilities (10.2% reduction in overall LSPT time) and can outperform passive rest (4.2% reduction in total LSPT time).

Players' short-passing abilities did not differ significantly between grass and artificial turf, according to research by Meagher et al. (2022) Players should therefore not worry about the effect that being on two different types of turf may have on their short-passing ability. However, indoor springy wood flooring considerably improved players' short-passing abilities over grass and synthetic turf. Nevertheless, indoor 5-a-side soccer games are usually the only tournaments played on indoor resilient wood floors. Visual observation, as shown by Vansteenkiste et al. (2022), has a significant impact on players' short-passing ability. When players utilize short-passing abilities, spending too much time focusing on the ball might prevent them from seeing teammates' and defenders' locations, which can cause them to miss the ideal opportunity to pass the ball or lose possession. This suggests that players should be more observant of the ever-changing conditions on the field rather than just staring at the ball in the ratios. Coaches must be aware of this key point, which can be easily overlooked, and remind players of it during training, and players must recognize it themselves. Additionally, a study revealed that taking salbutamol had no discernible impact on players' short-passing abilities [ 55 ].

Limitations

This study systematically evaluated the factors that affect soccer players' short-passing ability. The results showed that these factors can be divided into positive and negative categories. This study provides a reference and support for soccer coaches and players to improve their short-passing abilities. However, there are a few limitations to this review. 1) Papers in languages other than English were excluded from the study, which influenced the selection of papers. 2) Because it is unknown whether the participants' sex, age, and level of sport affected the intervention effects of some research, the pertinent conclusions should not be extended without due care. 3) Despite the advantages of the LSPT over the conventional short-passing ability test, the LSPT cannot accurately imitate the intricacies of soccer players' use of the short-passing technique in games. 4) The present results should be applied with caution due to the lack of research on some of the influencing elements included in this study, which could affect the accuracy of some of the conclusions. Nevertheless, we believe that the current study can aid in the development and improvement of short-passing abilities in soccer because it examines some relevant strategies and elements.

Conclusions

This study's findings indicate that a variety of factors can influence soccer players' short-passing abilities. For example, in terms of the effect of training on football players' short-passing abilities, fitness training, small-sided games training, and some warm-up training positively impact these abilities, while high-intensity special-position training has no discernible impact. Mental and muscular exhaustion have a significantly negative effect. In terms of the effect of supplemental intake on football players’ short-passing ability, water intake has no significant effect, and the effect of nutritional ergogenic aid intake is not yet clear. Based on these findings, additional research is encouraged to investigate techniques or variables that affect short-passing ability in soccer players, such as additional training methods (e.g., Specialized short-passing ability training and functional training) and players' own factors (e.g., sleep and mood). However, whether the results of this study apply to all soccer players of all ages, sexes, and athletic levels is unknown. Future research should focus on determining whether a specific subset of the findings is appropriate for a particular group of soccer players. In addition, this study offers only a general directional reference for the sustainable development and improvement of soccer players' short-passing ability.

Availability of data and materials

Data are available on request to the corresponding author by e-mail ([email protected] OR [email protected] OR [email protected]), and registered in the International Platform for Registered Programs for Systematic Reviews and Meta-Analyses (INPLASY); https://inplasy.com , INPLASY202370041.

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A grant from the Ministry of Education of China, Grant No. 20YJA890002, supported this study.

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Bihan Wang, Bin Wan, Shu Chen, Yu Zhang, Changfa Tang & Bo Long

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Wang, B., Wan, B., Chen, S. et al. A Systematic review of the factors that affect soccer players’ short-passing ability—based on the Loughborough Soccer Passing Test. BMC Sports Sci Med Rehabil 16 , 96 (2024). https://doi.org/10.1186/s13102-024-00880-y

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Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27.

Handbook of eHealth Evaluation: An Evidence-based Approach [Internet].

Chapter 9 methods for literature reviews.

Guy Paré and Spyros Kitsiou .

9.1. Introduction

Literature reviews play a critical role in scholarship because science remains, first and foremost, a cumulative endeavour ( vom Brocke et al., 2009 ). As in any academic discipline, rigorous knowledge syntheses are becoming indispensable in keeping up with an exponentially growing eHealth literature, assisting practitioners, academics, and graduate students in finding, evaluating, and synthesizing the contents of many empirical and conceptual papers. Among other methods, literature reviews are essential for: (a) identifying what has been written on a subject or topic; (b) determining the extent to which a specific research area reveals any interpretable trends or patterns; (c) aggregating empirical findings related to a narrow research question to support evidence-based practice; (d) generating new frameworks and theories; and (e) identifying topics or questions requiring more investigation ( Paré, Trudel, Jaana, & Kitsiou, 2015 ).

Literature reviews can take two major forms. The most prevalent one is the “literature review” or “background” section within a journal paper or a chapter in a graduate thesis. This section synthesizes the extant literature and usually identifies the gaps in knowledge that the empirical study addresses ( Sylvester, Tate, & Johnstone, 2013 ). It may also provide a theoretical foundation for the proposed study, substantiate the presence of the research problem, justify the research as one that contributes something new to the cumulated knowledge, or validate the methods and approaches for the proposed study ( Hart, 1998 ; Levy & Ellis, 2006 ).

The second form of literature review, which is the focus of this chapter, constitutes an original and valuable work of research in and of itself ( Paré et al., 2015 ). Rather than providing a base for a researcher’s own work, it creates a solid starting point for all members of the community interested in a particular area or topic ( Mulrow, 1987 ). The so-called “review article” is a journal-length paper which has an overarching purpose to synthesize the literature in a field, without collecting or analyzing any primary data ( Green, Johnson, & Adams, 2006 ).

When appropriately conducted, review articles represent powerful information sources for practitioners looking for state-of-the art evidence to guide their decision-making and work practices ( Paré et al., 2015 ). Further, high-quality reviews become frequently cited pieces of work which researchers seek out as a first clear outline of the literature when undertaking empirical studies ( Cooper, 1988 ; Rowe, 2014 ). Scholars who track and gauge the impact of articles have found that review papers are cited and downloaded more often than any other type of published article ( Cronin, Ryan, & Coughlan, 2008 ; Montori, Wilczynski, Morgan, Haynes, & Hedges, 2003 ; Patsopoulos, Analatos, & Ioannidis, 2005 ). The reason for their popularity may be the fact that reading the review enables one to have an overview, if not a detailed knowledge of the area in question, as well as references to the most useful primary sources ( Cronin et al., 2008 ). Although they are not easy to conduct, the commitment to complete a review article provides a tremendous service to one’s academic community ( Paré et al., 2015 ; Petticrew & Roberts, 2006 ). Most, if not all, peer-reviewed journals in the fields of medical informatics publish review articles of some type.

The main objectives of this chapter are fourfold: (a) to provide an overview of the major steps and activities involved in conducting a stand-alone literature review; (b) to describe and contrast the different types of review articles that can contribute to the eHealth knowledge base; (c) to illustrate each review type with one or two examples from the eHealth literature; and (d) to provide a series of recommendations for prospective authors of review articles in this domain.

9.2. Overview of the Literature Review Process and Steps

As explained in Templier and Paré (2015) , there are six generic steps involved in conducting a review article:

• formulating the research question(s) and objective(s),
• searching the extant literature,
• screening for inclusion,
• assessing the quality of primary studies,
• extracting data, and
• analyzing data.

Although these steps are presented here in sequential order, one must keep in mind that the review process can be iterative and that many activities can be initiated during the planning stage and later refined during subsequent phases ( Finfgeld-Connett & Johnson, 2013 ; Kitchenham & Charters, 2007 ).

Formulating the research question(s) and objective(s): As a first step, members of the review team must appropriately justify the need for the review itself ( Petticrew & Roberts, 2006 ), identify the review’s main objective(s) ( Okoli & Schabram, 2010 ), and define the concepts or variables at the heart of their synthesis ( Cooper & Hedges, 2009 ; Webster & Watson, 2002 ). Importantly, they also need to articulate the research question(s) they propose to investigate ( Kitchenham & Charters, 2007 ). In this regard, we concur with Jesson, Matheson, and Lacey (2011) that clearly articulated research questions are key ingredients that guide the entire review methodology; they underscore the type of information that is needed, inform the search for and selection of relevant literature, and guide or orient the subsequent analysis. Searching the extant literature: The next step consists of searching the literature and making decisions about the suitability of material to be considered in the review ( Cooper, 1988 ). There exist three main coverage strategies. First, exhaustive coverage means an effort is made to be as comprehensive as possible in order to ensure that all relevant studies, published and unpublished, are included in the review and, thus, conclusions are based on this all-inclusive knowledge base. The second type of coverage consists of presenting materials that are representative of most other works in a given field or area. Often authors who adopt this strategy will search for relevant articles in a small number of top-tier journals in a field ( Paré et al., 2015 ). In the third strategy, the review team concentrates on prior works that have been central or pivotal to a particular topic. This may include empirical studies or conceptual papers that initiated a line of investigation, changed how problems or questions were framed, introduced new methods or concepts, or engendered important debate ( Cooper, 1988 ). Screening for inclusion: The following step consists of evaluating the applicability of the material identified in the preceding step ( Levy & Ellis, 2006 ; vom Brocke et al., 2009 ). Once a group of potential studies has been identified, members of the review team must screen them to determine their relevance ( Petticrew & Roberts, 2006 ). A set of predetermined rules provides a basis for including or excluding certain studies. This exercise requires a significant investment on the part of researchers, who must ensure enhanced objectivity and avoid biases or mistakes. As discussed later in this chapter, for certain types of reviews there must be at least two independent reviewers involved in the screening process and a procedure to resolve disagreements must also be in place ( Liberati et al., 2009 ; Shea et al., 2009 ). Assessing the quality of primary studies: In addition to screening material for inclusion, members of the review team may need to assess the scientific quality of the selected studies, that is, appraise the rigour of the research design and methods. Such formal assessment, which is usually conducted independently by at least two coders, helps members of the review team refine which studies to include in the final sample, determine whether or not the differences in quality may affect their conclusions, or guide how they analyze the data and interpret the findings ( Petticrew & Roberts, 2006 ). Ascribing quality scores to each primary study or considering through domain-based evaluations which study components have or have not been designed and executed appropriately makes it possible to reflect on the extent to which the selected study addresses possible biases and maximizes validity ( Shea et al., 2009 ). Extracting data: The following step involves gathering or extracting applicable information from each primary study included in the sample and deciding what is relevant to the problem of interest ( Cooper & Hedges, 2009 ). Indeed, the type of data that should be recorded mainly depends on the initial research questions ( Okoli & Schabram, 2010 ). However, important information may also be gathered about how, when, where and by whom the primary study was conducted, the research design and methods, or qualitative/quantitative results ( Cooper & Hedges, 2009 ). Analyzing and synthesizing data : As a final step, members of the review team must collate, summarize, aggregate, organize, and compare the evidence extracted from the included studies. The extracted data must be presented in a meaningful way that suggests a new contribution to the extant literature ( Jesson et al., 2011 ). Webster and Watson (2002) warn researchers that literature reviews should be much more than lists of papers and should provide a coherent lens to make sense of extant knowledge on a given topic. There exist several methods and techniques for synthesizing quantitative (e.g., frequency analysis, meta-analysis) and qualitative (e.g., grounded theory, narrative analysis, meta-ethnography) evidence ( Dixon-Woods, Agarwal, Jones, Young, & Sutton, 2005 ; Thomas & Harden, 2008 ).

9.3. Types of Review Articles and Brief Illustrations

EHealth researchers have at their disposal a number of approaches and methods for making sense out of existing literature, all with the purpose of casting current research findings into historical contexts or explaining contradictions that might exist among a set of primary research studies conducted on a particular topic. Our classification scheme is largely inspired from Paré and colleagues’ (2015) typology. Below we present and illustrate those review types that we feel are central to the growth and development of the eHealth domain.

9.3.1. Narrative Reviews

The narrative review is the “traditional” way of reviewing the extant literature and is skewed towards a qualitative interpretation of prior knowledge ( Sylvester et al., 2013 ). Put simply, a narrative review attempts to summarize or synthesize what has been written on a particular topic but does not seek generalization or cumulative knowledge from what is reviewed ( Davies, 2000 ; Green et al., 2006 ). Instead, the review team often undertakes the task of accumulating and synthesizing the literature to demonstrate the value of a particular point of view ( Baumeister & Leary, 1997 ). As such, reviewers may selectively ignore or limit the attention paid to certain studies in order to make a point. In this rather unsystematic approach, the selection of information from primary articles is subjective, lacks explicit criteria for inclusion and can lead to biased interpretations or inferences ( Green et al., 2006 ). There are several narrative reviews in the particular eHealth domain, as in all fields, which follow such an unstructured approach ( Silva et al., 2015 ; Paul et al., 2015 ).

Despite these criticisms, this type of review can be very useful in gathering together a volume of literature in a specific subject area and synthesizing it. As mentioned above, its primary purpose is to provide the reader with a comprehensive background for understanding current knowledge and highlighting the significance of new research ( Cronin et al., 2008 ). Faculty like to use narrative reviews in the classroom because they are often more up to date than textbooks, provide a single source for students to reference, and expose students to peer-reviewed literature ( Green et al., 2006 ). For researchers, narrative reviews can inspire research ideas by identifying gaps or inconsistencies in a body of knowledge, thus helping researchers to determine research questions or formulate hypotheses. Importantly, narrative reviews can also be used as educational articles to bring practitioners up to date with certain topics of issues ( Green et al., 2006 ).

Recently, there have been several efforts to introduce more rigour in narrative reviews that will elucidate common pitfalls and bring changes into their publication standards. Information systems researchers, among others, have contributed to advancing knowledge on how to structure a “traditional” review. For instance, Levy and Ellis (2006) proposed a generic framework for conducting such reviews. Their model follows the systematic data processing approach comprised of three steps, namely: (a) literature search and screening; (b) data extraction and analysis; and (c) writing the literature review. They provide detailed and very helpful instructions on how to conduct each step of the review process. As another methodological contribution, vom Brocke et al. (2009) offered a series of guidelines for conducting literature reviews, with a particular focus on how to search and extract the relevant body of knowledge. Last, Bandara, Miskon, and Fielt (2011) proposed a structured, predefined and tool-supported method to identify primary studies within a feasible scope, extract relevant content from identified articles, synthesize and analyze the findings, and effectively write and present the results of the literature review. We highly recommend that prospective authors of narrative reviews consult these useful sources before embarking on their work.

Darlow and Wen (2015) provide a good example of a highly structured narrative review in the eHealth field. These authors synthesized published articles that describe the development process of mobile health ( m-health ) interventions for patients’ cancer care self-management. As in most narrative reviews, the scope of the research questions being investigated is broad: (a) how development of these systems are carried out; (b) which methods are used to investigate these systems; and (c) what conclusions can be drawn as a result of the development of these systems. To provide clear answers to these questions, a literature search was conducted on six electronic databases and Google Scholar . The search was performed using several terms and free text words, combining them in an appropriate manner. Four inclusion and three exclusion criteria were utilized during the screening process. Both authors independently reviewed each of the identified articles to determine eligibility and extract study information. A flow diagram shows the number of studies identified, screened, and included or excluded at each stage of study selection. In terms of contributions, this review provides a series of practical recommendations for m-health intervention development.

9.3.2. Descriptive or Mapping Reviews

The primary goal of a descriptive review is to determine the extent to which a body of knowledge in a particular research topic reveals any interpretable pattern or trend with respect to pre-existing propositions, theories, methodologies or findings ( King & He, 2005 ; Paré et al., 2015 ). In contrast with narrative reviews, descriptive reviews follow a systematic and transparent procedure, including searching, screening and classifying studies ( Petersen, Vakkalanka, & Kuzniarz, 2015 ). Indeed, structured search methods are used to form a representative sample of a larger group of published works ( Paré et al., 2015 ). Further, authors of descriptive reviews extract from each study certain characteristics of interest, such as publication year, research methods, data collection techniques, and direction or strength of research outcomes (e.g., positive, negative, or non-significant) in the form of frequency analysis to produce quantitative results ( Sylvester et al., 2013 ). In essence, each study included in a descriptive review is treated as the unit of analysis and the published literature as a whole provides a database from which the authors attempt to identify any interpretable trends or draw overall conclusions about the merits of existing conceptualizations, propositions, methods or findings ( Paré et al., 2015 ). In doing so, a descriptive review may claim that its findings represent the state of the art in a particular domain ( King & He, 2005 ).

In the fields of health sciences and medical informatics, reviews that focus on examining the range, nature and evolution of a topic area are described by Anderson, Allen, Peckham, and Goodwin (2008) as mapping reviews . Like descriptive reviews, the research questions are generic and usually relate to publication patterns and trends. There is no preconceived plan to systematically review all of the literature although this can be done. Instead, researchers often present studies that are representative of most works published in a particular area and they consider a specific time frame to be mapped.

An example of this approach in the eHealth domain is offered by DeShazo, Lavallie, and Wolf (2009). The purpose of this descriptive or mapping review was to characterize publication trends in the medical informatics literature over a 20-year period (1987 to 2006). To achieve this ambitious objective, the authors performed a bibliometric analysis of medical informatics citations indexed in medline using publication trends, journal frequencies, impact factors, Medical Subject Headings (MeSH) term frequencies, and characteristics of citations. Findings revealed that there were over 77,000 medical informatics articles published during the covered period in numerous journals and that the average annual growth rate was 12%. The MeSH term analysis also suggested a strong interdisciplinary trend. Finally, average impact scores increased over time with two notable growth periods. Overall, patterns in research outputs that seem to characterize the historic trends and current components of the field of medical informatics suggest it may be a maturing discipline (DeShazo et al., 2009).

9.3.3. Scoping Reviews

Scoping reviews attempt to provide an initial indication of the potential size and nature of the extant literature on an emergent topic (Arksey & O’Malley, 2005; Daudt, van Mossel, & Scott, 2013 ; Levac, Colquhoun, & O’Brien, 2010). A scoping review may be conducted to examine the extent, range and nature of research activities in a particular area, determine the value of undertaking a full systematic review (discussed next), or identify research gaps in the extant literature ( Paré et al., 2015 ). In line with their main objective, scoping reviews usually conclude with the presentation of a detailed research agenda for future works along with potential implications for both practice and research.

Unlike narrative and descriptive reviews, the whole point of scoping the field is to be as comprehensive as possible, including grey literature (Arksey & O’Malley, 2005). Inclusion and exclusion criteria must be established to help researchers eliminate studies that are not aligned with the research questions. It is also recommended that at least two independent coders review abstracts yielded from the search strategy and then the full articles for study selection ( Daudt et al., 2013 ). The synthesized evidence from content or thematic analysis is relatively easy to present in tabular form (Arksey & O’Malley, 2005; Thomas & Harden, 2008 ).

One of the most highly cited scoping reviews in the eHealth domain was published by Archer, Fevrier-Thomas, Lokker, McKibbon, and Straus (2011) . These authors reviewed the existing literature on personal health record ( phr ) systems including design, functionality, implementation, applications, outcomes, and benefits. Seven databases were searched from 1985 to March 2010. Several search terms relating to phr s were used during this process. Two authors independently screened titles and abstracts to determine inclusion status. A second screen of full-text articles, again by two independent members of the research team, ensured that the studies described phr s. All in all, 130 articles met the criteria and their data were extracted manually into a database. The authors concluded that although there is a large amount of survey, observational, cohort/panel, and anecdotal evidence of phr benefits and satisfaction for patients, more research is needed to evaluate the results of phr implementations. Their in-depth analysis of the literature signalled that there is little solid evidence from randomized controlled trials or other studies through the use of phr s. Hence, they suggested that more research is needed that addresses the current lack of understanding of optimal functionality and usability of these systems, and how they can play a beneficial role in supporting patient self-management ( Archer et al., 2011 ).

9.3.4. Forms of Aggregative Reviews

Healthcare providers, practitioners, and policy-makers are nowadays overwhelmed with large volumes of information, including research-based evidence from numerous clinical trials and evaluation studies, assessing the effectiveness of health information technologies and interventions ( Ammenwerth & de Keizer, 2004 ; Deshazo et al., 2009 ). It is unrealistic to expect that all these disparate actors will have the time, skills, and necessary resources to identify the available evidence in the area of their expertise and consider it when making decisions. Systematic reviews that involve the rigorous application of scientific strategies aimed at limiting subjectivity and bias (i.e., systematic and random errors) can respond to this challenge.

Systematic reviews attempt to aggregate, appraise, and synthesize in a single source all empirical evidence that meet a set of previously specified eligibility criteria in order to answer a clearly formulated and often narrow research question on a particular topic of interest to support evidence-based practice ( Liberati et al., 2009 ). They adhere closely to explicit scientific principles ( Liberati et al., 2009 ) and rigorous methodological guidelines (Higgins & Green, 2008) aimed at reducing random and systematic errors that can lead to deviations from the truth in results or inferences. The use of explicit methods allows systematic reviews to aggregate a large body of research evidence, assess whether effects or relationships are in the same direction and of the same general magnitude, explain possible inconsistencies between study results, and determine the strength of the overall evidence for every outcome of interest based on the quality of included studies and the general consistency among them ( Cook, Mulrow, & Haynes, 1997 ). The main procedures of a systematic review involve:

• Formulating a review question and developing a search strategy based on explicit inclusion criteria for the identification of eligible studies (usually described in the context of a detailed review protocol).
• Searching for eligible studies using multiple databases and information sources, including grey literature sources, without any language restrictions.
• Selecting studies, extracting data, and assessing risk of bias in a duplicate manner using two independent reviewers to avoid random or systematic errors in the process.
• Analyzing data using quantitative or qualitative methods.
• Presenting results in summary of findings tables.
• Interpreting results and drawing conclusions.

Many systematic reviews, but not all, use statistical methods to combine the results of independent studies into a single quantitative estimate or summary effect size. Known as meta-analyses , these reviews use specific data extraction and statistical techniques (e.g., network, frequentist, or Bayesian meta-analyses) to calculate from each study by outcome of interest an effect size along with a confidence interval that reflects the degree of uncertainty behind the point estimate of effect ( Borenstein, Hedges, Higgins, & Rothstein, 2009 ; Deeks, Higgins, & Altman, 2008 ). Subsequently, they use fixed or random-effects analysis models to combine the results of the included studies, assess statistical heterogeneity, and calculate a weighted average of the effect estimates from the different studies, taking into account their sample sizes. The summary effect size is a value that reflects the average magnitude of the intervention effect for a particular outcome of interest or, more generally, the strength of a relationship between two variables across all studies included in the systematic review. By statistically combining data from multiple studies, meta-analyses can create more precise and reliable estimates of intervention effects than those derived from individual studies alone, when these are examined independently as discrete sources of information.

The review by Gurol-Urganci, de Jongh, Vodopivec-Jamsek, Atun, and Car (2013) on the effects of mobile phone messaging reminders for attendance at healthcare appointments is an illustrative example of a high-quality systematic review with meta-analysis. Missed appointments are a major cause of inefficiency in healthcare delivery with substantial monetary costs to health systems. These authors sought to assess whether mobile phone-based appointment reminders delivered through Short Message Service ( sms ) or Multimedia Messaging Service ( mms ) are effective in improving rates of patient attendance and reducing overall costs. To this end, they conducted a comprehensive search on multiple databases using highly sensitive search strategies without language or publication-type restrictions to identify all rct s that are eligible for inclusion. In order to minimize the risk of omitting eligible studies not captured by the original search, they supplemented all electronic searches with manual screening of trial registers and references contained in the included studies. Study selection, data extraction, and risk of bias assessments were performed inde­­pen­dently by two coders using standardized methods to ensure consistency and to eliminate potential errors. Findings from eight rct s involving 6,615 participants were pooled into meta-analyses to calculate the magnitude of effects that mobile text message reminders have on the rate of attendance at healthcare appointments compared to no reminders and phone call reminders.

Meta-analyses are regarded as powerful tools for deriving meaningful conclusions. However, there are situations in which it is neither reasonable nor appropriate to pool studies together using meta-analytic methods simply because there is extensive clinical heterogeneity between the included studies or variation in measurement tools, comparisons, or outcomes of interest. In these cases, systematic reviews can use qualitative synthesis methods such as vote counting, content analysis, classification schemes and tabulations, as an alternative approach to narratively synthesize the results of the independent studies included in the review. This form of review is known as qualitative systematic review.

A rigorous example of one such review in the eHealth domain is presented by Mickan, Atherton, Roberts, Heneghan, and Tilson (2014) on the use of handheld computers by healthcare professionals and their impact on access to information and clinical decision-making. In line with the methodological guide­lines for systematic reviews, these authors: (a) developed and registered with prospero ( www.crd.york.ac.uk/ prospero / ) an a priori review protocol; (b) conducted comprehensive searches for eligible studies using multiple databases and other supplementary strategies (e.g., forward searches); and (c) subsequently carried out study selection, data extraction, and risk of bias assessments in a duplicate manner to eliminate potential errors in the review process. Heterogeneity between the included studies in terms of reported outcomes and measures precluded the use of meta-analytic methods. To this end, the authors resorted to using narrative analysis and synthesis to describe the effectiveness of handheld computers on accessing information for clinical knowledge, adherence to safety and clinical quality guidelines, and diagnostic decision-making.

In recent years, the number of systematic reviews in the field of health informatics has increased considerably. Systematic reviews with discordant findings can cause great confusion and make it difficult for decision-makers to interpret the review-level evidence ( Moher, 2013 ). Therefore, there is a growing need for appraisal and synthesis of prior systematic reviews to ensure that decision-making is constantly informed by the best available accumulated evidence. Umbrella reviews , also known as overviews of systematic reviews, are tertiary types of evidence synthesis that aim to accomplish this; that is, they aim to compare and contrast findings from multiple systematic reviews and meta-analyses ( Becker & Oxman, 2008 ). Umbrella reviews generally adhere to the same principles and rigorous methodological guidelines used in systematic reviews. However, the unit of analysis in umbrella reviews is the systematic review rather than the primary study ( Becker & Oxman, 2008 ). Unlike systematic reviews that have a narrow focus of inquiry, umbrella reviews focus on broader research topics for which there are several potential interventions ( Smith, Devane, Begley, & Clarke, 2011 ). A recent umbrella review on the effects of home telemonitoring interventions for patients with heart failure critically appraised, compared, and synthesized evidence from 15 systematic reviews to investigate which types of home telemonitoring technologies and forms of interventions are more effective in reducing mortality and hospital admissions ( Kitsiou, Paré, & Jaana, 2015 ).

9.3.5. Realist Reviews

Realist reviews are theory-driven interpretative reviews developed to inform, enhance, or supplement conventional systematic reviews by making sense of heterogeneous evidence about complex interventions applied in diverse contexts in a way that informs policy decision-making ( Greenhalgh, Wong, Westhorp, & Pawson, 2011 ). They originated from criticisms of positivist systematic reviews which centre on their “simplistic” underlying assumptions ( Oates, 2011 ). As explained above, systematic reviews seek to identify causation. Such logic is appropriate for fields like medicine and education where findings of randomized controlled trials can be aggregated to see whether a new treatment or intervention does improve outcomes. However, many argue that it is not possible to establish such direct causal links between interventions and outcomes in fields such as social policy, management, and information systems where for any intervention there is unlikely to be a regular or consistent outcome ( Oates, 2011 ; Pawson, 2006 ; Rousseau, Manning, & Denyer, 2008 ).

To circumvent these limitations, Pawson, Greenhalgh, Harvey, and Walshe (2005) have proposed a new approach for synthesizing knowledge that seeks to unpack the mechanism of how “complex interventions” work in particular contexts. The basic research question — what works? — which is usually associated with systematic reviews changes to: what is it about this intervention that works, for whom, in what circumstances, in what respects and why? Realist reviews have no particular preference for either quantitative or qualitative evidence. As a theory-building approach, a realist review usually starts by articulating likely underlying mechanisms and then scrutinizes available evidence to find out whether and where these mechanisms are applicable ( Shepperd et al., 2009 ). Primary studies found in the extant literature are viewed as case studies which can test and modify the initial theories ( Rousseau et al., 2008 ).

The main objective pursued in the realist review conducted by Otte-Trojel, de Bont, Rundall, and van de Klundert (2014) was to examine how patient portals contribute to health service delivery and patient outcomes. The specific goals were to investigate how outcomes are produced and, most importantly, how variations in outcomes can be explained. The research team started with an exploratory review of background documents and research studies to identify ways in which patient portals may contribute to health service delivery and patient outcomes. The authors identified six main ways which represent “educated guesses” to be tested against the data in the evaluation studies. These studies were identified through a formal and systematic search in four databases between 2003 and 2013. Two members of the research team selected the articles using a pre-established list of inclusion and exclusion criteria and following a two-step procedure. The authors then extracted data from the selected articles and created several tables, one for each outcome category. They organized information to bring forward those mechanisms where patient portals contribute to outcomes and the variation in outcomes across different contexts.

9.3.6. Critical Reviews

Lastly, critical reviews aim to provide a critical evaluation and interpretive analysis of existing literature on a particular topic of interest to reveal strengths, weaknesses, contradictions, controversies, inconsistencies, and/or other important issues with respect to theories, hypotheses, research methods or results ( Baumeister & Leary, 1997 ; Kirkevold, 1997 ). Unlike other review types, critical reviews attempt to take a reflective account of the research that has been done in a particular area of interest, and assess its credibility by using appraisal instruments or critical interpretive methods. In this way, critical reviews attempt to constructively inform other scholars about the weaknesses of prior research and strengthen knowledge development by giving focus and direction to studies for further improvement ( Kirkevold, 1997 ).

Kitsiou, Paré, and Jaana (2013) provide an example of a critical review that assessed the methodological quality of prior systematic reviews of home telemonitoring studies for chronic patients. The authors conducted a comprehensive search on multiple databases to identify eligible reviews and subsequently used a validated instrument to conduct an in-depth quality appraisal. Results indicate that the majority of systematic reviews in this particular area suffer from important methodological flaws and biases that impair their internal validity and limit their usefulness for clinical and decision-making purposes. To this end, they provide a number of recommendations to strengthen knowledge development towards improving the design and execution of future reviews on home telemonitoring.

9.4. Summary

Table 9.1 outlines the main types of literature reviews that were described in the previous sub-sections and summarizes the main characteristics that distinguish one review type from another. It also includes key references to methodological guidelines and useful sources that can be used by eHealth scholars and researchers for planning and developing reviews.

Typology of Literature Reviews (adapted from Paré et al., 2015).

As shown in Table 9.1 , each review type addresses different kinds of research questions or objectives, which subsequently define and dictate the methods and approaches that need to be used to achieve the overarching goal(s) of the review. For example, in the case of narrative reviews, there is greater flexibility in searching and synthesizing articles ( Green et al., 2006 ). Researchers are often relatively free to use a diversity of approaches to search, identify, and select relevant scientific articles, describe their operational characteristics, present how the individual studies fit together, and formulate conclusions. On the other hand, systematic reviews are characterized by their high level of systematicity, rigour, and use of explicit methods, based on an “a priori” review plan that aims to minimize bias in the analysis and synthesis process (Higgins & Green, 2008). Some reviews are exploratory in nature (e.g., scoping/mapping reviews), whereas others may be conducted to discover patterns (e.g., descriptive reviews) or involve a synthesis approach that may include the critical analysis of prior research ( Paré et al., 2015 ). Hence, in order to select the most appropriate type of review, it is critical to know before embarking on a review project, why the research synthesis is conducted and what type of methods are best aligned with the pursued goals.

9.5. Concluding Remarks

In light of the increased use of evidence-based practice and research generating stronger evidence ( Grady et al., 2011 ; Lyden et al., 2013 ), review articles have become essential tools for summarizing, synthesizing, integrating or critically appraising prior knowledge in the eHealth field. As mentioned earlier, when rigorously conducted review articles represent powerful information sources for eHealth scholars and practitioners looking for state-of-the-art evidence. The typology of literature reviews we used herein will allow eHealth researchers, graduate students and practitioners to gain a better understanding of the similarities and differences between review types.

We must stress that this classification scheme does not privilege any specific type of review as being of higher quality than another ( Paré et al., 2015 ). As explained above, each type of review has its own strengths and limitations. Having said that, we realize that the methodological rigour of any review — be it qualitative, quantitative or mixed — is a critical aspect that should be considered seriously by prospective authors. In the present context, the notion of rigour refers to the reliability and validity of the review process described in section 9.2. For one thing, reliability is related to the reproducibility of the review process and steps, which is facilitated by a comprehensive documentation of the literature search process, extraction, coding and analysis performed in the review. Whether the search is comprehensive or not, whether it involves a methodical approach for data extraction and synthesis or not, it is important that the review documents in an explicit and transparent manner the steps and approach that were used in the process of its development. Next, validity characterizes the degree to which the review process was conducted appropriately. It goes beyond documentation and reflects decisions related to the selection of the sources, the search terms used, the period of time covered, the articles selected in the search, and the application of backward and forward searches ( vom Brocke et al., 2009 ). In short, the rigour of any review article is reflected by the explicitness of its methods (i.e., transparency) and the soundness of the approach used. We refer those interested in the concepts of rigour and quality to the work of Templier and Paré (2015) which offers a detailed set of methodological guidelines for conducting and evaluating various types of review articles.

To conclude, our main objective in this chapter was to demystify the various types of literature reviews that are central to the continuous development of the eHealth field. It is our hope that our descriptive account will serve as a valuable source for those conducting, evaluating or using reviews in this important and growing domain.

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Idiopathic intracranial hypertension associated with SARS-CoV-2 infection in an adult male patient: a case report and review of the literature

• Gashaw Solela   ORCID: orcid.org/0000-0002-2233-9270 1 ,
• Addis A. Tenaw 1 ,
• Henok Fisseha 2 ,
• Abel M. Argaw 2 ,
• Tamirat Petros 2 &
• Betelhem Mengistu 3  

Journal of Medical Case Reports volume  18 , Article number:  206 ( 2024 ) Cite this article

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Headache is a frequent symptom in coronavirus disease 2019 (COVID-19) patients, and idiopathic intracranial hypertension (pseudotumor cerebri) has been reported among patients who underwent lumbar puncture for persistent headaches.

Case presentation

A 45-year-old black man presented with dyspnea, cough, fever and headache for 05 days followed by blurring of vision associated with worsening of the headache. Physical examination was significant for tachypnea and oxygen desaturation and there were no abnormal neurologic findings. He tested positive for SARS-CoV-2 with nasopharyngeal swab PCR. His CSF opening pressure appeared high with normal CSF analysis and brain magnetic resonance imaging (MRI) revealed prominent subarachnoid space around the optic nerves and bilateral papilledema. He had significant improvement with medical therapy alone.

Idiopathic intracranial hypertension (IIH) may occur in association with SARS-CoV-2 infection and should be considered when making a differential diagnosis for headache and blurring of vision. COVID-19 may play a role in the development of intracranial hypertension, even in the absence of known risk factors. Early diagnosis and treatment of IIH has paramount importance to prevent vision loss and other morbidities.

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Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), has been the main global public health concern since March 2020 [ 1 ]. Although respiratory conditions are the predominating manifestations of COVID-19, neurological disorders are also becoming more frequently reported. Well known neurologic disorders reported in COVID-19 include encephalitis, encephalopathy, cerebrovascular illness, and Guillain-Barré syndrome ( 2 ).

Patients with COVID-19 frequently complain of headaches, and idiopathic intracranial hypertension (IIH), also called as pseudotumor cerebri has been observed in those who had lumbar puncture for persistent headaches ( 3 ). Patients with various neurologic conditions associated with COVID-19 have also been reported to have elevated intracranial pressure, usually in a mild form ( 4 ).

Cases reports of IIH associated with COVID-19 have been rare and they are described mainly in children and limited number of adult female patients. To the best of our knowledge, this is the first adult male patient who developed idiopathic intracranial hypertension associated with COVID-19.

A 45-year-old black Ethiopian man presented to our COVID-19 isolation center with intermittent dry cough and dyspnea for 05 days associated with new onset mild holocranial headache, low grade fever, myalgia and arthralgia. One day after his admission to the center, he started to develop blurring of vision associated with worsening of the headache. He also had one episode of projectile vomiting of ingested matter. He had no known chronic medical illnesses and no history of drug intake including vitamin A derivatives and tetracycline before the onset of the aforementioned symptoms.

Physical examination revealed blood pressure of 127/91 mmHg, pulse rate of 98 beats per minute, respiratory rate of 28 breaths per minute, oxygen saturation of 86% without oxygen and 92% with 2 L/min intranasal oxygen and body mass index (BMI) of 22.8 kg/m 2 . He had bilateral coarse crepitation over his lower lung fields. He was conscious with Glasgow Coma Scale (GCS) of 15/15 and all the cranial nerves were intact with normal visual acuity (20/20) and visual fields. Meningeal signs were negative and there were no sensory or motor deficits.

Upon investigations, he tested positive for SARS-CoV-2 with nasopharyngeal swab polymerase chain reaction (PCR) and he had mild leukocytosis with left shift and lymphopenia. Lumbar puncture was performed after doing brain magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) opening pressure appeared high, though it was not measured. The other laboratory results were non-remarkable (Table  1 ).

Brain MRI revealed prominent subarachnoid space around the optic nerves and bilateral papilledema, but didn’t show any mass lesion, hemorrhage, or cerebrovascular lesion and brain magnetic resonance venography (MRV) was normal (Fig.  1 A and B). Chest x-ray revealed bilateral ground glass opacities mainly in the middle and lower lung zones with right side blunted costophrenic angle which was suggestive of COVID-19 pneumonia (Fig.  1 C).

T2 axial and sagittal brain MRI scan showed prominent subarachnoid space around the optic nerves ( A ) and flattening of pituitary gland ( B ). Chest X-ray showed bilateral ground glass opacities mainly in the middle and lower lung zones with right side blunted costophrenic angle ( C )

The patient initially received supportive therapies for severe COVID-19 infection including IV antibiotics, dexamethasone 6 mg IV daily, intranasal oxygen, and prophylactic dose of unfractionated heparin. Acetazolamide 250 mg three times daily was added after establishing the diagnosis of idiopathic intracranial hypertension. He was then followed clinically if he could have an indication for ventriculoperitoneal shunt but his headache and blurring of vision improved and he did not require any surgical intervention. He was finally discharged after 10 days of inpatient supportive medical treatment with significant improvement except occasional cough and mild headache. He did not have any complaint upon reevaluation on the second week of discharge and the acetazolamide was discontinued. He was then doing well throughout his follow up over 6 months in the outpatient department.

Coronavirus disease 2019 (COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is clinically characterized by fever, myalgia, diarrhea, and respiratory illness ( 5 ). However, a number of neurological manifestations have been linked to COVID-19 in the literature, which can be divided into peripheral nervous system (PNS) manifestations like hyposmia/anosmia, hypogeusia/ageusia, myalgia, and Guillain–Barre syndrome and central nervous system (CNS) manifestations like headache, dizziness, impaired consciousness, acute cerebrovascular disease, and seizure disorders ( 6 , 7 ).

Only a small number of cases of idiopathic intracranial hypertension (IIH) linked to COVID-19 have been reported, the majority of which affected children ( 8 , 9 , 10 ). In one study made on 58 patients with distinct neurological conditions associated with COVID-19, cerebrospinal fluid (CSF) analysis revealed that CSF pressure was elevated in one-third of COVID-19 patients with different neurological conditions and all of these patients presented early with intracranial hypertension and none of them developed loss of vision ( 11 ). In line with the results of this study, our patient appeared to have high CSF opening pressure, though not measured; indicating high intracranial hypertension and he had blurring of vision which subsequently improved with acetazolamide.

Idiopathic intracranial hypertension (IIH) is still exceedingly uncommon with 12 to 20 cases per 100,000 persons per year and the main risk factors are obesity, female gender, and reproductive age ( 13 ). The idea that obesity is an inflammatory illness is growing and markers of inflammation were found in the CSF of individuals with idiopathic IHT ( 13 ). A case series of eight adult patients described an association between IIH and COVID-19 ( 14 ). All of these patients were women; many of them were obese; and most of them improved with medical therapy alone (Table  2 ). Unlike the patients described in this case series, our patient was male and non-obese, but similar to most of these cases, he improved with medical therapy alone.

The cause of IIH in COVID-19 is uncertain and debatable. According to one study, increased CSF pressure is linked to high levels of neurofilament light chain proteins, which may be an indication of an active and exaggerated inflammatory process ( 11 ). Cerebral venous sinus thrombosis (CVT), which has been observed in COVID-19 patients, is another mechanism linked to IIH ( 12 ).

There were two case reports of middle aged female patients who had idiopathic intracranial hypertension and visual loss associated with COVID-19. The first one was a 40-year-old obese female patient, who presented with headache, bilateral optic disc edema, and visual loss, which occurred two weeks after making the diagnosis of COVID-19. Her CSF opening pressure was 410 mmH 2 O, and cranial imaging was normal. Visual loss improved after initiation of accetazolamide 250 mg three times daily ( 15 ). The second case was a 49-year-old non-obese woman, who presented with headache and vision loss and found to have COVID-19. Upon further work ups, she was diagnosed to have COVID-19 related IIH, after which she treated with mannitol infusion and oral acetazolamide 250 mg twice daily and then the headache and visual loss got improved. However, she presented again with acute vision loss, which was managed by endoscopic optic nerve fenestration surgery and then she had a good recovery ( 16 ). Our patient had similar clinical manifestations with the aforementioned cases, though he was male by gender and he did not have severe degree of visual impairment. Besides, he had remarkable improvement with medical treatment (acetazolamide) alone like that of the first case ( 16 ).

Our patient was male and had none of the aforementioned risk factors for IIH like obesity and CVT implying that SARS-CoV-2 infection could be the sole culprit in the development of IIH. To the best of our knowledge, all of the cases reported to have IIH associated with COVID-19 were women and most of them were obese and we reported the first male patient with a case of idiopathic intracranial hypertension (IIH) following COVID-19 infection.

Idiopathic intracranial hypertension (IIH) may occur in association with SARS-CoV-2 infection and should be kept in mind when making a differential diagnosis for headache and blurring of vision. COVID-19 may play a role in the development of intracranial hypertension, even in the absence of known risk factors. Early diagnosis and treatment of IIH has paramount importance to prevent vision loss and other morbidities.

Data availability statement

Data supporting this case report will be available with the corresponding author upon reasonable request.

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GS was involved in data curation, validation, and writing–review and editing. AA was involved in conceptualization, data curation and writing–original draft. HF, AM, TP and BM were involved in data curation and writing–original draft. All authors read and approved the final manuscript.

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Solela, G., Tenaw, A.A., Fisseha, H. et al. Idiopathic intracranial hypertension associated with SARS-CoV-2 infection in an adult male patient: a case report and review of the literature. J Med Case Reports 18 , 206 (2024). https://doi.org/10.1186/s13256-024-04519-x

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Concomitant ectopic Enterobius vermicularis infection in uterine cervical cancer

• Iztok Takač 1 , 2 ,
• Rajko Kavalar 3 ,
• Matija Rudolf Lovrec 2 &
• Vida Gavrić Lovrec 1 , 2  

BMC Women's Health volume  24 , Article number:  265 ( 2024 ) Cite this article

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Enterobius vermicularis ( E. vermicularis ), also referred to as pinworm, is a widespread human intestinal parasite which predominantly occurs in young children, making their caretakers a population at risk for the transmission of this helminth. It can occasionally affect extraintestinal organs and tissues, including the female genital tract. Infestation can be asymptomatic or manifest as different kinds of gynaecological disorders, such as pelvic inflammation mimicking tumours, abnormal uterine bleeding, or vaginitis. Diagnosis is made by identifying ova in the sample collected from the perineal skin using a transparent adhesive tape or microscopic examination of resected tissue. Mebendazole is the first-line medication and should also be administered to all household members.

Case presentation

We present a case of a patient who had undergone surgery for invasive cervical cancer with an accidental finding of E. vermicularis eggs in the cervix.

Conclusions

Although not very common, infestation with E. vermicularis should be considered in differential diagnoses of various gynaecological disorders accompanied by histological findings of granulomatous inflammation.

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E. vermicularis , also known as pinworm, is the most prevalent intestinal parasite, and enterobiasis affects over 200 million people worldwide [ 1 ]. Humans are the only known hosts of this parasitic worm, as its entire life cycle occurs within the lumen of the human gastrointestinal tract [ 2 ].

Occasionally, extraintestinal organs and tissues can be infested by E. vermicularis , including the female genital tract [ 3 ]. Several case reports present different clinical manifestations; however, according to publications, E. vermicularis in the uterine cervix is rare [ 4 ]. Until now, no report of E. vermicularis infestation of the cervix with concomitant cervical cancer was recorded.

A 35-year-old patient was admitted to the Department of Gynecology at the University Medical Centre Maribor, for surgical treatment of verified cervical squamous cell carcinoma FIGO stage IB, grade 2 without necrosis. A PAP smear of the cervix revealed a high-grade squamous intraepithelial lesion (HSIL). Histologic examination of two colposcopically suspicious regions confirmed invasive squamous cell carcinoma FIGO stage IB, grade 2, with necrosis and without lymphovascular invasion (LVI) or perineural invasion (PNI). Clinical examination, ultrasonography and MRI failed to show any cervical tumour or lymph nodes in the lower pelvis. Tumour marker squamous cell carcinoma antigen (SCC) was slightly elevated (1,7 ng/mL). A differential blood count was not performed; there was no information about potential eosinophilia. The patient was healthy, without any accompanying diseases. She had regular menstrual cycles; she gave birth twice and had one ectopic pregnancy. She worked as a teacher in a kindergarten. There was no record of recent travels or prior anthelminthic treatment.

Diagnostic cold knife conisation was performed a month later to determine the actual stage of the disease. Histological findings were that of an invasive squamous cell carcinoma with a diameter of 20 mm and a depth of 15 mm, with LVI but without PNI and invasion in blood vessels. According to FIGO Classification from 2019, the disease was diagnosed as stage FIGO IB2 and radical surgery sec. Wertheim-Meigs-Novak, including radical hysterectomy, bilateral salpingectomy and pelvic lymphadenectomy were performed. Final pathological findings confirmed residual 4,5 mm thick invasive squamous cell carcinoma of the cervix without contact with the resection plane, with LVI, non-keratinizing, p-16 positive. Twenty-nine lymph nodes were removed, and all were cancer cell free. At the microscopic examination of the resected uterus, the residua of an invasive nonkeratinizing squamous cell cancer (SCC) were present in the cervix, partly ulcerated and with lymphovascular invasion. Deep in the cervical stroma away from the SCC, foci of acute and chronic inflammation with foreign body granuloma formation were present. In their center, there were multiple E. vermicularis eggs (Fig.  1 ). The eggs, identifiable by the dimensions and form as eggs of E. vermicularis , were oval with one flattened side, some altered by the regressive process. They were measuring approximately an average of 50–60 µ in length and 20–25 µ in width. No pinworm larvae were present (Fig.  2 ). Diagnosis of E. vermicularis infection was confirmed by the Laboratory for Parasitology of the Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana. In the postoperative period, the patient complained of paraesthesia in the legs and hypaesthesia in the thighs and had a transient elevation of liver enzymes. After the diagnosis of E. vermicularis infestation was made, mebendazole was administered. Ten days after surgery, the patient was released from the hospital in a stable state. Mebendazole was also administered to all family members. The patient complained about occasional urinary incontinence, and six months after the surgery, a vesicovaginal fistula was diagnosed. It was successfully surgically corrected. No signs of disease were discovered at 6-month check-ups over two years.

Residua of an invasive nonkeratinizing squamous cell cancer in the cervix (arrowhead), partly ulcerated and with lymphovascular invasion (double arrow). Deep in the cervical stroma away from the SCC, foci of acute and chronic inflammation with foreign body granuloma formation are present and, in their center, there are multiple Enterobius vermicularis eggs (star). (H&E, original magnification x2)

The center of granuloma with dense eosinophilic and neutrophilic granulocytes with parasitic eggs. On the edge of granuloma there are some multinucleated foreign body giant cells. No pinworm larvae are present. (H&E, original magnification x20)

Written consent was obtained from the patient, allowing the processing of her medical and personal data for purposes other than medical care.

E. vermicularis is predominantly an intestinal parasite. The infective cycle begins with the ingestion of parasitic ova, transferred by the fingers from perineal skin to the mouth or nose (autoinfection) or various objects, such as furniture, door handles, banknotes, etc. [ 2 ]. Other people, most commonly family members and kindergarten or school children can be infected from there [ 5 ]. This was probably the way of infection in our patient who worked in the kindergarten. A recent study in Slovenia showed that the overall prevalence of E. vermicularis infestation in symptomatic preschool and school children was 34.2%, and the mean age of children positive for E. vermicularis was 5.8 years. Family size affected the rate, as the mean number of siblings was higher in positive children [ 5 ]. The infection predominantly occurs in young children, ages 5–10 years, and is more frequent in temperate regions of Western Europe and North America. Factors such as overcrowding and poor sanitation also increase the risk of infection [ 2 ].

After ingesting the ova, larvae are released into the small intestine, typically the duodenum. They mature as they migrate towards their mating site in the caecum and its vicinity. This process lasts 2–6 weeks. After mating, male worms die, and fertilised females migrate at night through the anus to the warm and moist skin of perineal folds, where they lay up to 15,000 ova. This movement of the pinworms, along with the gelatinous substance deposited with the eggs, causes perineal itching and scratching, resulting in finger contamination, thus completing the cycle [ 2 , 3 ].

E. vermicularis infection rarely involves extraintestinal sites, with the female genital tract being the most reported [ 6 ]. Recently, liver involvement was described and attributed to hematogenous migration in the setting of phlebitis with thrombosis of the inferior mesenteric vein [ 7 ]. Infestation of the eye and nasal mucosa have been described, and urinary tract infestation leading to recurrent urinary tract infections [ 8 , 9 , 10 ].

Genital infestation may result from the migration of gravid female worms from the perianal area to the vagina [ 11 ]. There are reports in the literature about ovarian enterobiasis, presenting as tubo-ovarian abscess with peritonitis [ 12 ], salpingitis with oophoritis, dermoid [ 3 ] or peritoneal lesions suspected to be malignant disease or metastases of ovarian cancer [ 6 , 13 ]. Infestation of the uterus can be asymptomatic [ 14 ], and the presence of E. vermicularis can be detected accidentally. On the other hand, E. vermicularis infection can also affect the endometrium and cause abnormal uterine bleeding [ 15 ] or postmenopausal bleeding [ 16 ]. Infection of the endometrium might also cause fertility problems [ 17 ]. E. vermicularis ova were discovered in a cervical PAP smear, but according to our knowledge, not yet in the cervix of a patient with cervical cancer. Cervical infestation can cause a wide range of symptoms or be asymptomatic [ 4 , 11 ].

Enterobiasis is usually diagnosed via microscopic identification of ova in the sample collected from the perineal skin by a transparent adhesive tape. This method is cheap, easy to perform and ensures a rapid result [ 1 ]. A stool sample is usually not helpful for a diagnosis since only 5% of those infected have the ova in stool, and adult worms are generally not passed in the faeces [ 2 ]. On microscopic examination of the tissue, parasitic ova and adult pinworms are often associated with acute and chronic inflammation with foreign body granuloma formation [ 2 ].

E. vermicularis infection should be treated with anthelminthic agents after its conformation [ 1 ]. In Slovenia, we use mebendazole or albendazole equivalently. A single dose of the drug is administered and then repeated after 14 days. Because E. vermicularis is easily transmitted among family members, simultaneous treatment of household members is recommended [ 18 ].

To our knowledge, this is the first case of E. vermicularis diagnosed in the cervical stroma of a patient with cervical cancer. Although not very common, infestation with E. vermicularis should be considered in differential diagnoses of various gynaecological disorders accompanied by histological findings of granulomatous inflammation.

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Abbreviations

High–grade squamous intraepithelial lesion

Lymphovascular invasion

Perineural invasion

Squamous cell carcinoma antigen

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The research was funded by the Slovenian Research Agency (ARIS), research grant no. J3-3069.

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Iztok Takač, Matija Rudolf Lovrec & Vida Gavrić Lovrec

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IT initiated the case report idea and edited and reviewed the manuscript. RK performed the histological examination of the uterine cervix and contributed to writing the manuscript. He prepared Figs. 1 and 2. VGL and MRL were significant contributors in writing the case report. All authors read and approved the final manuscript.

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Takač, I., Kavalar, R., Lovrec, M.R. et al. Concomitant ectopic Enterobius vermicularis infection in uterine cervical cancer. BMC Women's Health 24 , 265 (2024). https://doi.org/10.1186/s12905-024-03073-4

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Received : 26 January 2024

Accepted : 03 April 2024

Published : 27 April 2024

DOI : https://doi.org/10.1186/s12905-024-03073-4

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• Enterobius vermicularis
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