functions of the literature review

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Literature reviews: functions, types and methods

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When we think of a literature review, we often forget to consider the different types of reviews and the different roles or functions that literature reviews can have.

In this short presentation I will first discuss some functions of literature reviews, and then make some points about how the function or purpose of your review should inform the type that you choose to do, and the methods that you employ.

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What is the Purpose of a Literature Review?

4-minute read

• 23rd October 2023

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

1. Provide a foundation for current research.

2. Define key concepts and theories.

3. Demonstrate critical evaluation.

4. Show how research and methodologies have evolved.

5. Identify gaps in existing research.

6. Support your argument.

Keep reading to enter the exciting world of literature reviews!

What is a Literature Review?

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

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

Provide a Foundation for Current Research

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

Define Key Concepts and Theories

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

Demonstrate Critical Evaluation 

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

Show How Research and Methodologies Have Evolved

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

Identify Gaps in Existing Research

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

Support Your Argument

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

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Library Guide to Capstone Literature Reviews: Role of the Literature Review

The role of the literature review.

Your literature review gives readers an understanding of the scholarly research on your topic.

In your literature review you will:

• demonstrate that you are a well-informed scholar with expertise and knowledge in the field by giving an overview of the current state of the literature
• find a gap in the literature, or address a business or professional issue, depending on your doctoral study program; the literature review will illustrate how your research contributes to the scholarly conversation
• provide a synthesis of the issues, trends, and concepts surrounding your research

Be aware that the literature review is an iterative process. As you read and write initial drafts, you will find new threads and complementary themes, at which point you will return to search, find out about these new themes, and incorporate them into your review.

The purpose of this guide is to help you through the literature review process. Take some time to look over the resources in order to become familiar with them. The tabs on the left side of this page have additional information.

Short video: Research for the Literature Review

Short Video: Research for the Literature Review

(4 min 10 sec) Recorded August 2019 Transcript 

Literature review as a dinner party

To think about the role of the literature review, consider this analogy:  pretend that you throw a dinner party for the other researchers working in your topic area. First, you’d need to develop a guest list.

• The guests of honor would be early researchers or theorists; their work likely inspired subsequent studies, ideas, or controversies that the current researchers pursue.
• Then, think about the important current researchers to invite. Which guests might agree with each other?  Which others might provide useful counterpoints?
• You likely won’t be able to include everyone on the guest list, so you may need to choose carefully so that you don’t leave important figures out. 
• Alternatively, if there aren’t many researchers working in your topic area, then your guest list will need to include people working in other, related areas, who can still contribute to the conversation.

After the party, you describe the evening to a friend. You’ll summarize the evening’s conversation. Perhaps one guest made a comment that sparked a conversation, and then you describe who responded and how the topic evolved. There are other conversations to share, too. This is how you synthesize the themes and developments that you find in your research. Thinking about your literature research this way will help you to present your dinner party (and your literature review) in a lively and engaging way.

Short video: Empirical research

Video: How to locate and identify empirical research for your literature review

(6 min 16 sec) Recorded May 2020 Transcript 

Here are some useful resources from the Writing Center, the Office of Research and Doctoral Services, and other departments within the Office of Academic Support. Take some time to look at what is available to help you with your capstone/dissertation.

• Familiarize yourself with Walden support
• Doctoral Capstone Resources website
• Capstone writing resources
• Office of Student Research Administration
• Office of Research and Doctoral Services
• Visit the Writing Center

You can watch recorded webinars on the literature review in our Library Webinar Archives .

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

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

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

What are Literature Reviews?

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

Goals of Literature Reviews

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

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

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

What kinds of sources require a Literature Review?

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

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

Types of Literature Reviews

What kinds of literature reviews are written?

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

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

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

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

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

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

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

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

Literature Reviews in the Health Sciences

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

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Literature Reviews

• What is a literature review?
• Steps in the Literature Review Process
• Define your research question
• Determine inclusion and exclusion criteria
• Choose databases and search
• Review Results
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What is a Literature Review?

A literature or narrative review is a comprehensive review and analysis of the published literature on a specific topic or research question. The literature that is reviewed contains: books, articles, academic articles, conference proceedings, association papers, and dissertations. It contains the most pertinent studies and points to important past and current research and practices. It provides background and context, and shows how your research will contribute to the field. 

A literature review should: 

• Provide a comprehensive and updated review of the literature;
• Explain why this review has taken place;
• Articulate a position or hypothesis;
• Acknowledge and account for conflicting and corroborating points of view

From  S age Research Methods

Purpose of a Literature Review

A literature review can be written as an introduction to a study to:

• Demonstrate how a study fills a gap in research
• Compare a study with other research that's been done

Or it can be a separate work (a research article on its own) which:

• Organizes or describes a topic
• Describes variables within a particular issue/problem

Limitations of a Literature Review

Some of the limitations of a literature review are:

• It's a snapshot in time. Unlike other reviews, this one has beginning, a middle and an end. There may be future developments that could make your work less relevant.
• It may be too focused. Some niche studies may miss the bigger picture.
• It can be difficult to be comprehensive. There is no way to make sure all the literature on a topic was considered.
• It is easy to be biased if you stick to top tier journals. There may be other places where people are publishing exemplary research. Look to open access publications and conferences to reflect a more inclusive collection. Also, make sure to include opposing views (and not just supporting evidence).

Source: Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal, vol. 26, no. 2, June 2009, pp. 91–108. Wiley Online Library, doi:10.1111/j.1471-1842.2009.00848.x.

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Susan Macicak : Linguistics

Imelda Vetter : Dell Medical School

For help in other subject areas, please see the guide to library specialists by subject .

Periodically, UT Libraries runs a workshop covering the basics and library support for literature reviews. While we try to offer these once per academic year, we find providing the recording to be helpful to community members who have missed the session. Following is the most recent recording of the workshop, Conducting a Literature Review. To view the recording, a UT login is required.

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

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

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

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

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

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• Last Updated: May 2, 2024 10:39 AM
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• What is a Literature Review? | Guide, Template, & Examples

What is a Literature Review? | Guide, Template, & Examples

Published on 22 February 2022 by Shona McCombes . Revised on 7 June 2022.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research.

There are five key steps to writing a literature review:

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

A good literature review doesn’t just summarise sources – it analyses, synthesises, and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

Why write a literature review, examples of literature reviews, step 1: search for relevant literature, step 2: evaluate and select sources, step 3: identify themes, debates and gaps, step 4: outline your literature review’s structure, step 5: write your literature review, frequently asked questions about literature reviews, introduction.

• Quick Run-through
• Step 1 & 2

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

• Demonstrate your familiarity with the topic and scholarly context
• Develop a theoretical framework and methodology for your research
• Position yourself in relation to other researchers and theorists
• Show how your dissertation addresses a gap or contributes to a debate

You might also have to write a literature review as a stand-alone assignment. In this case, the purpose is to evaluate the current state of research and demonstrate your knowledge of scholarly debates around a topic.

The content will look slightly different in each case, but the process of conducting a literature review follows the same steps. We’ve written a step-by-step guide that you can follow below.

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

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

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

Download Word doc Download Google doc

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

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

If you are writing a literature review as a stand-alone assignment, you will have to choose a focus and develop a central question to direct your search. Unlike a dissertation research question, this question has to be answerable without collecting original data. You should be able to answer it based only on a review of existing publications.

Make a list of keywords

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

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

Search for relevant sources

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

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

You can use boolean operators to help narrow down your search:

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

To identify the most important publications on your topic, take note of recurring citations. If the same authors, books or articles keep appearing in your reading, make sure to seek them out.

You probably won’t be able to read absolutely everything that has been written on the topic – you’ll have to evaluate which sources are most relevant to your questions.

For each publication, ask yourself:

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

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

You can find out how many times an article has been cited on Google Scholar – a high citation count means the article has been influential in the field, and should certainly be included in your literature review.

The scope of your review will depend on your topic and discipline: in the sciences you usually only review recent literature, but in the humanities you might take a long historical perspective (for example, to trace how a concept has changed in meaning over time).

Remember that you can use our template to summarise and evaluate sources you’re thinking about using!

Take notes and cite your sources

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

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

You can use our free APA Reference Generator for quick, correct, consistent citations.

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

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

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

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

There are various approaches to organising the body of a literature review. You should have a rough idea of your strategy before you start writing.

Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

If you are writing the literature review as part of your dissertation or thesis, reiterate your central problem or research question and give a brief summary of the scholarly context. You can emphasise the timeliness of the topic (“many recent studies have focused on the problem of x”) or highlight a gap in the literature (“while there has been much research on x, few researchers have taken y into consideration”).

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

As you write, make sure to follow these tips:

• Summarise and synthesise: give an overview of the main points of each source and combine them into a coherent whole.
• Analyse and interpret: don’t just paraphrase other researchers – add your own interpretations, 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 transitions and topic sentences to draw connections, comparisons and contrasts.

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

If the literature review is part of your dissertation or thesis, reiterate how your research addresses gaps and contributes new knowledge, or discuss how you have drawn on existing theories and methods to build a framework for your research. This can lead directly into your methodology section.

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

It is often written as part of a dissertation , thesis, research paper , or proposal .

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

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

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

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

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What Is A Literature Review?

A plain-language explainer (with examples).

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

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

Literature Review 101

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

What is a literature review?

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

Reviewing the literature

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

The literature review chapter

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

What’s the purpose of a literature review?

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

Purpose #1 – Demonstrate your topic knowledge

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

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

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

Purpose #3 – Lay the foundation for your conceptual framework

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

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

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

Purpose #4 – To inform your methodology

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

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

How do I find articles for my literature review?

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

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

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

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

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

Need a helping hand?

How should I structure my literature review?

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

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

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

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

Example of a literature review

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

Wrapping Up

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

Psst… there’s more!

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

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16 Comments

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

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

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

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

Timothy T. Chol [email protected]

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

This was so useful. Thank you so much.

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

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

Great Brief Explanation, thanks

So helpful to me as a student

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

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

Well-presented overview of the literature!

This was brilliant. So clear. Thank you

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What is a literature review?

A literature review is a critical analysis of the literature related to your research topic. It evaluates and critiques the literature to establish a theoretical framework for your research topic and/or identify a gap in the existing research that your research will address.

A literature review is not a summary of the literature. You need to engage deeply and critically with the literature. Your literature review should show your understanding of the literature related to your research topic and lead to presenting a rationale for your research.

A literature review focuses on:

• the context of the topic
• key concepts, ideas, theories and methodologies
• key researchers, texts and seminal works
• major issues and debates
• identifying conflicting evidence
• the main questions that have been asked around the topic
• the organisation of knowledge on the topic
• definitions, particularly those that are contested
• showing how your research will advance scholarly knowledge (generally referred to as identifying the ‘gap’).

This module will guide you through the functions of a literature review; the typical process of conducting a literature review (including searching for literature and taking notes); structuring your literature review within your thesis and organising its internal ideas; and styling the language of your literature review.

The purposes of a literature review

A literature review serves two main purposes:

1) To show awareness of the present state of knowledge in a particular field, including:

• seminal authors
• the main empirical research
• theoretical positions
• controversies
• breakthroughs as well as links to other related areas of knowledge.

2) To provide a foundation for the author’s research. To do that, the literature review needs to:

• help the researcher define a hypothesis or a research question, and how answering the question will contribute to the body of knowledge;
• provide a rationale for investigating the problem and the selected methodology;
• provide a particular theoretical lens, support the argument, or identify gaps.

Before you engage further with this module, try the quiz below to see how much you already know about literature reviews.

Research and Writing Skills for Academic and Graduate Researchers Copyright © 2022 by RMIT University is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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

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

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 
• How to write a good literature review 
• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• Frequently asked questions 

What is a literature review?

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

What is the purpose of literature review?

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

• Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 
• Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field. 
• Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 
• Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 
• Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 
• Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example

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

Literature Review on Climate Change Impacts on Biodiversity:

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

a. Habitat Loss and Species Extinction:

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

b. Range Shifts and Phenological Changes:

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

c. Ocean Acidification and Coral Reefs:

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

d. Adaptive Strategies and Conservation Efforts:

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

How to write a good literature review

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

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

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

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

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

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

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

Conducting a literature review

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

Choose a Topic and Define the Research Question:

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

Decide on the Scope of Your Review:

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

Select Databases for Searches:

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

Conduct Searches and Keep Track:

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

Review the Literature:

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

Organize and Write Your Literature Review:

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

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. 

Frequently asked questions

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

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

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

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

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

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

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

References 

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

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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.

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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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Literature Review: Purpose of a Literature Review

• Literature Review
• Purpose of a Literature Review
• Work in Progress
• Compiling & Writing
• Books, Articles, & Web Pages
• Types of Literature Reviews
• Departmental Differences
• Citation Styles & Plagiarism
• Know the Difference! Systematic Review vs. Literature Review

The purpose of a literature review is to:

• Provide a foundation of knowledge on a topic
• Identify areas of prior scholarship to prevent duplication and give credit to other researchers
• Identify inconstancies: gaps in research, conflicts in previous studies, open questions left from other research
• Identify the need for additional research (justifying your research)
• Identify the relationship of works in the context of their contribution to the topic and other works
• Place your own research within the context of existing literature, making a case for why further study is needed.

Videos & Tutorials

VIDEO: What is the role of a literature review in research? What's it mean to "review" the literature? Get the big picture of what to expect as part of the process. This video is published under a Creative Commons 3.0 BY-NC-SA US license. License, credits, and contact information can be found here: https://www.lib.ncsu.edu/tutorials/litreview/

Elements in a Literature Review

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The objective of a literature review

Questions to Consider

B. In some fields or contexts, a literature review is referred to as the introduction or the background; why is this true, and does it matter?

The elements of a literature review • The first step in scholarly research is determining the “state of the art” on a topic. This is accomplished by gathering academic research and making sense of it. • The academic literature can be found in scholarly books and journals; the goal is to discover recurring themes, find the latest data, and identify any missing pieces. • The resulting literature review organizes the research in such a way that tells a story about the topic or issue.

The literature review tells a story in which one well-paraphrased summary from a relevant source contributes to and connects with the next in a logical manner, developing and fulfilling the message of the author. It includes analysis of the arguments from the literature, as well as revealing consistent and inconsistent findings. How do varying author insights differ from or conform to previous arguments?

Language in Action

A. How are the terms “critique” and “review” used in everyday life? How are they used in an academic context?

In terms of content, a literature review is intended to:

• Set up a theoretical framework for further research • Show a clear understanding of the key concepts/studies/models related to the topic • Demonstrate knowledge about the history of the research area and any related controversies • Clarify significant definitions and terminology • Develop a space in the existing work for new research

The literature consists of the published works that document a scholarly conversation or progression on a problem or topic in a field of study. Among these are documents that explain the background and show the loose ends in the established research on which a proposed project is based. Although a literature review focuses on primary, peer -reviewed resources, it may begin with background subject information generally found in secondary and tertiary sources such as books and encyclopedias. Following that essential overview, the seminal literature of the field is explored. As a result, while a literature review may consist of research articles tightly focused on a topic with secondary and tertiary sources used more sparingly, all three types of information (primary, secondary, tertiary) are critical.

The literature review, often referred to as the Background or Introduction to a research paper that presents methods, materials, results and discussion, exists in every field and serves many functions in research writing.

Adapted from Frederiksen, L., & Phelps, S. F. (2017). Literature Reviews for Education and Nursing Graduate Students. Open Textbook Library

Review and Reinforce

Two common approaches are simply outlined here. Which seems more common? Which more productive? Why? A. Forward exploration 1. Sources on a topic or problem are gathered. 2. Salient themes are discovered. 3. Research gaps are considered for future research. B. Backward exploration 1. Sources pertaining to an existing research project are gathered. 2. The justification of the research project’s methods or materials are explained and supported based on previously documented research.

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What is Literature Review? Importance, Functions, Process,

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What is Literature Review?

A literature review is a critical and comprehensive analysis of existing research, studies, articles, books, and other relevant sources on a specific topic or subject. It serves as a foundational step in the research process, helping researchers understand the current state of knowledge, identify gaps in the literature, and establish a context for their own study.

Table of Content

• 1 What is Literature Review?
• 2 Importance of a Literature Review
• 3 Functions of a Literature Review
• 4.1 Search the Existing Literature in Your Field of Interest
• 4.2 Review the Literature Obtained
• 4.3 Develop a Theoretical Framework
• 4.4 Write the Literature Review
• 5 How to Write a Literature Review
• 6 Types of Sources for Review

In most research reports or research papers, you will see that literature review is an essential element and it forms the basis for advancing knowledge, facilitates theory development, discovers new research areas and closes old ones. When researchers want to understand the management dilemma, they study various books, articles and all other available sources.

In the research reports, the researchers present a summary of their search, study and evaluation of the literature that is already available related to the research topic. When the researcher presents a summary of their study of present literature in addition to their analysis of how this literature is related to or essential for the current research report; then, this process is known as literature review.

For example, in a research paper titled ‘Attrition Analysis in a Leading Sales Organisation in India’, authored by Mamta Mohapatra (International Management Institute, New Delhi, India), Amisha Gupta (Birlasoft, New Delhi, India) and Nikita Lamba (Genpact, New Delhi, India), literature review is presented as follows:

Organisations and researchers usually conduct literature review in order to establish how their own research fits within the context of existing literature.

Apart from these, some other objectives of carrying out literature review are:

• Develop an understanding of how each source of literature helps in understanding the research problem
• Examine the interrelationships among different variables
• Find out ways to interpret earlier similar researches on the topic under study
• Rectify the conflicts that exist among previously conducted studies
• Get an idea regarding the required sample size
• Get an estimate of how much variance is there in the variables of interest
• Understand the type of relationship that exists among variables
• Determine the research method that can be used in the research

Importance of a Literature Review

There are various reasons for carrying out literature review. Majorly, literature review helps in:

• Assessing the current state and level of research on a given topic
• Identifying experts related to particular research
• Identifying questions that need further research and exploration
• Identifying what methodologies have been used in the related past studies and what methodology should be used in current research
• Justifying a proposed research methodology
• Indicating the originality and relevance of the given research problem
• Demonstrating the preparedness of a researcher to complete the research

Functions of a Literature Review

Some of the major functions of literature review are:

• Establishing a context for the research
• Demonstrating that the researcher has actually read related literature extensively and is aware of most theory and methodology related to the given research topic
• Providing a shape for the research under consideration
• Establishing a connection between what the researcher is proposing and what he has already read
• Demonstrating how the findings of researcher can be integrated with the already existing research findings.
• Revealing the differences or areas of gap between present and earlier research findings
• Improving researcher’s research methodology
• Expanding researcher’s knowledge base
• Ensuring that the researcher is carrying out new research that has not been carried out earlier

Process of a Literature Review

The second step in the research process is to carry out the review of already existing literature. Before engaging in literature review, the researcher must be clear as to what is the area and topic of research. There are four steps involved in the literature review process as shown in Figure:

Search the Existing Literature in Your Field of Interest

In the literature review process, the first step is to find out what research has already been done in the area that the researcher has chosen. This step involves preparing a list or bibliography of existing sources of relevant literature such as books, journals, abstracts of articles on your research topic, citation indices and digital libraries.

Review the Literature Obtained

After the researcher has identified related literature including journals, books, research papers, etc.; the next step is to study, evaluate and analyse the literature critically. This study of literature helps a researcher identify themes and issues related to the research topic.

An evaluation of literature helps in:

• Identifying the different theories and their criticism
• Identifying different methodologies used in different studies including their sample size, data used, measurement methods
• Assessing if the researcher’s theory is confirmed beyond doubt
• Preparing a list of different opinions of different researchers and researcher should also add his/her opinion about the validity of these different opinions

Develop a Theoretical Framework

Since carrying out literature review is a time-consuming activity but the researcher has to do it within a limited time. In order to do so, the researcher usually establishes a boundary and parameters for the research work. Also, the researcher must sort information obtained from all the sources of literature. For a researcher, the theoretical framework acts as a base on which he can further or extend his research. At times, the researchers may modify their research framework after analysing the available literature.

Write the Literature Review

The last step in literature review is to make a summary of all the literature that the researcher has studied and reviewed. Usually, writing a literature review starts with a write-up on the main theme of research followed by the important ideas on which the research would focus. After this, the all the major themes and sub-themes to be discussed are organised and related. This will help the researcher in structuring the literature review. The researcher should also identify and describe the theories and studies that are relevant for the study under consideration. The researcher should then list and describe all the gaps that are present in the current body of knowledge. In addition, the researcher may also explain the recent advances and trends in the given research field. To conclude, the researcher should compare and evaluate his findings on the basis of research assumptions, related research theories, hypotheses, applied research designs, variables selected and potential future work speculated by the researchers. Finally, the researcher must acknowledge, cite and quote all the sources that he/she has used in his research. One specific characteristic of literature review is that the researcher must ensure that he gives due credit to all people who have contributed in the research work.

How to Write a Literature Review

While writing the literature review, the researcher must adopt or adhere to certain strategies as follows:

• Establish a focus around the central theme and ideas of the research
• Describe what a reader can expect from the given research study
• Organise the literature research to include basic elements such as introduction, body and conclusions

Types of Sources for Review

A researcher usually uses secondary data for literature review. Some of the major and widely used sources for literature reviews include articles in professional journals, statistical data from government websites and website material from professional organisations.

Apart from the previously mentioned sources, certain other sources of data can also be used by researchers that provide them first-hand information that is important for the study. These sources include reports, theses, emails, letters, conference proceedings, company reports, autobiographies, official reports, research articles, etc.

Apart from these, the researcher may also refer to other such as review articles, academic journals, books, newspapers, documentaries, encyclopaedias, dictionaries, bibliographies and citation indexes.

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Functions of a literature review

A literature review basically has three functions:

• to convey to the reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are;
• in doing so, you clearly pass the message to the reader that you are familiar with these theories & ideas. Consequently, you are somewhat more of an expert writer, or so the reader may think.
• present your ideas on the matter & your theorie(s).

• Open access
• Published: 30 April 2024

Application of exercise therapy in patients with chronic kidney disease-induced muscle atrophy: a scoping review

• Jiawei Yin 1 ,
• Xiaotu Zhang 1 ,
• Zilin Wang 1 ,
• Zihan Qu 1 ,
• Xuefeng Sun 1 ,
• Yuqing Song 1 &
• Hongshi Zhang 1  

BMC Sports Science, Medicine and Rehabilitation volume  16 , Article number:  100 ( 2024 ) Cite this article

90 Accesses

Metrics details

The prevalence of muscle atrophy in patients suffering from chronic kidney disease (CKD) presents a significant challenge to healthcare providers, necessitating innovative approaches to management and care. Against this backdrop, this study embarks on a comprehensive review of literature concerning the application of exercise interventions in the nursing care of these patients. Such interventions are critical in addressing the debilitating effects of the condition, which include progressive loss of muscle mass and strength, adversely affecting patient mobility, quality of life, and overall survival. This review aims to identify the specific exercise modalities, contents, outcome indicators, and application effects associated with this intervention, in the context of the complex interplay of metabolic, inflammatory, and hormonal factors contributing to muscle wasting in CKD patients. By examining the efficacy of various exercise interventions, this study seeks to elucidate optimal strategies for mitigating the impact of CKD-induced muscle atrophy, thereby informing clinical practices and improving patient outcomes.

According to the method of a scoping review, nine databases (Cochrane, PubMed, EMBASE, Web of Science, ProQuest, Ovid, CNKI, Wanfang Data, and VIP) were searched until September 28, 2023. The included literature was screened, summarized, and analyzed.

A total of 20 pieces of literature were included. Some types include aerobic exercise, resistance exercise, and aerobic combined resistance exercise. The exercise intensity primarily falls within the mild to moderate range, with a recommended frequency of 2 − 3 times a week, lasting 30 − 60 min each time. The types of outcomes encompassed in this study include body composition, functional testing, strength measurements, laboratory examinations, cardiopulmonary function assessments, and patient-reported outcomes. To varying degrees, exercise intervention positively impacts the subjects' physical activity ability, body composition, and skeletal muscle status. Currently, resistance training is the primary type of intervention used for preventing and treating CKD patients induced by muscle atrophy.

Exercise intervention can improve muscle strength, physical function, and quality of life in patients with CKD muscle atrophy. Therefore, patients should be fully informed of the effect of exercise intervention in the treatment of chronic kidney disease-induced muscle atrophy in future, so as to promote the standardized implementation of exercise intervention.

Peer Review reports

Introduction

Chronic kidney disease (CKD) significantly impacts global health, with its management complicated by the high prevalence of sarcopenia, identified as a loss of skeletal muscle mass and strength. Duarte et al. [ 1 ] report a notable prevalence of sarcopenia in CKD patients at 24.5%, with a higher incidence observed in those undergoing dialysis. This condition, especially severe in 26.2% of dialysis patients compared to 3.0% in non-dialysis patients, underscores the critical need for early identification and intervention.Chronic Kidney Disease (CKD) is associated with various pathophysiological processes, including mitochondrial dysfunction. Studies reported that muscle atrophy in CKD patients is related to mitochondrial dysfunction [ 2 ]. Exercise intervention can reduce oxidative stress, increase mitochondrial capacity, and enhance mitochondrial function [ 3 ]. Furthermore, it is particularly noteworthy that research has identified the combination of moderate-intensity continuous exercise (MICE) with blood flow restriction (BFR) as effective in suppressing the appetite of obese adults through the promotion of Lac-Phe and ghrelin secretion [ 4 ]. This finding underscores the significant implications of exercise not only for CKD but also for diabetes management, highlighting its potential as a pivotal intervention in the treatment and prevention strategies for these conditions. Mitochondrial DNA copy number (mtDNA-CN) is considered a novel biomarker for CKD risk, as higher levels of mtDNA-CN are associated with a lower risk of CKD. This relationship is independent of traditional CKD risk factors, suggesting that mtDNA-CN could serve as an important indicator for identifying CKD progression and severity [ 5 ]. Furthermore, the onset of diabetes in patients with CKD is significant, as mitochondrial dysfunction can exacerbate metabolic dysregulation. The relationship between mitochondrial function and CKD highlights the potential for targeted interventions to improve mitochondrial health and manage CKD, particularly in the context of comorbid conditions like diabetes [ 6 ].

Recent meta-analyses showed that exercise training can increase cardiorespiratory endurance, improve muscle strength and muscle volume, reduce the risk of cardiovascular disease, delay the progression of CKD, and improve the quality of life of CKD patients [ 7 ]. Therefore, we should identify muscle atrophy in CKD patients as early as possible and implement the intervention. While patients diagnosed with CKD may participate in resistance training, flexibility exercises, and aerobic exercise [ 8 ], it is crucial to consider the diverse physical capacities and tolerances of subjects at various phases of CKD. Furthermore, the lack of clear evaluation criteria for the type, specific content, and outcomes of exercise interventions for CKD patients leads to significant heterogeneity in the type, frequency, and intensity of exercise interventions [ 7 ].

A scoping review assists researchers in elucidating their research inquiries, presenting the scope and extent of research involved, summarizing research results, identifying the limitations of existing research, and finding research progress in a particular knowledge field [ 9 ]. This study used a scoping review methodology to analyze and synthesize the application research on exercise intervention in chronic nephritis muscle atrophy. Our objective is to furnish medical and nursing professionals with a comprehensive summary of exercise intervention types, content elements, evaluation indices, and efficacy, serving as a valuable resource.

Research question

① What are the methods, intensity, frequency, and time of exercise intervention for chronic kidney disease-related muscle atrophy? ② How does the application affect the exercise intervention program?

Identifying relevant studies

Search strategy.

Using a computer, a search was conducted in the Cochrane Library, PubMed, EMBASE, Ovid, ProQuest, Web of Science, CNKI, Wanfang, and VIP. The search time was covered from the establishment of the database until September 2023. The search words were combined with the MeSH words and entry terms in the PubMed database, including the search terms "Sarcopenias," "Muscle wasting," "Muscle atrophy," "Diabetes Mellitus," "Diabetes Insipidus" "Diet, Diabetic," "Prediabetic State" "Exercise Therapy" "Remedial Exercise," "Rehabilitation Exercises," "Physical Activities," "Aerobic Exercise," "Acute Exercise," "Isometric Exercise," "Exercise Training." The relevant references were tracked and noted.

Inclusion criteria and Exclusion criteria

Inclusion criteria: (1) Population: The study subjects included CKD patients with muscle atrophy or sarcopenia. (2) Intervention:Articles that employ exercise therapy as an intervention strategy are included, covering a range of modalities such as aerobic training, resistance training, and stretching exercises. Studies focusing on traditional physical therapy interventions, such as electrostimulation, and pharmacological treatments are excluded from this review. (3) Comparison: The control arm was subjected to conventional care, incorporating stretching routines or engaging in physical activities quantitatively inferior to the normative daily exertion levels. (4) Outcomes: Muscle Mass, Muscle Strength, Physical Performance, Biochemical Markers, Functional Status were measured at baseline and post-exercise. (5) Study: The literature categories comprised a variety of original research encompassing randomized controlled trials, quantitative studies, qualitative studies, and mixed studies.

Exclusion criteria: Reviews, conference abstracts, thematic summaries, protocols, duplicate publications, and full-text articles that were not accessible were excluded from the analysis. Literature that missed any discussion of the specific details regarding the execution, substance, or impact of exercise intervention in individuals afflicted with muscular atrophy due to chronic renal illness was likewise disregarded.

Study selection

Two proficient researchers conducted an exhaustive review of titles and abstracts based on the inclusion and exclusion criteria, completing preliminary literature screening. Subsequently, they reviewed the complete text to make a final selection. The screening was conducted independently, and then the results were compared. The issue was referred to the research team for discussion in a dispute.Through open dialogue and a rigorous examination of the inclusion and exclusion criteria, we reconciled differing viewpoints and reached a mutually agreed-upon selection of literature. This process highlights the critical role of collaborative discussion and meticulous scrutiny in achieving a consensus on literature screening outcomes, ensuring the integrity and quality of our research methodology.

Data extraction and synthesis

Two researchers independently extracted all the information from the included literature as follows: (1) authors, research type, country and year of publication, and sample size; (2) intervention method, intervention content and type, intervention duration of the experimental group and the control group; (3) outcome indicators, and measurement content of outcome indicators.

Study characteristics

Following the initial retrieval of 875 articles, a final selection of 20 articles was made [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Figure 1 depicts the specific screening process. These included studies were conducted in China ( n  = 9), United Kingdom( n  = 3), Brazil ( n  = 2), Australia ( n  = 1), Germany ( n  = 1), Italy ( n  = 1), South Korea (= 1), Sweden ( n  = 1), and the USA ( n  = 1). Regarding the publication years of the studies included in this article, the distribution is as follows: 2023 ( n  = 3), 2022 ( n  = 4), 2021 ( n  = 4), 2019 ( n  = 3), 2018 ( n  = 1), 2016 ( n  = 1), 2015 ( n  = 1), 2014 ( n  = 2), and 2007 ( n  = 1). The distribution of the studies by year and geographic location is presented in the supplementary figure. Among the 20 pieces of literature included in this study, 14 literatures described RCTs [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] and six literatures are quantitative non-random studies [ 10 , 11 , 13 , 19 , 22 , 29 ]. Table 1 lists the characteristics of the included literature and is discussed below.

Types of Exercise Intervention Programs

The exercise intervention scheme mainly includes resistance exercise [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], aerobic exercise [ 23 , 29 ], and aerobic exercise combined with resistance exercise [ 13 , 15 , 22 , 24 ]. (1) Currently, resistance training is the most prevalent form of exercise intervention. The common resistance exercise intervention scheme involves strength training of the upper and lower limbs. Upper limb strength training includes biceps curl with dumbbells, elastic ball movement on the non-internal fistula side, pull-ups, and chest and shoulder compression. However, lower limb strength training focuses on the muscle groups around the knee joint, including lunge, squat, sitting leg raising, knee flexion and extension, and quadriceps strength training with elastic belts. Furthermore, there are resistance exercises for the hip joint, such as leg compression and hip flexion. (2) The aerobic exercise intervention scheme primarily consists of several modalities, such as bicycle modalities [ 11 , 16 ], treadmill exercise [ 13 ], Baduanjin [ 29 ], and steady-state walking [ 23 ]. In this context, Luca et al. [ 23 ] used steady-state walking as an intervention plan for aerobic exercise and examined the impact of this simple aerobic exercise on the subjects. (3) The intervention program mostly incorporates resistance exercise with low-to-moderate intensity aerobic exercise. The three most prevalent forms of aerobic exercise are cycling, treadmill, and rowing. Liming et al. [ 19 ] used psychological theory to guide patients in resistance exercise, helping patients develop healthy behaviors through the healthy action process orientation model.

Intensity, frequency, and duration of exercise intervention

The intervention intensity and frequency varied among the studies. (1) Exercise intensity: Eight studies [ 10 , 11 , 12 , 18 , 19 , 22 , 24 , 26 ] set the exercise intensity according to the scores of the subjects' perceived exertion (RPE). The intensity target of exercise training was established in two studies [ 14 , 26 ] based on the patient's capacity to tolerate the quantity of exercise. The training intensity progressively escalated until the patients reached the optimal tolerance level. Two studies [ 21 , 27 ] assessed the exercise intensity of the subjects based on maximum repetitions (RM) and the percentage of maximum loading (1RM) of the exercise load. Four studies [ 13 , 15 , 16 , 19 ] set the exercise intensity based on the subjects' cardiopulmonary function indexes. This was achieved by measuring the heart rate of the patients during exercise as a reference, setting the appropriate exercise intensity after evaluating the heart rate at the maximum exercise intensity they could tolerate. Zhang Bo et al. [ 13 ] divided the exercise training into low intensity (25% ~ 44% VO 2 max ) and moderate intensity (45% ~ 59% VO 2 max ) based on the subjects' peak oxygen uptake (VO 2 max ). There was a gradual transition from low to moderate intensity during the intervention. This. (2) Exercise frequency: The intervention frequency of each study varied from 2 to 3 times per week, while the duration of intervention was typically set based on the subjects' tolerance level and training objectives. (3) Duration of exercise intervention: There are a total of 13 studies in which the intervention period spans 12 weeks [ 11 , 12 , 13 , 15 , 16 , 17 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 ], two studies have an intervention duration of 24 weeks [ 14 , 19 ], three studies have an intervention duration of 12 months [ 10 , 18 , 28 ], and two studies have an intervention duration of 6 months [ 19 , 23 ].

Outcome indicators and measurement tools

Outcome indicators included functional tests, body composition, strength, laboratory examination, cardiopulmonary function, and strength, and functional evaluations. The principal physical activity assessments comprised a walk test, sit-to-stand test, functional reach, balance test, SPPB score, and physical activity recall. The measurement of body composition included weight, body mass index, body fat, and lean body mass. Skeletal muscle mass was assessed using dual-energy X-ray absorptiometry, anthropometry, and muscle ultrasound. Laboratory examination indicators included inflammatory markers, renal profile, and body fat. Cardiopulmonary function indicators examined forced expiratory volume in one second (FEV-1), vital capacity, forced vital capacity (FVC), maximum inspiratory pressure (MIP), and peak oxygen uptake (VO 2 max ). In terms of patient-reported outcomes, the primary measurement tools encompassed the Quality-of-Life Questionnaire, Pain Scale, Leicester Uremic Symptom Score, Sarcopenia Quality of Life Scale, Activities of Daily Living Scale, Barthel Index, Kidney Disease Quality of Life Scale, Dialysis Patient Quality of Life Scale, and Revised Piper Fatigue Scale.

Effects of Exercise Intervention

(1) Effects of resistance exercise intervention: The exercise intervention schemes for muscle atrophy in CKD patients in the literature included different levels of resistance exercise. A total of ten studies have documented that resistance training protocols yielded a positive impact on several aspects of the subjects' physical function [ 10 , 11 , 13 , 16 , 29 ], muscle strength [ 10 , 13 , 16 , 22 , 26 , 27 , 28 , 29 ], daily living ability [ 10 , 13 , 27 ] and renal function [ 19 , 22 ]. Danielle and colleagues [ 12 ] found that a 12-week program of high-intensity progressive resistance exercise training (PRET) for hemodialysis patients led to a statistically and clinically significant increase in thigh muscle volume, with a mean difference of 193 cm 3 (95% CI: 63 to 324 cm 3 ; P  = 0.007) compared to the control group. However, it did not significantly enhance the subjects' physical activity capacity or overall quality of life. (2) Aerobic exercise intervention effect: Eleven studies [ 11 , 13 , 15 , 16 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ] reported the effects of different levels of aerobic exercise on subjects. Since low-intensity aerobic exercise was difficult to improve muscle strength [ 30 ] significantly, it was mostly used as an exercise intervention program for the control group [ 11 , 13 , 16 , 22 , 23 , 26 , 27 , 28 ]. Furthermore, other studies showed positive impacts of aerobic exercise training interventions on the subjects. For example, Wu Qian et al. [ 29 ] found significant improvements in the intervention group's handgrip strength, daily walking speed, and physical activity level compared to the control group, with the revised Piper fatigue scale (RPFS) scores also being significantly lower (indicating less fatigue) in the intervention group. These differences were statistically significant ( P  < 0.05). (3) Effects of aerobic exercise combined with resistance exercise intervention: Four literatures [ 13 , 15 , 22 , 24 ] incorporated a combination of aerobic exercise and resistance training in their physical exercise intervention program. Emma et al. [ 24 ] showed that combined resistance and aerobic training were more beneficial than aerobic training alone. Zhang Bo et al. [ 13 ] demonstrated that after 12 weeks of low and medium intensity aerobic combined with resistance exercise, elderly patients with chronic kidney disease complicated with sarcopenia showed significant improvements in appendicular skeletal muscle mass index (ASMI), grip strength index, 6-m walking speed, peak oxygen uptake (VO 2 max ), one-leg standing time, and reach in seat distance, with p-values indicating statistical significance ( P  < 0.05) for these improvements. This indicates that the exercise intervention was effective in enhancing muscle mass, muscle strength, and motor function without adversely affecting renal function.

This study demonstrates that exercise intervention for muscle atrophy in individuals with CKD includes different modalities, mostly resistance training and a combination of aerobic exercise. Guiding patients regarding resistance training can facilitate the anabolism and metabolism of skeletal muscle, enhancing muscle quality, improving muscle strength, and effectively enhancing patients' overall quality of life [ 31 ]. Exercise intervention schemes for CKD patients are often carried out in various forms of exercise combinations. Researchers often use aerobic exercise as an important auxiliary intervention method that benefits cardiovascular health. It improves the heart and lung function of the subjects, enhances their endurance, and facilitates the development of resistance training.

There are significant differences among CKD patients at different stages, so we should comprehensively evaluate the physiological function and tolerance of CKD patients and develop individualized exercise intervention programs for patients [ 7 ]. This study showed that the exercise intervention program includes detailed pre-exercise examinations, such as preliminarily assessing the subjects’ muscle strength and cardiopulmonary function status, determining whether they can tolerate exercise intervention, and developing personalized exercise prescriptions. Jonathan [ 15 ] and colleagues completed detailed medical examinations before the intervention, measuring the subjects' cardiopulmonary function and upper and lower limb strength. Results indicated that the design of the exercise intervention program was personalized. This study showed that the exercise form of CKD patients is not a single repeat of a certain type of exercise but a combination of various exercise methods that can achieve the best effect. Despite numerous RCTs reported that resistance exercise could significantly improve muscle strength in patients with CKD [ 32 ], a meta-analysis [ 33 ] has revealed that the use of progressive resistance exercise as the sole intervention did not result in a significant improvement in the 6-min walk test, which serves as a proxy indicator of cardiopulmonary function. It indicates that resistance training alone makes it difficult to improve the cardiopulmonary function of subjects significantly. As resistance exercise training necessitates a minimum level of cardiopulmonary function as a foundation, it also imposes specific cardiopulmonary function requirements on the subjects. Low-intensity, long-duration aerobic exercise has been shown to enhance the cardiopulmonary function and exercise capacity of patients with chronic kidney disease [ 34 ]. Therefore, clinical researchers frequently combine two forms of exercise to enhance patients' quality of life by enhancing their cardiopulmonary function and muscle strength. It demonstrates the comprehensive nature of exercise intervention program design. Universality: For patients with non-maintenance dialysis CKD, regular visits to the hospital for dialysis treatment means that they cannot receive the supervision of clinical researchers throughout the process. They also face problems such as a lack of exercise equipment and professional guidance. Emma et al. [ 24 ] found that patients considered frequent visits to the hospital as a major obstacle to participating in the study. So, future research needs to design simple and feasible home training programs for different patient situations and provide feedback when patients come to the hospital for dialysis. Luca’s [ 23 ] exercise training program was designed and organized by the hospital and ultimately completed by patients at home. It improved patients' physical function significantly after six months of intervention with low-intensity exercise.

The results of this study show that exercise intervention can improve physical function, activity ability, muscle atrophy, and quality of life in patients with CKD. This viewpoint is also supported by Vanden et al.'s systematic review of exercise intervention in CKD patients [ 35 ]. Furthermore, a cross-sectional study [ 36 ] also suggested that clinical medical staff should actively implement exercise interventions for CKD patients to address adverse outcomes such as muscle atrophy and decreased quality of life caused by long-term catabolism and dialysis treatment. Although exercise intervention positively impacts CKD patients, the current studies are mainly small-sample randomized controlled trials with low quality. Therefore, larger-sample randomized controlled trials are needed to evaluate the impact of exercise intervention on muscle atrophy in CKD patients more accurately. Notably, the frequency and duration of exercise intervention are not positively correlated with the intervention effect. Excessive exercise intensity may lead to lactic acidosis in patients, and severe cases may cause acute renal failure secondary to rhabdomyolysis [ 37 ]. Therefore, exercise frequency must be determined by the patient's condition; high-intensity training should not be pursued indiscriminately. Furthermore, cardiac function in CKD patients must be matched with the intensity of exercise. A systematic review have shown that high-intensity interval exercise with passive recovery leads to a greater increase in cardiac troponin T levels compared to moderate-intensity continuous exercise [ 38 ]. To minimize cardiovascular risk during exercise, exercise prescriptions should be tailored based on individual circumstances.A unified standard regarding the exercise frequency and intervention cycle of CKD patients does not exist. The guidelines indicate that the optimal resistance exercise frequency is 2 − 3 times per week, with an interval of 24 − 48 h each time, which is consistent with the results shown in this study [ 39 ]. In the literature included in this study, only seven articles [ 12 , 16 , 17 , 19 , 25 , 26 , 29 ] mentioned the safety of exercise intervention, and 3 of them [ 12 , 17 , 19 ] reported adverse events. Danielle et al. [ 12 ] reported muscle soreness and laceration of the back wound, indicating that there is a lack of comprehensive reports regarding the safety of exercise intervention trials in CKD patients. Some researchers failed to fully consider the safety of exercise intervention based on individual differences among subjects.

Integrating insights from the studies on exercise's impact on CKD, sarcopenia in hemodialysis patients, and diabetes management through physical activity, the future perspective emphasizes a holistic approach to CKD treatment. This approach advocates for the incorporation of tailored exercise programs to address the multifaceted challenges of CKD. A study elucidates how diverse exercise modalities can significantly impact blood glucose levels, emphasizing the importance of exercise in the management of diabetes, particularly in patients with CKD. It underscores the role of physical activity in enhancing insulin sensitivity and glycemic control, offering a non-pharmacological strategy to mitigate diabetes-related complications in CKD patients [ 40 ]. Additionally, exercise has beneficial effects on mitochondrial function and diabetes management. The research emphasizes that various exercise modalities, such as resistance and endurance training, can enhance mitochondrial density, dynamics, and oxidative capacity in muscle tissues. These improvements aid in boosting glucose metabolism and insulin sensitivity, which are crucial for diabetes control. The findings indicate that structured exercise programs are an indispensable component in addressing mitochondrial dysfunction and managing diabetes, especially in populations with chronic conditions like CKD [ 41 ]. Moreover, research has identified the efficacy of exercise in alleviating fatigue among hemodialysis patients, highlighting the potential of structured exercise programs to enhance energy levels and overall health in this demographic, regular physical activity could be an essential component of comprehensive care for hemodialysis patients, thus improving their quality of life and physical function [ 42 ]. The envisioned future includes rigorous clinical trials to further validate exercise as a key adjunct therapy, potentially leading to standardized exercise recommendations that enhance patient outcomes and quality of life in CKD management.

Strengths and limitations

The strengths of this scoping review include an extensive and repeated search of the literature to capture all relevant articles and limit emissions while strictly adhering to the PRISMA reporting guidelines. Unpublished dissertations are more likely to report uncertain or negative results, which may produce a reverse publication bias and be excluded from this study. The literature included in this study lacks large-sample, multi-center, randomized controlled studies, and the methodological rigor and data quality of the included studies have not been systematically evaluated.

Patients with CKD face many complex issues that seriously affect their quality of life. For them, long-term dialysis treatment has produced negligible side effects, and exercise therapy is needed to improve their quality of life. Exercise intervention can improve the muscle strength, physical function, and quality of life of patients with chronic nephritis muscle atrophy, which is an effective intervention method. We are still waiting to find its potential positive effects on CKD patients. In future nursing work, we should evaluate the physiological function status of CKD patients, formulate safe and effective exercise intervention plans, and intervene early in their muscle atrophy symptoms to promote their rehabilitation and improve their clinical outcomes.

Availability of data and materials

All data generated or analysed during this study are included in supplementary information files.

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The literature review and inclusion criteria were collaboratively developed by all authors, while Jiawei Yin and Xiaotu Zhang conducted the systematic literature search and screening. Data extraction from relevant literature was performed solely by Jiawei Yin. Following data extraction, Jiawei Yin composed the manuscript. Zilin Wang managed the data. Yuqing Song, Zihan Qu, and Xuefeng Sun undertook data collection and analysis, as well as provided suggestions. The final draft was reviewed and approved by Hongshi Zhang.

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Yin, J., Zhang, X., Wang, Z. et al. Application of exercise therapy in patients with chronic kidney disease-induced muscle atrophy: a scoping review. BMC Sports Sci Med Rehabil 16 , 100 (2024). https://doi.org/10.1186/s13102-024-00876-8

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Librarians' and information scientists' roles in health information literacy: a review of literature, gbenga anate michael, patience uloaku ikegwuiro, rimamatari d. nyatse, nneka jennifer odoh.

In Nigeria as a society, and to every individual, Health literacy is an important aspect to consider. This is due to the fact that a health  literate person understands his/her health status, take prevention and control measures of various diseases. Health literacy was  commonly conceptualized as a set of knowledge, a set of skills or a hierarchy of functions (functional- interactive- critical). The construct  of health literacy covers three broad elements: (1) knowledge of health, healthcare and health systems; (2) processing and using  information in various formats in relation to health and healthcare; and (3) ability to maintain health through self- management and  working in partnerships with health providers. The paper discusses the roles of librarian in health information literacy for individual to  obtain and translate knowledge and information in order to maintain and improve health in appropriate ways. The researcher reviewed  several literatures and found out that libraries have a big role to play to ensure that community recognize their information needs, search  for relevant information and make use of the information to make informed health decisions. The paper concludes that librarians  are ideally placed to raise awareness of the impact on health information literacy and to work with health professionals to embed the use  of tools and techniques to improve health literacy into their daily practice. The paper recommends that Medical librarian should develop  the public's digital and health literacy skills, and includes it in their services; create health information literacy support programmes for   its publics etc.

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Spectrum of renal disease in scleroderma other than scleroderma renal crisis: A review of the literature

• PMID: 38699985
• DOI: 10.5414/CN111243

Background: Systemic sclerosis (SSc) is a multi-system rheumatic disease characterized by vascular and fibrotic manifestations that can affect practically every organ. Scleroderma renal crisis (SRC) is the most common renal manifestation of SSc. However, with the use of angiotensin-converting enzyme inhibitors (ACEi), the morbidity and mortality associated with SRC has significantly reduced. Renal manifestations in SSc other than SRC have been generally under-recognized and can be left untreated, which can lead to grave consequences in this patient population. In this article, we will describe the spectrum of renal disease in SSc besides SRC.

Materials and methods: A literature search was conducted on PubMed and Cochrane from inception to December 2022 using medical subject headings (MeSH) terms for "scleroderma", "systemic sclerosis" combined with "renal injury", and "renal dysfunction". We included case reports, case series, observational studies, and literature reviews.

Results: The initial search revealed 393 articles. After the exclusion of duplicates and non-relevant articles, data was included from 30 articles and 45 patients. The mean age was 55.2 years, 9 males (20%) and 36 females (80%). The most reported renal manifestations included: ANCA-associated vasculitis (n = 22), penicillamine-induced renal injury (n = 8), oxalate nephropathy (n = 5), Goodpasture syndrome (n = 4), nephrotic range proteinuria (n = 2), renal artery stenosis (n = 2), membranous glomerulonephritis (n = 1), and Evans syndrome (n = 1).

Conclusion: The spectrum of kidney involvement in SSc can range from asymptomatic reduction of the glomerular filtration rate to life-threatening scleroderma renal crisis. Therefore, it is essential that physicians closely monitor renal function in these patients for any emerging renal dysfunction.

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Minimally invasive treatment of uterine necrosis with favorable outcomes: an uncommon case presentation and literature review

• Tengge Yu 1  

BMC Women's Health volume  24 , Article number:  267 ( 2024 ) Cite this article

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Uterine necrosis is a rare condition and is considered a life-threatening complication. However, cases of uterine necrosis were rarely reported, particularly those caused by infection. In terms of treatment, no minimally invasive treatment for uterine necrosis has been reported, and total hysterectomy is mostly considered as the treatment option.

The article specifically focuses on minimally invasive treatments and provides a summary of recent cases of uterine necrosis.

Case presentation

We report the case of a 28-year-old patient gravid 1, para 0 underwent a cesarean section after unsuccessful induction due to fetal death. She presented with recurrent fever and vaginal discharge. The blood inflammation markers were elevated, and a CT scan revealed irregular lumps with low signal intensity in the uterine cavity. The gynecological examination revealed the presence of gray and white soft tissue, approximately 5 cm in length, exuding from the cervix. The secretions were found to contain Fusobacterium necrophorum, Escherichia coli, and Proteus upon culturing. Given the patient’s sepsis and uterine necrosis caused by infection, laparoscopic exploration uncovered white pus and necrotic tissue openings in the anterior wall of the uterus. The necrotic tissue was removed during the operation, and the uterus was repaired. Postoperative pathological findings revealed complete degeneration and necrosis of fusiform cell-like tissue. Severe uterine necrosis caused by a multi-drug resistant bacterial infection was considered after the operation. She was treated with antibiotics for three weeks and was discharged after the infection was brought under control. The patient expressed satisfaction with the treatment plan, which preserved her uterus, maintained reproductive function, and minimized the extent of surgery.

Based on the literature review of uterine necrosis, we found that it presents a potential risk of death, emphasizing the importance of managing the progression of the condition. Most treatment options involve a total hysterectomy. A partial hysterectomy reduces the extent of the operation, preserves fertility function, and can also yield positive outcomes in the treatment of uterine necrosis, serving as a complement to the overall treatment of this condition.

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Uterine necrosis is a rare complication. Several cases of uterine necrosis have been reported following embolization of the uterine arteries for postpartum hemorrhage or uterine fibroids, or as a result of severe endometritis [ 1 ]. Symptoms of uterine necrosis caused by infection typically include lower abdominal pain, fever, and foul-smelling vaginal discharge. When the infection affects the tissue surrounding the uterus, the uterus becomes enlarged and tender, and the edema of the inflamed tissue holds the uterus in place. Some complications may occur infrequently, including peritonitis, pelvic vein thrombosis, pulmonary embolism, pelvic abscess, sepsis, kidney damage, and even death. Diagnosis is usually based on clinical symptoms and physical examination. Inflammatory markers, imaging studies, and secretion cultures can also assist in the diagnosis. Hysteronecrosis is typically treated with a total hysterectomy. Most patients recover, and only a small number of patients do not survive. We reported a case of uterine necrosis caused by infection. We removed part of the uterus instead of performing a total hysterectomy. The patient recovered well. Few cases of uterine necrosis have been reported, and no one has reported minimally invasive treatment for it. Given the rarity of the case and the lack of minimally invasive treatment options for uterine necrosis, this report was written in conjunction with a literature review summarizing similar cases of uterine necrosis.

We report the case of a 28-year-old patient who was gravid 1, para 0, with no significant medical history. The patient is Asian, from the Han ethnic group, China’s largest ethnic group. When she was 32 weeks pregnant, intrauterine fetal demise was confirmed by ultrasound. A cesarean section was performed due to the difficulty of vaginal trial labor following a lateral perineal incision, which was necessary because the fetus’s shoulder was exposed. After the operation, the patient continued to experience a high fever, with a maximum temperature of 39.5 degrees Celsius, and the fat around the abdominal incision has become liquefied. The number of patient’s pulses was 140, respiratory rate was 22 times per minute, and blood pressure was 131/87mmhg. After receiving treatment with medications such as Tienam and Piperacillin, the patient’s body temperature and inflammation returned to normal, and she was discharged from Municipal integrated traditional Chinese and Western medicine hospital. The type of antibiotic Tienam is Carbapenem antibiotics, and the dose is 500 mg by injection three times a day. The type of antibiotic Piperacillin is semi-synthetic penicillin antibiotics, and the dose is 1.5 g by injection three times a day. The disease subside after 7 days treatment.

A week later, she was admitted to Municipal integrated traditional Chinese and Western medicine hospital for the second time due to fever and pain in her lower left abdomen. The patient’s heart rate was normal, respiratory rate was 20 times per minute, and blood pressure was 121/80mmhg. The blood inflammation index was elevated, indicated by a C-reactive protein level of 52.01 mg/L. Brain CT and lung CT scans revealed no significant abnormalities. She was discharged after two weeks of treatment with medications such as Tienam and Piperacillin with the same dose as last time. The disease subside after 5 days treatment.

Five days later, she was admitted to our hospital for the third time due to a recurring fever, accompanied by vaginal purulent discharge and odor. The patient’s heart rate was 110 times per minute, respiratory rate was 23 times per minute, and blood pressure was 132/85mmhg. There was no increase in β-HCG, white cell count was 12.3 × 10^9 /L in the differential blood count, hemoglobin was 104 g/L, and procalcitonin was 0.12 ng/ml. She felt feverish and lethargic, with mild nausea. The patient was treated orally with Moxifloxacin by 1 tablet once a day for 3 days. A vaginal color ultrasound revealed a hypoechoic area in front of the uterus, indicating encapsulated effusion. The ultrasound also revealed an abnormal uterine echo, uneven uterine enlargement with abundant blood supply, trace effusion of the cervical canal, and pelvic effusion. The enhanced CT scan revealed swelling and adhesion of the anterior wall of the uterus and the adjacent anterior abdominal wall, along with changes in the surrounding exudate. Additionally, a lumpy, uneven low signal shadow was observed in the uterine cavity, along with visible pelvic fluid (Fig.  1 ). The histopathological analysis of intrauterine effluents revealed degenerative smooth muscle tissue accompanied by pus. Anaerobic culture of cervical secretions suggested the presence of Fusobacterium necrophorum. Biopsy of cervical and vaginal lesions revealed complete necrosis of fusiform cell-like tissue, with increased infiltration of inflammatory cells, and no identifiable endometrial tissue. Due to the presence of pus in the uterus, morinidazole was administered, and uterine drainage was performed. However, the result was not favorable. A gynecological examination revealed the presence of necrotic tissue in the vagina, extending approximately 5 cm from the cervical opening. The tissue appeared white and emitted a foul odor. It was recommended to undergo a laparoscopic surgery.

Sagittal computed tomography images. The uterus shows heterogeneous spongiform enlargement with multiple air locules, measuring 4 × 2.6 cm and extending over 5 cm. We have observed a difficulty in distinguishing between the myometrium and the endometrial cavity

Given that the patient had strong fertility requirements, the surgical procedure included laparoscopic necrotic tissue excision, uterine reconstruction, and the uterine drainage tube placement. During the laparoscopy, adhesion of the uterus to the anterior wall of the abdomen was observed. An opening with white pus and necrotic tissue was visible in the anterior wall of the uterus. The necrotic tissue in the cavity was removed during the operation (Fig.  2 Fig.  3 ). Cefoxitin (1.5 g tid ivgtt) and ornidazole (500 mg bid oral) were administered postoperatively to prevent infection for 2 days. After the surgery, the patient developed a fever with a peak body temperature of 39.3 degrees Celsius, which prompted a switch to cefoperazone-sulbactam sodium (2 g bid ivgtt) and ornidazole antibiotics (500 mg bid oral) for 7 days. After the body temperature returned to normal, the antibiotics were downgraded, the uterine drainage tube was removed, and oral antibiotics were continued after discharge. The results of the vaginal secretion culture indicated the presence of Escherichia coli and Proteus bacteria. The pathological results revealed extensively denatured necrotic tissue with calcification and heightened inflammatory cell infiltration.

The images seen during the surgery. The necrotic tissue of the uterus, attached to the anterior wall of the abdomen, is clearly visible in gray and white colors. It is situated in the anterior wall of the uterus and is connected to the uterine cavity

The gross specimen appeared gray in color, with an extremely soft texture, measuring about 5 cm in length, and accompanied by a foul odor

Uterine necrosis is a rare and serious complication. Cases of uterine necrosis have been reported in the literature as a complication of cesarean section, embolization for postpartum hemorrhage, or for a leiomyomatous uterus, as well as in cases of severe endometritis [ 2 , 3 , 4 , 5 , 6 , 7 ] (Table  1 ). Several authors have described cases of uterine necrosis associated with intrapartum or postpartum complications that increase the risk of infection. The literature reports cases of uterine necrosis resulting from the placement of B-Lynch compression sutures, uterine artery embolization, or surgical ligation techniques used to treat postpartum hemorrhage. These procedures may increase the risk of infection as the tissue becomes devascularized. A. Fouad et al. described a case similar to ours in which a patient underwent a cesarean section due to fetal death, followed by postoperative sepsis and purulent uterine necrosis. Despite undergoing a hysterectomy, the disease continued to progress and ultimately resulted in death due to septic shock and multiple organ failure.

The case we report has identified pathogenic bacteria in the culture, which is significant for diagnosing infection-induced uterine necrosis. Fusobacterium necrophorum is a pleomorphic, Gram-negative, non-spore-forming obligate anaerobic coccobacillus. It is associated with localized abscesses, throat infections, and life-threatening systemic diseases. It is a common resident of the oral cavity and the vagina. Of the two subspecies of Fusobacterium necrophorum, biovar B is the primary pathogen for humans. Potential virulence factors include cell wall endotoxin lipopolysaccharide, hemagglutinin, and hemolysin. Most reported cases related to gynaecology occurred in the postpartum or post-abortion period, in addition to a few reports associated with the use of intrauterine devices, tubo-ovarian abscesses, and gynecological Lemierre’s syndrome [ 8 , 9 , 10 ]. Although infected with the same pathogen, the case reported by T. Widelock et al. developed more severe symptoms, including lung abscesses and kidney failure, as a result of hematoplasm infection [ 11 , 12 , 13 ].

A pelvic ultrasound is the initial diagnostic test that can reveal signs of uterine necrosis. The uterine cavity is typically expanded and exhibits multiple echogenic foci with accompanying dirty acoustic shadowing. Little or no vascularity is observed [ 14 ]. The diagnosis requires further exploration through a CT scan or MRI, as these are the preferred methods of investigation. The CT scan is highly useful for diagnosis as it demonstrates the presence of gas in the myometrium, the lack of enhancement of the myometrium after contrast injection associated with uterine enlargement, and the presence of free fluid in the peritoneal space [ 15 , 16 ].

Since uterine necrosis is described as a life-threatening complication, it is suggested to manage it with hysterectomy and broad-spectrum antibiotic therapy [ 17 , 18 ]. But sometimes it’s a case-by-case situation.

Avoid the chances of associated infections by systematic vaginal sampling in the third trimester, and promote good asepsis during surgery and antibiotic coverage in case of doubt about any undiagnosed prepartum infection, which may potentiate hypoxia and the risk of necrosis. Uterine necrosis may be secondary to all these intertwined factors and could be potentiated by an environment of hypoxia, hypoperfusion, hypovolemia secondary to hemorrhage, massive transfusions with disadvantages in a patient who is immunocompromised by pregnancy, and possibly, by other vitamin and iron deficiencies.

Given the limited number of reported cases of uterine necrosis in the past, there is no standardized treatment protocol. However, due to the potential fatality of uterine necrosis, most treatment options involve total hysterectomy. In our case, only the necrotic tissue of the uterus was removed in young women who had not given birth, and the prognosis for the patient is good. This study also has limitations, including the short follow-up time and the small number of cases collected. It needs to be complemented by subsequent case reports related to uterine necrosis.

Data availability

No datasets were generated or analysed during the current study.

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Yu, T. Minimally invasive treatment of uterine necrosis with favorable outcomes: an uncommon case presentation and literature review. BMC Women's Health 24 , 267 (2024). https://doi.org/10.1186/s12905-024-03089-w

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Novel SETBP1 D874V adjacent to the degron causes canonical schinzel–giedion syndrome: a case report and review of the literature

• Jing Zheng 1 , 2 ,
• Meiqun Gu 1 , 2 ,
• Shasha Xiao 1 , 2 ,
• Chongzhen Li 1 , 2 ,
• Hongying Mi 1 , 2 &
• Xiaoyan Xu 1 , 2  

BMC Pediatrics volume  24 , Article number:  309 ( 2024 ) Cite this article

Metrics details

Schinzel-Giedion syndrome (SGS) is a severe multisystem disorder characterized by distinctive facial features, profound intellectual disability, refractory epilepsy, cortical visual impairment, hearing loss, and various congenital anomalies. SGS is attributed to gain-of-function (GoF) variants in the SETBP1 gene, with reported variants causing canonical SGS located within a 12 bp hotspot region encoding SETBP1 residues aa868-871 (degron). Here, we describe a case of typical SGS caused by a novel heterozygous missense variant, D874V, adjacent to the degron. The female patient was diagnosed in the neonatal period and presented with characteristic facial phenotype (midface retraction, prominent forehead, and low-set ears), bilateral symmetrical talipes equinovarus, overlapping toes, and severe bilateral hydronephrosis accompanied by congenital heart disease, consistent with canonical SGS. This is the first report of a typical SGS caused by a, SETBP1 non-degron missense variant. This case expands the genetic spectrum of SGS and provides new insights into genotype-phenotype correlations.

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Introduction

Schinzel-Giedion syndrome (SGS, OMIM 269,150) is a rare autosomal dominant genetic disorder first reported in 1978 [ 1 ]. Clinical features of SGS include distinctive facial appearance (commonly midface retraction), profound intellectual disability, refractory epilepsy, cortical visual impairment, hearing loss, and various congenital anomalies such as congenital heart disease, hydronephrosis, delayed neurological development, and skeletal dysplasia [ 2 ]. Liu et al. proposed revised diagnostic criteria for SGS, classifying it into three types based on clinical presentation and/or pathogenic SETBP1 variant, enabling definitive diagnosis for patients with atypical clinical phenotypes via genetic testing and broadening the phenotypic spectrum [ 3 ].

Hoischen et al. confirmed that SGS is caused by variant in the SETBP1 gene. In contrast to loss-of-function (LoF) variant leading to SETBP1 haploinsufficiency disease (SETBP1-HD), characterized by hypotonia and mild motor developmental delay/intellectual disability (MIM: #616,078), known SETBP1 variants causing SGS are gain-of-function (GoF) and located within a 12 bp hotspot region encoding SETBP1 amino acid residues 868–871, which are associated with the canonical SGS phenotype. The SETBP1 aa868-871 region functions as a degron, a signal regulating protein degradation, and pathogenic variants within the degron result in SETBP1 protein accumulation. Missense variants of residues I871 and D868 have been demonstrated to be associated with the lowest and highest levels of pathogenic SETBP1 protein, respectively, indicating a significant genotype-phenotype correlation in this region [ 4 ].

In this study, we report a patient with a typical SGS clinical presentation, who was found to carry a novel de novo heterozygous SETBP1 D874V variant. The mutated residue is located near the degron region, but the patient presents with a classical clinical phenotype that could not be explained by the currently known genotype-phenotype correlations.

Materials and methods

A female neonate who was admitted to the neonatal intensive care unit of First People’s Hospital of Yunnan Province was included in this study. She exhibited dysmorphic facial features (midface retraction, frontal bossing, and low-set ears), bilateral varus, syndactyly of the 4th and 5th toe, hydronephrosis, and congenital heart disease. We conducted follow-up for her clinical condition. The patient’s parents provided written informed consent to the study.

Genetic tests

Two milliliters of the peripheral blood collected from the patient were used (anticoagulant: EDTA), and whole-exome sequencing was performed by Beijing Chigene Translational Medicine Research Center Co., Ltd (Beijing, China). Genomic DNA was extracted using the Blood Genome Column Medium Extraction Kit (Kangweishiji, China) according to the manufactural instructions. The extracted DNA samples were subjected to quality control using Qubit 2.0 fluorimeter and electrophoresis using 0.8% agarose gel for further protocol. Protein-coding exome enrichment was performed using xGen® Exome Research Panel v1.0 (IDT, Iowa, USA) that consists of 429,826 individually synthesized and quality-controlled probes, which targets 39 Mb protein-coding region (19,396 genes) of the human genome and covers 51 Mb of end-to-end tiled probe space. After target enrichment, high-throughput sequencing was performed on Illumina NovaSeq 6000 series sequencer (PE150), which was used to perform paired-end 150 bp sequencing, with a mean sequencing depth of 100X and sequencing coverage of 99%. Raw data were processed by the fastp software for adapters removing and low-quality reads filtering [ 5 ]. The paired-end reads were aligned to the Ensemble GRCh37/hg19 reference genome using the Burrows-Wheeler Aligner (BWA) software pacakage, and the GATK software was used reads calling. Detected single nucleotide polymorphisms (SNPs) and insertions and deletions (indels) not longer than 50 bp were then annotated using the ANNOVAR software. The common variants, with minor allele frequency (MAF) > 0.05, found in the 1000 Genomes Project and the ExAC and gnomAD databases were filtered out.

The primers designed for polymerase chain reaction (PCR) were as SETBP1 -F, 5′-GGGAGCAGAAATCAAAAGAGTACC-3′ and SETBP1 -R, 5′-CCAAAACCCAAAAGGGAATACACA-3′. Sanger sequencing was performed using the ABI 2720 DNA analyzer (USA). The NCBI BLAST algorithm was used for sequence alignment.

Pathogenicity analysis of genetic variants

Computer software, including REVEL, SIFT, Polyphen2-HVAR, Polyphen2-HDIV, PROVEAN, and MutationTaster, were used to predict the deleterious effects of each variant on the protein function. Exomiser and Phenolyzer software were used to perform genotype-phenotype analysis. Homology modeling was performed using the Modeller software ( https://salilab.org/modeller/ ) to analyze changes in the three-dimensional structure, and evolutionarily conserved regions were analyzed using UGENE software ( http://ugene.unipro.ru/ ). Finally, the pathogenicity assessment and genetic interpretation of candidate gene variants were performed according to the American College of Medical Genetics and Genomics guidelines and criteria [ 5 ] for variant classification.

Review of the literature

Variants and clinical features of previously reported cases with genetically diagnosed with SGS were collected. Data on these patients were retrieved from PubMed ( http://www.ncbi.nlm.nih.gov/pubmed ) using the search terms “Schinzel–Giedion syndrome” or “SGS” and “ SETBP1 ” Only articles in English were included.

Case presentation

The patient was admitted to the hospital with " high-risk delivery”, G1P1, born by cesarean section at a gestational age of 40 + 4 weeks, with a birth weight of 3430 g and an Apgar score of 9-9-9. Her parents were healthy, not consanguineous, and had no family history of specific diseases. The examination during pregnancy revealed that the mother suffered form gallbladder polyps and hypothyroidism.The fetus displayed severe hydronephrosis, pericardial effusion, and cauda equina cysts. Her physical examination upon admission showed stable vital signs, and stable breathing. Unique facial features included midface retraction, frontal bossing, and low-set ears (Fig. 1 A). The anterior fontanelle was flat and soft, the size is 3.0 cm*3.0 cm. There wasn’t flaring of nares, nor perioral and fingertip cyanosis. The pulmonary examination showed no abnormalities, heart rate was 125 beats/min, heart rhythm was regular, and class II/6 systolic murmur could be heard in the precordial region. The abdomen was significantly enlarged (Fig.  1 B), with an abdominal circumference of 38 cm, 2–3 bowel sounds/min, increased muscle tone of the limbs, limited abduction of both upper and lower limbs, bilateral varus, syndactyly of the 4th and 5th toe and vulvar malformation (dysplasia of the labia majora). During hospitalization, the patient had normal lab results for full biochemistry profile, routine blood, urine, and stool examinations, and thyroid function tests. In addition, tandem mass spectrometry screening of blood and urine samples showed normal results. Chest radiographs revealed broad bones (Fig.  2 A). Color Doppler echocardiography showed atrial septal defect, patent ductus arteriosus, right atrial and right ventricular enlargement. Moreover, color Doppler ultrasonography of the urinary system detected bilateral severe hydronephrosis (Fig.  2 D, E). Abdominal CT showed a significant increase in the size of both kidneys and signs of severe hydronephrosis in both kidneys (Fig.  2 F). Cranial color Doppler ultrasonography showed grade II-IVH on the left side and moderate enlargement of bilateral lateral cerebral ventricles (Fig.  2 B, C). Video electroencephalogram (EEG) showed normal results. No ocular fundus abnormalities were observed. Moreover, both ears did not respond to the rapid auditory brainstem response test. Due to the deformities of the heart, kidney, bone and other organs of the child, congenital genetic metabolic diseases could not be excluded. After obtaining the consent of the family members, the Whole-Exome Sequencing was improved. The child was treated with nasal catheter oxygen and anti-infection during the hospitalization. The child had difficulty in early feeding(weak sucking reflex) and could be fully fed orally before discharge, but the sucking power was also poor. Her parents abandoned treatment and was discharged from the hospital 13 days after birth. 8 months after birth, in the outpatient follow-up, the child presented with delayed gross motor development and no seizures, and the patient’s family members refused to perform a cranial MRI.

Phenotypic variants of the patient. ( A ) Characteristic midface retraction, frontal bossing, and low-set ears at 1 day after birth; ( B ) A grossly distended abdomen

Photographs show the clinical features of the patient in this study. ( A ) Chest radiographs at 1 day after birth show wide ribsn ( B, C ) Color doppler ultrasonography at 10 days after birth shows widened bodies and anterior horns of lateral ventricles; ( D, E ) Color doppler ultrasonography at 10 days after birth shows severe hydronephrosis was found in both kidneys, bilateral pelvis and calyces were severely dilated with a “palette” appearancete ( F ) Abdominal CT at 1 day after birth shows Significant increase in the size of both kidneys, signs of severe hydronephrosis in both kidneys

Result of genetic tests

Whole-exome sequencing suggested a heterozygous variant (c.2621 A > T, p.Asp874Val) in exon 4 of SETBP1 (NM_015559). This variant was a missense variant. The detected variant was not found in many databases including the 1,000 Genomes Project, ExAC gnomAD and dbSNP databases.

Analysis of the pathogenicity of gene variant

Sanger sequencing of the genome of the patient and her parents suggested that the patient had a de novo variant; As both parents had the wild-type gene (Fig.  3 ). Some silico predictions, including REVEL, SIFT, Polyphen2-HVAR, Polyphen2-HDIV, PROVEAN, and MutationTaster, suggested the deleterious effects of this variant on protein function. There has been no previous report of such variants. This variant was classified as likely pathogenic according to American College of Medical Genetics and Genomics guidelines (the supporting evidence for likely pathogenicity was PS2 + PM1 + PM2_Supporting + PP3).

Sanger sequencing confirms de novo c.2621 A > T variant(p.Asp874Val) in the SETBP1 gene in the patient

Protein-DNA/RNA docking using HDOCK server( http://hdock.phys.hust.edu.cn/ ) (hybrid algorithm of template-based modeling and ab initio free docking) is shown in Fig.  4 A. Green represents SETBP1 protein and sky blue represents E3 ubiquitin ligase, which promotes ubiquitination and degradation of SETBP1 protein. When mutated, SETBP1 protein fails to bind to E3 ubiquitin ligase, leading to protein overexpression. As shown in Fig.  4 A: S876, D868, S869, G870, I871, G872, T873 and D874 of SETBP1 form interactions with L48, K50, G101, C103, R105, P158 and N159 of E3 ubiquitin ligase, which in turn promote SETBP1 binding to E3 ubiquitin ligase and thus ubiquitination occurs. The hotspot variants D868, S869, G870 and I871 of the SETBP1 gene significantly affect the binding of SETBP1 to E3 ubiquitin ligase, thereby affecting ubiquitination. The D874V variant(p.Asp874Val) reported in this paper is also in the vicinity of the SETBP1 gene binding E3 ubiquitin ligase, which may also affect the binding of SETBP1 protein to E3 ubiquitin ligase and thus affect SETBP1 protein ubiquitination, ultimately leading to the development of the disease.Alignment of the SETBP1 sequences revealed that the amino acid residues at position 874 were strictly conserved (Fig. 4 B).

In-silico analysis of SETBP1 c.2621 A > T/p.Asp874Val variant. ( A ) Protein-DNA/RNA docking using HDOCK server ( http://hdock.phys.hust.edu.cn/ ) (hybrid algorithm of template-based modeling and ab initio free docking). As shown in Fig.  4 A: Green represents SETBP1 protein and sky blue represents E3 ubiquitin ligase. S876, D868, S869, G870, I871, G872, T873 and D874 of SETBP1 form interactions with L48, K50, G101, C103, R105, P158 and N159 of E3 ubiquitin ligase, which in turn promote SETBP1 binding to E3 ubiquitin ligase and thus ubiquitination occurs. The hotspot variants D868, S869, G870 and I871 of SETBP1 gene significantly affect the binding of SETBP1 to E3 ubiquitin ligase, thereby affecting ubiquitination. The D874V variant reported in this paper is also in the vicinity of the SETBP1 gene binding E3 ubiquitin ligase, which may also affect the binding of SETBP1 protein to E3 ubiquitin ligase and thus affect SETBP1 protein ubiquitination, ultimately leading to the development of the disease. ( B ) Alignment of the SETBP1 sequences revealed that the amino acid residues at position 874 were strictly conserved

The aforementioned data, the patient’s clinical manifestations, and the SETBP1 variant status indicated that SGS was caused by a heterozygous variant (c.2621 A > T, p.Asp874Val) in SETBP1 .

We evaluated a total of 20 articles and 60 patients. All data were curated in Table  1 .

Discussions

Liu et al. have updated the diagnostic criteria for Schinzel-Giedion (SGS). The revised criteria now classify SGS into three distinct types based on clinical observations and the presence of the SETBP1 variant [ 3 ]. SGS type I, also known as the classic type, is characterized by the hallmark clinical features, including developmental delays and distinctive facial morphology such as a prominent forehead, midface retraction, and low-set ears, as well as the presence of hydronephrosis or two of the four characteristic skeletal anomalies, including a sclerotic skull base, wide occipital synchondrosis, increased cortical density or thickness, and broad ribs. This classification aligns with the previously proposed diagnostic criteria by Lehman and colleagues. Type II refers to as an intermediate phenotype of SGS, is diagnosed in patients with development delays and the distinctive facial features, but without the presence of hydronephrosis or typical skeletal abnormalities, with the presence of the SETBP1 variant. Type III, also known as the simple type, is diagnosed in patients with the SETBP1 variant and developmental delays, with expressive language delay being the most prominent feature. These revised criteria will aid in the accurate diagnosis and management of SGS.

As far as we know, all reported cases of classical SGS meeting the diagnostic criteria proposed by Lehman and colleagues have exhibited missense variants within a 12-basepair hotspot located in exon 4 of the SETBP1 gene (Table  1 ) [ 4 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. This hotspot, which encodes four amino acid residues (D868, S869, G870, and I871), known as the degron, is located within the SKI homologous region of the SETBP1 protein and is a critical site for substrate recognition by the cognate SCF-β-TrCP E3 ubiquitin ligase [ 4 , 12 ]. Variants within the degron prevent the binding of SETBP1 protein to E3 ubiquitin ligase, leading to protein overexpression [ 24 , 25 ]. Patients with missense variants in residues 862, 867, and 873 near the hotspot region exhibit a milder SGS phenotype, and the proximity of the mutated position to the degron is associated with clinical overlap with the classic SGS phenotype [ 4 , 7 ]. Notably, D874V found in this study is adjacent to the degron, which is inconsistent with the previous knowledge.

To date, 63 cases of genetically confirmed SGS have been reported, including 16 missense variants and 1 insertion variant (Table  1 ). SETBP1 D874V reported in this paper is a novel variant and the first report of SETBP1 non-hotspot variant identified in a canonical SGS case. Being highly conserved in different species, D874 might have an important biological role. In addition, protein model analysis of the variant suggests that the hotspot variants D868, S869, G870 and I871 of the SETBP1 gene significantly affect the binding of SETBP1 to E3 ubiquitin ligase, thereby affecting ubiquitination. The D874V variant reported in this paper is located in proximity of the bliding site for E3 ubiquitin ligase, which may also affect the binding of SETBP1 protein to E3 ubiquitin ligase and thus affect SETBP1 protein ubiquitination, ultimately leading to the development of the disease.

Diagnosing SGS in the neonatal period can be challenging due to the presence of non-specific symptoms, including genital abnormalities, reduced sucking ability, decreased muscle tone, and EEG waveform abnormalities, in addition to the typical clinical manifestations of SGS [ 12 ]. In a 2022 case report by Yang et al. [ 10 ], a neonatal patient with midface retraction and developmental delay was diagnosed with “non-classical” SGS based on the absence of hydronephrosis and skeletal abnormalities at birth, and the presence of a SETBP1 gene variant, S869G, according to the Lehman diagnostic criteria. However, after 18 months of follow-up, bilateral hydronephrosis was detected by color Doppler ultrasonography, leading to a revised diagnosis of classical SGS. The authors emphasize the importance of long-term follow-up to observe the evolution of phenotypes diagnosed by early molecular testing, as phenotypic changes are common, particularly in infants. Out of 56 patients with SGS exhibiting variants in the degron sequence (hotspot variants sequence), five did not have hydronephrosis. According to Yang et al.‘s case report, progressive hydronephrosis may occur in long-term survivors, albeit at a slower development rate. However, the patient reported in this study developed severe hydronephrosis in the neonatal period, underscoring the need for close monitoring of renal function during later follow-up.

The SETBP1 protein is expressed throughout the body, but its levels are highest during brain development before birth, when nerve cells undergo proliferation and migration to specific regions of the brain. Variants in the SETBP1 gene can result in severe neurological developmental abnormalities, given its critical role in this process. A study by Banfi F et al. revealed that SETBP1 variants lead to the accumulation of the SETBP1 and SET proteins and the consequent P53 inhibition in neural cells. These molecular changes promote the onset of cancer-like behavior in neural progenitors that accumulate widespread DNA damage without programmed cell death engagement [ 26 ]. Neurodevelopmental delay is a hallmark characteristic of SGS, with asphyxia, feeding difficulties, and recurrent apnea being common symptoms in the neonatal period [ 11 ]. A stud y by Wong MM et a l illustrated that the variants that carrying SETBP1 missense variants outside the degron, cause a clinically and functionally variable developmental syndrome, showing only partial overlaps with classical SGS and SETBP1-HD, and primarily characterised by intellectual disability, epilepsy, speech and motor impairment [ 27 ]. The incidence of developmental delay, epilepsy, and expressive language delay is extremely high with increasing age, with 97% (56/58) of reported cases of children with SGS presenting with neurological developmental abnormalities, including developmental delay and seizures. In this study, cranial color Doppler ultrasonography showed moderate enlargement of bilateral lateral cerebral ventricles and a normal EEG waveform during the neonatal period. However, the patient’s family members did not approve of performing a cranial MRI. Currently, at 8 months of age, the patient exhibits retardation of gross motor development but has not experienced epileptic seizures. Long-term follow-up visits are required to monitor the patient’s progress. These findings highlight the importance of early diagnosis and appropriate imaging studies in the management of SGS, particularly in patients with a suspected neurological developmental abnormality.

In summary, this study reports the first case of canonical SGS in a Chinese neonate caused by a novel SETBP1 non-degron region variant, D874V. This finding expands the genetic spectrum of SGS and provides a new case for investigating genotype-phenotype correlations in SGS.

Data availability

The datasets presented in this article are not readily available because of privacy restrictions (the guardians of patients are reluctant to authorize the release of all the raw data of whole-exome sequencing, but agree to contribute positive sanger-sequencing results). Requests to access the datasets should be directed to the corresponding author.

Abbreviations

• Schinzel-Giedion syndrome

Gain-of-function

Loss-of-function

Electroencephalogram

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Acknowledgements

We would like to thank the patient and their family for their participation in this study. We sincerely thank the Beijing Chgene Translational Medicine Research Center, the Beijing Kangxu Medical Inspection Institute and the Wuhan Kindstar Medical Inspection Institute provide us with essential help for genetic testing.

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Jing Zheng, Meiqun Gu, Shasha Xiao, Chongzhen Li, Hongying Mi & Xiaoyan Xu

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ZJ, GM, and XS conceptualized and designed the study, collected data, carried out the analyses, drafted the initial manuscript, and reviewed and revised the manuscript. LC provides color ultrasound examinations for children. MH and XX conceptualized and designed the study, and critically reviewed the manuscript. All authors reviewed and approved the final version.

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Correspondence to Xiaoyan Xu .

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Zheng, J., Gu, M., Xiao, S. et al. Novel SETBP1 D874V adjacent to the degron causes canonical schinzel–giedion syndrome: a case report and review of the literature. BMC Pediatr 24 , 309 (2024). https://doi.org/10.1186/s12887-024-04779-y

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Received : 01 November 2023

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DOI : https://doi.org/10.1186/s12887-024-04779-y

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