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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.

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A literature review surveys prior research published in 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 used in researching a particular topic and to demonstrate to your readers how your research fits within existing scholarship about the topic.

Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper . Fourth edition. Thousand Oaks, CA: SAGE, 2014.

Importance of a Good Literature Review

A literature review may consist of simply a summary of key sources, but in the social sciences, a literature review usually has an organizational pattern and combines both summary and synthesis, often within specific conceptual categories . A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information in a way that informs how you are planning to investigate a research problem. The analytical features of a literature review might:

• Give a new interpretation of old material or combine new with old interpretations,
• Trace the intellectual progression of the field, including major debates,
• Depending on the situation, evaluate the sources and advise the reader on the most pertinent or relevant research, or
• Usually in the conclusion of a literature review, identify where gaps exist in how a problem has been researched to date.

Given this, the purpose of a literature review is to:

• Place each work in the context of its contribution to understanding the research problem being studied.
• Describe the relationship of each work to the others under consideration.
• Identify new ways to interpret prior research.
• Reveal any gaps that exist in the literature.
• Resolve conflicts amongst seemingly contradictory previous studies.
• Identify areas of prior scholarship to prevent duplication of effort.
• Point the way in fulfilling a need for additional research.
• Locate your own research within the context of existing literature [very important].

Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper. 2nd ed. Thousand Oaks, CA: Sage, 2005; Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1998; Jesson, Jill. Doing Your Literature Review: Traditional and Systematic Techniques . Los Angeles, CA: SAGE, 2011; Knopf, Jeffrey W. "Doing a Literature Review." PS: Political Science and Politics 39 (January 2006): 127-132; Ridley, Diana. The Literature Review: A Step-by-Step Guide for Students . 2nd ed. Los Angeles, CA: SAGE, 2012.

Types of Literature Reviews

It is important to think of knowledge in a given field as consisting of three layers. First, there are the primary studies that researchers conduct and publish. Second are the reviews of those studies that summarize and offer new interpretations built from and often extending beyond the primary studies. Third, there are the perceptions, conclusions, opinion, and interpretations that are shared informally among scholars that become part of the body of epistemological traditions within the field.

In composing a literature review, it is important to note that it is often this third layer of knowledge that is cited as "true" even though it often has only a loose relationship to the primary studies and secondary literature reviews. Given this, while literature reviews are designed to provide an overview and synthesis of pertinent sources you have explored, there are a number of approaches you could adopt depending upon the type of analysis underpinning your study.

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

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

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

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

Systematic Review This form consists of an overview of existing evidence pertinent to a clearly formulated research question, which uses pre-specified and standardized methods to identify and critically appraise relevant research, and to collect, report, and analyze data from the studies that are included in the review. The goal is to deliberately document, critically evaluate, and summarize scientifically all of the research about a clearly defined research problem . Typically it focuses on a very specific empirical question, often posed in a cause-and-effect form, such as "To what extent does A contribute to B?" This type of literature review is primarily applied to examining prior research studies in clinical medicine and allied health fields, but it is increasingly being used in the social sciences.

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

NOTE: Most often the literature review will incorporate some combination of types. For example, a review that examines literature supporting or refuting an argument, assumption, or philosophical problem related to the research problem will also need to include writing supported by sources that establish the history of these arguments in the literature.

Baumeister, Roy F. and Mark R. Leary. "Writing Narrative Literature Reviews."  Review of General Psychology 1 (September 1997): 311-320; Mark R. Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper . 2nd ed. Thousand Oaks, CA: Sage, 2005; Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1998; Kennedy, Mary M. "Defining a Literature." Educational Researcher 36 (April 2007): 139-147; Petticrew, Mark and Helen Roberts. Systematic Reviews in the Social Sciences: A Practical Guide . Malden, MA: Blackwell Publishers, 2006; Torracro, Richard. "Writing Integrative Literature Reviews: Guidelines and Examples." Human Resource Development Review 4 (September 2005): 356-367; Rocco, Tonette S. and Maria S. Plakhotnik. "Literature Reviews, Conceptual Frameworks, and Theoretical Frameworks: Terms, Functions, and Distinctions." Human Ressource Development Review 8 (March 2008): 120-130; Sutton, Anthea. Systematic Approaches to a Successful Literature Review . Los Angeles, CA: Sage Publications, 2016.

Structure and Writing Style

I.  Thinking About Your Literature Review

The structure of a literature review should include the following in support of understanding the research problem :

• An overview of the subject, issue, or theory under consideration, along with the objectives of the literature review,
• Division of works under review into themes or categories [e.g. works that support a particular position, those against, and those offering alternative approaches entirely],
• An explanation of how each work is similar to and how it varies from the others,
• Conclusions as to which pieces are best considered in their argument, are most convincing of their opinions, and make the greatest contribution to the understanding and development of their area of research.

The critical evaluation of each work should consider :

• Provenance -- what are the author's credentials? Are the author's arguments supported by evidence [e.g. primary historical material, case studies, narratives, statistics, recent scientific findings]?
• Methodology -- were the techniques used to identify, gather, and analyze the data appropriate to addressing the research problem? Was the sample size appropriate? Were the results effectively interpreted and reported?
• Objectivity -- is the author's perspective even-handed or prejudicial? Is contrary data considered or is certain pertinent information ignored to prove the author's point?
• Persuasiveness -- which of the author's theses are most convincing or least convincing?
• Validity -- are the author's arguments and conclusions convincing? Does the work ultimately contribute in any significant way to an understanding of the subject?

II.  Development of the Literature Review

Four Basic Stages of Writing 1.  Problem formulation -- which topic or field is being examined and what are its component issues? 2.  Literature search -- finding materials relevant to the subject being explored. 3.  Data evaluation -- determining which literature makes a significant contribution to the understanding of the topic. 4.  Analysis and interpretation -- discussing the findings and conclusions of pertinent literature.

Consider the following issues before writing the literature review: Clarify If your assignment is not specific about what form your literature review should take, seek clarification from your professor by asking these questions: 1.  Roughly how many sources would be appropriate to include? 2.  What types of sources should I review (books, journal articles, websites; scholarly versus popular sources)? 3.  Should I summarize, synthesize, or critique sources by discussing a common theme or issue? 4.  Should I evaluate the sources in any way beyond evaluating how they relate to understanding the research problem? 5.  Should I provide subheadings and other background information, such as definitions and/or a history? Find Models Use the exercise of reviewing the literature to examine how authors in your discipline or area of interest have composed their literature review sections. Read them to get a sense of the types of themes you might want to look for in your own research or to identify ways to organize your final review. The bibliography or reference section of sources you've already read, such as required readings in the course syllabus, are also excellent entry points into your own research. Narrow the Topic The narrower your topic, the easier it will be to limit the number of sources you need to read in order to obtain a good survey of relevant resources. Your professor will probably not expect you to read everything that's available about the topic, but you'll make the act of reviewing easier if you first limit scope of the research problem. A good strategy is to begin by searching the USC Libraries Catalog for recent books about the topic and review the table of contents for chapters that focuses on specific issues. You can also review the indexes of books to find references to specific issues that can serve as the focus of your research. For example, a book surveying the history of the Israeli-Palestinian conflict may include a chapter on the role Egypt has played in mediating the conflict, or look in the index for the pages where Egypt is mentioned in the text. Consider Whether Your Sources are Current Some disciplines require that you use information that is as current as possible. This is particularly true in disciplines in medicine and the sciences where research conducted becomes obsolete very quickly as new discoveries are made. However, when writing a review in the social sciences, a survey of the history of the literature may be required. In other words, a complete understanding the research problem requires you to deliberately examine how knowledge and perspectives have changed over time. Sort through other current bibliographies or literature reviews in the field to get a sense of what your discipline expects. You can also use this method to explore what is considered by scholars to be a "hot topic" and what is not.

III.  Ways to Organize Your Literature Review

Chronology of Events If your review follows the chronological method, you could write about the materials according to when they were published. This approach should only be followed if a clear path of research building on previous research can be identified and that these trends follow a clear chronological order of development. For example, a literature review that focuses on continuing research about the emergence of German economic power after the fall of the Soviet Union. By Publication Order your sources by publication chronology, then, only if the order demonstrates a more important trend. For instance, you could order a review of literature on environmental studies of brown fields if the progression revealed, for example, a change in the soil collection practices of the researchers who wrote and/or conducted the studies. Thematic [“conceptual categories”] A thematic literature review is the most common approach to summarizing prior research in the social and behavioral sciences. Thematic reviews are organized around a topic or issue, rather than the progression of time, although the progression of time may still be incorporated into a thematic review. For example, a review of the Internet’s impact on American presidential politics could focus on the development of online political satire. While the study focuses on one topic, the Internet’s impact on American presidential politics, it would still be organized chronologically reflecting technological developments in media. The difference in this example between a "chronological" and a "thematic" approach is what is emphasized the most: themes related to the role of the Internet in presidential politics. Note that more authentic thematic reviews tend to break away from chronological order. A review organized in this manner would shift between time periods within each section according to the point being made. Methodological A methodological approach focuses on the methods utilized by the researcher. For the Internet in American presidential politics project, one methodological approach would be to look at cultural differences between the portrayal of American presidents on American, British, and French websites. Or the review might focus on the fundraising impact of the Internet on a particular political party. A methodological scope will influence either the types of documents in the review or the way in which these documents are discussed.

Other Sections of Your Literature Review Once you've decided on the organizational method for your literature review, the sections you need to include in the paper should be easy to figure out because they arise from your organizational strategy. In other words, a chronological review would have subsections for each vital time period; a thematic review would have subtopics based upon factors that relate to the theme or issue. However, sometimes you may need to add additional sections that are necessary for your study, but do not fit in the organizational strategy of the body. What other sections you include in the body is up to you. However, only include what is necessary for the reader to locate your study within the larger scholarship about the research problem.

Here are examples of other sections, usually in the form of a single paragraph, you may need to include depending on the type of review you write:

• Current Situation : Information necessary to understand the current topic or focus of the literature review.
• Sources Used : Describes the methods and resources [e.g., databases] you used to identify the literature you reviewed.
• History : The chronological progression of the field, the research literature, or an idea that is necessary to understand the literature review, if the body of the literature review is not already a chronology.
• Selection Methods : Criteria you used to select (and perhaps exclude) sources in your literature review. For instance, you might explain that your review includes only peer-reviewed [i.e., scholarly] sources.
• Standards : Description of the way in which you present your information.
• Questions for Further Research : What questions about the field has the review sparked? How will you further your research as a result of the review?

IV.  Writing Your Literature Review

Once you've settled on how to organize your literature review, you're ready to write each section. When writing your review, keep in mind these issues.

Use Evidence A literature review section is, in this sense, just like any other academic research paper. Your interpretation of the available sources must be backed up with evidence [citations] that demonstrates that what you are saying is valid. Be Selective Select only the most important points in each source to highlight in the review. The type of information you choose to mention should relate directly to the research problem, whether it is thematic, methodological, or chronological. Related items that provide additional information, but that are not key to understanding the research problem, can be included in a list of further readings . Use Quotes Sparingly Some short quotes are appropriate if you want to emphasize a point, or if what an author stated cannot be easily paraphrased. Sometimes you may need to quote certain terminology that was coined by the author, is not common knowledge, or taken directly from the study. Do not use extensive quotes as a substitute for using your own words in reviewing the literature. Summarize and Synthesize Remember to summarize and synthesize your sources within each thematic paragraph as well as throughout the review. Recapitulate important features of a research study, but then synthesize it by rephrasing the study's significance and relating it to your own work and the work of others. Keep Your Own Voice While the literature review presents others' ideas, your voice [the writer's] should remain front and center. For example, weave references to other sources into what you are writing but maintain your own voice by starting and ending the paragraph with your own ideas and wording. Use Caution When Paraphrasing When paraphrasing a source that is not your own, be sure to represent the author's information or opinions accurately and in your own words. Even when paraphrasing an author’s work, you still must provide a citation to that work.

V.  Common Mistakes to Avoid

These are the most common mistakes made in reviewing social science research literature.

• Sources in your literature review do not clearly relate to the research problem;
• You do not take sufficient time to define and identify the most relevant sources to use in the literature review related to the research problem;
• Relies exclusively on secondary analytical sources rather than including relevant primary research studies or data;
• Uncritically accepts another researcher's findings and interpretations as valid, rather than examining critically all aspects of the research design and analysis;
• Does not describe the search procedures that were used in identifying the literature to review;
• Reports isolated statistical results rather than synthesizing them in chi-squared or meta-analytic methods; and,
• Only includes research that validates assumptions and does not consider contrary findings and alternative interpretations found in the literature.

Cook, Kathleen E. and Elise Murowchick. “Do Literature Review Skills Transfer from One Course to Another?” Psychology Learning and Teaching 13 (March 2014): 3-11; Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper . 2nd ed. Thousand Oaks, CA: Sage, 2005; Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1998; Jesson, Jill. Doing Your Literature Review: Traditional and Systematic Techniques . London: SAGE, 2011; Literature Review Handout. Online Writing Center. Liberty University; Literature Reviews. The Writing Center. University of North Carolina; Onwuegbuzie, Anthony J. and Rebecca Frels. Seven Steps to a Comprehensive Literature Review: A Multimodal and Cultural Approach . Los Angeles, CA: SAGE, 2016; Ridley, Diana. The Literature Review: A Step-by-Step Guide for Students . 2nd ed. Los Angeles, CA: SAGE, 2012; Randolph, Justus J. “A Guide to Writing the Dissertation Literature Review." Practical Assessment, Research, and Evaluation. vol. 14, June 2009; Sutton, Anthea. Systematic Approaches to a Successful Literature Review . Los Angeles, CA: Sage Publications, 2016; Taylor, Dena. The Literature Review: A Few Tips On Conducting It. University College Writing Centre. University of Toronto; Writing a Literature Review. Academic Skills Centre. University of Canberra.

Writing Tip

Break Out of Your Disciplinary Box!

Thinking interdisciplinarily about a research problem can be a rewarding exercise in applying new ideas, theories, or concepts to an old problem. For example, what might cultural anthropologists say about the continuing conflict in the Middle East? In what ways might geographers view the need for better distribution of social service agencies in large cities than how social workers might study the issue? You don’t want to substitute a thorough review of core research literature in your discipline for studies conducted in other fields of study. However, particularly in the social sciences, thinking about research problems from multiple vectors is a key strategy for finding new solutions to a problem or gaining a new perspective. Consult with a librarian about identifying research databases in other disciplines; almost every field of study has at least one comprehensive database devoted to indexing its research literature.

Frodeman, Robert. The Oxford Handbook of Interdisciplinarity . New York: Oxford University Press, 2010.

Another Writing Tip

Don't Just Review for Content!

While conducting a review of the literature, maximize the time you devote to writing this part of your paper by thinking broadly about what you should be looking for and evaluating. Review not just what scholars are saying, but how are they saying it. Some questions to ask:

• How are they organizing their ideas?
• What methods have they used to study the problem?
• What theories have been used to explain, predict, or understand their research problem?
• What sources have they cited to support their conclusions?
• How have they used non-textual elements [e.g., charts, graphs, figures, etc.] to illustrate key points?

When you begin to write your literature review section, you'll be glad you dug deeper into how the research was designed and constructed because it establishes a means for developing more substantial analysis and interpretation of the research problem.

Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1 998.

Yet Another Writing Tip

When Do I Know I Can Stop Looking and Move On?

Here are several strategies you can utilize to assess whether you've thoroughly reviewed the literature:

• Look for repeating patterns in the research findings . If the same thing is being said, just by different people, then this likely demonstrates that the research problem has hit a conceptual dead end. At this point consider: Does your study extend current research?  Does it forge a new path? Or, does is merely add more of the same thing being said?
• Look at sources the authors cite to in their work . If you begin to see the same researchers cited again and again, then this is often an indication that no new ideas have been generated to address the research problem.
• Search Google Scholar to identify who has subsequently cited leading scholars already identified in your literature review [see next sub-tab]. This is called citation tracking and there are a number of sources that can help you identify who has cited whom, particularly scholars from outside of your discipline. Here again, if the same authors are being cited again and again, this may indicate no new literature has been written on the topic.

Onwuegbuzie, Anthony J. and Rebecca Frels. Seven Steps to a Comprehensive Literature Review: A Multimodal and Cultural Approach . Los Angeles, CA: Sage, 2016; Sutton, Anthea. Systematic Approaches to a Successful Literature Review . Los Angeles, CA: Sage Publications, 2016.

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Literature review sources

Sources for literature review can be divided into three categories as illustrated in table below. In your dissertation you will need to use all three categories of literature review sources:

Sources for literature review and examples

Generally, your literature review should integrate a wide range of sources such as:

• Books . Textbooks remain as the most important source to find models and theories related to the research area. Research the most respected authorities in your selected research area and find the latest editions of books authored by them. For example, in the area of marketing the most notable authors include Philip Kotler, Seth Godin, Malcolm Gladwell, Emanuel Rosen and others.
• Magazines . Industry-specific magazines are usually rich in scholarly articles and they can be effective source to learn about the latest trends and developments in the research area. Reading industry magazines can be the most enjoyable part of the literature review, assuming that your selected research area represents an area of your personal and professional interests, which should be the case anyways.
• Newspapers can be referred to as the main source of up-to-date news about the latest events related to the research area. However, the proportion of the use of newspapers in literature review is recommended to be less compared to alternative sources of secondary data such as books and magazines. This is due to the fact that newspaper articles mainly lack depth of analyses and discussions.
• Online articles . You can find online versions of all of the above sources. However, note that the levels of reliability of online articles can be highly compromised depending on the source due to the high levels of ease with which articles can be published online. Opinions offered in a wide range of online discussion blogs cannot be usually used in literature review. Similarly, dissertation assessors are not keen to appreciate references to a wide range of blogs, unless articles in these blogs are authored by respected authorities in the research area.

Your secondary data sources may comprise certain amount of grey literature as well. The term grey literature refers to type of literature produced by government, academics, business and industry in print and electronic formats, which is not controlled by commercial publishers. It is called ‘grey’ because the status of the information in grey literature is not certain. In other words, any publication that has not been peer reviewed for publication is grey literature.

The necessity to use grey literature arises when there is no enough peer reviewed publications are available for the subject of your study.

John Dudovskiy

Harvey Cushing/John Hay Whitney Medical Library

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• Steps in Conducting a Literature Review

What is a literature review?

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

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

Why is it important?

A literature review is important because it:

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

APA7 Style resources

APA Style Blog - for those harder to find answers

1. Choose a topic. Define your research question.

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

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

2. Decide on the scope of your review

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

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

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

Make a list of the databases you will search. 

Where to find databases:

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

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

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

Review the literature

Some questions to help you analyze the research:

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

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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• Correction 09 December 2020

How to write a superb literature review

Andy Tay is a freelance writer based in Singapore.

You can also search for this author in PubMed   Google Scholar

Literature reviews are important resources for scientists. They provide historical context for a field while offering opinions on its future trajectory. Creating them can provide inspiration for one’s own research, as well as some practice in writing. But few scientists are trained in how to write a review — or in what constitutes an excellent one. Even picking the appropriate software to use can be an involved decision (see ‘Tools and techniques’). So Nature asked editors and working scientists with well-cited reviews for their tips.

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doi: https://doi.org/10.1038/d41586-020-03422-x

Interviews have been edited for length and clarity.

Updates & Corrections

Correction 09 December 2020 : An earlier version of the tables in this article included some incorrect details about the programs Zotero, Endnote and Manubot. These have now been corrected.

Hsing, I.-M., Xu, Y. & Zhao, W. Electroanalysis 19 , 755–768 (2007).

Article   Google Scholar  

Ledesma, H. A. et al. Nature Nanotechnol. 14 , 645–657 (2019).

Article   PubMed   Google Scholar  

Brahlek, M., Koirala, N., Bansal, N. & Oh, S. Solid State Commun. 215–216 , 54–62 (2015).

Choi, Y. & Lee, S. Y. Nature Rev. Chem . https://doi.org/10.1038/s41570-020-00221-w (2020).

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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: 
• How to write a literature review faster with Paperpal? 
• Frequently asked questions 

What is a literature review?

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

What is the purpose of literature review?

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

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

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

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

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

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

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

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

Literature review example

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

Literature Review on Climate Change Impacts on Biodiversity:

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

a. Habitat Loss and Species Extinction:

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

b. Range Shifts and Phenological Changes:

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

c. Ocean Acidification and Coral Reefs:

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

d. Adaptive Strategies and Conservation Efforts:

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

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

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

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

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

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

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

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

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

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

Conducting a literature review

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

Choose a Topic and Define the Research Question:

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

Decide on the Scope of Your Review:

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

Select Databases for Searches:

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

Conduct Searches and Keep Track:

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

Review the Literature:

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

Organize and Write Your Literature Review:

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

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

How to write a literature review faster with Paperpal?

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

Here’s how to use the Research feature:  

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

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

Frequently asked questions

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

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

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

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

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

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

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

References 

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

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

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

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

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• UConn Library
• Literature Review: The What, Why and How-to Guide
• Evaluating Sources & Lit. Reviews

Literature Review: The What, Why and How-to Guide — Evaluating Sources & Lit. Reviews

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

Reading Critically

To be able to write a good literature review, you need to be able to read critically. Below are some tips that will help you evaluate the sources for your paper.

Reading critically (summary from How to Read Academic Texts Critically)

• Who is the author? What is his/her standing in the field?
• What is the author’s purpose? To offer advice, make practical suggestions, solve a specific problem, to critique, or clarify?
• Note the experts in the field. Are there specific names/labs that are frequently cited?
• Pay attention to methodology. Is it sound? What testing procedures, subjects, and materials were used?
• Note conflicting theories, methodologies and results. Are there any assumptions being made by most/some researchers?
• Theories: Have they evolved overtime?
• Evaluate and synthesize the findings and conclusions. How does this study contribute to your project?

Useful links:

Tips to Evaluate Sources

Criteria to evaluate sources:

Authority : Who is the author? what is his/her credentials--what university he/she is affliliated? Is his/her area of expertise?

Usefulness : How this source related to your topic? How current or relevant it is to your topic?

Reliability : Does the information comes from a reliable, trusted source such as an academic journal?

Useful sites

• Critically Analyzing Information Sources (Cornell University Library)

Evaluating Literature Reviews and Sources

A good literature review evaluates a wide variety of sources (academic articles, scholarly books, government/NGO reports). It also evaluates literature reviews that study similar topics. This page offers you a list of resources and tips on how to evaluate the sources that you may use to write your review.

• A Closer Look at Evaluating Literature Reviews Excerpt from the book chapter, “Evaluating Introductions and Literature Reviews” in Fred Pyrczak’s Evaluating Research in Academic Journals: A Practical Guide to Realistic Evaluation , (Chapter 4 and 5). This PDF discusses and offers great advice on how to evaluate "Introductions" and "Literature Reviews" by listing questions and tips.

• Tips for Evaluating Sources (Print vs. Internet Sources) Excellent page that will guide you on what to ask to determine if your source is a reliable one. Check the other topics in the guide: Evaluating Bibliographic Citations and Evaluation During Reading on the left side menu.
• << Previous: Strategies to Find Sources
• Next: Tips for Writing Literature Reviews >>
• Last Updated: Sep 21, 2022 2:16 PM
• URL: https://guides.lib.uconn.edu/literaturereview

• Subject guides
• Researching for your literature review
• Literature sources

Researching for your literature review: Literature sources

• Literature reviews
• Before you start
• Develop a search strategy
• Keyword search activity
• Subject search activity
• Combined keyword and subject searching
• Online tutorials
• Apply search limits
• Run a search in different databases
• Supplementary searching
• Save your searches
• Manage results

Scholarly databases

It's important to make a considered decision as to where to search for your review of the literature. It's uncommon for a disciplinary area to be covered by a single publisher, so searching a single publisher platform or database is unlikely to give you sufficient coverage of studies for a review. A good quality literature review involves searching a number of databases individually.

The most common method is to search a combination of large inter-disciplinary databases such as Scopus & Web of Science Core Collection, and some subject-specific databases (such as PsycInfo or EconLit etc.). The Library databases are an excellent place to start for sources of peer-reviewed journal articles.

Depending on disciplinary expectations, or the topic of our review, you may also need to consider sources or search methods other than database searching. There is general information below on searching grey literature. However, due to the wide varieties of grey literature available, you may need to spend some time investigating sources relevant for your specific need.

Grey literature

Grey literature is information which has been published informally or non-commercially (where the main purpose of the producing body is not commercial publishing) or remains unpublished. One example may be Government publications.

Grey literature may be included in a literature review to minimise publication bias . The quality of grey literature can vary greatly - some may be peer reviewed whereas some may not have been through a traditional editorial process.

See the Grey Literature guide for further information on finding and evaluating grey sources.

See the Moodle book MNHS: Systematically searching the grey literature for a comprehensive module on grey literature for systematic reviews.

In certain disciplines (such as physics) there can be a culture of preprints being made available prior to submissions to journals. There has also been a noticeable rise in preprints in medical and health areas in the wake of Covid-19.

If preprints are relevant for you, you can search preprint servers directly. A workaround might be to utilise a search engine such as Google Scholar to search specifically for preprints, as Google Scholar has timely coverage of most preprint servers including ArXiv, RePec, SSRN, BioRxiv, and MedRxiv.

Articles in Press are not preprints, but are accepted manuscripts that are not yet formally published. Articles in Press have been made available as an early access online version of a paper that may not yet have received its final formatting or an allocation of a volume/issue number. As well as being available on a journal's website, Articles in Press are available in databases such as Scopus and Web of Science, and so (unlike preprints) don't necessarily require a separate search.

Conference papers

Conference papers are typically published in conference proceedings (the collection of papers presented at a conference), and may be found on an organisation or Society's website, as a journal, or as a special issue of journal.

In certain disciplines (such as computer science), conference papers may be highly regarded as a form of scholarly communication; the conferences are highly selective, the papers are generally peer reviewed, and papers are published in proceedings affiliated with high-quality publishing houses.

Conference papers may be indexed in a range of scholarly databases. If you only want to see conference papers, database limits can be used to filter results, or try a specific index such as the examples below:

• Conference proceedings citation index. Social science & humanities (CPCI-SSH)
• Conference proceedings citation index. Science (CPCI-S)
• ASME digital library conference proceedings

Honours students and postgraduates may request conference papers through Interlibrary Loans . However, conference paper requests may take longer than traditional article requests as they can be difficult to locate; they may have been only supplied to attendees or not formally published. Sometimes only the abstract is available.

If you are specifically looking for statistical data, try searching for the keyword statistics in a Google Advanced Search and limiting by a relevant site or domain. Below are some examples of sites, or you can try a domain such as .gov for government websites.

Statistical data can be found in the following selected sources:

• Australian Bureau of Statistics
• World Health Organization: Health Data and statistics
• Higher Education Statistics
• UNESCO Institute for Statistics
• Tourism Australia Statistics

For a list of databases that include statistics see: Databases by Subject: Statistics .

If you are specifically looking for information found in newspapers, the library has a large collection of Australian and overseas newspapers, both current and historical.

To search the full-text of newspapers in electronic format use a database such as  Newsbank.

Alternatively, see the Newspapers subject guide for comprehensive information on newspaper sources available via Monash University library and open source databases, as well as searching tips, online videos and more.

Dissertations and theses

The Monash University Library Theses subject guide provides resources and guidelines for locating and accessing theses (dissertations) produced by Monash University as well as other universities in Australia and internationally.  

International theses:

There are a number of theses databases and repositories.

A popular source is:

• ProQuest Dissertations & Theses Global  which predominantly, covers North American masters and doctoral theses. Full text is available for theses added since 1997. 

Australia and New Zealand theses:

Theses that are available in the library can be found using the  Search catalogue.

These include:

• Monash doctoral, masters and a small number of honours theses 
• other Australian and overseas theses that have been purchased for the collection.

Formats include print (not available for loan), microfiche and online (some may have access restrictions).

Trove includes doctoral, masters and some honours theses from all Australian and New Zealand universities, as well as theses awarded elsewhere but held by Australian institutions.

Tips:  

• Type in the title, author surname and/or keywords. Then on the results page refine your search to 'thesis'.
• Alternatively, use the Advanced search and include 'thesis' as a keyword or limi t your result to format = thesis
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Chapter 5: The Literature Review

5.3 Acceptable sources for literature reviews

Following are a few acceptable sources for literature reviews, listed in order from what will be considered most acceptable to less acceptable sources for your literature review assignments:

• Peer reviewed journal articles.
• Edited academic books.
• Articles in professional journals.
• Statistical data from government websites.
• Website material from professional associations (use sparingly and carefully). The following sections will explain and provide examples of these various sources.

Peer reviewed journal articles (papers)

A peer reviewed journal article is a paper that has been submitted to a scholarly journal, accepted, and published. Peer review journal papers go through a rigorous, blind review process of peer review. What this means is that two to three experts in the area of research featured in the paper have reviewed and accepted the paper for publication. The names of the author(s) who are seeking to publish the research have been removed (blind review), so as to minimize any bias towards the authors of the research (albeit, sometimes a savvy reviewer can discern who has done the research based upon previous publications, etc.). This blind review process can be long (often 12 to 18 months) and may involve many back and forth edits on the behalf of the researchers, as they work to address the edits and concerns of the peers who reviewed their paper. Often, reviewers will reject the paper for a variety of reasons, such as unclear or questionable methods, lack of contribution to the field, etc. Because peer reviewed journal articles have gone through a rigorous process of review, they are considered to be the premier source for research. Peer reviewed journal articles should serve as the foundation for your literature review.

The following link will provide more information on peer reviewed journal articles. Make sure you watch the little video on the upper left-hand side of your screen, in addition to reading the material at the following website:    http://guides.lib.jjay.cuny.edu/c.php?g=288333&p=1922599

Edited academic books

An edited academic book is a collection of scholarly scientific papers written by different authors. The works are original papers, not published elsewhere (“Edited volume,” 2018). The papers within the text also go through a process of review; however, the review is often not a blind review because the authors have been invited to contribute to the book. Consequently, edited academic books are fine to use for your literature review, but you also want to ensure that your literature review contains mostly peer reviewed journal papers.

Articles in professional journals

Articles from professional journals should be used with caution for your literature review. This is because articles in trade journals are not usually peer reviewed, even though they may appear to be. A good way to find out is to read the “About Us” section of the professional journal, which should state whether or not the papers are peer reviewed. You can also find out by Googling the name of the journal and adding “peer reviewed” to the search.

Statistical data from governmental websites

Governmental websites can be excellent sources for statistical data, e.g, Statistics Canada collects and publishes data related to the economy, society, and the environment (see https://www.statcan.gc.ca/eng/start ).

Website material from professional associations

Material from other websites can also serve as a source for statistics that you may need for your literature review. Since you want to justify the value of the research that interests you, you might make use of a professional association’s website to learn how many members they have, for example. You might want to demonstrate, as part of the introduction to your literature review, why more research on the topic of PTSD in police officers is important. You could use peer reviewed journal articles to determine the prevalence of PTSD in police officers in Canada in the last ten years, and then use the Ontario Police Officers´ Association website to determine the approximate number of police officers employed in the Province of Ontario over the last ten years. This might help you estimate how many police officers could be suffering with PTSD in Ontario. That number could potentially help to justify a research grant down the road. But again, this type of website- based material should be used with caution and sparingly.

Research Methods for the Social Sciences: An Introduction Copyright © 2020 by Valerie Sheppard is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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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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This publication is licensed under a Creative Commons License, Attribution-Noncommercial 4.0 International License (CC BY-NC 4.0): see https://creativecommons.org/licenses/by-nc/4.0/

• Cite this Page Paré G, Kitsiou S. Chapter 9 Methods for Literature Reviews. In: Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27.
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• Overview of the Literature Review Process and Steps
• Types of Review Articles and Brief Illustrations
• Concluding Remarks

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Literature Reviews: Overview

This video from NCSU Libraries gives a helpful overview of literature reviews. Even though it says it's "for graduate students," the principles are the same for undergraduate students too!

Reading a Scholarly Article

• Reading a Scholarly Article or Literature Review Highlights sections of a scholarly article to identify structure of a literature review.
• Anatomy of a Scholarly Article (NCSU Libraries) Interactive tutorial that describes parts of a scholarly article typical of a Sciences or Social Sciences research article.
• Evaluating Information | Reading a Scholarly Article (Brown University Library) Provides examples and tips across disciplines for reading academic articles.
• Reading Academic Articles for Research [LIBRE Project] Gabriel Winer & Elizabeth Wadell (ASCCC Open Educational Resources Initiative (OERI))

Literature Review Examples

What is a Literature Review?

The literature review is a written explanation by you, the author, of the research already done on the topic, question or issue at hand. What do we know (or not know) about this issue/topic/question?

• A literature review provides a thorough background of the topic by giving your reader a guided overview of major findings and current gaps in what is known so far about the topic. 
• The literature review is not a list (like an annotated bibliography) -- it is a narrative helping your reader understand the topic and where you will "stand" in the debate between scholars regarding the interpretation of meaning and understanding why things happen. Your literature review  helps your reader start to see the "camps" or "sides" within a debate, plus who studies the topic and their arguments. 
• A good literature review should help the reader sense how you will answer your research question and should highlight the preceding arguments and evidence you think are most helpful in moving the topic forward.
• The purpose of the literature review is to dive into the existing debates on the topic to learn about the various schools of thought and arguments, using your research question as an anchor. If you find something that doesn't help answer your question, you don't have to read (or include) it. That's the power of the question format: it helps you filter what to read and include in your literature review, and what to ignore.

How Do I Start?

Essentially you will need to:

• Identify and evaluate relevant literature (books, journal articles, etc.) on your topic/question.
• Figure out how to classify what you've gathered. You could do this by schools of thought, different answers to a question, the authors' disciplinary approaches, the research methods used, or many other ways.
• Use those groupings to craft a narrative, or story, about the relevant literature on this topic. 
• Remember to cite your sources properly! 
• Research: Getting Started Visit this guide to learn more about finding and evaluating resources.
• Literature Review: Synthesizing Multiple Sources (IUPUI Writing Center) An in-depth guide on organizing and synthesizing what you've read into a literature review.
• Guide to Using a Synthesis Matrix (NCSU Writing and Speaking Tutorial Service) Overview of using a tool called a Synthesis Matrix to organize your literature review.
• Synthesis Matrix Template (VCU Libraries) A word document from VCU Libraries that will help you create your own Synthesis Matrix.

Additional Tutorials and Resources

• UR Writer's Web: Using Sources Guidance from the UR Writing Center on how to effectively use sources in your writing (which is what you're doing in your literature review!).
• Write a Literature Review (VCU Libraries) "Lit Reviews 101" with links to helpful tools and resources, including powerpoint slides from a literature review workshop.
• Literature Reviews (UNC Writing Center) Overview of the literature review process, including examples of different ways to organize a lit review.
• “Ten Simple Rules for Writing a Literature Review.” Pautasso, Marco. “Ten Simple Rules for Writing a Literature Review.” PLOS Computational Biology, vol. 9, no. 7, July 2013, p. e1003149.
• Writing the Literature Review Part I (University of Maryland University College) Video that explains more about what a literature review is and is not. Run time: 5:21.
• Writing the Literature Review Part II (University of Maryland University College) Video about organizing your sources and the writing process. Run time: 7:40.
• Writing a Literature Review (OWL @ Purdue)
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Literature Review: Lit Review Sources

• Lit Review Types
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Where do I find information for a literature review?

Research is done by...

...by way of...

...communicated through...

...and organized in...

Types of sources for a review...

• Primary source: Usually a report by the original researchers of a study (unfiltered sources)
• Secondary source: Description or summary by somebody other than the original researcher, e.g. a review article (filtered sources)
• Conceptual/theoretical: Papers concerned with description or analysis of theories or concepts associated with the topic
• Anecdotal/opinion/clinical: Views or opinions about the subject that are not research, review or theoretical (case studies or reports from clinical settings)

A Heirarchy of research information:

Source: SUNY Downstate Medical Center. Medical Research Library of Brooklyn. Evidence Based Medicine Course. A Guide to Research Methods: The Evidence Pyramid: http://library.downstate.edu/EBM2/2100.htm

Life Cycle of Publication

Click image to enlarge

Scientific information has a ‘life cycle’ of its own… it is born as an idea, and then matures and becomes more available to the public. First it appears within the so-called ‘invisible college’ of experts in the field, discussed at conferences and symposia or posted as pre-prints for comments and corrections. Then it appears in the published literature (the primary literature), often as a journal article in a peer-reviewed journal.

Researchers can use the indexing and alerting services of the secondary literature to find out what has been published in a field. Depending on how much information is added by the indexer or abstracter, this may take a few months (though electronic publication has sped up this process). Finally, the information may appear in more popular or reference sources, sometimes called the tertiary literature.

The person beginning a literature search may take this process in reverse: using tertiary sources for general background, then going to the secondary literature to survey what has been published, following up by finding the original (primary) sources, and generating their own research Idea.

(Original content by Wade Lee-Smith)

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Eugene McDermott Library

Literature review.

• Collecting Resources for a Literature Review
• Organizing the Literature Review
• Writing the Literature Review
• Examples of Literature Reviews

Sources for Literature Review Items

Sources for a Literature Review will come from a variety of places, including:

•Books Use the Library Catalog  to see what items McDermott Library has on your topic or if McDermott Library has a specific source you need. The WorldCat   database allows you to search the catalogs on many, many libraries. WorldCat is a good place to find out what books exist on your topic.

•Reference Materials Reference Materials such as encyclopedias and dictionaries provide good overall views of topics and provide keyword hints for searching. Many will include lists of sources to consider for your literature review.

•Journals via Electronic Databases Journals are a major source of materials for a literature review. With the library's databases, you can search thousands of journals back a century or more.   

•Conference Papers At conferences, professionals and scholars explore the latest trends, share new ideas, and present new research. Searching Conference papers allows you to see research before it is published and get a feel for what is going on in a particular organization or within a particular group. 

Many electronic databases include conference proceedings, but with Conference Proceedings Citation Index database, you can search proceedings alone. 

•Dissertations & Theses Here is a link to databases licensed by UTD McDermott library with full-text access to Dissertations and Theses

Some of these are specific to Texas or UTD produced studies. Choose the Global option to search more broadly.

•Internet The general internet can be a valuable resource for information. However, it is largely unregulated. Be sure to critically evaluate internet sources. Look at the Evaluating Websites  LibGuide for suggestions on evaluating websites.

•Government Publications The U.S. government produces a wide variety of information sources, from consumer brochures to congressional reports to large amounts of data to longitudinal studies. For the United States, Usa.gov is a good place to start.  Official state websites can be helpful for individual state statistics and information. 

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10 Best Literature Review Tools for Researchers

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Boost your research game with these Best Literature Review Tools for Researchers! Uncover hidden gems, organize your findings, and ace your next research paper!

Conducting literature reviews poses challenges for researchers due to the overwhelming volume of information available and the lack of efficient methods to manage and analyze it.

Researchers struggle to identify key sources, extract relevant information, and maintain accuracy while manually conducting literature reviews. This leads to inefficiency, errors, and difficulty in identifying gaps or trends in existing literature.

Advancements in technology have resulted in a variety of literature review tools. These tools streamline the process, offering features like automated searching, filtering, citation management, and research data extraction. They save time, improve accuracy, and provide valuable insights for researchers. 

In this article, we present a curated list of the 10 best literature review tools, empowering researchers to make informed choices and revolutionize their systematic literature review process.

Table of Contents

Top 10 Literature Review Tools for Researchers: In A Nutshell (2023)

#1. semantic scholar – a free, ai-powered research tool for scientific literature.

Semantic Scholar is a cutting-edge literature review tool that researchers rely on for its comprehensive access to academic publications. With its advanced AI algorithms and extensive database, it simplifies the discovery of relevant research papers. 

By employing semantic analysis, users can explore scholarly articles based on context and meaning, making it a go-to resource for scholars across disciplines. 

Additionally, Semantic Scholar offers personalized recommendations and alerts, ensuring researchers stay updated with the latest developments. However, users should be cautious of potential limitations. 

Not all scholarly content may be indexed, and occasional false positives or inaccurate associations can occur. Furthermore, the tool primarily focuses on computer science and related fields, potentially limiting coverage in other disciplines. 

Researchers should be mindful of these considerations and supplement Semantic Scholar with other reputable resources for a comprehensive literature review. Despite these caveats, Semantic Scholar remains a valuable tool for streamlining research and staying informed.

#2. Elicit – Research assistant using language models like GPT-3

Elicit is a game-changing literature review tool that has gained popularity among researchers worldwide. With its user-friendly interface and extensive database of scholarly articles, it streamlines the research process, saving time and effort. 

The tool employs advanced algorithms to provide personalized recommendations, ensuring researchers discover the most relevant studies for their field. Elicit also promotes collaboration by enabling users to create shared folders and annotate articles.

However, users should be cautious when using Elicit. It is important to verify the credibility and accuracy of the sources found through the tool, as the database encompasses a wide range of publications. 

Additionally, occasional glitches in the search function have been reported, leading to incomplete or inaccurate results. While Elicit offers tremendous benefits, researchers should remain vigilant and cross-reference information to ensure a comprehensive literature review.

#3. Scite.Ai – Your personal research assistant

Scite.Ai is a popular literature review tool that revolutionizes the research process for scholars. With its innovative citation analysis feature, researchers can evaluate the credibility and impact of scientific articles, making informed decisions about their inclusion in their own work. 

By assessing the context in which citations are used, Scite.Ai ensures that the sources selected are reliable and of high quality, enabling researchers to establish a strong foundation for their research.

However, while Scite.Ai offers numerous advantages, there are a few aspects to be cautious about. As with any data-driven tool, occasional errors or inaccuracies may arise, necessitating researchers to cross-reference and verify results with other reputable sources. 

Moreover, Scite.Ai’s coverage may be limited in certain subject areas and languages, with a possibility of missing relevant studies, especially in niche fields or non-English publications. 

Therefore, researchers should supplement the use of Scite.Ai with additional resources to ensure comprehensive literature coverage and avoid any potential gaps in their research.

Rayyan offers the following paid plans:

• Monthly Plan: $20
• Yearly Plan: $12

#4. DistillerSR – Literature Review Software

DistillerSR is a powerful literature review tool trusted by researchers for its user-friendly interface and robust features. With its advanced search capabilities, researchers can quickly find relevant studies from multiple databases, saving time and effort. 

The tool offers comprehensive screening and data extraction functionalities, streamlining the review process and improving the reliability of findings. Real-time collaboration features also facilitate seamless teamwork among researchers.

While DistillerSR offers numerous advantages, there are a few considerations. Users should invest time in understanding the tool’s features and functionalities to maximize its potential. Additionally, the pricing structure may be a factor for individual researchers or small teams with limited budgets.

Despite occasional technical glitches reported by some users, the developers actively address these issues through updates and improvements, ensuring a better user experience. 

Overall, DistillerSR empowers researchers to navigate the vast sea of information, enhancing the quality and efficiency of literature reviews while fostering collaboration among research teams .

#5. Rayyan – AI Powered Tool for Systematic Literature Reviews

Rayyan is a powerful literature review tool that simplifies the research process for scholars and academics. With its user-friendly interface and efficient management features, Rayyan is highly regarded by researchers worldwide. 

It allows users to import and organize large volumes of scholarly articles, making it easier to identify relevant studies for their research projects. The tool also facilitates seamless collaboration among team members, enhancing productivity and streamlining the research workflow. 

However, it’s important to be aware of a few aspects. The free version of Rayyan has limitations, and upgrading to a premium subscription may be necessary for additional functionalities. 

Users should also be mindful of occasional technical glitches and compatibility issues, promptly reporting any problems. Despite these considerations, Rayyan remains a valuable asset for researchers, providing an effective solution for literature review tasks.

Rayyan offers both free and paid plans:

• Professional: $8.25/month
• Student: $4/month
• Pro Team: $8.25/month
• Team+: $24.99/month

#6. Consensus – Use AI to find you answers in scientific research

Consensus is a cutting-edge literature review tool that has become a go-to choice for researchers worldwide. Its intuitive interface and powerful capabilities make it a preferred tool for navigating and analyzing scholarly articles. 

With Consensus, researchers can save significant time by efficiently organizing and accessing relevant research material.People consider Consensus for several reasons. 

Its advanced search algorithms and filters help researchers sift through vast amounts of information, ensuring they focus on the most relevant articles. By streamlining the literature review process, Consensus allows researchers to extract valuable insights and accelerate their research progress.

However, there are a few factors to watch out for when using Consensus. As with any automated tool, researchers should exercise caution and independently verify the accuracy and relevance of the generated results. Complex or niche topics may present challenges, resulting in limited search results. Researchers should also supplement Consensus with manual searches to ensure comprehensive coverage of the literature.

Overall, Consensus is a valuable resource for researchers seeking to optimize their literature review process. By leveraging its features alongside critical thinking and manual searches, researchers can enhance the efficiency and effectiveness of their work, advancing their research endeavors to new heights.

Consensus offers both free and paid plans:

• Premium: $9.99/month
• Enterprise: Custom

#7. RAx – AI-powered reading assistant

Consensus is a revolutionary literature review tool that has transformed the research process for scholars worldwide. With its user-friendly interface and advanced features, it offers a vast database of academic publications across various disciplines, providing access to relevant and up-to-date literature. 

Using advanced algorithms and machine learning, Consensus delivers personalized recommendations, saving researchers time and effort in their literature search. 

However, researchers should be cautious of potential biases in the recommendation system and supplement their search with manual verification to ensure a comprehensive review. 

Additionally, occasional inaccuracies in metadata have been reported, making it essential for users to cross-reference information with reliable sources. Despite these considerations, Consensus remains an invaluable tool for enhancing the efficiency and quality of literature reviews.

RAx offers both free and paid plans. Currently offering 50% discounts as of July 2023:

• Premium: $6/month $3/month
• Premium with Copilot: $8/month $4/month

#8. Lateral – Advance your research with AI

“Lateral” is a revolutionary literature review tool trusted by researchers worldwide. With its user-friendly interface and powerful search capabilities, it simplifies the process of gathering and analyzing scholarly articles. 

By leveraging advanced algorithms and machine learning, Lateral saves researchers precious time by retrieving relevant articles and uncovering new connections between them, fostering interdisciplinary exploration.

While Lateral provides numerous benefits, users should exercise caution. It is advisable to cross-reference its findings with other sources to ensure a comprehensive review. 

Additionally, researchers must be mindful of potential biases introduced by the tool’s algorithms and should critically evaluate and interpret the results. 

Despite these considerations, Lateral remains an indispensable resource, empowering researchers to delve deeper into their fields of study and make valuable contributions to the academic community.

RAx offers both free and paid plans:

• Premium: $10.98
• Pro: $27.46

#9. Iris AI – Introducing the researcher workspace

Iris AI is an innovative literature review tool that has transformed the research process for academics and scholars. With its advanced artificial intelligence capabilities, Iris AI offers a seamless and efficient way to navigate through a vast array of academic papers and publications. 

Researchers are drawn to this tool because it saves valuable time by automating the tedious task of literature review and provides comprehensive coverage across multiple disciplines. 

Its intelligent recommendation system suggests related articles, enabling researchers to discover hidden connections and broaden their knowledge base. However, caution should be exercised while using Iris AI. 

While the tool excels at surfacing relevant papers, researchers should independently evaluate the quality and validity of the sources to ensure the reliability of their work. 

It’s important to note that Iris AI may occasionally miss niche or lesser-known publications, necessitating a supplementary search using traditional methods. 

Additionally, being an algorithm-based tool, there is a possibility of false positives or missed relevant articles due to the inherent limitations of automated text analysis. Nevertheless, Iris AI remains an invaluable asset for researchers, enhancing the quality and efficiency of their research endeavors.

Iris AI offers different pricing plans to cater to various user needs:

• Basic: Free
• Premium: Monthly ($82.41), Quarterly ($222.49), and Annual ($791.07)

#10. Scholarcy – Summarize your literature through AI

Scholarcy is a powerful literature review tool that helps researchers streamline their work. By employing advanced algorithms and natural language processing, it efficiently analyzes and summarizes academic papers, saving researchers valuable time. 

Scholarcy’s ability to extract key information and generate concise summaries makes it an attractive option for scholars looking to quickly grasp the main concepts and findings of multiple papers.

However, it is important to exercise caution when relying solely on Scholarcy. While it provides a useful starting point, engaging with the original research papers is crucial to ensure a comprehensive understanding. 

Scholarcy’s automated summarization may not capture the nuanced interpretations or contextual information presented in the full text. 

Researchers should also be aware that certain types of documents, particularly those with heavy mathematical or technical content, may pose challenges for the tool. 

Despite these considerations, Scholarcy remains a valuable resource for researchers seeking to enhance their literature review process and improve overall efficiency.

Scholarcy offer the following pricing plans:

• Browser Extension and Flashcards: Free 
• Personal Library: $9.99
• Academic Institution License: $8K+

Final Thoughts

In conclusion, conducting a comprehensive literature review is a crucial aspect of any research project, and the availability of reliable and efficient tools can greatly facilitate this process for researchers. This article has explored the top 10 literature review tools that have gained popularity among researchers.

Moreover, the rise of AI-powered tools like Iris.ai and Sci.ai promises to revolutionize the literature review process by automating various tasks and enhancing research efficiency. 

Ultimately, the choice of literature review tool depends on individual preferences and research needs, but the tools presented in this article serve as valuable resources to enhance the quality and productivity of research endeavors. 

Researchers are encouraged to explore and utilize these tools to stay at the forefront of knowledge in their respective fields and contribute to the advancement of science and academia.

Q1. What are literature review tools for researchers?

Literature review tools for researchers are software or online platforms designed to assist researchers in efficiently conducting literature reviews. These tools help researchers find, organize, analyze, and synthesize relevant academic papers and other sources of information.

Q2. What criteria should researchers consider when choosing literature review tools?

When choosing literature review tools, researchers should consider factors such as the tool’s search capabilities, database coverage, user interface, collaboration features, citation management, annotation and highlighting options, integration with reference management software, and data extraction capabilities. 

It’s also essential to consider the tool’s accessibility, cost, and technical support.

Q3. Are there any literature review tools specifically designed for systematic reviews or meta-analyses?

Yes, there are literature review tools that cater specifically to systematic reviews and meta-analyses, which involve a rigorous and structured approach to reviewing existing literature. These tools often provide features tailored to the specific needs of these methodologies, such as:

Screening and eligibility assessment: Systematic review tools typically offer functionalities for screening and assessing the eligibility of studies based on predefined inclusion and exclusion criteria. This streamlines the process of selecting relevant studies for analysis.

Data extraction and quality assessment: These tools often include templates and forms to facilitate data extraction from selected studies. Additionally, they may provide features for assessing the quality and risk of bias in individual studies.

Meta-analysis support: Some literature review tools include statistical analysis features that assist in conducting meta-analyses. These features can help calculate effect sizes, perform statistical tests, and generate forest plots or other visual representations of the meta-analytic results.

Reporting assistance: Many tools provide templates or frameworks for generating systematic review reports, ensuring compliance with established guidelines such as PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

Q4. Can literature review tools help with organizing and annotating collected references?

Yes, literature review tools often come equipped with features to help researchers organize and annotate collected references. Some common functionalities include:

Reference management: These tools enable researchers to import references from various sources, such as databases or PDF files, and store them in a central library. They typically allow you to create folders or tags to organize references based on themes or categories.

Annotation capabilities: Many tools provide options for adding annotations, comments, or tags to individual references or specific sections of research articles. This helps researchers keep track of important information, highlight key findings, or note potential connections between different sources.

Full-text search: Literature review tools often offer full-text search functionality, allowing you to search within the content of imported articles or documents. This can be particularly useful when you need to locate specific information or keywords across multiple references.

Integration with citation managers: Some literature review tools integrate with popular citation managers like Zotero, Mendeley, or EndNote, allowing seamless transfer of references and annotations between platforms.

By leveraging these features, researchers can streamline the organization and annotation of their collected references, making it easier to retrieve relevant information during the literature review process.

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A systematic exploration of scoping and mapping literature reviews

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• Published: 23 May 2024

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• Eirini Christou   ORCID: orcid.org/0000-0001-6928-1013 1 ,
• Antigoni Parmaxi   ORCID: orcid.org/0000-0002-0687-0176 1 &
• Panayiotis Zaphiris   ORCID: orcid.org/0000-0001-8112-5099 1  

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Systematic literature mapping can help researchers identify gaps in the research and provide a comprehensive overview of the available evidence. Despite the importance and benefits of conducting systematic scoping and mapping reviews, many researchers may not be familiar with the methods and best practices for conducting these types of reviews. This paper aims to address this gap by providing a step-by-step guide to conducting a systematic scoping or mapping review, drawing on examples from different fields. This study adopts a systematic literature review approach aiming to identify and present the steps of conducting scoping and mapping literature reviews and serves as a guide on conducting scoping or mapping systematic literature reviews. A number of 90 studies were included in this study. The findings describe the steps to follow when conducting scoping and mapping reviews and suggest the integration of the card sorting method as part of the process. The proposed steps for undertaking scoping and mapping reviews presented in this manuscript, highlight the importance of following a rigorous approach for conducting scoping or mapping reviews.

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1 Introduction

An essential component of academic research is literature review. A systematic literature review, also known as a systematic review, is a method for locating, assessing, and interpreting all research related to a specific research question, topic, or phenomenon of interest [ 1 ].

Scoping and mapping reviews are variations of systematic literature mapping [ 2 ]. Both mapping and scoping reviews can help researchers to understand the scope and breadth of the literature in a given field, identify gaps in the research, and provide a comprehensive overview of the available evidence. Systematic literature mapping purposely focuses on a narrower but more general academic or policy issue and does not try to synthesize the results of research to address a particular subject. The scoping review is exploratory in nature, whereas the mapping review can be conclusive in describing the available evidence and identifying gaps. Mapping review includes a thorough, systematic search of a wide field. It identifies the body of literature that is currently available on a subject and points out any glaring gaps in the evidence [ 3 ].

1.1 Rationale

Despite the importance and benefits of conducting systematic scoping and mapping reviews, many researchers may not be familiar with the methods and best practices for conducting these types of reviews. This paper aims to address this gap by providing a step-by-step guide to conducting a systematic scoping or mapping review, drawing on examples from different fields.

This study adopts a systematic literature review approach aiming to identify and present the differences and the steps of conducting scoping and mapping literature review. The paper provides practical guidance on how to address common challenges in conducting systematic scoping or mapping reviews, such as dealing with the volume of studies identified, managing the data extraction and synthesis process, and ensuring rigor and reproducibility in the review methodology. The main research questions that guide this study are:

RQ1: What is a systematic scoping review and how is it conducted?

RQ2: What is a systematic mapping review and how is it conducted?

RQ3: What are the main differences between systematic scoping and systematic mapping reviews?

Overall, this paper will be a valuable resource for researchers who are interested in conducting a systematic scoping or mapping review. By providing clear guidance and practical examples, the paper aims to promote best practices in systematic scoping and mapping review methodology. The study is organized as follows: The following section presents the methodology of the study, followed by the results showing the process of the scoping and mapping literature review and presenting some examples. Finally, suggestions on how to plan and perform a quality scoping and mapping review are presented.

2 Methodology

The methodology of this paper was adopted by Xiao and Watson [ 4 ].

2.1 Literature search

The search was conducted in two well-known online databases, Web of Science and EBSCOHost, across various disciplines. The searched terms combined keywords related to the performance of scoping and mapping literature review, such as “systematic literature review”, “methodology”, “map”, “mapping” and “scoping”. The title of each manuscript was used to determine its initial relevance. If the content of the title suggested that it would explain the method of the literature review process, we obtained the full reference, which included the author, year, title, and abstract, for additional analysis.

2.2 Initial search results

The query string used for the database search is the following: systematic literature review AND methodology AND (“map” OR “mapping” OR “scoping”). Abstract search was conducted in both databases for the last 10 years (2013–2022). A search on EBSCOHost revealed 643 results of which 291 were duplicated and automatically removed. After applying the database filters to limit the articles to peer-reviewed academic journal articles written in English, a number of 102 papers were excluded. Additional 109 papers were duplicated and removed manually. After an initial screening of the titles, a total of 13 studies were identified as relevant to the methodology of the scoping and mapping literature review. A search on Web of Science, revealed 888 results of which 9 were duplicate and removed, and 157 were found to be related to the methodology of scoping or mapping literature reviews after the first title screening. Last search was conducted on the 2nd of November 2022. Both sources revealed 161 related studies, excluding 9 duplicates that were removed.

2.3 Inclusion and exclusion criteria

Only studies that provide instructions on how to perform a scoping or mapping review were included in this paper. Reviews of the literature on certain subjects and in languages other than English were excluded. The study is limited to papers published within the last 10 years, aiming to collect recent information for performing scoping or mapping reviews. Inclusion and exclusion criteria can be found in Table  1 .

2.4 Screening

To further assess the 161 studies’ applicability to the study topic, their abstracts were reviewed. The manuscripts were evaluated independently and in parallel by two researchers. The researchers’ differing opinions were discussed and settled. Then the full-text of a total of 20 studies was acquired for quality evaluation.

2.5 Eligibility and quality evaluation

To further assess the quality and relevance of the studies, the full-text papers were reviewed. Journal articles and books published by prominent publishers were included in the review as they contained high-quality research. Because there is no peer review procedure, the majority of technical reports and online presentations were excluded.

Two researchers worked independently and simultaneously on evaluating eligibility and quality. Any disagreements between them were discussed and resolved. A total of ten (10) studies were excluded after careful review: one study was excluded because it lacked instructions on how the scoping or mapping review methodology was conducted, three studies were excluded because the methodology was not related to scoping or mapping review, while five studies were disregarded because they focused on a particular subject. One of the studies’ full text couldn’t be accessed. This resulted in ten (10) eligible for full-text analysis.

2.6 Iterations

Through backward and forward searching, additional 18 studies were discovered, from which only 10 met the inclusion criteria. The forward and backward search was also used to find manuscripts that applied scoping or mapping literature review methodology. After finding the article that established the scoping or mapping review methodology, articles that had cited the methodology paper to find instances of best practices in different fields were searched. Following consideration of examples’ adherence to the methodology, preference was given to planning-related articles. In total, 90 studies were analyzed in this study, i.e. 10 methodological papers that describe the application of scoping or mapping review, as well as 80 papers that demonstrate the application of the scoping and mapping methodology in different fields, that are used as examples. The PRISMA flow diagram (see Fig.  1 ) depicts the process of the search strategy [ 5 ].

PRISMA flow diagram

2.7 Extraction and analysis of data

Data were extracted in the process of scoping literature reviews, including information with regards to formulating the problem, establishing and validating the review procedure, searching the literature, screening for inclusion, evaluating quality, extracting data, analyzing and synthesizing data, and reporting the findings (Xiao & Watson, 2019). NVivo software was used for all data extraction and coding procedures. Initially, two researchers each took information from articles for cross-checking. The two researchers reached an agreement on what to extract from the publications after reviewing a few articles together. Then the first author classified the data based on the research questions.

In this section we present the findings of our review.

3.1 Defining “Scoping” and “mapping” review

According to [ 2 ], scoping and mapping reviews are variations of systematic literature mapping that focus on narrower but more general academic or policy issues. A scoping review is exploratory in nature, seeking to identify the nature and extent of research on a particular topic, and can be used to identify gaps in the literature. An example of a research question suitable for a scoping review is “What engagement strategies do educators use in classroom settings to facilitate teaching and learning of diverse students in undergraduate nursing programs?“ [ 6 ]. A mapping review, on the other hand, is a thorough and systematic search of a wide field of literature that aims to identify the body of literature currently available on a subject and point out any glaring gaps in the evidence. An example of a research question suitable for a mapping review is “What are the currently available animal models for cystic fibrosis” [ 3 ]. Overall, each type of review has its own specific aims and can be useful for different types of research questions.

3.1.1 Defining scoping review

There is no single definition for scoping reviews in the literature. According to [ 7 ], scoping review is a type of knowledge synthesis that uses a systematic process to map the evidence on a subject and identify key ideas, theories, sources, and knowledge gaps. The goal of a scoping review is to include all relevant information that is available, including ‘grey’ literature, which includes unpublished research findings, therefore including all available literature and evidence, but the reviewers can decide what type of publications they would like to include [ 8 , 9 , 10 , 11 ].

Scoping review process is sometimes used as a preliminary step before a systematic literature review, in cases where the topic or research area in focus has not yet been extensively reviewed or is complicated or heterogeneous in nature and the types of evidence available remain unclear [ 3 ]. For example, while a scoping review might serve as the foundation for a full systematic review, it does not aim to evaluate the quality of the evidence like systematic reviews do [ 8 ]. Moreover, scoping review is also referred to as a “pilot study” [ 12 ], that can be used as a “trial run” of the entire systematic map; it helps to mold the intended approach for the review and inform the protocol development.

Rapid and scoping meta-reviews were also referred as types of scoping reviews. A “rapid review” is a particular kind of scoping review, which aims to provide an answer to a particular query and can shorten the process compared to a full systematic review [ 3 ]. The “scoping meta-review” (SMR) is a scoping evaluation of systematic reviews that offers researchers a flexible framework for field mapping and a way to condense pertinent research activities and findings, similar to a scoping review [ 13 ].

Almost all of the scoping studies identified in the corpus, draw from previews scoping review frameworks, such as the one proposed by [ 14 , 15 ] and the authors’ manual provided by the Joanna Briggs Institute [ 11 , 16 , 17 , 18 ].

3.1.2 Defining mapping review

A mapping review, also referred to as a “systematic map”, is “a high-level review with a broad research question” [ 3 ](p.133). The mapping review includes a thorough, systematic search of a wide field. It identifies the body of literature that is currently available on a subject and points out any gaps in the evidence. The mapping review can be conclusive in describing the available evidence and identifying gaps, whereas the scoping review is exploratory in nature [ 3 ].

The term “mapping” is used to describe the process of synthesizing and representing the literature numerically and thematically in tables, figures, or graphical representations, which can be thought of as the review output. Mapping enables researchers to pinpoint potential areas for further study as well as gaps in the literature [ 19 ].

Systematic mapping uses the same strict procedures as systematic reviews do. However, systematic mapping can be used to address open or closed-framed questions on broad or specific topics, because it is not constrained by the requirement to include fully specified and defined key elements [ 12 ]. Systematic mapping is especially useful for broad, multifaceted questions about an interesting topic that might not be appropriate for systematic review because they involve a variety of interventions, populations, or outcomes, or because they draw on evidence that is not just from primary research [ 12 ].

3.2 Process of conducting mapping and scoping reviews

As noted in the previous sections, mapping reviews and scoping reviews both aim to provide a broad overview of the literature, but the former focuses on the scope of the literature while the latter focuses on the nature and extent of available evidence on a specific research question or topic. In understanding the process for conducting mapping and scoping reviews, we adopted the eight steps proposed by Xiao and Watson [ 4 ] that are common for all types of reviews: (1) Formulate the problem; (2) Establishing and validating the review procedure; (3) Searching the literature; (4) Screening for inclusion; (5) Evaluating quality; (6) Extracting data; (7) Analyzing and synthesizing data; (8) Reporting the findings. The steps are explained in detail below and describe the methodology for both scoping and mapping reviews, distinguishing their differences where applicable. A summary of the review types along with their characteristics and steps as identified from the literature are presented in Table  2 .

3.2.1 Step 1 formulate the problem

The first step for undertaking a mapping or a scoping review is to formulate the problem by setting the research question that should be investigated, taking into account the topic’s scope [ 12 ]. It is important to clearly state the review objectives and specific review questions for the scoping review. The objectives should indicate what the scoping review is trying to achieve [ 10 , 20 ].

In mapping reviews, it can be helpful to create a conceptual framework or model (visual or textual) to describe what will be explored by the map when determining the mapping review’s scope. It should also be determined whether the topic’s scope is broad, specific, or likely to be supported by a substantial body of evidence [ 12 ].

3.2.1.1 Defining the research question(s)

Prior to beginning their search and paper selection process, the authors should typically define their research question(s) [ 3 ]. There are specific formats that are recommended for structuring the research question(s), as well as the exclusion and inclusion criteria of mapping and scoping reviews [ 21 ] (see Table  3 ).

PCC (Population, Concept, and Context) and PICO format (Population, Intervention, Comparator and Outcome) are often used in scoping and mapping reviews. It is recommended that research questions for scoping reviews follow the PCC format and include all of its components [ 17 , 18 , 21 ]. Information about the participants (e.g. age), the principal idea or “concept,” and the setting of the review, should all be included in the research question. The context should be made explicit and may take into account geographical or locational considerations, cultural considerations, and particular racial or gender-based concerns [ 10 ].

Researchers use the PCC format in order to determine the eligibility of their research questions, as well as to define their inclusion criteria (e.g [ 22 , 23 , 24 , 25 , 26 ]). Most scoping reviews have a single main question, but some of them are better served by one or more sub-questions that focus on specific PCC characteristics [ 8 , 18 ].

3.2.2 Step 2. Establishing and validating the review procedure

A protocol is crucial for scoping and mapping reviews because it pre-defines the scoping review’s goals and procedures [ 11 , 17 , 18 , 20 ], it clearly states all methodological decisions since the very beginning [ 2 ], and it also specifies the strategy to be used at each stage of the review process [ 12 ]. Similar to all systematic reviews, scoping reviews start with the creation of an a-priori protocol that includes inclusion and exclusion criteria that are directly related to the review’s objectives and questions [ 7 , 11 , 17 , 18 , 20 ]. In order to decrease study duplication and improve data reporting transparency, the use of formalized, registered protocols is suggested [ 18 , 19 ]. The international prospective register of systematic reviews, known as PROSPERO, states that scoping reviews (and literature reviews) are currently ineligible for registration in the database. While this could change in the future, scoping reviews can currently be registered with the Open Science Framework ( https://osf.io/ ) or Figshare ( https://figshare.com/ ), and their protocols can be published in select publications, including the JBI Evidence Synthesis [ 18 ].

Scoping and mapping reviews should require at least two reviewers in order to minimize reporting bias, as well as to ensure consistency and clarity [ 3 , 16 , 17 , 18 ]. The reviewers should include a plan for the results presentation during the protocol development, such as a draft chart or table that could be improved at the end when the reviewers become more familiar with the information they have included in the review [ 17 , 18 ].

3.2.3 Step 3. Searching the literature

Searching the literature requires to prepare a search strategy, decide on search terms, search databases or journals, and perform a manual search [ 27 ]. For example, deciding on search terms, can follow an iterative process that is further explained in the sub-section below. Thinking about searching in terms of broader to narrower strategies is helpful. Fewer databases and/or journals will be checked out in narrower searches (search only in the title, keywords, and abstract fields), which are frequently used in scoping reviews, while multiple databases can be checked for mapping reviews [ 2 ].

Search strategy

Mapping and scoping review search should aim to be as thorough as possible [ 12 ] to find both published and unpublished evidence. An inclusive approach is frequently preferred for scoping reviews to prevent potential omission of crucial information [ 10 , 17 , 18 ].

According to JBI, there should be a three-step search process for scoping reviews [ 10 , 17 , 18 ]. The first step is a quick search of at least two databases followed by a text word check of the article’s title, abstract, and body of text that are then analyzed. All determined index terms and keywords are used in the second stage across all included databases. In the third stage, additional studies should be looked up in the identified reports and articles’ reference lists [ 10 , 11 , 18 ]. The reviewers may look solely at the reference lists of the studies that were chosen from the full-text and/or included in the review, or they may look at the reference lists of all identified studies. In any case, it needs to be made very clear which group of studies will be looked at [ 8 , 11 , 18 ]. As reviewers gain more familiarity with the body of available evidence, new keywords, sources, and possibly helpful search terms may be found and incorporated into the search strategy, hence the search for a scoping review may be quite iterative. If so, it is crucial that the entire search process and the outcomes are open to scrutiny and audit [ 11 , 18 ].

In the same line, it is recommended for mapping reviews to search multiple databases [ 2 ] in all pertinent searchable fields (e.g., title, abstract, keywords, etc.) [ 3 ]. Thematic keywords, along with all of their synonyms and regional/temporal variations, are joined together to form Boolean strings using Boolean signs. Building looser, multiple Boolean strings instead of well-targeted ones (for example, using OR instead of AND, NOT, and exact phrases, respectively) is preferable. The latter runs the risk of omitting crucial references, whereas the former may return a sizable sample of sparsely relevant references [ 2 ]. Focusing the search on a specific component and then filtering all the results can be more effective for mapping reviews [ 3 ].

3.2.4 Step 4. Screening for inclusion

Screening and choosing the studies to be included in a review are the main objectives of this phase. According to [ 27 ], there are two levels of screening. Titles and abstracts are scanned in the first level to limit the range of the studies to be included, while full texts are scanned in the second level to re-examine the relevance of the studies and to settle disagreements between reviewers regarding the study selection. Discussions, meetings, consulting a third reviewer, and determining inter-rater reliability/agreement (using Cohen’s kappa coefficient or intraclass correlation coefficient) are the most typical ways to resolve disagreements. Soaita et al. (2020) [ 2 ] also support that the sample of retrieved references should be ‘cleaned-up’ once it has been finalized and duplicates have been automatically removed.

Different methodological approaches, including primary research articles, summary articles, opinion pieces, and grey literature, can all be included in the literature that scoping reviews identify and analyze [ 7 , 18 , 19 ], but they may also serve as an exclusion criterion [ 2 ]. Peters, Godfrey, et al. (2020) [ 18 ] advice against limiting source inclusion based on language unless there are compelling justifications for doing so (such as practical considerations).

According to the PRISMA extension for scoping reviews (PRISMA-ScR), a description of the study selection process must be provided in both a narrative and flow diagram format. Including the date of the most recent literature search, enables the reader to assess how current the scoping review is [ 7 ].

3.2.4.1 Inclusion and exclusion criteria

Inclusion criteria offer a framework on which the reviewers can decide which sources to include in the scoping review. To ensure transparency and replicability, the exclusion and inclusion criteria need to be documented [ 7 , 8 , 10 , 11 , 17 ]. Authors should specify any limitations by year, language, publication status, or other factors, and explain why each one was put in place [ 7 ].

When it comes to mapping reviews, criteria should be created whenever possible with participation from stakeholders. Depending on the type of research questions, stakeholders may include practitioners, designers, policy makers, scientists and research funding bodies, but attention should be paid to avoid bias [ 12 ].

3.2.5 Step 5. Evaluating quality

Scoping and mapping reviews are not concerned with quality assessment as a criterion for inclusion [ 2 ]. Assessments of reporting quality and bias risk are typically outside the scope. Although it is possible to extract study characteristics that reflect study and reporting quality, bias cannot be assessed against a specific hypothesis if a mapping review is exploratory [ 3 ].

3.2.6 Step 6. Extracting data

The process of data extraction for a scoping review is also known as “charting the results”. A draft charting table or form needs to be created to capture the key details about the relevance of the included studies to the review question, as well as the characteristics of the included studies. The data extraction process can be iterative, with the charting table being constantly updated.

The reviewers should become familiar with the source results and test the extraction form on two or three studies to ensure that all relevant results are extracted [ 7 , 8 , 10 , 11 , 17 , 18 , 28 ]. In order to increase reporting transparency, authors should explain the main revisions with a justification if the charting process was iterative (i.e., the form was continuously updated). If appropriate, details about the procedures used to collect and verify information from the researchers of the included sources of evidence should be provided [ 7 ]. Author(s), year of publication, source origin, country of origin, objectives, purpose, study population, sample size, methodology, intervention type and comparator, concept, duration of the intervention, how outcomes are measured, and key findings that are related to the review question are all types of information that may be extracted [ 7 , 8 , 10 , 11 , 17 ].

When it comes to data extraction for mapping reviews, it is restricted to important study characteristics and outcomes due to the size of a mapping review [ 3 ]. The process of mapping is intended to produce a practical and organized resource that provides enough detail about studies to be helpful in further work [ 12 ].

To move beyond a straightforward list of citations, it is crucial to maintain a high level of clarity throughout any databases that are created. Studies that are discussed in several papers or that seem to be connected should be marked in the database. In the future, this helps prevent the double counting of research findings in syntheses that might overlook connections between study lines in the databases [ 12 ].

Aiming to capture the key characteristics of the included studies in the scoping and mapping reviews, we suggest the use of a guiding table for extracting data (see Supplementary_Material_1_Guiding_Table).

3.2.7 Step 7. Analyzing and synthesizing data

Authors may extract results and map descriptively. Simple frequency counts of concepts, populations, characteristics, or other fields of data will suffice for many scoping reviews [ 17 , 18 ]. In-depth analysis of quantitative data is not typically required in scoping reviews, although in some cases the authors may take into consideration a more advanced analysis depending on the nature and purpose of their review. A meta-analysis or interpretive qualitative analysis is probably not necessary in scoping reviews [ 17 , 18 ].

When it comes to mapping reviews, no results synthesis is carried out [ 12 ]. Different analytical approaches can be used to map chronological, geographical, conceptual, and thematic trends, which include some form of coding, once the sample has been limited to the pertinent references [ 2 ]. It is possible to identify correlations, trends, gaps, and clusters using simple numerical accounts of frequencies in each category (for example, the number of studies looking at a specific species) and more complex cross-tabulations (for instance, the number of studies looking at the effectiveness of a specific intervention, in a particular farming system, for a named species). Users have access to the map and can query it to find information pertaining to any chosen combinations of the subsets of the meta-data [ 12 ].

3.2.8 Step 8. Reporting the findings

Authors should specify exactly how the evidence will be presented, whether it be in a narrative format, table, or visual representation, such as a map or diagram [ 7 ].

In scoping reviews, a summary of all the relevant information gathered can be presented [ 8 ] using a logical and descriptive summary of the findings based on the research questions [ 10 , 11 , 17 ]. The distribution of studies by year or period of publication, countries of origin, field of intervention, and research methodologies, may be displayed in the tables and charts accompanied with a narrative summary that explains how the results relate to the review’s objectives [ 7 , 11 , 17 , 18 ].

The conclusions should be consistent with the review objective or question based on the findings of the scoping review [ 10 ]. Following the conclusions, specific recommendations for future research based on gaps in knowledge identified by the review results can be presented. Because of the lack of a methodological quality appraisal, recommendations for practice may be unable to be developed; however, suggestions based on the conclusions may be made [ 10 ].

A scoping review’s results section should include a PRISMA flow diagram and details the outcomes of the search strategy and selection procedure [ 7 , 17 ] outlining the grounds for exclusion at the full-text level of screening [ 7 ]. For example, a study [ 29 ] used the PRISMA-ScR extension for scoping reviews to ensure all important sections have been covered in their review.

Mapping reviews may place more emphasis on describing the evidence. The use of pivot tables and pivot charts is helpful for quickly visualizing the amount (and quality, if it is measured) of evidence across a variety of meta-data variables [ 12 ]. Such visualizations can display the quantity of research, the conclusions of a critical appraisal, the sample size across nations, outcomes, populations, or variables. These visualizations can contain categorical variables as additional dimensions. The geographic distribution of study effort and type may be particularly important in mapping reviews with a global or large-scale reach [ 12 ].

4 Discussion

This systematic literature review aimed to describe the process of conducting mapping and scoping literature reviews. In summary, the main difference between the two types of reviews is in their focus and scope. Mapping reviews provide a comprehensive overview of the literature while scoping reviews identify gaps and inconsistencies in the literature and outline potential areas for future research.

A lot of the methodological papers included in this systematic literature review (e.g [ 10 , 19 , 28 ]), referred to the “consultation process” as an additional, optional step that has been suggested by [ 14 ]. In this stage, subject experts or potential review users like practitioners, consumers, and policymakers may be consulted [ 8 ]. Researchers argue that this step should be mandatory [ 15 , 28 ]. In agreement with Levac et al.’s [ 15 ] choice, Daudt et al. [ 28 ] encourage the use of the consultation stage whenever it is practical because it adds richness to the entire research process and, consequently, the findings. Despite the fact that stakeholder consultations can make scoping review planning and execution more difficult, they guarantee that the findings are pertinent to educational practice and/or policies [ 19 ].

Scoping and mapping reviews should require more than one author to eliminate bias and ensure their quality. The card-sorting technique is suggested to be employed within the review process as a means for resolving discrepancies between the stakeholders and come to an agreement on the categorization and evaluation of the data to be included. Other studies (e.g [ 30 , 31 , 32 , 33 ]), propose the card-sorting technique as a method for resolving disagreements between people’s disparities, as well as to evaluate and verify extracted themes from datasets. Card sorting is a quick and reliable sorting method that finds patterns in how users would expect to find content or functionality. Due to the patterns and insights it exposes about how people organize and categorize content, card sorting is a successful approach for resolving categorization disagreements [ 34 ]. According to Wood and Wood [ 35 ], the majority of card sorting projects involve an open sort, where participants receive a list of items and are asked to organize them in the most appropriate way. However, in some cases, a pre-existing set of categories is given to the participants, the so-called closed card sorting project. This assumes that the existing categories are already well-organized, and the goal is to make minor adjustments. Wood and Wood [ 35 ], suggest that it’s best to start with an open sort and analyze the data before conducting a closed sort for validation. If a closed sort is necessary, it should be kept simple, and the results may not be optimal. For example, in a study [ 30 ] that aimed to review the use of makerspaces for educational purposes, the card sorting technique was used for the development of the coding scheme. A three-member academic committee, consisting of three professors took part in the card sorting exercise where they went through the abstracts of the relevant papers and were asked to categorize each manuscript after discussion. They then categorized the manuscripts in the three major themes and 11 subcategories that emerged during the card sorting exercise [ 30 ]. Similarly, the authors of [ 31 ] employed the card sorting technique in their research in order to agree on the main categorization and sub-categorization of the articles identified for inclusion in their review. Card sorting can be integrated as an additional step when conducting scoping and mapping reviews, as it provides useful insights from the experts’ perspective and makes the mapping process more inclusive (see Fig.  2 ).

Proposed steps for conducting scoping and mapping reviews

5 Conclusion

Scoping and mapping reviews need a methodological framework that is rigorous, consistent, and transparent, so that the results can be trusted and the review replicated. This provides enough information for the readers to evaluate the review’s accuracy, relevance, and thoroughness [ 8 ]. Scoping reviews should be carried out in accordance with established methodological guidance and reported using reporting standards (like PRISMA-ScR) guidelines [ 36 ]. The proposed steps for undertaking scoping and mapping reviews presented in this manuscript, highlight the importance of following a rigorous approach for conducting scoping or mapping reviews. Overall, this paper is a valuable resource for researchers who are interested in conducting a systematic scoping or mapping review in different fields and are looking to apply these review methods to their own research questions.

5.1 Limitations and future work

This study does not lack limitations. As specific keywords and specific databases were searched, not all relevant work is included. The study was also limited to the past 10 years, letting out methodologies and frameworks for scoping and mapping literature reviews that were not published within the specific timeframe. The fact that the number of methodological papers identified for inclusion are limited to ten, makes it difficult to clarify the differences between mapping and scoping reviews. Therefore, further research is encouraged in order to clarify and verify the differences and similarities between the two. The application of the proposed process for conducting systematic scoping and mapping reviews on specific topics will verify the process.

Data availability

The data that support the findings of this study are available from the corresponding author, [EC], upon reasonable request.

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Eirini Christou, Antigoni Parmaxi & Panayiotis Zaphiris

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Vertebral hemangiomas: a review on diagnosis and management

• Kyle Kato 1 ,
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Journal of Orthopaedic Surgery and Research volume  19 , Article number:  310 ( 2024 ) Cite this article

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Vertebral hemangiomas (VHs) are the most common benign tumors of the spinal column and are often encountered incidentally during routine spinal imaging.

A retrospective review of the inpatient and outpatient hospital records at our institution was performed for the diagnosis of VHs from January 2005 to September 2023. Search filters included “vertebral hemangioma,” "back pain,” “weakness,” “radiculopathy,” and “focal neurological deficits.” Radiographic evaluation of these patients included plain X-rays, CT, and MRI. Following confirmation of a diagnosis of VH, these images were used to generate the figures used in this manuscript. Moreover, an extensive literature search was conducted using PubMed for the literature review portion of the manuscript.

VHs are benign vascular proliferations that cause remodeling of bony trabeculae in the vertebral body of the spinal column. Horizontal trabeculae deteriorate leading to thickening of vertical trabeculae which causes a striated appearance on sagittal magnetic resonance imaging (MRI) and computed tomography (CT), “Corduroy sign,” and a punctuated appearance on axial imaging, “Polka dot sign.” These findings are seen in “typical vertebral hemangiomas” due to a low vascular-to-fat ratio of the lesion. Contrarily, atypical vertebral hemangiomas may or may not demonstrate the “Corduroy” or “Polka-dot” signs due to lower amounts of fat and a higher vascular component. Atypical vertebral hemangiomas often mimic other neoplastic pathologies, making diagnosis challenging. Although most VHs are asymptomatic, aggressive vertebral hemangiomas can present with neurologic sequelae such as myelopathy and radiculopathy due to nerve root and/or spinal cord compression. Asymptomatic vertebral hemangiomas do not require therapy, and there are many treatment options for vertebral hemangiomas causing pain, radiculopathy, and/or myelopathy. Surgery (corpectomy, laminectomy), percutaneous techniques (vertebroplasty, sclerotherapy, embolization), and radiotherapy can be used in combination or isolation as appropriate. Specific treatment options depend on the lesion's size/location and the extent of neural element compression. There is no consensus on the optimal treatment plan for symptomatic vertebral hemangioma patients, although management algorithms have been proposed.

While typical vertebral hemangioma diagnosis is relatively straightforward, the differential diagnosis is broad for atypical and aggressive lesions. There is an ongoing debate as to the best approach for managing symptomatic cases, however, surgical resection is often considered first line treatment for patients with neurologic deficit.

Introduction

Vertebral hemangiomas (VHs) are benign vascular lesions formed from vascular proliferation in bone marrow spaces that are limited by bony trabeculae [ 1 ]. VHs are quite common and are often incidental findings on spinal computed tomography (CT) and magnetic resonance imaging (MRI) of patients presenting with back or neck pain [ 2 , 3 ]. Previous, large autopsy series such as Schmorl (1926) and Junghanns (1932) found a VH prevalence of 11% in adult specimens [ 1 , 4 ]. However, the prevalence is believed to be higher as modern imaging techniques allow for better detection of small VHs that may not be easily diagnosed on autopsy specimens [ 5 ]. They can occur at any age but are most often seen in individuals in their 5th decade of life with a slight female preponderance [ 2 , 6 , 7 ]. Most VHs are found in the thoracic or lumbar spinal column and often involve the vertebral body, though they can extend to the pedicle, lamina, or spinous process, and may span multiple spinal segments [ 5 ].

The vast majority of VHs are asymptomatic, quiescent lesions [ 3 ]. Prior studies have stated less than 5% of VHs are symptomatic [ 8 , 9 ], although the 2023 study by Teferi et. al. demonstrated 35% of their 75 VH patients presented with symptoms including localized pain, numbness, and/or paresthesia [ 1 ]. 85% of symptomatic cases in this series were found to have VHs localized in the thoracic spine [ 1 ].

Among symptomatic VHs, up to 20–45% of cases may exhibit aggressive features including damage to surrounding bone and soft tissue or demonstrate rapid growth that extends beyond the vertebral body and invades the paravertebral and/or epidural space [ 1 , 5 , 10 , 11 ]. When “aggressive”, VHs may compress the spinal cord and nerve roots causing severe symptoms [ 1 , 5 ]. 45% of symptomatic VH patients present with neurologic deficits secondary to compressive lesions, bony expansion, disrupted blood flow, or vertebral body collapse while the remaining 55% present solely with back pain [ 8 , 12 , 13 , 14 , 15 ].

VHs are primarily diagnosed with radiographs, CT, and MRI, although other studies such as angiography, nuclear medicine studies, and positron emission—computed tomography (PET-CT) have been previously utilized to a lesser extent [ 1 , 15 , 16 , 17 , 18 , 19 ]. Radiologically, these lesions can be grouped into Typical, Atypical, and Aggressive subtypes (see radiological features). Histologically, VHs are composed of varying proportions of adipocytes, blood vessels, and interstitial edema which leads to thickening of vertical trabeculae in the affected vertebra [ 5 ]. This histopathology leads to the characteristic “polka-dot” sign on axial CT/MRI and “corduroy” sign on coronal and sagittal CT/MRI [ 5 , 20 ].

In terms of management, conservative treatment with observation and pain control are the mainstay of treatment for asymptomatic VH patients and those with mild-to-moderate pain respectively [ 21 ]. Surgical decompression is indicated for patients with neurologic deficits including compressive myelopathy or radiculopathy [ 22 ]. Other symptomatic patients have a wide variety of treatment options available including sclerotherapy, embolization, radiotherapy, and/or vertebroplasty [ 1 , 5 , 23 ]. The best approach in managing an individual patient with a symptomatic VH has not been elucidated and there have been different management algorithms suggested based on varying institutional experiences [ 1 , 5 , 24 , 25 ].

This article will review what is currently known regarding VHs. Diagnostic techniques and challenges will be highlighted as well as current treatment recommendations from the literature.

A retrospective review of the inpatient and outpatient hospital records at our institution was performed for the diagnosis of VHs from January 2005 to September 2023. Search filters included “vertebral hemangioma” "back pain,” “weakness,” “radiculopathy,” and “focal neurological deficits.” Radiographic evaluation of these patients included plain X-rays, CT, and MRI. Following confirmation of a diagnosis of VH, these images were used to generate the figures used in this manuscript. Moreover, an extensive literature search was conducted using PubMed for the literature review portion of the manuscript.

68 Articles were selected from our PubMed search. This article will review what is currently known about VHs. Diagnostic techniques and challenges will be highlighted as well as current treatment recommendations from the literature.

Histopathological features

VHs are benign tumors composed of various sized blood vessels, adipocytes, smooth muscle, fibrous tissue, hemosiderin, interstitial edema, and remodeled bone [ 5 , 7 , 26 , 27 ]. Macroscopically, they appear as soft, well-demarcated, dark red masses with intralesional, sclerotic boney trabeculae and scattered blood-filled cavities lending to a honeycomb appearance [ 5 , 6 , 7 ].

Microscopically, there are four subtypes of hemangiomas based on vascular composition: capillary, cavernous, arteriovenous (AV), and venous hemangiomas [ 28 ] (Fig.  1 ). Capillary hemangiomas are composed of small, capillary-sized blood vessels while cavernous hemangiomas present with collections of larger, dilated blood vessels [ 1 ]. AV hemangiomas are composed of interconnected arterial and venous networks while an abnormal collection of veins comprises venous hemangiomas [ 1 ]. VHs are predominately capillary and cavernous subtypes with thin-walled blood vessels surrounded by edematous stroma and boney trabeculae that permeate the bone marrow space [ 1 , 7 , 27 ]. In a sample of 64 surgically treated VHs cases, Pastushyn et al. reported 50% were capillary subtype, 28% were cavernous subtype, and 22% were mixed [ 29 ]. Occasionally, secondary reactive phenomena such as fibrous and/or adipose involution of bone marrow and remodeling of bone trabeculae may be seen [ 7 , 26 ]. Symptomatic VHs can be caused by all hemangioma subtypes, and there are no distinguishing features between subtypes on imaging [ 1 ]. However, cavernous and capillary subtypes are associated with favorable postsurgical outcomes [ 29 ].

Capillary hemangioma ( A and B ): A H&E 200× magnification showing proliferation of small caliber vessels within a fibrous stroma with surrounding bone, B CD34 immunohistochemical stain, 200× magnification highlighting small caliber vascular spaces. Cavernous hemangioma ( C and D ): C H&E 100× magnification showing proliferation of thin-walled, dilated, blood filled vascular channels, D H&E 200× magnification: Thin-walled, dilated vascular channels within a loose stroma with adjacent mature bone. Venous hemangioma ( E and F ): E H&E 100 ×  magnification showing abnormal proliferation of thick-walled vessels with dilated lumens. F H&E 100× magnification reveals tightly packed, thick-walled vessels with adjacent fragments of mature bone

Radiographic features

The histopathology of VHs gives rise to imaging features used to classify VHs as typical, atypical, or aggressive [ 13 ]. Typical and atypical MRI findings are correlated with the intralesional ratio of fat to vascular components [ 20 ]. Lesions with a high fat content are more likely to demonstrate features of typical VHs while those with a high vascular content (atypical VHs) tend to present without these findings [ 5 , 30 , 31 ]. Aggressive VHs have features including destruction of the cortex, invasion of the epidural and paravertebral spaces, and lesions extending beyond the vertebral body [ 13 , 15 , 20 ].

Laredo et al. demonstrated that VHs with a higher fatty content are generally quiescent lesions, while those with a higher vascular content are more likely to display “active” behavior and potentially evolve into compressive lesions [ 20 ]. Therefore, asymptomatic VHs can display both typical or atypical imaging findings while symptomatic lesions are more likely to present with atypical or aggressive findings [ 1 ]. Despite radiographically typical VHs being relatively easy to diagnose, atypical and aggressive VHs are much more challenging to recognize as they do not present with classic imaging findings and often mimic other pathologies such as multiple myeloma, metastatic bone lesions, and inflammatory conditions [ 5 , 30 , 31 ]. Compressive VHs often have coinciding radiologic and clinical classifications due to the correlation between aggressive behavior and compressive symptoms [ 5 ].

While MRI, CT, and radiographs are the primary imaging modalities used in the workup of VHs, other studies have also been used. Angiography will occasionally be performed to identify feeding/draining vessels and evaluate the blood supply to the spinal cord [ 5 ]. Multiphase technetium 99-methyl diphosphonate ( 99 Tc-MDP) bone scintigraphy may show increased tracer uptake in all phases (perfusion, blood pool, and delayed) due to technetium 99-labeled red blood cell accumulation in the tumors, which occurs in all hemangiomas [ 16 ]. PET-CT has been used to classify VHs as “hot” or “cold” lesions based on the degree of 18-FDG and 68-Ga DOTATATE uptake [ 17 , 18 , 19 ]. Although angiography is useful in clarifying the vascular network of aggressive VHs primarily, nuclear medicine studies offer a much more limited contribution to diagnosis when compared to CT and MRI [ 5 ].

Typical VHs

The collection of thin-walled, blood-filled spaces that comprise VHs cause resorption of horizontal trabeculae and reinforcement of vertical trabeculae, leading to a pattern of thickened vertical trabeculae interspersed with lower density bone of the nonexpanding vertebral body [ 15 , 31 , 32 ]. This composition is responsible for the “corduroy cloth” appearance seen in typical VHs on radiographic images [ 31 ].

On unenhanced axial CT images, typical VHs are characterized by a “polka dot” appearance, termed polka-dot sign. This is caused by small, punctate areas of high attenuation from hyperdense trabeculae surrounded by hypodense stroma [ 20 , 33 ] (Fig.  2 ). Like radiographs, sagittal and coronal CT images display the “corduroy” sign caused by thickened trabeculae in a field of hypodense bone (Fig.  2 ). There is no extraosseous extension of the hemangioma in typical VHs [ 5 ].

Sagittal ( A ) and axial ( B ) CT scans of a typical VH in an asymptomatic 50-year-old male demonstrating the “Corduroy” and “Polka-dot” signs respectively. Sagittal ( C ) and axial ( D ) T1-weighted MRIs of typical VHs are predominately hyperintense with areas of hypo-intensity due to thickening of vertical trabeculae. Sagittal ( E ) and axial ( F ) T2-weighted MRIs of typical VHs also appear as hyperintense lesions with areas of hypo-intensity that may demonstrate the “Corduroy” and “Polka-dot” signs as seen in CT images of typical VHs

Typical VHs tend to appear as hyperintense lesions on T1- and T2-weighted MRI sequences due to predominately fatty overgrowth with penetrating blood vessels [ 31 ] (Fig.  2 ). There are punctate areas of slight hypointensity within the lesion on axial T1-weighted MRI due to thickened vertical trabeculae which resembles the “polka-dot" sign [ 5 ] (Fig.  2 ). These trabeculae appear as linear striations on sagittal/coronal T1- and T2-weighted MRI [ 5 ] (Fig.  2 ). Fluid-sensitive sequences (i.e. short-tau inversion recovery or fat-saturated T2-weighted MRI) appear slightly hyperintense due to the vascular components of the lesion, and T1-weighted MRI with contrast demonstrates heterogenous enhancement of the lesion [ 3 ] (Fig.  3 ).

Contrast-enhanced T1 MRIs of a T8 VH in an asymptomatic fourteen-year-old female ( A ) and L3, L5 VHs in a thirty-one-year-old female with back pain ( B ), illustrating the heterogenous presentation of hemangiomas on post-contrast MRI

Atypical VHs

In contrast to typical VHs, atypical VHs tend to have a higher vascular component-to-fat ratio and may not demonstrate the classical imaging findings such as the “corduroy” and “polka-dot” signs [ 5 ]. This composition gives the lesion an iso- to hypointense appearance on T1-weighted MRI as well as a very high intensity appearance on T2-weighted and fluid-sensitive MRI [ 20 , 31 ] (Fig.  4 ). Atypical VHs often mimic primary bony malignancies or metastases and are more likely to demonstrate aggressive features, often making them difficult to diagnose [ 12 , 13 , 14 , 15 ].

Asymptomatic fifty-six-year-old male with a T9 atypical vertebral hemangioma that appears iso- to hypointense on axial T1 MRI ( A ) and hyperintense on axial T2 MRI ( B ). Atypical vertebral hemangiomas of the L3 and L5 vertebral bodies in a thirty-one-year-old female who presented with backpain. Sagittal T1 ( C ) and T2 ( D ) demonstrate hypo- and hyperintense lesions respectively

Aggressive VHs

Aggressive VHs routinely have atypical features on any imaging modality [ 1 , 5 ]. They may appear radiographically normal or show nonspecific findings such as osteoporosis, pedicle erosion, cortex expansion, vertebral collapse, or irregular vertical trabeculae associated with lytic areas of varying size [ 13 , 15 ] (Fig.  5 ).

Fifty-five-year-old female with an aggressive vertebral hemangioma of the L4 vertebral body with extension into the spinal canal. A Sagittal T1 MRI shows hypo-intensity of the entire vertebral body, although vertebral height is maintained. B Sagittal T2 MRI redemonstrates the lesion but appears hyperintense due to the vascularity of the hemangioma. Axial T1 ( C ) and T2 ( D ) MRI show involvement of the pedicles bilaterally and extension of the lesion into the anterior epidural space

CT findings are often nonspecific, including features such as extraosseous soft tissue expansion, cortical ballooning, or cortical lysis [ 34 , 35 ]. As with atypical VHs, the “corduroy” and “polka-dot” signs may not be readily visualized in aggressive or destructive lesions due to the higher vascular-to-fat ratio common in these hemangiomas [ 5 ]. However, it is important to be mindful of these signs because they can guide to the correct diagnosis. Other CT features that may assist in the diagnosis of inconspicuous VHs include extension of the lesion into the neural arch, involvement of the entire vertebral body, or an irregular honeycomb pattern due to serpentine vascular channels and fatty proliferation within the network of reorganizing bony trabeculae [ 20 ]. Vertebral fractures are rare due to the reinforcement of vertical trabeculae [ 1 ].

The composition of aggressive VHs, with a hypervascular stroma and less fat, results in a hypointense lesion on T1-weighted MRI [ 20 , 31 ] (Fig.  5 ). Again, this may conceal the “corduroy” and “polka-dot” signs which remain amongst the most useful imaging findings in the diagnosis of VHs, particularly in cases where other findings are nonspecific [ 5 ]. These non-specific findings may include hyperintensity on T2-weighted MRI due to the vascular components of the lesion (Fig.  5 ), which is also seen in most neoplastic and inflammatory lesions [ 31 ]. Areas of hyperintensity on fluid-sensitive MRI and the presence of lipid-dense content within the lesion may be seen as well [ 31 , 36 ]. Other features suggestive of an aggressive VH include a maintained vertebral body height, a sharp margin with normal marrow, an intact cortex adjacent to a paraspinal mass, or enlarged paraspinal vessels, however these findings are also nonspecific and relatively uncommon [ 5 , 13 ]. Although highly unusual, there have been cases of aggressive VHs with extensive intraosseous fatty stroma and simultaneous extraosseous extension of the lesion, permitting a straightforward diagnosis [ 36 ].

Even though some aggressive VHs may be diagnosed on CT and MRI, challenging cases may warrant the use of more advanced imaging techniques for accurate diagnosis. Higher fluid content relative to cellular soft tissue gives hemangiomas a bright appearance on diffusion weighted imaging (DWI) with elevated apparent diffusion coefficient (ADC) values, distinguishing them from metastases [ 37 ]. Volume transfer constant (K trans ) and plasma volume, which reflect capillary permeability and vessel density respectively, are quantitative measures derived from dynamic contrast enhanced magnetic resonance imaging (DCE MRI) perfusion imaging that can also be used to differentiate VHs and metastases [ 38 ]. K trans and plasma volume are both low in VHs and elevated in metastatic lesions [ 38 ]. Furthermore, aggressive VHs may show a signal drop when comparing non-contrast T1-weighted MRI with and without fat suppression, as well as microscopic lipid content on chemical shift imaging [ 39 ]. Finally, characteristic findings of aggressive VHs in angiography include vertebral body arteriole dilation, multiple capillary phase blood pools, and complete vertebral body opacification [ 15 ].

Laredo et al. [ 15 ] proposed a six-point scoring system to assist in the diagnosis of aggressive VHs based on the more common features observed in radiographs and CT. One point was given for each of the following findings: a soft tissue mass, thoracic location between T3–T9, involvement of the entire vertebral body, an irregular honeycomb appearance, cortical expansion, and extension into the neural arch [ 15 ]. The authors suggest that aggressive VHs should be suspected when a patient presents with nerve root pain in association with three or more of these features [ 15 ]. However, additional studies are needed to determine the utility of this scoring system as the predictive power has not been determined [ 5 ].

Some VHs are difficult to diagnose because they can have nonspecific findings on radiographs, CT, and MRI, making characteristic findings such as the “corduroy” and “polka-dot” signs, when present, important diagnostic features. VHs may also coexist with other vertebral lesions, further complicating the diagnosis. In these cases, angiography can differentiate a VH from a nonvascular lesion [ 40 ]. Ultimately, a biopsy may be required for accurate diagnosis, especially when there is potential for a malignant lesion such as angiosarcoma or epithelioid hemangioendothelioma.

Clinical features

VHs are often noted incidentally on spinal imaging and are often observed in patients in their fifth to sixth decade of life. Studies have shown that vertebral hemangiomas exhibit a slight female preponderance, with a male-to-female ratio of 1:1.5. [ 6 ]. Clinically, most VHs are asymptomatic and quiescent lesions, which rarely demonstrate active behavior and become symptomatic [ 41 ]. VHs occur most frequently in the thoracic spine [ 42 ], followed by the lumbar spine and cervical spine; sacral involvement is very rare [ 43 ].

When symptomatic, VHs can present with localized back pain or result in neurologic symptoms that are attributable to spinal cord compression, nerve root compression, or both, leading to myelopathy and/or radiculopathy [ 1 ]. At least 4 mechanisms of spinal cord and nerve root compression have been suggested: (1) hypertrophy or ballooning of the posterior cortex of the vertebral body caused by the angioma, (2) extension of the angioma through the cortex into the epidural space, (3) compression fracture of the involved vertebra, and (4) epidural hematoma [ 44 ]. When aggressive and symptomatic with spinal cord compression, VHs tend to occur in the thoracic spine [ 42 ].

Boriani et al. classified VHs into 4 groups based on the presence of symptoms and radiographic findings [ 45 ]. These include: Type I—latent, mild bony destruction with no symptoms; Type II—active, bony destruction with pain; Type III—aggressive, asymptomatic lesion with epidural and/or soft-tissue extension; and Type IV—aggressive, neurologic deficit with epidural and/or soft tissue extension.

Management options

Most VHs are asymptomatic and do not require treatment [ 1 , 21 ]. Treatment is indicated in cases with back pain or neurological symptoms, including myelopathy and/or radiculopathy, often caused by neuronal compression or vertebral fracture [ 1 ]. Previously, surgery was the primary treatment option offered to these patients, which was associated with an increased risk of complications, particularly intraoperative bleeding [ 1 ]. New modalities such as vertebroplasty have since gained traction as adjuncts or alternatives to surgery [ 1 ]. Today, there are several management options available for the treatment of symptomatic VHs, including conservative medical therapy, surgery, percutaneous techniques, radiotherapy, or a combination of these modalities [ 1 , 46 ].

There is no consensus on the best treatment strategy, however recently Teferi et. al. proposed a treatment algorithm for VHs based on their institutional experience and literature review (Fig.  6 ) [ 1 ]. They recommend conservative management for typical, asymptomatic VHs, CT-guided biopsy and metastatic workup with PET-CT for radiographically atypical VHs, surgical intervention with or without adjuvant therapy in cases with epidural spinal cord compression or vertebral compression fracture, and radiotherapy for recurrent, asymptomatic VHs following surgery.

Algorithm for diagnosis and management of VHs proposed by Teferi et al. [ 1 ]

Surgical treatment of VHs is recommended in cases with rapid or progressive neurologic symptoms including compressive myelopathy or radiculopathy [ 47 ]. Baily et al. documented the first case of surgical management for VHs after they successfully resolved a patient’s paraplegia secondary to an aggressive VH [ 48 ]. Prior to the 1960s, the average neurological recovery rate was 73% (range, 43–85%) with a mortality rate of 11.7% [ 49 ]. This is consistent with a series published by Ghormley et al. in 1941 where 5 symptomatic VH patients were treated with decompressive laminectomy and postoperative radiotherapy. Although three patients achieved partial or complete resolution of neurologic deficits, the procedure resulted in the death of the remaining two patients secondary to significant blood loss [ 50 ]. There were very few cases of symptomatic VHs documented prior to the 1960s, with one literature review reporting only 64 instances of VHs with neurologic dysfunction [ 49 ]. More recent studies demonstrate improvement in surgical outcomes with neurological recovery reaching 100% and mortality as low as 0% [ 42 ].

The goal of surgery is to decompress neural elements and stabilize the spine [ 1 ]. Potential options include corpectomy, involving resection of a portion of the vertebral body containing the hemangioma, followed by anterior column reconstruction and/or laminectomy, which offers indirect decompression [ 1 ]. The selected approach depends on the size of the hemangioma and the extent of vertebral body and/or neural arch involvement due to potential weaknesses in the anterior column and the location of the epidural intrusion into the spinal canal [ 1 ]. For example, corpectomy and reconstruction could be performed in cases with ventral spinal cord compression while cases with dorsal compression could be treated with laminectomy [ 1 ].

Corpectomy has an increased risk of substantial intraoperative blood loss, up to 5 L in some cases, due to the hypervascular nature of VHs [ 1 , 51 ]. Acosta et al. reported an average blood loss of 2.1 L in their series of 10 aggressive VHs treated with corpectomy [ 51 ]. Conversely, laminectomy has a lower surgical burden and reduced risk of significant intraoperative blood loss [ 1 ]. Laminectomy blood loss can be further reduced by nearly 50% by performing vertebroplasty before laminectomy [ 8 ]. Preoperative embolization of VHs should also be considered to minimize intraoperative blood loss and reduce mortality [ 1 , 22 ].

Goldstein et al. demonstrated that en bloc resection may not be necessary, as intralesional resection produced equivalent long-term survival and prevention of recurrence in their series of 65 patients [ 47 ]. However, there have not been any large-scale studies comparing outcomes and recurrence rates of indirect decompression versus corpectomy [ 1 ].

The treatment algorithm proposed by Teferi et al. suggests dividing symptomatic VH patients with radiculopathy or neurological deficit into cohorts of epidural spinal cord compression (ESCC) versus vertebral body compression fracture to determine appropriate surgical intervention (Fig.  6 ) [ 1 ]. Patients with ESCC are encouraged to undergo preoperative embolization followed by laminectomy with or without fusion depending on spinal stability, or preoperative embolization followed by corpectomy and fusion if ESCC is accompanied by extensive anterior column compromise [ 1 ]. Conversely, the recommended treatment for symptomatic VHs secondary to vertebral body compression fracture is posterior laminectomy with decompression and fusion [ 1 ].

Whether through corpectomy or laminectomy, surgical management of VHs has a low recurrence rate [ 1 ]. Piper et al. reported complete remission in 84% of VHs treated surgically in their 2020 meta-analysis [ 52 ]. They also reported a severe complication rate, including pathological fracture, significant intraoperative blood loss, wound infection, and cerebrospinal fluid leak, of 3.5% [ 1 , 52 ].

Percutaneous techniques

Percutaneous techniques include vertebroplasty, sclerotherapy, and embolization which have been rising in popularity as treatment options for VHs in isolation or in combination with surgery [ 1 ].

Vertebroplasty is a minimally invasive procedure that improves the structural integrity of a vertebra by injecting an acrylic compound, such as polymethyl methacrylate (PMMA), into a lesion [ 1 ]. It was first utilized in the treatment of VHs by Galibert et al. in 1987 [ 53 ]. PMMA causes thrombosis and irreversible sclerosis of the hemangiomatous venous pool, shrinking the lesion and consolidating trabecular microfractures [ 1 ]. It allows for rapid recovery of mobility, enhances anterior column support, and provides vertebral stabilization, but does not induce new bone formation due to poor biological activity and absorbability [ 54 , 55 ]. Vertebroplasty is particularly effective in alleviating back pain in VH patients with intravertebral fractures by providing an immediate analgesic effect and has previously been recommended as stand-alone first line therapy for VHs with moderate to severe back pain without neurologic compromise [ 1 , 54 ]. It can also be used in combination with surgery to reduce intraoperative blood loss when given as a preoperative adjunct therapy [ 8 ]. The most common complication of vertebroplasty is extravasation of injected compound outside the vertebral body with rates of 20–35% [ 55 , 56 ]. However, some researchers suggest small amounts of extravasation should be considered a stopping point rather than a complication as the vast majority of cases are asymptomatic [ 55 , 56 ]. In a series of 673 vertebroplasty cases, Layton et al. reported extravasation in 25% of patients with only 1% developing clinical symptoms of new onset radiculopathy (5 patients) or symptomatic pulmonary embolism (1 patient) [ 56 ]. Their second most common complication was rib fracture related to lying prone on the fluoroscopy table during the procedure which occurred in 1% of cases (7 patients) [ 56 ].

Alternatively, sclerotherapy involves direct intralesional injection of ethanol under percutaneous CT-guidance which causes thrombosis and destruction of endothelium, resulting in devascularization, shrinkage of the lesion, and, consequently, decompression of the neural elements [ 46 ]. It was first described as a treatment for VHs in 1994 by Heiss et al. and is less common in the treatment of VHs [ 57 ]. CT angiography is a prerequisite to target the most hypervascular subsection of the lesion and ensure patients are candidates for the procedure without leakage of contrast media, which occurred in 25% of patients in a series of 18 cases [ 58 ]. There are reports of intraoperative sclerotherapy as an adjunct to surgery, but the sample sizes are similarly limited [ 59 , 60 ]. Complications of direct ethanol injection include neurologic deterioration (including Brown- Sequard syndrome), pathologic fractures, and VH recurrence [ 46 , 61 ].

The last option for percutaneous intervention is trans-arterial embolization of feeding vessels using particulate agents [ 1 ]. It has been used as a preoperative adjunct therapy with surgery to reduce blood loss as well as a primary treatment for VHs alone or in conjunction with vertebroplasty [ 41 , 62 , 63 , 64 ]. In a series of 26 patients, Premat et al. demonstrated embolization combined with vertebroplasty was safe and effective in treating pain associated with aggressive VHs but was less effective in resolving motor deficits [ 65 ]. The primary role for embolization in the treatment of compressive VHs is preoperative adjunct therapy to reduce the risk of procedural bleeding [ 62 ].

• Radiotherapy

Radiotherapy (XRT) is a noninvasive approach that can obliterate hemangiomas and relieve pain through vascular necrosis and/or anti-inflammatory effects [ 1 ]. It is a suitable option for VH patients with back pain and no neurologic deficits, or as postoperative adjunct therapy after suboptimal surgical decompression. Patients with neural element compromise often require prompt decompression to prevent irreversible injury that is more appropriately managed with surgery rather than the delayed response offered by XRT [ 1 , 21 , 66 ]. Neurological deficits may, in fact, be aggravated by XRT, as demonstrated in 20% of patients with aggressive VHs from a series of 29 cases by Jiang et al. [ 8 ]. Multiple studies have proclaimed a 60–80% success rate in eliminating symptoms from VHs using XRT, which increases to over 90% when including partial symptom relief [ 8 , 67 , 68 ]. This does include neurological deficits in some cases, but the response of these symptoms to XRT continues to vary [ 52 ]. A radiation dose of at least 34 Gy was recommended by Heyd et al. after their multicenter study identified significantly greater symptom relief and recurrence control compared to lower doses [ 67 ].

XRT is gaining popularity as a postoperative adjunct therapy intended to reduce local recurrence, especially in subtotal resections [ 8 , 52 , 67 ]. There is a 50% recurrence rate in partial resections without adjunct XRT [ 8 , 11 ]. The extent to which XRT can reduce recurrence has not been fully elucidated and has been suggested for future study [ 52 ]. However, these potential benefits must be weighed against the known adverse effects including nausea, fatigue, anorexia, ileus, radionecrosis, and specifically in spinal XRT, radiation myelitis [ 1 , 8 , 52 ].

VHs are often asymptomatic, incidental findings on routine spinal imaging that do not require treatment or follow-up imaging unless they become symptomatic. Most can be diagnosed with characteristic CT and MRI findings while atypical lesions may be difficult to differentiate from alternative diagnoses. Some authors suggest the utilization of emerging imaging techniques such as DWI or DCE MRI to differentiate atypical lesions from malignancies, which is a promising solution that requires further research. Other authors suggest observation with regular follow-up may be the best course of management for asymptomatic, atypical lesions while others still recommend biopsy for definitive diagnosis of atypical lesions. Regardless, there is a consensus that symptomatic lesions should be treated. Most authors recommend surgical decompression for treatment in patients with neurological deficits, but there is ongoing debate as to the optimal treatment for back pain alone. There are several treatment options which should be considered case-by-case given the properties of various lesions. Management algorithms have been suggested but additional research is required to identify the optimal treatment for the many different classifications of VHs.

Availability of data and materials

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Abbreviations

• Vertebral hemangioma

Computed tomography

Magnetic resonance imaging

Arteriovenous

Positron emission-computed tomography

Technetium 99-methyl diphosphonate

Diffusion weighted imaging

Apparent diffusion coefficient

Volume transfer constant

Dynamic contrast enhanced magnetic resonance imaging

Epidural spinal cord compression

Polymethyl methacrylate

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KK performed a portion of the literature review and was a major contributor in writing the manuscript/generating figures. NT performed most of the literature review and was a major contributor in reviewing the manuscript. MC contributed to writing the manuscript. KE provided histological images for figures. SY was a major contributor in reviewing the manuscript. All authors read and approved the final manuscript.

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Kato, K., Teferi, N., Challa, M. et al. Vertebral hemangiomas: a review on diagnosis and management. J Orthop Surg Res 19 , 310 (2024). https://doi.org/10.1186/s13018-024-04799-5

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DOI : https://doi.org/10.1186/s13018-024-04799-5

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