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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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See an example

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

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

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

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

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

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

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

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

 Statistics

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

Research bias

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

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

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

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

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

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

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

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

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

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• University of Texas Libraries

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
• Synthesize Results
• Analyze Results
• Librarian Support

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.

Meryl Brodsky : Communication and Information Studies

Hannah Chapman Tripp : Biology, Neuroscience

Carolyn Cunningham : Human Development & Family Sciences, Psychology, Sociology

Larayne Dallas : Engineering

Janelle Hedstrom : Special Education, Curriculum & Instruction, Ed Leadership & Policy ​

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

Libraries | Research Guides

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

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

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

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

• Next: Planning the Review >>
• Last Updated: Jan 17, 2024 10:05 AM
• URL: https://libguides.northwestern.edu/literaturereviews

Review of Related Literature: Format, Example, & How to Make RRL

A review of related literature is a separate paper or a part of an article that collects and synthesizes discussion on a topic. Its purpose is to show the current state of research on the issue and highlight gaps in existing knowledge. A literature review can be included in a research paper or scholarly article, typically following the introduction and before the research methods section.

This article will clarify the definition, significance, and structure of a review of related literature. You’ll also learn how to organize your literature review and discover ideas for an RRL in different subjects.

🔤 What Is RRL?

• ❗ Significance of Literature Review
• 🔎 How to Search for Literature
• 🧩 Literature Review Structure
• 📋 Format of RRL — APA, MLA, & Others
• ✍️ How to Write an RRL
• 📚 Examples of RRL

🔗 References

A review of related literature (RRL) is a part of the research report that examines significant studies, theories, and concepts published in scholarly sources on a particular topic. An RRL includes 3 main components:

• A short overview and critique of the previous research.
• Similarities and differences between past studies and the current one.
• An explanation of the theoretical frameworks underpinning the research.

❗ Significance of Review of Related Literature

Although the goal of a review of related literature differs depending on the discipline and its intended use, its significance cannot be overstated. Here are some examples of how a review might be beneficial:

• It helps determine knowledge gaps .
• It saves from duplicating research that has already been conducted.
• It provides an overview of various research areas within the discipline.
• It demonstrates the researcher’s familiarity with the topic.

🔎 How to Perform a Literature Search

Including a description of your search strategy in the literature review section can significantly increase your grade. You can search sources with the following steps:

🧩 Literature Review Structure Example

The majority of literature reviews follow a standard introduction-body-conclusion structure. Let’s look at the RRL structure in detail.

Introduction of Review of Related Literature: Sample

An introduction should clarify the study topic and the depth of the information to be delivered. It should also explain the types of sources used. If your lit. review is part of a larger research proposal or project, you can combine its introductory paragraph with the introduction of your paper.

Here is a sample introduction to an RRL about cyberbullying:

Bullying has troubled people since the beginning of time. However, with modern technological advancements, especially social media, bullying has evolved into cyberbullying. As a result, nowadays, teenagers and adults cannot flee their bullies, which makes them feel lonely and helpless. This literature review will examine recent studies on cyberbullying.

Sample Review of Related Literature Thesis

A thesis statement should include the central idea of your literature review and the primary supporting elements you discovered in the literature. Thesis statements are typically put at the end of the introductory paragraph.

Look at a sample thesis of a review of related literature:

This literature review shows that scholars have recently covered the issues of bullies’ motivation, the impact of bullying on victims and aggressors, common cyberbullying techniques, and victims’ coping strategies. However, there is still no agreement on the best practices to address cyberbullying.

Literature Review Body Paragraph Example

The main body of a literature review should provide an overview of the existing research on the issue. Body paragraphs should not just summarize each source but analyze them. You can organize your paragraphs with these 3 elements:

• Claim . Start with a topic sentence linked to your literature review purpose.
• Evidence . Cite relevant information from your chosen sources.
• Discussion . Explain how the cited data supports your claim.

Here’s a literature review body paragraph example:

Scholars have examined the link between the aggressor and the victim. Beran et al. (2007) state that students bullied online often become cyberbullies themselves. Faucher et al. (2014) confirm this with their findings: they discovered that male and female students began engaging in cyberbullying after being subject to bullying. Hence, one can conclude that being a victim of bullying increases one’s likelihood of becoming a cyberbully.

Review of Related Literature: Conclusion

A conclusion presents a general consensus on the topic. Depending on your literature review purpose, it might include the following:

• Introduction to further research . If you write a literature review as part of a larger research project, you can present your research question in your conclusion .
• Overview of theories . You can summarize critical theories and concepts to help your reader understand the topic better.
• Discussion of the gap . If you identified a research gap in the reviewed literature, your conclusion could explain why that gap is significant.

Check out a conclusion example that discusses a research gap:

There is extensive research into bullies’ motivation, the consequences of bullying for victims and aggressors, strategies for bullying, and coping with it. Yet, scholars still have not reached a consensus on what to consider the best practices to combat cyberbullying. This question is of great importance because of the significant adverse effects of cyberbullying on victims and bullies.

📋 Format of RRL — APA, MLA, & Others

In this section, we will discuss how to format an RRL according to the most common citation styles: APA, Chicago, MLA, and Harvard.

Writing a literature review using the APA7 style requires the following text formatting:

• When using APA in-text citations , include the author’s last name and the year of publication in parentheses.
• For direct quotations , you must also add the page number. If you use sources without page numbers, such as websites or e-books, include a paragraph number instead.
• When referring to the author’s name in a sentence , you do not need to repeat it at the end of the sentence. Instead, include the year of publication inside the parentheses after their name.
• The reference list should be included at the end of your literature review. It is always alphabetized by the last name of the author (from A to Z), and the lines are indented one-half inch from the left margin of your paper. Do not forget to invert authors’ names (the last name should come first) and include the full titles of journals instead of their abbreviations. If you use an online source, add its URL.

The RRL format in the Chicago style is as follows:

• Author-date . You place your citations in brackets within the text, indicating the name of the author and the year of publication.
• Notes and bibliography . You place your citations in numbered footnotes or endnotes to connect the citation back to the source in the bibliography.
• The reference list, or bibliography , in Chicago style, is at the end of a literature review. The sources are arranged alphabetically and single-spaced. Each bibliography entry begins with the author’s name and the source’s title, followed by publication information, such as the city of publication, the publisher, and the year of publication.

Writing a literature review using the MLA style requires the following text formatting:

• In the MLA format, you can cite a source in the text by indicating the author’s last name and the page number in parentheses at the end of the citation. If the cited information takes several pages, you need to include all the page numbers.
• The reference list in MLA style is titled “ Works Cited .” In this section, all sources used in the paper should be listed in alphabetical order. Each entry should contain the author, title of the source, title of the journal or a larger volume, other contributors, version, number, publisher, and publication date.

The Harvard style requires you to use the following text formatting for your RRL:

• In-text citations in the Harvard style include the author’s last name and the year of publication. If you are using a direct quote in your literature review, you need to add the page number as well.
• Arrange your list of references alphabetically. Each entry should contain the author’s last name, their initials, the year of publication, the title of the source, and other publication information, like the journal title and issue number or the publisher.

✍️ How to Write Review of Related Literature – Sample

Literature reviews can be organized in many ways depending on what you want to achieve with them. In this section, we will look at 3 examples of how you can write your RRL.

Thematic Literature Review

A thematic literature review is arranged around central themes or issues discussed in the sources. If you have identified some recurring themes in the literature, you can divide your RRL into sections that address various aspects of the topic. For example, if you examine studies on e-learning, you can distinguish such themes as the cost-effectiveness of online learning, the technologies used, and its effectiveness compared to traditional education.

Chronological Literature Review

A chronological literature review is a way to track the development of the topic over time. If you use this method, avoid merely listing and summarizing sources in chronological order. Instead, try to analyze the trends, turning moments, and critical debates that have shaped the field’s path. Also, you can give your interpretation of how and why specific advances occurred.

Methodological Literature Review

A methodological literature review differs from the preceding ones in that it usually doesn’t focus on the sources’ content. Instead, it is concerned with the research methods . So, if your references come from several disciplines or fields employing various research techniques, you can compare the findings and conclusions of different methodologies, for instance:

• empirical vs. theoretical studies;
• qualitative vs. quantitative research.

📚 Examples of Review of Related Literature and Studies

We have prepared a short example of RRL on climate change for you to see how everything works in practice!

Climate change is one of the most important issues nowadays. Based on a variety of facts, it is now clearer than ever that humans are altering the Earth's climate. The atmosphere and oceans have warmed, causing sea level rise, a significant loss of Arctic ice, and other climate-related changes. This literature review provides a thorough summary of research on climate change, focusing on climate change fingerprints and evidence of human influence on the Earth's climate system.

Physical Mechanisms and Evidence of Human Influence

Scientists are convinced that climate change is directly influenced by the emission of greenhouse gases. They have carefully analyzed various climate data and evidence, concluding that the majority of the observed global warming over the past 50 years cannot be explained by natural factors alone. Instead, there is compelling evidence pointing to a significant contribution of human activities, primarily the emission of greenhouse gases (Walker, 2014). For example, based on simple physics calculations, doubled carbon dioxide concentration in the atmosphere can lead to a global temperature increase of approximately 1 degree Celsius. (Elderfield, 2022). In order to determine the human influence on climate, scientists still have to analyze a lot of natural changes that affect temperature, precipitation, and other components of climate on timeframes ranging from days to decades and beyond.

Fingerprinting Climate Change

Fingerprinting climate change is a useful tool to identify the causes of global warming because different factors leave unique marks on climate records. This is evident when scientists look beyond overall temperature changes and examine how warming is distributed geographically and over time (Watson, 2022). By investigating these climate patterns, scientists can obtain a more complex understanding of the connections between natural climate variability and climate variability caused by human activity.

Modeling Climate Change and Feedback

To accurately predict the consequences of feedback mechanisms, the rate of warming, and regional climate change, scientists can employ sophisticated mathematical models of the atmosphere, ocean, land, and ice (the cryosphere). These models are grounded in well-established physical laws and incorporate the latest scientific understanding of climate-related processes (Shuckburgh, 2013). Although different climate models produce slightly varying projections for future warming, they all will agree that feedback mechanisms play a significant role in amplifying the initial warming caused by greenhouse gas emissions. (Meehl, 2019).

In conclusion, the literature on global warming indicates that there are well-understood physical processes that link variations in greenhouse gas concentrations to climate change. In addition, it covers the scientific proof that the rates of these gases in the atmosphere have increased and continue to rise fast. According to the sources, the majority of this recent change is almost definitely caused by greenhouse gas emissions produced by human activities. Citizens and governments can alter their energy production methods and consumption patterns to reduce greenhouse gas emissions and, thus, the magnitude of climate change. By acting now, society can prevent the worst consequences of climate change and build a more resilient and sustainable future for generations to come.

Have you ever struggled with finding the topic for an RRL in different subjects? Read the following paragraphs to get some ideas!

Nursing Literature Review Example

Many topics in the nursing field require research. For example, you can write a review of literature related to dengue fever . Give a general overview of dengue virus infections, including its clinical symptoms, diagnosis, prevention, and therapy.

Another good idea is to review related literature and studies about teenage pregnancy . This review can describe the effectiveness of specific programs for adolescent mothers and their children and summarize recommendations for preventing early pregnancy.

📝 Check out some more valuable examples below:

• Hospital Readmissions: Literature Review .
• Literature Review: Lower Sepsis Mortality Rates .
• Breast Cancer: Literature Review .
• Sexually Transmitted Diseases: Literature Review .
• PICO for Pressure Ulcers: Literature Review .
• COVID-19 Spread Prevention: Literature Review .
• Chronic Obstructive Pulmonary Disease: Literature Review .
• Hypertension Treatment Adherence: Literature Review .
• Neonatal Sepsis Prevention: Literature Review .
• Healthcare-Associated Infections: Literature Review .
• Understaffing in Nursing: Literature Review .

Psychology Literature Review Example

If you look for an RRL topic in psychology , you can write a review of related literature about stress . Summarize scientific evidence about stress stages, side effects, types, or reduction strategies. Or you can write a review of related literature about computer game addiction . In this case, you may concentrate on the neural mechanisms underlying the internet gaming disorder, compare it to other addictions, or evaluate treatment strategies.

A review of related literature about cyberbullying is another interesting option. You can highlight the impact of cyberbullying on undergraduate students’ academic, social, and emotional development.

📝 Look at the examples that we have prepared for you to come up with some more ideas:

• Mindfulness in Counseling: A Literature Review .
• Team-Building Across Cultures: Literature Review .
• Anxiety and Decision Making: Literature Review .
• Literature Review on Depression .
• Literature Review on Narcissism .
• Effects of Depression Among Adolescents .
• Causes and Effects of Anxiety in Children .

Literature Review — Sociology Example

Sociological research poses critical questions about social structures and phenomena. For example, you can write a review of related literature about child labor , exploring cultural beliefs and social norms that normalize the exploitation of children. Or you can create a review of related literature about social media . It can investigate the impact of social media on relationships between adolescents or the role of social networks on immigrants’ acculturation .

📝 You can find some more ideas below!

• Single Mothers’ Experiences of Relationships with Their Adolescent Sons .
• Teachers and Students’ Gender-Based Interactions .
• Gender Identity: Biological Perspective and Social Cognitive Theory .
• Gender: Culturally-Prescribed Role or Biological Sex .
• The Influence of Opioid Misuse on Academic Achievement of Veteran Students .
• The Importance of Ethics in Research .
• The Role of Family and Social Network Support in Mental Health .

Education Literature Review Example

For your education studies , you can write a review of related literature about academic performance to determine factors that affect student achievement and highlight research gaps. One more idea is to create a review of related literature on study habits , considering their role in the student’s life and academic outcomes.

You can also evaluate a computerized grading system in a review of related literature to single out its advantages and barriers to implementation. Or you can complete a review of related literature on instructional materials to identify their most common types and effects on student achievement.

📝 Find some inspiration in the examples below:

• Literature Review on Online Learning Challenges From COVID-19 .
• Education, Leadership, and Management: Literature Review .
• Literature Review: Standardized Testing Bias .
• Bullying of Disabled Children in School .
• Interventions and Letter & Sound Recognition: A Literature Review .
• Social-Emotional Skills Program for Preschoolers .
• Effectiveness of Educational Leadership Management Skills .

Business Research Literature Review

If you’re a business student, you can focus on customer satisfaction in your review of related literature. Discuss specific customer satisfaction features and how it is affected by service quality and prices. You can also create a theoretical literature review about consumer buying behavior to evaluate theories that have significantly contributed to understanding how consumers make purchasing decisions.

📝 Look at the examples to get more exciting ideas:

• Leadership and Communication: Literature Review .
• Human Resource Development: Literature Review .
• Project Management. Literature Review .
• Strategic HRM: A Literature Review .
• Customer Relationship Management: Literature Review .
• Literature Review on International Financial Reporting Standards .
• Cultures of Management: Literature Review .

To conclude, a review of related literature is a significant genre of scholarly works that can be applied in various disciplines and for multiple goals. The sources examined in an RRL provide theoretical frameworks for future studies and help create original research questions and hypotheses.

When you finish your outstanding literature review, don’t forget to check whether it sounds logical and coherent. Our text-to-speech tool can help you with that!

• Literature Reviews | University of North Carolina at Chapel Hill
• Writing a Literature Review | Purdue Online Writing Lab
• Learn How to Write a Review of Literature | University of Wisconsin-Madison
• The Literature Review: A Few Tips on Conducting It | University of Toronto
• Writing a Literature Review | UC San Diego
• Conduct a Literature Review | The University of Arizona
• Methods for Literature Reviews | National Library of Medicine
• Literature Reviews: 5. Write the Review | Georgia State University

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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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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

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

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

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

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

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

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

A literature review is important because it:

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

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

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

Not an essay 

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

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

A literature review serves several purposes. For example, it

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

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

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

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

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

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

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

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

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

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

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

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

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

Systematic review or meta-analysis?

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

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

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

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

Not all systematic reviews contain meta-analysis. 

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

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

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

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

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• Last Updated: Aug 21, 2023 4:07 PM
• URL: https://guides.lib.udel.edu/researchmethods

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 Udemy 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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Ten Simple Rules for Writing a Literature Review

Marco pautasso.

1 Centre for Functional and Evolutionary Ecology (CEFE), CNRS, Montpellier, France

2 Centre for Biodiversity Synthesis and Analysis (CESAB), FRB, Aix-en-Provence, France

Literature reviews are in great demand in most scientific fields. Their need stems from the ever-increasing output of scientific publications [1] . For example, compared to 1991, in 2008 three, eight, and forty times more papers were indexed in Web of Science on malaria, obesity, and biodiversity, respectively [2] . Given such mountains of papers, scientists cannot be expected to examine in detail every single new paper relevant to their interests [3] . Thus, it is both advantageous and necessary to rely on regular summaries of the recent literature. Although recognition for scientists mainly comes from primary research, timely literature reviews can lead to new synthetic insights and are often widely read [4] . For such summaries to be useful, however, they need to be compiled in a professional way [5] .

When starting from scratch, reviewing the literature can require a titanic amount of work. That is why researchers who have spent their career working on a certain research issue are in a perfect position to review that literature. Some graduate schools are now offering courses in reviewing the literature, given that most research students start their project by producing an overview of what has already been done on their research issue [6] . However, it is likely that most scientists have not thought in detail about how to approach and carry out a literature review.

Reviewing the literature requires the ability to juggle multiple tasks, from finding and evaluating relevant material to synthesising information from various sources, from critical thinking to paraphrasing, evaluating, and citation skills [7] . In this contribution, I share ten simple rules I learned working on about 25 literature reviews as a PhD and postdoctoral student. Ideas and insights also come from discussions with coauthors and colleagues, as well as feedback from reviewers and editors.

Rule 1: Define a Topic and Audience

How to choose which topic to review? There are so many issues in contemporary science that you could spend a lifetime of attending conferences and reading the literature just pondering what to review. On the one hand, if you take several years to choose, several other people may have had the same idea in the meantime. On the other hand, only a well-considered topic is likely to lead to a brilliant literature review [8] . The topic must at least be:

• interesting to you (ideally, you should have come across a series of recent papers related to your line of work that call for a critical summary),
• an important aspect of the field (so that many readers will be interested in the review and there will be enough material to write it), and
• a well-defined issue (otherwise you could potentially include thousands of publications, which would make the review unhelpful).

Ideas for potential reviews may come from papers providing lists of key research questions to be answered [9] , but also from serendipitous moments during desultory reading and discussions. In addition to choosing your topic, you should also select a target audience. In many cases, the topic (e.g., web services in computational biology) will automatically define an audience (e.g., computational biologists), but that same topic may also be of interest to neighbouring fields (e.g., computer science, biology, etc.).

Rule 2: Search and Re-search the Literature

After having chosen your topic and audience, start by checking the literature and downloading relevant papers. Five pieces of advice here:

• keep track of the search items you use (so that your search can be replicated [10] ),
• keep a list of papers whose pdfs you cannot access immediately (so as to retrieve them later with alternative strategies),
• use a paper management system (e.g., Mendeley, Papers, Qiqqa, Sente),
• define early in the process some criteria for exclusion of irrelevant papers (these criteria can then be described in the review to help define its scope), and
• do not just look for research papers in the area you wish to review, but also seek previous reviews.

The chances are high that someone will already have published a literature review ( Figure 1 ), if not exactly on the issue you are planning to tackle, at least on a related topic. If there are already a few or several reviews of the literature on your issue, my advice is not to give up, but to carry on with your own literature review,

The bottom-right situation (many literature reviews but few research papers) is not just a theoretical situation; it applies, for example, to the study of the impacts of climate change on plant diseases, where there appear to be more literature reviews than research studies [33] .

• discussing in your review the approaches, limitations, and conclusions of past reviews,
• trying to find a new angle that has not been covered adequately in the previous reviews, and
• incorporating new material that has inevitably accumulated since their appearance.

When searching the literature for pertinent papers and reviews, the usual rules apply:

• be thorough,
• use different keywords and database sources (e.g., DBLP, Google Scholar, ISI Proceedings, JSTOR Search, Medline, Scopus, Web of Science), and
• look at who has cited past relevant papers and book chapters.

Rule 3: Take Notes While Reading

If you read the papers first, and only afterwards start writing the review, you will need a very good memory to remember who wrote what, and what your impressions and associations were while reading each single paper. My advice is, while reading, to start writing down interesting pieces of information, insights about how to organize the review, and thoughts on what to write. This way, by the time you have read the literature you selected, you will already have a rough draft of the review.

Of course, this draft will still need much rewriting, restructuring, and rethinking to obtain a text with a coherent argument [11] , but you will have avoided the danger posed by staring at a blank document. Be careful when taking notes to use quotation marks if you are provisionally copying verbatim from the literature. It is advisable then to reformulate such quotes with your own words in the final draft. It is important to be careful in noting the references already at this stage, so as to avoid misattributions. Using referencing software from the very beginning of your endeavour will save you time.

Rule 4: Choose the Type of Review You Wish to Write

After having taken notes while reading the literature, you will have a rough idea of the amount of material available for the review. This is probably a good time to decide whether to go for a mini- or a full review. Some journals are now favouring the publication of rather short reviews focusing on the last few years, with a limit on the number of words and citations. A mini-review is not necessarily a minor review: it may well attract more attention from busy readers, although it will inevitably simplify some issues and leave out some relevant material due to space limitations. A full review will have the advantage of more freedom to cover in detail the complexities of a particular scientific development, but may then be left in the pile of the very important papers “to be read” by readers with little time to spare for major monographs.

There is probably a continuum between mini- and full reviews. The same point applies to the dichotomy of descriptive vs. integrative reviews. While descriptive reviews focus on the methodology, findings, and interpretation of each reviewed study, integrative reviews attempt to find common ideas and concepts from the reviewed material [12] . A similar distinction exists between narrative and systematic reviews: while narrative reviews are qualitative, systematic reviews attempt to test a hypothesis based on the published evidence, which is gathered using a predefined protocol to reduce bias [13] , [14] . When systematic reviews analyse quantitative results in a quantitative way, they become meta-analyses. The choice between different review types will have to be made on a case-by-case basis, depending not just on the nature of the material found and the preferences of the target journal(s), but also on the time available to write the review and the number of coauthors [15] .

Rule 5: Keep the Review Focused, but Make It of Broad Interest

Whether your plan is to write a mini- or a full review, it is good advice to keep it focused 16 , 17 . Including material just for the sake of it can easily lead to reviews that are trying to do too many things at once. The need to keep a review focused can be problematic for interdisciplinary reviews, where the aim is to bridge the gap between fields [18] . If you are writing a review on, for example, how epidemiological approaches are used in modelling the spread of ideas, you may be inclined to include material from both parent fields, epidemiology and the study of cultural diffusion. This may be necessary to some extent, but in this case a focused review would only deal in detail with those studies at the interface between epidemiology and the spread of ideas.

While focus is an important feature of a successful review, this requirement has to be balanced with the need to make the review relevant to a broad audience. This square may be circled by discussing the wider implications of the reviewed topic for other disciplines.

Rule 6: Be Critical and Consistent

Reviewing the literature is not stamp collecting. A good review does not just summarize the literature, but discusses it critically, identifies methodological problems, and points out research gaps [19] . After having read a review of the literature, a reader should have a rough idea of:

• the major achievements in the reviewed field,
• the main areas of debate, and
• the outstanding research questions.

It is challenging to achieve a successful review on all these fronts. A solution can be to involve a set of complementary coauthors: some people are excellent at mapping what has been achieved, some others are very good at identifying dark clouds on the horizon, and some have instead a knack at predicting where solutions are going to come from. If your journal club has exactly this sort of team, then you should definitely write a review of the literature! In addition to critical thinking, a literature review needs consistency, for example in the choice of passive vs. active voice and present vs. past tense.

Rule 7: Find a Logical Structure

Like a well-baked cake, a good review has a number of telling features: it is worth the reader's time, timely, systematic, well written, focused, and critical. It also needs a good structure. With reviews, the usual subdivision of research papers into introduction, methods, results, and discussion does not work or is rarely used. However, a general introduction of the context and, toward the end, a recapitulation of the main points covered and take-home messages make sense also in the case of reviews. For systematic reviews, there is a trend towards including information about how the literature was searched (database, keywords, time limits) [20] .

How can you organize the flow of the main body of the review so that the reader will be drawn into and guided through it? It is generally helpful to draw a conceptual scheme of the review, e.g., with mind-mapping techniques. Such diagrams can help recognize a logical way to order and link the various sections of a review [21] . This is the case not just at the writing stage, but also for readers if the diagram is included in the review as a figure. A careful selection of diagrams and figures relevant to the reviewed topic can be very helpful to structure the text too [22] .

Rule 8: Make Use of Feedback

Reviews of the literature are normally peer-reviewed in the same way as research papers, and rightly so [23] . As a rule, incorporating feedback from reviewers greatly helps improve a review draft. Having read the review with a fresh mind, reviewers may spot inaccuracies, inconsistencies, and ambiguities that had not been noticed by the writers due to rereading the typescript too many times. It is however advisable to reread the draft one more time before submission, as a last-minute correction of typos, leaps, and muddled sentences may enable the reviewers to focus on providing advice on the content rather than the form.

Feedback is vital to writing a good review, and should be sought from a variety of colleagues, so as to obtain a diversity of views on the draft. This may lead in some cases to conflicting views on the merits of the paper, and on how to improve it, but such a situation is better than the absence of feedback. A diversity of feedback perspectives on a literature review can help identify where the consensus view stands in the landscape of the current scientific understanding of an issue [24] .

Rule 9: Include Your Own Relevant Research, but Be Objective

In many cases, reviewers of the literature will have published studies relevant to the review they are writing. This could create a conflict of interest: how can reviewers report objectively on their own work [25] ? Some scientists may be overly enthusiastic about what they have published, and thus risk giving too much importance to their own findings in the review. However, bias could also occur in the other direction: some scientists may be unduly dismissive of their own achievements, so that they will tend to downplay their contribution (if any) to a field when reviewing it.

In general, a review of the literature should neither be a public relations brochure nor an exercise in competitive self-denial. If a reviewer is up to the job of producing a well-organized and methodical review, which flows well and provides a service to the readership, then it should be possible to be objective in reviewing one's own relevant findings. In reviews written by multiple authors, this may be achieved by assigning the review of the results of a coauthor to different coauthors.

Rule 10: Be Up-to-Date, but Do Not Forget Older Studies

Given the progressive acceleration in the publication of scientific papers, today's reviews of the literature need awareness not just of the overall direction and achievements of a field of inquiry, but also of the latest studies, so as not to become out-of-date before they have been published. Ideally, a literature review should not identify as a major research gap an issue that has just been addressed in a series of papers in press (the same applies, of course, to older, overlooked studies (“sleeping beauties” [26] )). This implies that literature reviewers would do well to keep an eye on electronic lists of papers in press, given that it can take months before these appear in scientific databases. Some reviews declare that they have scanned the literature up to a certain point in time, but given that peer review can be a rather lengthy process, a full search for newly appeared literature at the revision stage may be worthwhile. Assessing the contribution of papers that have just appeared is particularly challenging, because there is little perspective with which to gauge their significance and impact on further research and society.

Inevitably, new papers on the reviewed topic (including independently written literature reviews) will appear from all quarters after the review has been published, so that there may soon be the need for an updated review. But this is the nature of science [27] – [32] . I wish everybody good luck with writing a review of the literature.

Acknowledgments

Many thanks to M. Barbosa, K. Dehnen-Schmutz, T. Döring, D. Fontaneto, M. Garbelotto, O. Holdenrieder, M. Jeger, D. Lonsdale, A. MacLeod, P. Mills, M. Moslonka-Lefebvre, G. Stancanelli, P. Weisberg, and X. Xu for insights and discussions, and to P. Bourne, T. Matoni, and D. Smith for helpful comments on a previous draft.

Funding Statement

This work was funded by the French Foundation for Research on Biodiversity (FRB) through its Centre for Synthesis and Analysis of Biodiversity data (CESAB), as part of the NETSEED research project. The funders had no role in the preparation of the manuscript.

Reference management. Clean and simple.

What is a literature review? [with examples]

What is a literature review?

The purpose of a literature review, how to write a literature review, the format of a literature review, general formatting rules, the length of a literature review, literature review examples, frequently asked questions about literature reviews, related articles.

A literature review is an assessment of the sources in a chosen topic of research.

In a literature review, you’re expected to report on the existing scholarly conversation, without adding new contributions.

If you are currently writing one, you've come to the right place. In the following paragraphs, we will explain:

• the objective of a literature review
• how to write a literature review
• the basic format of a literature review

Tip: It’s not always mandatory to add a literature review in a paper. Theses and dissertations often include them, whereas research papers may not. Make sure to consult with your instructor for exact requirements.

The four main objectives of a literature review are:

• Studying the references of your research area
• Summarizing the main arguments
• Identifying current gaps, stances, and issues
• Presenting all of the above in a text

Ultimately, the main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

The format of a literature review is fairly standard. It includes an:

• introduction that briefly introduces the main topic
• body that includes the main discussion of the key arguments
• conclusion that highlights the gaps and issues of the literature

➡️ Take a look at our guide on how to write a literature review to learn more about how to structure a literature review.

First of all, a literature review should have its own labeled section. You should indicate clearly in the table of contents where the literature can be found, and you should label this section as “Literature Review.”

➡️ For more information on writing a thesis, visit our guide on how to structure a thesis .

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, it will be long. If your paper does not depend entirely on references, it will be short.

Take a look at these three theses featuring great literature reviews:

• School-Based Speech-Language Pathologist's Perceptions of Sensory Food Aversions in Children [ PDF , see page 20]
• Who's Writing What We Read: Authorship in Criminological Research [ PDF , see page 4]
• A Phenomenological Study of the Lived Experience of Online Instructors of Theological Reflection at Christian Institutions Accredited by the Association of Theological Schools [ PDF , see page 56]

Literature reviews are most commonly found in theses and dissertations. However, you find them in research papers as well.

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, then it will be long. If your paper does not depend entirely on references, then it will be short.

No. A literature review should have its own independent section. You should indicate clearly in the table of contents where the literature review can be found, and label this section as “Literature Review.”

The main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

• University of Oregon Libraries
• Research Guides

How to Write a Literature Review

What's a literature review.

• Literature Reviews: A Recap
• Reading Journal Articles
• Does it Describe a Literature Review?
• 1. Identify the Question
• 2. Review Discipline Styles
• Searching Article Databases
• Finding Full-Text of an Article
• Citation Chaining
• When to Stop Searching
• 4. Manage Your References
• 5. Critically Analyze and Evaluate
• 6. Synthesize
• 7. Write a Literature Review

What's a Literature Review? 

A literature review (or "lit review," for short) is an in-depth critical analysis of published scholarly research related to a specific topic. Published scholarly research (aka, "the literature") may include journal articles, books, book chapters, dissertations and thesis, or conference proceedings. 

A solid lit review must:

• be organized around and related directly to the thesis or research question you're developing
• synthesize results into a summary of what is and is not known
• identify areas of controversy in the literature
• formulate questions that need further research

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Literature Reviews - An Introduction: Definition

• How do I recognize a Literature Review?
• How do I find a Literature Review?
• How do I write a Literature Review?

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Literature review: definition and example.

A Literature Review is "a systematic, explicit, and reproducible method for identifying, evaluating, and synthesizing the existing body of completed and recorded work produced by researchers, scholars, and practitioners."

 - From Conducting Research Literature Reviews: From Internet to Paper , by Arlene Fink, 2nd ed. Sage Publications: Thousand Oaks, 2005.

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Literature Review: A Definition

What is a literature review, then.

A literature review discusses and analyses published information in a particular subject area.   Sometimes the information covers a certain time period.

A literature review is more than a summary of the sources, it has an organizational pattern that combines both summary and synthesis. 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. It might give a new interpretation of old material or combine new with old interpretations. Or it might trace the intellectual progression of the field, including major debates. And depending on the situation, the literature review may evaluate the sources and advise the reader on the most pertinent or relevant.

But how is a literature review different from an academic research paper?

While the main focus of an academic research paper is to support your own argument, the focus of a literature review is to summarize and synthesize the arguments and ideas of others. The academic research paper also covers a range of sources, but it is usually a select number of sources, because the emphasis is on the argument. Likewise, a literature review can also have an "argument," but it is not as important as covering a number of sources. In short, an academic research paper and a literature review contain some of the same elements. In fact, many academic research papers will contain a literature review section. What aspect of the study (either the argument or the sources) that is emphasized determines what type of document it is.

( "Literature Reviews" from The Writing Center, University of North Carolina at Chapel Hill )

Why do we write literature reviews?

Literature reviews provide you with a handy guide to a particular topic. If you have limited time to conduct research, literature reviews can give you an overview or act as a stepping stone.

For professionals, they are useful reports that keep them up to date with what is current in the field.

For scholars, the depth and breadth of the literature review emphasizes the credibility of the writer in his or her field. Literature reviews also provide a solid background for a research paper's investigation.

Comprehensive knowledge of the literature of the field is essential to most research papers.

Journal Articles on Writing Literature Reviews

• Research Methods for Comprehensive Science Literature Reviews Author: Brown,Barry N. Journal: Issues in Science & Technology Librarianship Date: Spring2009 Issue: 57 Page: 1 more... less... Finding some information on most topics is easy. There are abundant sources of information readily available. However, completing a comprehensive literature review on a particular topic is often difficult, laborious, and time intensive; the project requires organization, persistence, and an understanding of the scholarly communication and publishing process. This paper briefly outlines methods of conducting a comprehensive literature review for science topics. [ABSTRACT FROM AUTHOR];
• Research: Considerations in Writing a Literature Review Authors: Black,K. Journal: The New Social Worker Date: 01/01; 2007 Volume: 14 Issue: 2 Page: 12 more... less... Literature reviews are ubiquitous in academic journals, scholarly reports, and social work education. Conducting and writing a good literature review is both personally and professionally satisfying. (Journal abstract).
• How to do (or not to do) A Critical Literature Review Authors: Jesson,Jill; Lacey,Fiona Journal: Pharmacy Education Pub Date: 2006 Volume: 6 Issue: 2 Pages:139 - 148 more... less... More and more students are required to perform a critical literature review as part of their undergraduate or postgraduate studies. Whilst most of the latest research methods textbooks advise how to do a literature search, very few cover the literature review. This paper covers two types of review: a critical literature review and a systematic review. [ABSTRACT FROM AUTHOR]
• Conducting a Literature Review Authors: Rowley,Jennifer; Slack,Frances Journal: Management Research News Pub Date: 2004 Volume: 27 Issue: 6 Pages:31-39 more... less... Abstract: This article offers support and guidance for students undertaking a literature review as part of their dissertation during an undergraduate or Masters course. A literature review is a summary of a subject field that supports the identification of specific research questions. A literature review needs to draw on and evaluate a range of different types of sources including academic and professional journal articles, books, and web-based resources. The literature search helps in the identification and location of relevant documents and other sources. Search engines can be used to search web resources and bibliographic databases. Conceptual frameworks can be a useful tool in developing an understanding of a subject area. Creating the literature review involves the stages of: scanning, making notes, structuring the literature review, writing the literature review, and building a bibliography.

Some Books from the WU Catalog

• The SAGE handbook of visual research methods [electronic resource] by Edited by Luc Pauwels and Dawn Mannay. ISBN: 9781526417015 Publication Date: SAGE Publications, Inc., 2020.

Helpful Websites

• "How to do a Literature Review" from Ferdinand D. Bluford Library
• "The Literature Review: A Few Tips on Conducting It." from the University of Toronto
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Systematic Literature Review: Inter-Reletedness of Innovation, Resilience and Sustainability - Major, Emerging Themes and Future Research Directions

• Review paper
• Published: 25 July 2022
• Volume 3 , pages 1157–1185, ( 2023 )

Cite this article

• N. Zupancic   ORCID: orcid.org/0000-0002-5582-8687 1  

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Research has been using resilience, sustainability and innovation interchangeably, but there is a lack of research that would provide an insight into how they are related to each other. This systematic literature review thus investigates research on sustainability, innovation and resilience, how they are related to each other, and also identifies major, emerging themes and future research directions on these topics.

We used Bibliometrix software to visually describe articles with the highest number of citations, to present the thematic evolution of the field and present a historical map. The triangulation and thematic groups were identified and compared by two independent researchers. 

Resilience is involved in processes, sustainability is concerned with the outcomes, while innovation represents a pathway to achieving both resilience and sustainability. Resilience can ensure the provision of the system functions in the face of shocks and stresses and sustainability can ensure the adequate performance of the system in general. Three major themes were identified, ‘socio-ecological systems’, ‘transformational innovation’ and ‘political governance’, as well as three emerging themes, ‘food security and agriculture’, ‘businesses and finance’ and ‘interconnected systems’. There is a need for longitudinal, multi-scale and interdisciplinary research that would explore various aspects of integrating these concepts. 

There is a great overlap between the concepts of resilience, sustainability and innovation. Future research could study these concepts in relation to each other. 

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Introduction

Countries and societies face issues as a result of climate change, such as excessive or insufficient precipitation, rising sea levels, extreme temperature changes, storms, droughts, floods and other climate hazards that are only going to increase in the future [ 72 , 100 ], thus making it ever more important to prepare for [ 40 ]. Resilience enables adaptivity to an unknown future [ 75 ], and sustainability, as defined by the United Nations Brundtland Commission [ 92 ], is concerned about meeting the needs of the present without compromising the ability of the future generations to meet their own needs. Resilience is important in overcoming the inevitable problems that arise when faced with unpredicted shocks and stressors [ 75 ]. The two concepts can be regarded as vital if humanity is to successfully face the major changes that may occur in the near future [ 70 ]. However, the distinguishment among both is still debated and differently approached by the authors [ 70 , 76 ]. On the other hand, the underlying concept that could help societies to achieve both resilience and sustainability can be found in innovation. Leach et al. [ 40 ] define innovation as new ways of doing things, both in science and technology, but also associated with institutions and social practices.

Innovative approaches are needed to deal with large-scale changes [ 22 , 97 ], steer away from potential Earth system thresholds [ 77 ] and to build the resilience of social-ecological systems, so they are better able to deal with changes as opportunities [ 97 , 98 ]. Innovation has so far often occurred without reference to the issue of ecological integrity, even though it is essential to consider this before implementation as many innovations can have considerable ecological and societal risks (Olsson et al. [ 70 ]). However, we must also consider technological advances that have the potential to combat climate change. What was once considered as science fiction is now slowly moving into the centre of international climate change discussions, research and politics [ 21 ]. Such innovations can be closely linked with the concepts of sustainability and resilience. In fact, the overlap between resilience and sustainability is considerable, as can also be seen by Lebel et al. [ 41 ], suggesting that the critical factors for sustainability are resilience, the capacity to cope and adapt, and the conservation of sources of innovation and renewal. Therefore, one could argue that we are talking about very similar concepts, which are inter-related. In this study, we systematically review the academic literature and examine the empirical examples of how sustainability, resilience and innovation have been applied simultaneously to understand the interrelations among the concepts and their application in diverse settings. While much research has been performed to study sustainability, resilience and innovation, there is a significant lack of research that would assess the relations among them in a systematic way. Our study thus aims to overcome this gap and to identify how the concepts are interlinked and to provide a framework to study these concepts in practice.

RQ1: How are the concepts of sustainability, resilience and innovation related?

Many authors suggest that an interdisciplinary approach is needed to study sustainability, resilience and innovation [ 13 , 14 ], with a multitude of stakeholders involved in the process [ 12 ]. For future research studies that aim to integrate these three concepts, it is therefore necessary to understand how they have been studied empirically and where gaps in the literature may occur. The implementation of sustainability, resilience and innovation requires a multi-scale and multi-stakeholder approach [ 40 ]. We are therefore interested to understand what research methods were used and at what scales were they studied at. In this context, Lebel et al. ([ 41 ], pp.1) furthermore argue that we should ask not only The resilience of what, to what? but also For whom? Continued involvement from a variety of stakeholders is integral to effective decision-making and institutionalisation of programmes in the long run [ 6 ]. In further research or in applying these concepts in practice, researchers may also need to better understand the variety of stakeholders involved in the process, the research methods used to study such concepts empirically and at what scales are they are referred to.

RQ2: What research methods are used by the researchers to study resilience, innovation and sustainability?

RQ3: What scales authors referred to in the study of innovation, resilience and sustainability?

RQ4: Who are the stakeholders involved in the study of resilience, sustainability and innovation?

Our paper provides a review of the most influential publications, as well as newly published articles, to identify the major trends within this research and what the most promising directions are for new research studies. We use a systematic literature review, which has a high level of evidence, as represented by the evidence-based pyramid [ 85 ]. A bibliographic mapping was used for a visual interpretation of the connections between groups. Most articles reviewed were published in journals such as Ecosystems , Ecology , International Journal of Agricultural Sustainability , Journal of Environmental Planning and Management , Local Environment , Ecology and Systems , AMBIO , PNAS , Climate Risk Management and Global Environmental . Two independent researchers triangulated the themes to identify major and emerging themes among the highly cited and newly published articles. The related research has adequately addressed all three concepts, and our review of the literature found 269 articles that refer to resilience, sustainability and innovation simultaneously. However, no research was found that would address all three concepts in a systematic way. Our review of the literature identifies major and emerging themes of research, which can provide guidelines for future research directions in the field of sustainability, resilience and innovation.

RQ5: What are the major and emerging themes within the field of sustainability, resilience and innovation?

RQ6: What are the future research directions on innovation, resilience and sustainability?

Our systematic review of literature maps out the data from Thomson Reuters’ Web of Science, where we searched for all the articles referring to resilience, sustainability and innovation simultaneously. The rest of this article proceeds as follows: In ‘ Research Methodology ’, we discuss the methodology used in developing the article; ‘ Results ’ presents the results, using descriptive statistics to map out the authors with the highest number of citations and a historical mapping approach to identify and discuss the three major themes referring to ‘political governance’, ‘socio-ecological systems’ and ‘transformational innovation’. In the second part of ‘ Results ’, we identify the emerging themes of ‘food security and agriculture’, ‘business and finance’ and ‘interconnected systems’. In ‘ Discussion ’, we present a discussion of the findings of our research, give an overview of the inter-relatedness among the fields of sustainability, resilience and innovation and provide a framework to study these concepts in practice. We then provide a critical overview of the major and emerging themes. Based on our findings, we provide new research directions in ‘ Future Research Directions ’. ‘ Conclusion ’ then concludes the article and sets an agenda for further research on sustainability, resilience and innovation.

Research Methodology

Our study used a method of systematic literature review. Systematic literature reviews differ from traditional narrative reviews since they enable researchers to adopt replicable, scientific and transparent processes of analysing research. By using technology to carry out a systematic literature review, we were able to overcome some of the normal bias in literature searches [ 49 ]. The methodology includes a set of applied procedures and techniques, which provide an insight into information about the specific topic of research, which supports the overall scientific credibility of the study. To visually describe the articles included in the review, we have used the Bibiloshiny package [ 11 ] within the Bibliometrix command in R, which allowed us to import from the bibliographic database in the Web of Science. The bibliographic mapping approach is commonly used to systematically review a field of research and its influential publications. The result of this method is a bibliographic map that enables researchers to visually describe the structure of the literature in a chronological manner, providing information on the most cited works and the relationships among them [ 49 ]. We used this approach as it enabled us to develop an objective assessment of the topics of interest [ 45 , 48 ].

Data Collection and Data Cleaning

The study was pre-registered on the OSF platform [ 106 ]. Our article follows the steps in data collection, as outlined by Janssen et al. [ 29 ], Janssen [ 28 ], Linnenluecke et al. [ 48 ], and Linnenluecke et al. [ 46 ]. In the Thomson Reuters Web of Science platform, we searched for articles referring to ‘sustainability’, ‘resilience’ and ‘innovation’. Studies referring to all three concepts were included in our review. The initial search included 376 records. Following the example of previous researchers Linnenluecke et al. [ 49 ], Janssen et al. [ 29 ], Janssen [ 28 ] and Linnenluecke et al. [ 46 ], the records were manually cleaned by two reviewers that checked the title, abstract and keywords for each record. For each article, we retrieved the following information: name(s) of the author(s), title of the article, name of the journal, citation details (volume, issue and page numbers), as well as abstract and keywords. After the initial review, articles referring to urban planning, peace engineering, cultural heritage and historical development were excluded from further review. The final literature review included 269 articles. We have included studies in the review that have the largest number of citations for major themes, which were listed on the historical map. Finally, we review all the studies that were published up to one year before the review took place.

Data Analysis and Synthesis

We visually represented the descriptive analysis of the most influential articles by using a thematic evolution technique and a historical bibliographic mapping approach. Two researchers independently assessed and identified major themes based on the bibliographic map and then triangulated the research topics by reading the abstracts or articles in detail, if necessary. The researchers independently triangulated research studies into groups and then compared the results. Based on discussions, they agreed on the major themes of research. A similar procedure was followed to identify emerging themes, just without the visual representation. The researchers looked through those articles published up to one year before the data was collected to identify emerging themes. They then independently classified them into groups based on the similarities of research topics. Both times, two independent researchers classified the research into groups independently and then, after discussions, decided on the major and emerging themes. When the groups were identified, the analysis of the research groups followed. Based on the major and emerging themes, new directions for future work were identified for each of these.

Descriptive Statistics

The author with the most citations in the review was Olsson, followed by Folke, Galaz and Thompson. We followed the example of Linnenluecke [ 47 ] in using a cut-off score set at the point where the local citation score (LCS) was levelling off, which happened to be at 6 or more citations, which showed 36 authors among those with the most local citations (Fig.  1 ).

Number of citations per leading authors

Thematic Evolution

Looking at the thematic evolution, we can see how research evolved over time (Fig.  2 ). The general trend shows the fragmentation of research into sub-topics from 1999–2018 to 2019–2021. In 1999–2018, we see corporate social responsibility, management, dynamics, resilience and knowledge as the major themes of research. In 2019–2021, we see the main topics of have become systems, transition, sustainability, impact, adaptation, knowledge, policy, vulnerability and agriculture. Resilience was the largest field of research by far from 1999 to 2018 and then fragmented into various sub-topics referring to sustainability, impact, adaptation, knowledge, policy and vulnerability. What is interesting is that resilience is not a topic of such interest in the later years, from 2019 to 2021, while sustainability only starts to become the topic of interest from 2019 to 2021, when the highest number of articles were published on the sustainability domain. The theme referring to management has in recent years transitioned towards systems, sustainability and impact, while the theme referring to science has fragmented to more specific topics, such as sustainability, adaptation and knowledge. Knowledge is a much smaller topic of interest in 2019–2021 than in 1999–2018, and it has fragmented into agriculture, policy and knowledge.

Thematic evolution

Historical Mapping and Major Themes of Research

Historical mapping was used to identify the major thematic groups. Even though the historical mapping does not include every possible article included in this review, it has enabled us to arrive at a classification of major research streams, which were identified by manually looking through the articles and categorising them into their research groups. In Table 1 , top publications are listed with a local citation score (LCS), which is the number of citations by authors included in the study, and a global citation score (GCS), which is the number of citations that the publication has received in total. Most articles with the highest number of citations were published in 2014, although several were published in later years (Fig.  3 ). The predominant approaches among the highly cited articles were a literature review (nine out of 19 articles), six case studies and three example reviews, one used a qualitative method and one a global quantitative study. Three major thematic groups of articles were identified, encompassing social-ecological systems, transformational innovation and political governance.

Major themes of research among highly cited articles

Transformational Innovation

The first group of research works was concerned with how transformational innovation can be reached at the level of systems or society and how it can contribute towards achieving resilience and sustainability. Olsson et al. [ 70 , 71 ] and Westley et al. [ 98 ] highlighted the importance of linking innovation to ecological integrity, with the main issue being how innovation is used [ 98 ]. Innovation within research has represented a tool to ensure resilience and achieve sustainability [ 60 , 62 , 69 , 98 ]. Furthermore, innovation represents a tool for the transformation of socio-ecological systems [ 63 , 70 , 71 , 97 ]. Olsson et al. [ 70 ] argue that scholars should make a distinction between adaptation and transformation when referring to resilience. Transformation must necessarily be included when looking at resilience in relation to the concept of sustainability [ 63 ]. Two types of innovation are identified as those that have transformative capacities to achieve a large-scale transformation: social and technological innovation. In the domain of technological innovation, Olsson et al. [ 70 ] referred to information and communication technology, nano- and biotechnology, synthetic biology, new energy systems and geo-engineering techniques. Within social innovation, they referred to new modes of governance, business models, microcredits and crowd sourcing. Social innovation is a more frequent theme in contributing to resilience and sustainability [ 57 , 60 , 62 , 63 , 70 , 97 , 98 ] than technological innovation [ 70 , 98 ]. Two case studies were identified that studied how the processes of social innovation can have effects on ecosystem-based land-use planning, namely Oak Ridges Moraine [ 57 ] and Great Barrier Reef Marine Park [ 69 ].

Both top-down and bottom-up approaches can be considered as sources of innovation [ 98 ]. Moore et al. [ 60 , 62 ] studied social innovation through a global fellowship programme and showed that introducing the insights of individual fellows included in the programme into new complex system dynamics can contribute towards transformational innovation. However, Moore et al. [ 63 ] argued that while social movements create conditions towards transformability, they are not the transformation itself. Disruption only creates opportunities for change to occur within the system. Individuals can interpret the problem and mobilise others to self-organise around a new idea or practice that addresses the issue [ 63 ]. Transformational innovations often require altering the dominant power structures and embedding the newly reconfigured social-ecological elements and feedback within institutions. The new trajectory itself then gains power, which is why a multi-stakeholder approach is necessary to adequately address transformational innovation [ 60 , 62 ]. Research regarding innovation should encompass both the related power structures and various stakeholders when implementing resilience [ 70 ]. Frameworks to study the implementation of transformational innovation have been provided by many authors (Hölscher et al. 2019, [ 60 , 62 , 63 , 97 , 98 ]) while two groups of researchers used the adaptive cycle as a theory of how systems can implement innovation to ensure resilience [ 57 , 97 ].

Change demands innovation across multiple scales [ 98 ], as a transformation can occur on a single scale and lead to change on multiple scales [ 63 , 70 ]. Researchers who consider the issue of transformability within that of resilience note that the scale dimension is necessary, as this will indicate whether factors should be considered in contrast or even conflict [ 70 ]. Westley et al. [ 98 ] consider macro-, meso- and micro-scales as those that need to be considered if transformational innovation can achieve long-term change. At a macro-scale, authors refer to the political, economic, cultural and legal institutions that should be transformed away from what favours environmental destruction. At the meso-scale, authors refer to the problem or domain scale, which represents the opportunities that need to be incorporated to promote novelty and innovation. Finally, the micro-scale refers to individuals and small groups where invention originates and where the early sources of disruptive or catalytic innovation can be found. Various authors [ 69 , 70 , 97 ] often refer to the size of the transformation on a scale dimension (large vs. small scale). However, while Olsson et al. [ 69 ] focus on large-scale innovation in order to achieve a large-scale change, small niche innovations have also shown the capacity to scale up and transform institutions [ 63 , 97 , 98 ].

Research has considered a wide variety of stakeholders when referring to resilience, sustainability and innovation, ranging from social, economic and state actors [ 60 , 62 , 70 , 71 , 98 ] to environmental organisations such as park authorities, scientific and policy agencies, as well as the broader community. Moore et al. [ 63 ] were less specific in identifying stakeholders, as they consider either individuals or collectives. According to Olsson et al. [ 71 ], individual stakeholders included in their study were entrepreneurs and consumers. Westley et al. [ 97 ] refer to individuals or institutions. Besides individuals, McCarthy et al. [ 57 ] delineate collectives onto groups, organisations and agencies. Westley et al. [ 98 ] also consider NGOs and private sector firms as stakeholders.

Political Governance

Within the major theme of political governance, researchers have provided specific frameworks to understand how political decision-making can be guided to achieve adaptive co-management [ 6 , 7 ] and sustainability [ 40 ]. Butler et al. [ 6 ], Butler et al. [ 7 ] applied resilience theory to adaptation pathways, which can provide a decision-making framework whose aim is to push societies towards a more sustainable future by considering complex systems, uncertainty and multiple stakeholders. The use of an adaptive pathways approach, however, showed limited evidence for institutional change to existing processes [ 7 ].

Chapin et al. ([ 12 ], pp. 16,641) define resilience as the ‘capacity of social-ecological system to absorb shocks or perturbations and still retain fundamental function, structure, identity and feedbacks due to changing conditions’. Climate change works in interaction with population growth and ecosystem loss, which reduces land, water and food supply. Bad resilience may occur as a trap, which means that self-reinforcing social and ecological feedback can make moving to new trajectories extremely difficult. Poverty can remain due to corruption, traditional institutions and fatalism. Transformation is required when the system is trapped in an undesired state. Resilience can be improved by addressing the negative feedback that prevents systems from changing, thus fostering ecological, cultural, institutional and economic diversity, as well as adaptability [ 12 ]. Innovation can help the system to stay in its current state or to transform it [ 6 ], and it can foster sustainable development and resilience [ 40 ]. Adaptability can be enhanced through policies that promote learning and innovation [ 12 ]. A case study by Chapin et al. [ 12 ] of Alaskan boreal forests provided researchers with broad policy strategies that can be widely applicable in other settings. Socially innovative initiatives at the community level can, through the co-ordinating role of the state, be scaled up and act as a pressure for more participatory forms of governance when implementing grassroots innovation [ 1 ]. Grassroots innovations, in this way, emerge as networks generating innovative solutions for climate change adaptation and mitigation and therefore work as strategies towards achieving sustainability and resilience [ 18 , 19 ].

Feola and Nunes’ [ 18 , 19 ] study is the only study on the major themes which acknowledged both local and global contextual factors in a case study of transition movements. Grassroots innovations support the process of local niche innovation creation and the incubation of socio-technical innovation. Less successful transition initiatives underestimate the importance of contextual factors and material resources in influencing success [ 18 , 19 ]. Sustainable development goals enable major transformations to take place, not only in policies and technologies but also in modes of innovation too. Leach et al. [ 40 ] examine examples from East Africa and Latin America and proposed a 3-D framework where the policymakers evaluate their decision-making based on direction, diversity and distribution when implementing innovation in moving towards sustainable development. Political governance can play an important role in designing, implementing as well as regulating an innovation. An innovation should address socio-ecological feedback and support the stewardship of ecosystem services [ 21 ]. Galaz [ 21 ] argue that geo-engineering and Earth stewardship are not necessarily in conflict, but rather can be viewed as complementary, which is why it is important to have institutional settings and regulations that are strong enough to prevent ecological risk while allowing for novelty, fail-safe experimentation and continuous learning.

When studying the diverse nature of political governance, we need to understand it within the cross-scale and multi-scale contexts [ 6 ,  7 ,  40 ]. Researchers have thus used various scales of reference, with the one referring to the spatial (large vs. small scale) being the predominant frame of reference [ 6 , 7 ,  12 , 21 , 40 ] followed by a territorial scale that considers local vs. global level of initiatives [ 6 , 12 , 18 , 19 , 40 ]. Some authors also consider related issues using a temporal scale and the notion of time [ 18 , 19 , 12 ]. Research in the major theme of political governance refers to a diverse set of stakeholders, with most of the studies including governmental institutions. Butler et al. [ 6 ,  7 ] classified stakeholders into individuals, institutions and governmental organisations. Leach et al. [ 40 ] referred to stakeholders as farmers and consumers. Feola and Nunes [ 18 , 19 ] have looked into how resilience, sustainability and innovation can be achieved from an NGO perspective, while Chapin et al. [ 12 ] are more specific and include resource harvesting, conservation, hazard reduction and ecological externality institutions as the topics of interest.

Socio-ecological Systems

The final group on major themes included articles concerned predominantly with the interactions among social-ecological systems. However, studying both the ecological as well as social dimensions has often been neglected by research studies [ 1 ]. Within this major theme, a substantial overlap can be found among the constructs of resilience, innovation and sustainability, while all concepts seem to be concerned about social and ecological interaction [ 1 , 13 , 14 ]. Cumming et al. [ 13 ] are the most influential authors within this theme. According to them, resilience is defined in terms of the system’s ability to maintain an identity while being faced with internal changes and external shocks and disturbances. The two aspects of identity can refer to the ecosystem (e.g. amount of focal habitat) and social factors (e.g. cultural groups). The relationship component within the definition refers to how the components fit together, while the continuity component represents the variables that maintain a system’s identity through space and time [ 14 ]. Resilience thinking in the integration of sustainability, resilience and innovation integrates both social and ecological aspects. Resilience focuses on the process of enhancing the likelihood that the system will be able to weather shocks or pass through inevitable adaptive cycles in an unproblematic manner, reduce serious vulnerabilities and move system states from an undesirable to a desirable state [ 13 ]. Cumming et al. [ 13 ] identified an exploratory framework for operationalisation and a measure of resilience which can be used for empirical studies across cases. This allows for the socio-ecological system to be studied, as well as to make predictions about whether properties of interest are resilient.

Progress towards sustainability in this theme depends on our understanding of socio-ecological systems. Resilience in the domain of socio-ecological systems is based on the interdisciplinary synthesis, which when applied to farming can lead towards sustainability [ 14 ]. Innovation can represent a part of or a pathway to achieving resilience [ 13 , 14 ]. Innovation in socio-ecological systems is more concerned with how variables that are related to novel solutions and responses to change can be shaped by biodiversity, cultural and livelihood diversity [ 13 ], as well as how learning and innovation can shape socio-ecological system interaction in fostering the resilience [ 14 ]. Darnhofer et al. [ 14 ] have shown that farming systems are too complex and variable over time and space for resilience models to give specific and closely predictive guidance to farmers. For a farm to achieve sustainability, it must take advantage of current opportunities while managing conditions that expand future possibilities, ensuring adaptability and transformability [ 14 ]. As such, sustainability considers the resilience of the system using both the short to the long term. Research work in socio-ecological systems builds on the idea of the adaptive cycles proposed by Holling [ 26 ], which consist of four phases: exploitation, conservation, release and reorganisation [ 13 , 14 ].

Interest in socio-ecological system interactions has remained on the temporal and spatial scales [ 1 , 14 ], with Baker and Mehmood [ 1 ] adding the functional scale. Each subsystem interacts with other subsystems at other spatial scales and other domains, which in turn are influenced by them. This is difficult to measure and thus make accurate predictions of how a system will respond, which gives rise to a need to address both the spatial and temporal mismatches that exist between a certain biophysical system and the governance system that is responsible for managing human–environment interactions. This mismatch may also occur when implementing social innovation, which can cause governance practices to fail with regard to promoting resilience on the social and ecological levels [ 1 ]. The research into socio-ecological systems looked at a diverse set of stakeholders ranging from public, private and civil society actors [ 1 ]. Stakeholders among them consider state agencies, universities, NGOs and communities [ 13 ], as well as farmers, local farmer groups associations and communities [ 14 ].

Emerging Research Trends

Bibliographic mapping investigates research that is well cited, and it does not consider newer research, which is why in the following section, we review the most recently published papers (up to a year before data collection started) and identify the most important themes in the most recent works. We review the papers that were published in one year before data collection. The results show that literature reviews [ 8 , 16 , 25 , 35 , 43 , 51 ,  55 , 67 , 79 ,  91 ] and case studies [ 2 , 4 , 9 ,  17 , 24 , 30 , 54 , 61 , 83 , 88 ] are still the predominant research methods, although more sophisticated methods of research are starting to become adopted, though, such as systematic literature reviews [ 15 ], comparative analysis of the investment criteria and other reports [ 33 ], interviews [ 23 , 81 ] and surveys [ 32 , 50 , 66 , 90 ].

Food Security and Agriculture

The first emerging theme, on food security and agriculture, encompasses the largest set of articles ([ 2 , 8 , 16 , 33 ,  55 , 67 , 76 , 79 , 81 , 83 , 91 ] which could be due to the rising need to consider food security within the frame of resilience, sustainability and innovation. The constraint of the natural resources should not exceed natural regenerative capacity, while the economic return should meet certain expectations to be considered sustainable [ 16 ]. Dong [ 16 ] argues that there is a paradigm shift occurring from efficiency-driven industrial agriculture to resilience-focused eco-friendly agriculture.

Sustainable systems require adequate performance across economic, social and environmental domains [ 76 , 83 ]. On the other hand, Reidsma et al. ([ 76 ], pp. 19) define resilience as the ‘ability to ensure the provision of the system functions in the face of complex and accumulating economic, social, environmental and institutional shocks and stresses’. It can thus be argued that there is a substantial overlap between resilience and sustainability. Resilience can work as a catalyst in sustaining the sustainability of the system when faced with external pressures and shocks, while sustainability is the umbrella that requires adequate performance in general and is therefore a broader concept and less specific. Resilience considers adaptability – ‘the capacity to actively respond to shock and stresses without changing the systems structures and feedback mechanisms’ – resilience also encompasses transformability, the ‘system’s capacity to reorganise its structure and feedback mechanisms in response to shocks and stresses’. While Reidsma et al. ([ 76 ], pp. 19) add the robustness of the system, which refers to ‘the capacity to resist and endure shocks or stressors’ ([ 76 pp. 19). When looking into the definition of resilience, a distinction was made by Reidsma et al. [ 76 ] between specific resilience, which considers what, to what and for what purpose, and general resilience, which considers the system’s overall robustness, adaptability and transformability. Studying these from the farming systems perspective, it was found that the resilience of the focal systems was perceived as low to moderate, and robustness and adaptability were often greater than transformability. Liu et al. [ 50 ] investigate technological innovation as the key to improving productivity in food production and agriculture. The implementation of technological innovation is linked to financial prosperity. Even in the newer research on food security and agriculture, the theory of adaptive cycles continues to be applied [ 5 ], while a new theory of change is presented by Seghieri et al. [ 83 ].

There is a need to define agroecological or sustainable innovations in the context of people [ 83 ]. Consumers have become a topic of interest. Sustainable agriculture can deliver benefits for human health, as well as prevent environmental sustainability from being compromised. However, each consumer is only a limited agent of change, which is why broader perspectives need to be considered within the farming and agriculture domain [ 81 ]. Researchers consider both the social domain regarding using the agriculture to reduce hunger and the related impacts on the ecological aspects of food system security, as the race to meet sustainable development goals to achieve zero hunger by 2030 increases the need to intensify agricultural production, which raises concerns for the related environmental footprint. The deployment of new and improved technologies, especially advanced biotechnology, can help reach the targets set [ 67 ].

In terms of food security and agriculture, the stakeholders involved in research on sustainability, resilience and innovation were farm owners and farming communities. However, different stakeholders were also involved in the agricultural value chain, such as governments, scientific communities, the public [ 16 ], non-governmental organisations and academic experts [ 81 ]. Research in this domain also acknowledges environmental parks [ 55 ], and primary forest owners [ 79 ] as those where resilience, sustainability and innovation play an important role. A broad array of stakeholders can be classified into public, civil and private stakeholders [ 83 ]. Benitez et al. [ 2 ] investigated how more specifically how females as stakeholders through participation and leadership contribute to positive economic, ecological and sociocultural changes in farming households and communities. Researchers looked at different scales, such as various spatial scales (small, medium vs. large) and territorial scale (municipal, provincial and national vs. local, national and international) [ 8 ,  16 , 33 ,  67 , 76 , 79 , 81 ], and individual vs. household scale [ 2 ], or at the level of the forest, farm, community and territory ([ 79 , 83 , 91 ]. The related technologies have the potential to play a role in improving the sustainability and resilience of food systems, at cell, plant, field and farm scales [ 8 ]. The notion of a temporal scale in terms of time has also been introduced into the discussion on food security and agriculture [ 81 , 91 ].

Business and Finance

The idea of a win–win strategy emerges in the business and finance domain. Organisations act as a catalyst for the sustainable development of society, while at the same time need to develop in a sustainable way to realise their potential. The concept of organisational resilience is complex, and methods of effectively modelling resilient organisations are still developing. Nyaupane et al. [ 66 ] performed a study at the Bureau of Land Management, the largest public land management agency in the USA, which investigated organisational resilience. The employee-organisation relationship (E-O-R) framework was developed to understand the relationship between employees’ skillsets, organisational traits and organisational resilience. It is possible to have employees whose skillset is adaptive, but it can occur that at the organisational level, such adaptability can be low, and thus, there are low resilience levels [ 66 ]. On the other hand, a survey of 455 organisations showed that long-term organisational resilience enables sustainable competitiveness through fostering dynamic capabilities [ 32 ]. Therefore, the concepts of resilience and sustainability are also interlinked in the business and finance domain.

Del Giudice et al. [ 15 ] further link the business model innovation theory and resilience theory within their research. Including socio-ecological systems, resilience theory and socio-technical transitions, the concept of transformational adaptation has been introduced to the study of climate change. Kasdan et al. [ 33 ] consider how transformational adaptation has influenced the funding priorities and financing of projects. They performed an analysis of investment criteria, board meetings, minutes, documents and reports under the convention of United Nations Framework Convention on Climate Change. Transformative potential guides funding decisions; however, it is important to consider whether transformational change is achievable and desirable at all times. Research also investigated how industry 4.0 adoption contributes towards sustainable business practice, and how digital technologies can improve resilience aftershocks [ 43 ], as well as how technology can be implemented towards achieving sustainability and resilience in the tourism sector [ 9 , 51 , 96 , 102 ], seaports [ 15 ], and barriers to implementing the innovation for pottery businesses in Iran [ 23 ]. During the COVID-19 pandemic, the resilience of global logistics has become an important topic in global supply chain management [ 3 ,  24 , 90 ]). Information sharing, logistics, networking and transportation are the most powerful factors that impact sustainable business and supply chain performance, while the need to move from corporate social responsibility towards also sustainability arises in this context [ 90 ]. Technological advances could help through the use of new technologies and the adoption of advanced analytics such as blockchain [ 3 ]. Research also investigates how innovation presents an important factor in implementing a circular economy [ 9 , 61 ].

Carraresi and Broring [ 9 ] argue that while research can often focus on innovation in a company’s business, an innovative solution does not lie only in a particular object or process, but in a frame of mind. Therefore, the behavioural aspects are starting to be considered as success factors in the implementation of innovations in business settings. The multilevel nature of an innovation is considered in business research, where the innovative output of nations is impacted at the local and organisational levels [ 23 ]. Stakeholders represent organisations [ 32 ], employees [ 66 ], customers [ 9 ] and governmental organisations [ 23 ]. Most researchers within the domain of business and finance do not refer to the scale used,only Moore et al. [ 61 ] refer to the national scale and Trivellas et al. [ 90 ] to the small scale.

Interconnected Systems

We can only understand the concepts of sustainability, resilience and innovation when we understand the complexity of the system we are considering. Kok et al. [ 35 ] acknowledge the importance of human agency, as well as non-human factors, such as technology. There are three important, mutually related dynamic properties of complex adaptive systems: emergence, self-organisation and adaptation. Within non-linear interactions, systematic feedback loops can emerge in the system, which allows small changes to either accelerate the systematic change through a positive feedback loop or diminish the systemic change through a negative feedback loop. This level of operationalisation proposes that we shift the analysis from the individual parts to the systems perspectives. The power dynamics agency has become a topic of interest in the transition towards sustainability, while individual-level factors such as the autonomy of actors and collaboration between them have also started to be topics of interest [ 35 ].

Sustainability is defined with seven attributes referring to productivity, stability, reliability, adaptability, equity, self-management and resilience [ 52 ]. Resilience is therefore considered as a part of sustainability. Nevertheless, they argue that sustainability cannot be measured directly, but must be measured through transversal evaluation by comparing management systems at the same time, or through longitudinal evaluation, by looking into the evolution of the system over time [ 54 ]. Sustainability can work in both ways – governance can work towards achieving sustainability or a need for sustainability can change the governance. Maqueda et al. [ 54 ] investigated an intervention project in the Ecuadorian Andes. They investigated the impact on sustainability before and after an intervention by applying the framework for the evaluation of natural resource management systems (MESMIS). Infrastructure networks, such as those for energy, transportation and telecommunications, perform key functions for society. Systems have largely been developed and managed in isolation,however, infrastructure now functions as a system of systems, exhibiting complex interdependencies that can leave critical functions vulnerable to failure [ 24 ]. Grafius et al. [ 24 ] argue that research efforts and management strategies have so far focused on risks and negative aspects of the complexity of the systems perspectives,however, their case study review identified how interdependencies can also be seen positively, representing possibilities to increase organisational resilience and sustainability. The integrated social innovation and scenario-thinking mechanism was developed by Bonsu et al. [ 4 ] as a bottom-up tool for empowering citizens, including youth and decision-makers, in delivering sustainable development goals, plans, policies and programmes.

Research has become more interested in how humanity can work towards the prosperous development of civilisation. Echaubard et al. [ 17 ] refer to socio-ecological systems theory to describe resilience, as this remains the best operational framework for meeting the need for integration and adaptive governance to obtain sustainable development goals. The Anthropocene reality of rising system-wide turbulence calls for transformative change towards a sustainable future. Emerging technologies and social innovations work towards a more resilient biosphere and are considered as essential parts of such transformations [ 20 ]. Tim et al. [ 88 ] introduced the concept of digital social innovation. They studied e-commerce to bring people out of poverty and how both bottom-up and top-down interventions can be instrumental in overcoming the bottlenecks to developing a resilient community. Gender equality and empowerment are considered as indicators contributing towards the natural sustainability of the system [ 54 ]. In their work on a case study of the watchmaking region of the Swiss Jura, Jeannerat [ 30 ] introduce the concept of ‘valuation’ to interpret the contemporary territorial dynamics of innovation.

Stakeholders and how they are related to technology are the central part of interconnected systems. Kok et al. [ 35 ] refer to this as human and non-human agency. Maqueda et al. [ 54 ] and Echaubard et al. [ 17 ] investigated communities as stakeholders. Jeannerat [ 30 ] looked into whole industries as stakeholders, while Grafius et al. [ 24 ] consider a multitude of infrastructure stakeholders including the energy, ICT, transportation, waste and water sectors, while also including stakeholders from academia and governance. Kok et al. [ 35 ] consider that both macro- and micro-scales need to be studied to consider the properties of wholes as well as those of parts of the system. Researchers consider spatial scales by referring to large [ 35 ] and small scales [ 20 , 67 ]. Territorial scales local vs global scale are used by Jeannerat [ 30 ], with Folke et al. [ 20 ] adding planetary scale. Cross-scale scale [ 4 , 17 ] is also considered by the researchers.

The aim of this paper was to highlight the interrelations among resilience, sustainability and innovation, identify the major and emerging themes in the literature and provide an understanding as to how they are studied in practice and identify future research directions.

Interrelations Among Sustainability, Resilience and Innovation

To answer the first research question on the interrelations of the topics of resilience, sustainability and innovation, our study showed that there is a strong overlap among the constructs, with authors on multiple occasions using the concepts interchangeably or without specifically distinguishing them, only referring to interactions among socio-ecological and economic systems. A majority of the authors identify resilience as a potential pathway to achieving sustainability [ 1 , 10 , 13 , 14 , 63 , 69 , 97 ] or a trait of sustainability [ 54 ], while innovation is presented as the way to achieve both [ 1 , 13 , 14 , 18 , 19 , 21 ,  69 , 71 , 97 , 98 ]. The strong overlap between sustainability and resilience can already be seen in the definitions of the terms. For example, Reidsma et al. [ 76 ] define resilience as the ‘ability to ensure the provision of the system functions in the face of complex and accumulating economic, social, environmental and institutional shocks and stresses’. The definition of sustainability, on the other hand, considers the adequate performance of the system across economic, social and environmental domains [ 76 , 83 ]. Therefore, sustainability can be considered as an umbrella under which resilience can be studied more specifically when referring to interactions between socio-ecological and economic systems. Resilience can mean ensuring adequate performance of the system when faced with shocks and stressors, while sustainability can ensure the adequate performance of the system in general. This could explain why in 2019–2021, the thematic evolution showed there was a move in the research from resilience, which was a major theme of interest from 1999 to 2018, towards sustainability and other topics, such as vulnerability, policy, knowledge, adaptation and impact. Innovation, on the other hand, was not one of the themes identified in the examination of the thematic evolution, which could be explained by the fact that innovation is involved in the processes of obtaining both, and therefore, no specific distinguishment is present.

Resilience encompasses both aspects of adaptation and transformation if it is referred to in the context of sustainability [ 14 ,  37 , 38 , 70 , 97 ] while Reidsma et al. [ 76 ] also add the robustness of the system under the resilience domain. Robustness can also refer to the negative side of resilience. Olsson et al. [ 70 ] call for a clear distinction between resilience and robustness in this regard. Newer research merges the two concepts of transformation and adaptation together into transformational adaptation when referring to resilience [ 33 ]. The literature differs when it comes to social [ 57 , 60 , 62 , 63 , 70 , 97 , 98 ], technological [ 70 , 98 ] and a hybrid version of socio-digital innovation [ 88 ], and sustainability requires adequate performance across economic, social and environmental domains [ 76 , 83 ]. As such, one can argue that resilience and innovation refer to the processes, while sustainability is concerned with the outcomes [ 76 , 83 ]. Research on integrating the three concepts of sustainability, resilience and innovation shows promising results, with the three concepts being used interchangeably or in relation to each other. Resilience can work as a catalyst in maintaining the sustainability of the system when faced with external pressures and shocks, while sustainability can be considered as a broader concept, which requires adequate functioning of the system even when no external shocks or stressors occur. Furthermore, our overview of the literature suggests that two theories are used when referring to resilience, sustainability and innovation by many of authors – the theories of closing [ 9 , 61 , 74 ] and adaptive cycles [ 5 , 13 , 14 , 57 , 97 ]. The theory of the adaptive cycle represents the most used theory when looking into processes related to exploitation, conservation, release and reorganisation. The resilience of the system enables the system to continue in an unproblematic manner through the adaptive cycle [ 14 ,  37 , 38 , 97 ]. The second theory that often appears in the literature, that of the closing cycle, has become more popular in recent years, and especially in relation to the circular economy and minimising waste in the environment [ 9 , 61 , 74 ].

Stakeholders

If we wish to achieve a large-scale change towards utilising innovation to foster resilience and sustainability, then we have to consider the multitude of actors within systems and their interactions in the implementation. To answer the second research question, our review of the literature found that researchers rarely involve one type of stakeholder in their analysis of sustainability, resilience and innovation. The stakeholders range from individual, organisational and institutional stakeholders [ 7 ], while a newly emerging theme on interconnected systems proposes the importance of linking sustainability, resilience and innovation to both human and non-human agency [ 35 ]. With regard to the major themes of research, we have seen how complex and important the stakeholders involved in the process are due to the interdisciplinary nature and dependency of the field. We may classify stakeholders in terms of environmental protection organisations [ 12 , 69 ], farms and agriculture organisations [ 1 , 40 , 69 ], non-profit organisations [ 13 , 18 , 19 , 98 ], educational institutions [ 13 ], business organisations [ 40 ], infrastructure organisations [ 24 ] and governmental organisations [ 7 , 21 ,  40 , 60 , 62 , 70 , 98 ].

Another classification can be based on the individual level [ 6 , 7 ,  63 , 71 ] such as employees [ 66 ] or customers [ 9 ] and collectives or communities ([ 13 , 17 , 40 , 54 , 63 ,  69 ] institutions and organisations [ 6 , 32 , 57 , 70 , 97 ], as well as industries [ 30 ]. In some instances, the researchers consider social, economic and state actors [ 60 , 62 ]. Both top-down and bottom-up approaches can be considered as sources of transformational innovation, which is why different stakeholders at different positions of power should not be neglected while studying resilience, sustainability and innovation [ 23 , 98 ]. The reason why so many different stakeholders were included in the analysis or referred to in the literature could be due to the importance of the inter-connectedness and dependence of different actors within the fields of sustainability, resilience and innovation, which requires us to study the related concepts across multiple stakeholders [ 12 ]. Our research shows that sustainability, resilience and innovation can be applied simultaneously by considering the multitude of stakeholders involved in the process. The results also showed the need to consider multi-stakeholder systems and how they interact with each other.

Methods and Scales

The third research question was concerned with which methods are used by researchers in studying resilience, sustainability and innovation. Literature reviews were the main method used, followed by case studies. Among the major themes, there were only two quantitative and qualitative studies in the works examined, while researchers also used example reviews. In recent years within the emerging themes, there has been a shift towards more sophisticated methods, such as systematic literature review, comparative analysis of investment criteria and surveys, although literature reviews and case studies still dominate the research.

Our review of the literature showed that changes in one system may only be achieved on certain occasions by if there are also changes in another system. Our fourth research question was therefore concerned with what scales the research should be conducted at. Researchers emphasise the importance of studying the concepts across different scales or including a multi-scale approach [ 6 , 7 ,  60 , 62 , 63 , 70 ], as this is fundamental to the interplay between persistence, change, adaptability and transformability. Researchers have used several different scales referring to the spatial (large, medium, small), territorial (organisational, local, regional, national, international, planetary), temporal (short-term, mid-term, long-term) and functional. Researchers have also considered classifications on the micro-, meso- and macro-scales [ 57 , 98 ].

Major and Emerging Themes of Research

Concepts of resilience, sustainability and innovation are often used as solutions to the most pressing issues that humanity is facing; this can also be seen in the topics for major and emerging themes. To answer the fourth research question, our literature review identified three major themes: ‘transformational innovation’, ‘political governance’ and ‘socio-ecological systems’. The first major theme of transformational innovation emerged as a type of innovation that can establish the move to resilient and sustainable systems. The reason why this theme emerged could be due to the rising importance of linking innovation to ecological integrity [ 98 ] and socio-ecological transformation [ 63 , 70 , 71 , 97 ]. This theme also emerged due to relatability to the concepts of resilience to transformation trait as necessary to be included in contributing towards sustainability [ 14 ,  37 , 38 , 70 , 97 ]. The second major theme of political governance studied how policymaking can be guided to implement innovation or to achieve resilience and sustainability. Political governance is crucial, although while it may present the pathway towards achieving resilience and sustainability of the system, it has also shown limited results in Butler et al. [ 6 , 7 ]. This theme could have emerged due to the importance of linking political governance in implementing resilience, sustainability and innovation [ 12 ]. In fact, a study by Feola and Nunes [ 18 , 19 ] clearly showed the importance of initiatives to be supported by the policymakers to be successful. Finally, research on socio-ecological systems showcases the importance of studying these concepts from both the social and ecological dimensions. For example, Cumming et al. [ 13 ] placed the social and ecological dimensions under the definition of resilience. Such a definition is possible when referring to resilience in the context of sustainability, which encompasses both social and ecological dimensions [ 1 , 13 , 14 ].

Our article also identified three emerging themes: ‘food security and agriculture’, ‘business and finance’ and ‘interconnected systems’. The first of these, on food security and agriculture, was the theme with the highest number of research articles. The reason being could be due to the growing need to assess and design solutions necessary to combat food insecurity, as well as to get to reach sustainable development goals such as ending world hunger by 2030 [ 67 ]. There is a shift into resilience-focused eco-friendly agriculture [ 16 ], which could explain why the need for research in this domain rises in its importance. The second emerging theme referred to business and finance. Research in this domain has started to introduce the concept of organisational resilience, as well as the concepts of circular economy ([ 9 , 74 , 61 ]. The need to consider the resilience of the system has shown to be especially crucial during the COVID-19 pandemic, which is why research has looked to digital technology can improve resilience aftershocks in a-post COVID-19 context [ 3 ,  24 , 43 , 90 ]. The third emerging theme of interconnected systems reveals the importance of considering sustainability, resilience and innovation from the systems perspective, and how human agents and non-human agents interact. There is thus a move from looking at individual parts to the system as researchers start to consider how individual parts are nested inside the overall system [ 35 ]. The importance of interdependency begins to be an issue within this emerging theme, when interdependencies of the system can also play a positive role in influencing the system towards achieving resilience [ 24 ].

Limitations and Areas of Improvement

This literature review is limited to the interrelations among the concepts of sustainability, resilience and innovation, and thus, it did not include studies that investigated these separately. Our study only reviewed the most highly cited articles and the articles within the emerging themes and thus did not consider previous research that could have examined these concepts but was not highly cited or recent enough to be included in the review. This is especially true for the research on methods. It may be the case that literature reviews are more highly cited than empirical research, and therefore, our study did not identify more research that uses an empirical approach to study these concepts. Moreover, due to the complex nature of urban planning, infrastructure and other related concepts, the current study did not consider research in these areas that investigated sustainability, resilience and innovation in different domains. There is a need for more empirical work looking into the three concepts of sustainability, resilience and innovation together.

Future Research Directions

In the following sections, we highlight opportunities for knowledge integration and new research directions. Given the substantial overlap among the three concepts, the question arises as to whether sustainability, innovation and resilience could be integrated and in what ways can they be researched together. Future research is needed to study the propositions of inter-relatedness of the topics empirically by applying quantitative studies that would compare the systems response and involvement in sustainability, resilience and innovation across multiple cases and stakeholders. Furthermore, longitudinal research is needed to study these concepts in practice. In the next section, we review potential new directions in research on these concepts.

Future research on transformational innovation could examine how technological innovation has caused a change in certain environmental outcomes (CO 2 emissions, atmospheric temperature and rising sea levels). Research is necessary to identify how transformational innovation can contribute to longitudinal changes in socio-ecological systems, and what can be done when innovation reaches the routinised phase. Much more research is needed on how to classify the differences between harmful and non-harmful innovation [ 57 ]. A coherent theory could also be developed on the emergence of transformational innovation [ 70 , 71 ].

The researchers working on this theme of political governance mainly focused on developing countries [ 6 , 7 ], while research on developed countries remains limited. Moreover, Feola and Nunes [ 18 , 19 ] argue that studies on the dynamic nature of local and global linkages are rare, and their work was the only one among the highly cited articles included in our research that performed such investigation. More research is necessary on support by policymakers [ 18 , 19 ]. Future research could also explore factors contributing towards the emergence of bad resilience and the role power plays in implementing resilience towards achieving sustainability and innovation.

The frameworks developed by Darnhofer et al. [ 14 ] and Cumming et al. [ 13 ] can be used by researchers to study the concept of resilience in practice, although more research is needed to test these approaches. Future research should identify which feedbacks from the interactions between socio-ecological systems can shape the transformation towards achieving resilience and sustainability [ 13 , 14 ]. The results of such work could be used to identify how human factors interact with the environmental aspects [ 14 ].

With climate change, the interest in the topics of food security and agriculture is likely to rise in its importance. More research should be done to explore how innovation can potentially address the challenges posed by climate change in this context of food and agriculture. Even though changes in consumer preferences have started to attract the interest of researchers, research work on the policy agendas that contribute towards more sustainable food consumption choices remains limited [ 81 ]. Future research could explore how farming systems evolve to integrate consumption choices in their decision-making.

Research on business and finance could, in the future, consider both sides of the coin – what it takes to implement sustainability, resilience and innovation in practice, as well as what this means in terms of ecological, economic and social changes as such actions are taken. It is important to define and agree on the measure of sustainability; however, Carraresi and Broring [ 9 ] argue that no such measure has been proposed that would include both the elements of environmental as well as financial sustainability. Research could explore how can the two processes of the adaptative and closing cycles interact and contribute towards sustainable, resilient and innovative outcomes for organisations.

Future research could test the propositions of systems, as proposed by Kok et al. [ 35 ]. The research on interconnected systems considers that specific community-level interventions can offset certain changes on a societal level. More research is needed on how the individual-level factors such as belief in free will, attitudes, autonomous motivation, norms or learning can contribute towards a system that is innovative, resilient and sustainable. Kok et al. [ 35 ] also mention non-human agency, and much more research should be done to define the interactions between humans and technology in building adaptive and transformational systems that are sustainable.

The systematic review of the literature presented in this work shows there is considerable potential regarding studying resilience, innovation and sustainability together, as there is a great overlap among these concepts. Innovation is important for obtaining both resilience and sustainability, while resilience is involved in processes towards achieving and maintaining sustainability. Resilience is more concerned with processes and sustainability with outcomes. We identified three major themes in the literature: ‘socio-ecological systems’, ‘transformational innovation’ and ‘political governance’. We also found three emerging research streams: ‘food security and agriculture’, ‘business and finance’ and ‘interconnected systems’. The results indicate that multi-scale and multi-stakeholder approaches should be adopted when studying resilience, sustainability and innovation simultaneously. The predominant methods for studying these concepts in the literature were case studies and literature reviews. There remains a need for cross-scale and multilevel empirical quantitative studies that would investigate how these concepts are applied and work longitudinally and across different stakeholders and organisational levels. Future research should consider the human aspects of implementation, what fosters and what creates a barrier in implementation.

Data availability

All the abstracts of the articles used in the review of this study have been made available in the Supporting information.

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Zupancic, N. Systematic Literature Review: Inter-Reletedness of Innovation, Resilience and Sustainability - Major, Emerging Themes and Future Research Directions. Circ.Econ.Sust. 3 , 1157–1185 (2023). https://doi.org/10.1007/s43615-022-00187-5

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A scoping review of ‘Pacing’ for management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): lessons learned for the long COVID pandemic

• Nilihan E. M. Sanal-Hayes 1 , 7 ,
• Marie Mclaughlin 1 , 8 ,
• Lawrence D. Hayes 1 ,
• Jacqueline L. Mair   ORCID: orcid.org/0000-0002-1466-8680 2 , 3 ,
• Jane Ormerod 4 ,
• David Carless 1 ,
• Natalie Hilliard 5 ,
• Rachel Meach 1 ,
• Joanne Ingram 6 &
• Nicholas F. Sculthorpe 1  

Journal of Translational Medicine volume  21 , Article number:  720 ( 2023 ) Cite this article

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Controversy over treatment for people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a barrier to appropriate treatment. Energy management or pacing is a prominent coping strategy for people with ME/CFS. Whilst a definitive definition of pacing is not unanimous within the literature or healthcare providers, it typically comprises regulating activity to avoid post exertional malaise (PEM), the worsening of symptoms after an activity. Until now, characteristics of pacing, and the effects on patients’ symptoms had not been systematically reviewed. This is problematic as the most common approach to pacing, pacing prescription, and the pooled efficacy of pacing was unknown. Collating evidence may help advise those suffering with similar symptoms, including long COVID, as practitioners would be better informed on methodological approaches to adopt, pacing implementation, and expected outcomes.

In this scoping review of the literature, we aggregated type of, and outcomes of, pacing in people with ME/CFS.

Eligibility criteria

Original investigations concerning pacing were considered in participants with ME/CFS.

Sources of evidence

Six electronic databases (PubMed, Scholar, ScienceDirect, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials [CENTRAL]) were searched; and websites MEPedia, Action for ME, and ME Action were also searched for grey literature, to fully capture patient surveys not published in academic journals.

A scoping review was conducted. Review selection and characterisation was performed by two independent reviewers using pretested forms.

Authors reviewed 177 titles and abstracts, resulting in 17 included studies: three randomised control trials (RCTs); one uncontrolled trial; one interventional case series; one retrospective observational study; two prospective observational studies; four cross-sectional observational studies; and five cross-sectional analytical studies. Studies included variable designs, durations, and outcome measures. In terms of pacing administration, studies used educational sessions and diaries for activity monitoring. Eleven studies reported benefits of pacing, four studies reported no effect, and two studies reported a detrimental effect in comparison to the control group.

Conclusions

Highly variable study designs and outcome measures, allied to poor to fair methodological quality resulted in heterogenous findings and highlights the requirement for more research examining pacing. Looking to the long COVID pandemic, our results suggest future studies should be RCTs utilising objectively quantified digitised pacing, over a longer duration of examination (i.e. longitudinal studies), using the core outcome set for patient reported outcome measures. Until these are completed, the literature base is insufficient to inform treatment practises for people with ME/CFS and long COVID.

Introduction

Post-viral illness occurs when individuals experience an extended period of feeling unwell after a viral infection [ 1 , 2 , 3 , 4 , 5 , 6 ]. While post-viral illness is generally a non-specific condition with a constellation of symptoms that may be experienced, fatigue is amongst the most commonly reported [ 7 , 8 , 9 ]. For example, our recent systematic review found there was up to 94% prevalence of fatigue in people following acute COVID-19 infection [ 3 ]. The increasing prevalence of long COVID has generated renewed interest in symptomology and time-course of post-viral fatigue, with PubMed reporting 72 articles related to “post-viral fatigue” between 2020 and 2022, but less than five for every year since 1990.

As the coronavirus pandemic developed, it became clear that a significant proportion of the population experienced symptoms which persisted beyond the initial viral infection, meeting the definition of a post-viral illness. Current estimates suggest one in eight people develop long COVID [ 10 ] and its symptomatology has repeatedly been suggested to overlap with clinical demonstrations of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). In a study by Wong and Weitzer [ 11 ], long COVID symptoms from 21 studies were compared to a list of ME/CFS symptoms. Of the 29 known ME/CFS symptoms the authors reported that 25 (86%) were reported in at least one long COVID study suggesting significant similarities. Sukocheva et al. [ 12 ] reported that long COVID included changes in immune, cardiovascular, metabolic, gastrointestinal, nervous and autonomic systems. When observed from a pathological stance, this list of symptoms is shared with, or is similar to, the symptoms patients with ME/CFS describe [ 13 ]. In fact, a recent article reported 43% of people with long COVID are diagnosed with ME/CFS [ 13 ], evidencing the analogous symptom loads.

A striking commonality between long COVID and similar conditions such as ME/CFS is the worsening of symptoms including fatigue, pain, cognitive difficulties, sore throat, and/or swollen lymph nodes following exertion. Termed post exertional malaise (PEM) [ 14 , 15 , 16 , 17 ], lasting from hours to several days, it is arguably one of the most debilitating side effects experienced by those with ME/CFS [ 16 , 17 , 18 ]. PEM is associated with considerably reduced quality of life amongst those with ME/CFS, with reduced ability to perform activities of daily living, leading to restraints on social and family life, mental health comorbidities such as depression and anxiety, and devastating employment and financial consequences [ 19 , 20 , 21 , 22 ]. At present, there is no cure or pharmacological treatments for PEM, and therefore, effective symptom management strategies are required. This may be in part because the triggers of PEM are poorly understood, and there is little evidence for what causes PEM, beyond anecdotal evidence. The most common approach to manage PEM is to incorporate activity pacing into the day-to-day lives of those with ME/CFS with the intention of reducing the frequency of severity of bouts of PEM [ 23 ]. Pacing is defined as an approach where patients are encouraged to be as active as possible within the limits imposed by the illness [ 23 , 24 , 25 ]. In practice, pacing requires individuals to determine a level at which they can function, but which does not lead to a marked increase in fatigue and other symptoms [ 26 , 27 ].

Although long COVID is a new condition [ 3 , 14 ], the available evidence suggests substantial overlap with the symptoms of conditions such as ME/CFS and it is therefore pragmatic to consider the utility of management strategies (such as pacing) used in ME/CFS for people with long COVID. In fact, a recent Delphi study recommended that management of long COVID should incorporate careful pacing to avoid PEM relapse [ 28 ]. This position was enforced by a multidisciplinary consensus statement considering treatment of fatigue in long COVID, recommending energy conservation strategies (including pacing) for people with long COVID [ 29 ]. Given the estimated > 2 million individuals who have experienced long COVID in the UK alone [ 30 , 31 , 32 ], there is an urgent need for evidence-based public health strategies. In this context, it seems pragmatic to borrow from the ME/CFS literature.

From a historical perspective, the 2007 NICE guidelines for people with ME/CFS advised both cognitive behavioural therapy (CBT) and graded exercise therapy (GET) should be offered to people with ME/CFS [ 33 ]. As of the 2021 update, NICE guidelines for people with ME/CFS do not advise CBT or GET, and the only recommended management strategy is pacing [ 34 ]. In the years between changes to these guidelines, the landmark PACE trial [ 35 ] was published in 2011. This large, randomised control trial (RCT; n = 639) compared pacing with CBT and reported GET and CBT were more effective than pacing for improving symptoms. Yet, this study has come under considerable criticism from patient groups and clinicians alike [ 36 , 37 , 38 , 39 ]. This may partly explain why NICE do not advise CBT or GET as of 2021, and only recommend pacing for symptom management people with ME/CFS [ 34 ]. There has been some controversy over best treatment for people with ME/CFS in the literature and support groups, potentially amplified by the ambiguity of evidence for pacing efficacy and how pacing should be implemented. As such, before pacing can be advised for people with long COVID, it is imperative previous literature concerning pacing is systematically reviewed. This is because a consensus is needed within the literature for implementing pacing so practitioners treating people with ME/CFS or long COVID can do so effectively. A lack of agreement in pacing implementation is a barrier to adoption for both practitioners and patients. Despite several systematic reviews concerning pharmacological interventions or cognitive behavioural therapy in people with ME/CFS [ 36 , 40 , 41 ], to date, there are no systematic reviews concerning pacing.

Despite the widespread use of pacing, the literature base is limited and includes clinical commentaries, case studies, case series, and few randomised control trials. Consequently, while a comprehensive review of the effects of pacing in ME/CFS is an essential tool to guide symptom management advice, the available literature means that effective pooling of data is not feasible [ 42 ] and therefore, a traditional systematic review and meta-analysis, with a tightly focussed research question would be premature [ 43 ]. Consequently, we elected to undertake a scoping review. This approach retains the systematic approach to literature searching but aims to map out the current state of the research [ 43 ]. Using the framework of Arksey and O'Malley [ 44 ], a scoping review aims to use a broad set of search terms and include a wide range of study designs and methods (in contrast to a systematic review [ 44 ]). This approach, has the benefit of clarifying key concepts, surveying current data collection approaches, and identifying critical knowledge gaps.

We aimed to provide an overview of existing literature concerning pacing in ME/CFS. Our three specific objectives of this scoping review were to (1) conduct a systematic search of the published literature concerning ME/CFS and pacing, (2) map characteristics and methodologies used, and (3) provide recommendations for the advancement of the research area.

Protocol and registration

The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines [ 45 ] and the five-stage framework outlined in Arksey and O’Malley [ 44 ]. Registration is not recommended for scoping reviews.

Studies that met the following criteria were included in this review: (1) published as a full-text manuscript; (2) not a review; (3) participants with ME/CFS; (4) studies employed a pacing intervention or retrospective analysis of pacing or a case study of pacing. Studies utilising sub-analysis of the pacing, graded activity, and cognitive behaviour therapy: a randomised evaluation (PACE) trial were included as these have different outcome measures and, as this is not a meta-analysis, this will not influence effect size estimates. Additionally, due to the paucity of evidence, grey literature has also been included in this review.

Search strategy

The search strategy consisted of a combination of free-text and MeSH terms relating to ME/CFS and pacing, which were developed through an examination of published original literature and review articles. Example search terms for PubMed included: ‘ME/CFS’ OR ‘ME’ OR ‘CFS’ OR ‘chronic fatigue syndrome’ OR ‘PEM’ OR ‘post exertional malaise’ OR ‘pene’ OR ‘post-exertion neurogenic exhaust’ AND ‘pacing’ OR ‘adaptive pacing’. The search was performed within title/abstract. Full search terms can be found in Additional file 1 .

Information sources

Six electronic databases [PubMed, Scholar, ScienceDirect, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL)] were searched to identify original research articles published from the earliest available date up until 02/02/2022. Additional records were identified through reference lists of included studies. ‘Grey literature’ repositories including MEPedia, Action for ME, and ME Action were also searched with the same terms.

Study selection and data items

Once each database search was completed and manuscripts were sourced, all studies were downloaded into a single reference list (Zotero, version 6.0.23) and duplicates were removed. Titles and abstracts were screened for eligibility by two reviewers independently and discrepancies were resolved through discussion between reviewers. Subsequently, full text papers of potentially relevant studies were retrieved and assessed for eligibility by the same two reviewers independently. Any uncertainty by reviewers was discussed in consensus meetings and resolved by agreement. Data extracted from each study included sample size, participant characteristics, study design, trial registration details, study location, pacing description (type), intervention duration, intervention adherence, outcome variables, and main outcome data. Descriptions were extracted with as much detail as was provided by the authors. Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scale [ 46 , 47 ].

Role of the funding source

The study sponsors had no role in study design, data collection, analysis, or interpretation, nor writing the report, nor submitting the paper for publication.

Study selection

After the initial database search, 281 records were identified (see Fig.  1 ). Once duplicates were removed, 177 titles and abstracts were screened for inclusion resulting in 22 studies being retrieved as full text and assessed for eligibility. Of those, five were excluded, and 17 articles remained and were used in the final qualitative synthesis.

Schematic flow diagram describing exclusions of potential studies and final number of studies. RCT = randomized control trial. CT = controlled trial. UCT = uncontrolled trial

Study characteristics

Study characteristics are summarised in Table 1 . Of the 17 studies included, three were randomised control trials (RCTs [ 35 , 48 , 49 ]); one was an uncontrolled trial [ 50 ]; one was a case series [ 51 ]; one was a retrospective observational study [ 52 ], two were prospective observational studies [ 53 , 54 ]; four were cross-sectional observational studies [ 25 , 55 , 56 ]; and five were cross-sectional analytical studies [ 57 , 58 , 59 , 60 , 61 ] including sub-analysis of the PACE trial [ 35 , 56 , 59 , 61 ]. Seven of the studies were registered trials [ 35 , 48 , 49 , 50 , 56 , 57 , 58 ]. Diagnostic criteria for ME/CFS are summarised in Table 2 .

Types of pacing

Pacing interventions.

Of the 17 studies included, five implemented their own pacing interventions and will be discussed in this section. Sample sizes ranged from n = 7 in an interventional case series [ 51 ] to n = 641 participants in the largest RCT [ 35 ]. The first of these five studies considered an education session on pacing and self-management as the ‘pacing’ group, and a ‘pain physiology education’ group as the control group [ 49 ]. Two studies included educational sessions provided by a therapist plus activity monitoring via ActiGraph accelerometers [ 51 ] and diaries [ 48 ] at baseline and follow-up. In the first of these two studies, Nijs and colleagues [ 51 ] implemented a ‘self-management program’ which asked patients to estimate their current physical capabilities prior to commencing an activity and then complete 25–50% less than their perceived energy envelope. They[ 51 ] did not include a control group and had a sample size of only n = 7. Six years later, the same research group [ 48 ] conducted another pacing study which utilised relaxation as a comparator group (n = 12 and n = 14 in the pacing and relaxation groups, respectively). The pacing group underwent a pacing phase whereby participants again aimed to complete 25–50% less than their perceived energy envelope, followed by a gradual increase in exercise after the pacing phase (the total intervention spanned three weeks, and it is unclear how much was allocated to pacing, and how much to activity increase). Therefore, it could be argued that Kos et al. [ 48 ] really assessed pacing followed by a gradual exercise increase as outcome measures were assessed following the graded activity phase. Another pacing intervention delivered weekly educational sessions for six weeks and utilised a standardised rehabilitation programme using the ‘activity pacing framework’ [ 50 ] in a single-arm, no comparator group feasibility study. Finally, the PACE trial adopted an adaptive pacing therapy intervention consisting of occupational therapists helping patients to plan and pace activities utilising activity diaries to identify activities associated with fatigue and staying within their energy envelope [ 35 ]. This study incorporated standard medical care, cognitive behavioural therapy (CBT) and graded exercise therapy (GET) as comparator groups [ 35 ]. It is worth noting that the pacing group and the CBT group were both ‘encouraged’ to increase physical activity levels as long as participants did not exceed their energy envelope. Although not all five intervention studies explicitly mentioned the “Energy Envelope Theory”, which dictates that people with ME/CFS should not necessarily increase or decrease their activity levels, but moderate activity and practice energy conservation [ 62 ], all intervention studies used language analogous to this theory, such as participants staying within limits, within capacity, or similar.

The interventions included in this review were of varying durations, from a single 30-min education session [ 49 ], a 3-week (one session a week) educational programme [ 51 ], a 3-week (3 × 60–90 min sessions/week) educational programme [ 48 ], a 6-week rehabilitation programme [ 50 ], to a 24-week programme [ 35 ]. Intervention follow-up durations also varied across studies from immediately after [ 49 ], 1-week [ 51 ], 3-weeks [ 48 ], 3-months [ 50 ], and 1-year post-intervention [ 35 ].

Observational studies of pacing

Eight studies were observational and, therefore, included no intervention. Observational study sample sizes ranged from 16 in a cross-sectional interview study [ 25 ] to 1428 in a cross-sectional survey [ 52 ]. One study involved a retrospective analysis of participants’ own pacing strategies varying from self-guided pacing or pacing administered by a therapist compared with implementation of CBT and GET [ 52 ]. Five involved a cross-sectional analysis of participants own pacing strategies which varied from activity adjustment, planning and acceptance [ 50 , 55 ], and the Energy Envelope method [ 58 , 60 ]. Two studies were prospective observational studies investigating the Energy Envelope theory [ 53 , 54 ]. Four studies [ 56 , 57 , 59 , 61 ] included in this review involved sub-analysis of results of the PACE trial [ 35 ].

Outcome measures

Quantitative health outcomes.

ME/CFS severity and general health status were the most common outcome measures across studies (16/17) [ 35 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 63 ]. Studies utilised different instruments, including the Short-Form 36 (SF-36; 8/16) [ 35 , 51 , 53 , 54 , 56 , 57 , 58 , 60 ], SF-12 (2/16) [ 50 , 63 ], ME symptom and illness severity (2/16) [ 52 , 55 ], Patient health (PHQ-15; 1/16) [ 59 ], DePaul symptom questionnaire (DSQ; 1/16) [ 58 ], and the Patient health questionnaire-9 (1/16) [ 50 ]. Additionally, some studies used diagnostic criteria for ME/CFS as an outcome measure to determine recovery [ 57 , 59 , 61 ].

Pain was assessed by most included studies (11/17) [ 35 , 49 , 50 , 51 , 53 , 54 , 55 , 57 , 59 , 60 , 61 , 63 ]. Two studies [ 59 , 61 ] included the international CDC criteria for CFS which contain five painful symptoms central to a diagnosis of CFS: muscle pain and joint pain. Other methods of assessment included Brief Pain Inventory (1/11) [ 53 ], Chronic Pain Coping Inventory (CPCI; 1/11) [ 49 ], Pain Self Efficacy Questionnaire (PSEQ; 1/11) [ 50 ], Tampa Scale for Kinesiophobia–version CFS (1/11) [ 49 ], algometry (1/11) [ 49 ], Knowledge of Neurophysiology of Pain Test (1/12) [ 49 ], Pain Catastrophizing Scale (1/11) [ 49 ], Pain Anxiety Symptoms Scale short version (PASS-20; 1/11) [ 50 ], Pain Numerical Rating Scale (NRS; 1/11) [ 63 ].

Fatigue or post-exertional malaise was assessed by 11 of the 17 studies [ 35 , 48 , 50 , 51 , 53 , 54 , 56 , 57 , 60 , 61 , 63 ]. Again, measurement instruments were divergent between studies and included the Chalder Fatigue Questionnaire (CFQ; 4/11) [ 35 , 50 , 57 , 63 ], Fatigue Severity Scale (2/11) [ 53 , 60 ], the Chronic Fatigue Syndrome Medical Questionnaire (1/11) [ 60 ], and Checklist Individual Strength (CIS; 2/11) [ 48 , 51 ].

Anxiety and depression were also common outcome measures, utilised by four studies (4/17) [ 50 , 53 , 59 , 63 ]. These were also assessed using different instruments including Hospital Anxiety and Depression Scale (HADS; 2/4) [ 59 , 63 ], Generalised Anxiety Disorder Assessment (1/4 [ 50 ]), Beck Depression Inventory (BDI-II; 1/4) [ 53 ], Beck Anxiety Inventory (BAI; 1/4) [ 53 ], and Perceived Stress Scale (PSS; 1/4) [ 53 ].

Outcome measures also included sleep (2/17) [ 53 , 59 ], assessed by The Pittsburgh Sleep Quality Index (1/2) [ 53 ] and Jenkins sleep scale (1/2) [ 59 ]; and quality of life (2/17) [ 50 , 53 ] as assessed by the EuroQol five-dimensions, five-levels (EQ-5D-5L; 1/2) [ 50 ] and The Quality-of-Life Scale (1/2) [ 53 ]. Self-Efficacy was measured in four studies [ 50 , 53 , 59 , 60 ], assessed by the Brief Coping Orientation to Problems Experienced Scale (bCOPE; 1/4) [ 60 ] and the Chronic Disease Self-Efficacy measure (3/4) [ 50 , 53 , 59 ].

Quantitative evaluation of pacing

Some studies (4/17) [ 25 , 50 , 52 , 63 ] included assessments of the participants’ experiences of pacing, using the Activity Pacing Questionnaire (APQ-28; 1/4 [ 50 ], APQ-38 (2/4) [ 25 , 63 ]), a re-analysis of the 228 question survey regarding treatment (1/4) [ 52 ] originally produced by the ME Association [ 55 ], and qualitative semi-structured telephone interviews regarding appropriateness of courses in relation to individual patient needs (1/4) [ 25 ]. The APQ-28 and -38 have been previously validated, but the 228-question survey has not. When outcome measures included physical activity levels (4/17), the Canadian Occupational Performance Measure (COPM) was used in two studies [ 48 , 51 ], and two studies used accelerometers to record physical activity [ 51 , 54 ]. Of these two studies, Nijs [ 51 ] examined accelerometery after a 3-week intervention based on the Energy Envelope Theory and Brown et al. [ 54 ] evaluated the Energy Envelope Theory of pacing over 12 months.

Other outcomes

Two [ 53 , 59 ] of the 17 studies included structured clinical interviews for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) to assess psychiatric comorbidity and psychiatric exclusions. One study included a disability benefits questionnaire [ 55 ], and one study included employment and education questionnaire [ 55 ]. Additionally, satisfaction of primary care was also used as an outcome measure (2/17) [ 25 , 55 ] assessed using the Chronic Pain Coping Inventory (CPCI).

Efficacy of pacing interventions

The majority of studies (12/17) [ 25 , 48 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 58 , 60 , 63 ] highlighted improvements in at least one outcome following pacing (Fig.  2 ). When the effect of pacing was assessed by ME symptomology and general health outcomes, studies reported pacing to be beneficial [ 25 , 50 , 51 , 53 , 54 , 55 , 56 , 58 ]. It is worth noting however that pacing reportedly worsened ME symptoms in 14% of survey respondents, whilst improving symptoms in 44% of respondents [ 52 ]. Most studies using fatigue as an outcome measure reported pacing to be efficacious (7/10) [ 50 , 51 , 53 , 54 , 56 , 60 , 63 ]. However, one study reported no change in fatigue with a pacing intervention (1/10) [ 35 ], and 2/10 studies [ 53 , 63 ] reported a worsening of fatigue with pacing. Physical function was used to determine the efficacy of pacing in 11 studies [ 35 , 48 , 50 , 51 , 53 , 54 , 56 , 58 , 59 , 60 , 63 ]. Of these, the majority found pacing improved physical functioning (8/10) [ 48 , 50 , 51 , 53 , 54 , 56 , 58 , 60 ], with 1/10 [ 35 ] studies reporting no change in physical functioning, and 1/10 [ 59 ] reporting a worsening of physical functioning from pre- to post-pacing. Of the seven studies [ 35 , 49 , 50 , 51 , 53 , 54 , 60 ] which used pain to assess pacing efficacy, 4/7 [ 50 , 51 , 53 , 60 ] reported improvements in pain and 3/7 [ 35 , 51 , 53 ] reported no change in pain scores with pacing. All studies reporting quality of life (1/1) [ 53 ], self-efficacy (3/3) [ 50 , 53 , 59 ], sleep (2/2) [ 53 , 59 ], and depression and anxiety (4/4) [ 50 , 53 , 59 , 63 ], found pacing to be efficacious for ME/CFS participants.

Bubble plot displaying number of studies reporting each domain (x-axis) and the percentage of studies reporting improvement with pacing (y-axis), including a coloured scale of improvement from 0–100%. PEM = post-exertional malaise, 6MWT = 6-min walk time, CFS = chronic fatigue syndrome, DSQ = DePaul Symptom Questionnaire, PA = Physical Activity, HRQOL = Health-related quality of life, COPM = The Canadian Occupational Performance Measure

Participant characteristics

The majority of studies (10/17) [ 25 , 50 , 52 , 53 , 54 , 58 , 59 , 60 , 61 , 63 ] did not report age of the participants. For those which did report age, this ranged from 32 ± 14 to 43 ± 13 years. Where studies reported sex (11/17) [ 35 , 48 , 49 , 50 , 51 , 54 , 55 , 56 , 57 , 58 , 60 ], this was predominantly female, ranging from 75 to 100% female. Only six studies [ 35 , 54 , 56 , 57 , 58 , 60 ] reported ethnicity, with cohorts predominantly Caucasian (94–98%). Time since diagnosis was mostly unreported (12/17) [ 25 , 48 , 49 , 50 , 52 , 53 , 54 , 58 , 59 , 60 , 61 , 63 ] but ranged from 32 to 96 months, with a cross-sectional survey reporting 2% of the participants were diagnosed 1–2 years previously; 6% 3–4 years since diagnosis; 13% 3–4 years since diagnosis; 12% 5–6 years since diagnosis; 20% 7–10 years since diagnosis; 29% 11–21 years since diagnosis; 13% 21–30 years since diagnosis; and 5% > 30 years since diagnosis. Of the studies which reported comorbidities of the participants (6/17) [ 25 , 35 , 50 , 56 , 57 , 63 ], the comorbidities were chronic pain, depressive disorder, psychiatric disorder.

Study location

Of the 17 studies, 14 were from Europe [ 25 , 35 , 48 , 49 , 50 , 51 , 52 , 55 , 56 , 57 , 58 , 59 , 61 , 63 ], and three from North America [ 53 , 54 , 60 ]. Of the 14 studies[ 25 , 35 , 48 , 49 , 50 , 51 , 52 , 55 , 56 , 57 , 58 , 59 , 61 , 63 ] from Europe, ten [ 25 , 35 , 50 , 52 , 55 , 56 , 57 , 58 , 59 , 61 , 63 ] were conducted in the United Kingdom, three in Belgium [ 48 , 49 , 51 ], and one was a multicentred study between the United Kingdom and Norway [ 58 ].

Recruitment strategy

Of the 17 studies, three [ 53 , 54 , 60 ] used announcements in a newspaper and physician referrals to recruit participants, two [ 50 , 63 ] recruited patients referred by a consultant from a National Health Service (NHS) Trust following a pain diagnosis, two [ 52 , 55 ] concerned online platforms on the web, two [ 59 , 61 ] recruited from secondary care clinics, and two used the PACE trial databases [ 56 , 57 ]. Moreover, one study recruited from the hospital [ 58 ], one from physiotherapist referrals [ 25 ], two from specialist clinic centres [ 35 , 64 ], one from waiting list of rehabilitation centre [ 48 ], and one from medical files [ 49 ].

Study settings

Ten studies were carried out in hospital and clinic setting [ 25 , 35 , 48 , 49 , 50 , 51 , 58 , 59 , 61 , 63 ]. Two studies were performed on online platforms [ 52 , 55 ]. Three studies did not report study setting [ 53 , 54 , 60 ]. Two studies generated output from PACE trial databases [ 56 , 57 ]

Adherence and feasibility

All five intervention studies reported adherence rates (which they defined as number of sessions attended), which ranged from 4–44% (4% [ 49 ], 8% [ 35 ], 25% [ 48 ], 29% [ 51 ], and 44% [ 50 ]). One study reported the median number of rehabilitation programme sessions attended was five out of six possible sessions, with 58.9% [ 50 ] participants attending ≥ 5 sessions; 83.2% participants attending at least one educational session on activity pacing and 56.1% attending both activity pacing sessions.

This scoping review summarises the existing literature, with a view to aid physicians and healthcare practitioners better summarise evidence for pacing in ME/CFS and use this knowledge for other post-viral fatiguing conditions. Overall, studies generally reported pacing to be beneficial for people with ME/CFS. The exception to this trend is the controversial PACE trial [ 36 , 37 , 38 , 39 ], which we will expand on in subsequent sections. We believe information generated within this review can facilitate discussion of research opportunities and issues that need to be addressed in future studies concerning pacing, particularly given the immediate public health issue of the long COVID pandemic. As mentioned, we found some preliminary evidence for improved symptoms following pacing interventions or strategies. However, we wish to caution the reader that the current evidence base is extremely limited and hampered by several limitations which preclude clear conclusions on the efficacy of pacing. Firstly, studies were of poor to fair methodological quality (indicated by the PEDro scores), often with small sample sizes, and therefore unknown power to detect change. Moreover, very few studies implemented pacing, with most studies merely consulting on people’s views on pacing. This may of course lead to multiple biases such as reporting, recruitment, survivorship, confirmation, availability heuristic, to name but a few. Thus, there is a pressing need for more high-quality intervention studies. Secondly, the reporting of pacing strategies used was inconsistent and lacked detail, making it difficult to describe current approaches, or implement them in future research or symptom management strategies. Furthermore, outcome evaluations varied greatly between studies. This prevents any appropriate synthesis of research findings.

The lack of evidence concerning pacing is concerning given pacing is the only NICE recommended management strategy for ME/CFS following the 2021 update [ 34 ]. Given the analogous nature of long COVID with ME/CFS, patients and practitioners will be looking to the ME/CFS literature for guidance for symptom management. There is an urgent need for high quality studies (such as RCTs) investigating the effectiveness of pacing and better reporting of pacing intervention strategies so that clear recommendations can be made to patients. If this does not happen soon, there will be serious healthcare and economic implications for years to come [ 65 , 66 ].

Efficacy of pacing

Most studies (12/17) highlighted improvements in at least one outcome measure following pacing. Pacing was self-reported to be the most efficacious, safe, acceptable, and preferred form of activity management for people with ME/CFS [ 55 ]. Pacing was reported to improve symptoms and improve general health outcomes [ 25 , 50 , 52 , 58 , 63 ], fatigue and PEM [ 48 , 50 , 51 , 53 , 54 , 55 , 56 , 60 , 63 ], physical functioning [ 48 , 50 , 51 , 53 , 56 , 58 , 60 , 63 ], pain [ 25 , 50 , 55 , 63 ], quality of life [ 50 ], self-efficacy [ 50 , 53 ], sleep [ 53 , 55 ], and depression and anxiety [ 50 , 53 , 63 ]. These positive findings provide hope for those with ME/CFS, and other chronic fatiguing conditions such as long COVID, to improve quality of life through symptom management.

Conversely, some studies reported no effects of pacing on ME/CFS symptoms [ 52 ], fatigue, physical functioning [ 35 ], or pain scores [ 49 , 61 ]. Some studies even found pacing to have detrimental effects in those with ME/CFS, including a worsening of symptoms in 14% of survey participants recalling previous pacing experiences [ 52 ]. Furthermore, a worsening of fatigue [ 35 , 59 ], and physical functioning from pre- to post-pacing [ 35 , 57 , 59 , 61 ] was reported by the PACE trial and sub-analysis of the PACE trial [ 56 , 57 , 61 ]. The PACE trial [ 35 ], a large RCT (n = 639) comparing pacing with CBT and GET, reported GET and CBT were more effective for reducing ME/CFS-related fatigue and improving physical functioning than pacing. However, the methodology and conclusions from the PACE trial have been heavily criticised, mainly due to the authors lowering the thresholds they used to determine improvement [ 36 , 37 , 38 , 67 ]. With this in mind, Sharpe et al. [ 56 ] surveyed 75% of the participants from the PACE trial 1-year post-intervention and reported pacing improved fatigue and physical functioning, with effects similar to CBT and GET.

Lessons for pacing implementation

All pacing intervention studies (5/5) implemented educational or coaching sessions. These educational components were poorly reported in terms of the specific content and how and where they had been developed, with unclear pedagogical approaches. Consequently, even where interventions reported reduction in PEM or improved symptoms, it would be impossible to transfer that research into practice, future studies, or clinical guidance, given the ambiguity of reporting. Sessions typically contained themes of pacing such as activity adjustment (decrease, break-up, and reschedule activities based on energy levels), activity consistency (maintaining a consistently low level of activity to prevent PEM), activity planning (planning activities and rest around available energy levels), and activity progression (slowly progressing activity once maintaining a steady baseline) [ 35 , 48 , 49 , 50 , 51 ]. We feel it is pertinent to note here that although activity progression has been incorporated as a pacing strategy in these included studies, some view activity progression as a form of GET. The NICE definition of GET is “first establishing an individual's baseline of achievable exercise or physical activity, then making fixed incremental increases in the time spent being physically active” [ 34 ]. Thus, this form of pacing can also be considered a type of ‘long-term GET’ in which physical activity progression is performed over weeks or months with fixed incremental increases in time spent being physically.

Intervention studies attempted to create behaviour change, through educational programmes to modify physical activity, and plan behaviours. However, none of these studies detailed integrating any evidence-based theories of behaviour change [ 68 ] or reported using any frameworks to support behaviour change objectives. This is unfortunate since there is good evidence that theory-driven behaviour change interventions result in greater intervention effects [ 69 ]. Indeed, there is a large body of work regarding methods of behaviour change covering public health messaging, education, and intervention design, which has largely been ignored by the pacing literature. Interventions relied on subjective pacing (5/5 studies), with strategies including keeping an activity diary (3/5 studies) to identify links between activity and fatigue [ 35 , 48 , 50 ]. Given the high prevalence of ‘brain fog’ within ME/CFS [ 70 , 71 , 72 , 73 ], recall may be extremely difficult and there is significant potential for under-reporting. Other strategies included simply asking participants to estimate energy levels available for daily activities (2/5 studies [ 48 , 51 ]). Again, this is subjective and relies on participants’ ability to recall previous consequences of the activity. Other methods of activity tracking and measuring energy availability, such as wearable technology [ 74 , 75 , 76 , 77 , 78 ] could provide a more objective measure of adherence and pacing strategy fidelity in future studies. Despite technology such as accelerometers being widely accessible since well-before the earliest interventional study included in this review (which was published in 2009), none of the interventional studies utilised objective activity tracking to track pacing and provide feedback to participants. One study considered accelerometery alongside an activity diary [ 51 ]. However, accelerometery was considered the outcome variable, to assess change in activity levels from pre- to post-intervention and was not part of the intervention itself (which was one pacing coaching sessions per week for 3 weeks). Moreover, most research-grade accelerometers cannot be used as part of the intervention since they have no ability to provide continuous feedback and must be retrieved by the research team in order to access any data. Consequently, their use is mostly limited to outcome assessments only. As pacing comprises a limit to physical activity to prevent push-crash cycles, it is an astonishing observation from this scoping review that only two studies objectively measured physical activity to quantify changes to activity as a result of pacing [ 51 , 54 ]. If the aim of pacing is to reduce physical activity, or reduce variations in physical activity (i.e., push-crash cycles), only two studies have objectively quantified the effect pacing had on physical activity, so it is unclear whether pacing was successfully implemented in any of the other studies.

By exploring the pacing strategies previously used, in both intervention studies and more exploratory studies, we can identify and recommend approaches to improve symptoms of ME/CFS. These approaches can be categorised as follows: activity planning, activity consistency, activity progression, activity adjustment and staying within the Energy Envelope [ 50 , 53 , 60 , 63 ]. Activity planning was identified as a particularly effective therapeutic strategy, resulting in improvement of mean scores of all symptoms included in the APQ-28, reducing current pain, improvement of physical fatigue, mental fatigue, self-efficacy, quality of life, and mental and physical functioning [ 50 ]. Activity planning aligns with the self-regulatory behaviour change technique ‘Action Planning’ [ 79 ] which is commonly used to increase physical activity behaviour. In the case of ME/CFS, activity planning is successfully used to minimise rather than increase physical activity bouts to prevent expending too much energy and avoid PEM. Activity consistency, meaning undertaking similar amounts of activity each day, was also associated with reduced levels of depression, exercise avoidance, and higher levels of physical function [ 63 ]. Activity progression was associated with higher levels of current pain. Activity adjustment associated with depression and avoidance, and lower levels of physical function [ 63 ]. Staying within the Energy Envelope was reported to reduce PEM severity [ 53 , 60 ], improve physical functioning [ 53 , 60 ] and ME/CFS symptom scores [ 53 ], and more hours engaged in activity than individuals with lower available energy [ 53 ]. These results suggest that effective pacing strategies would include activity planning, consistency, and energy management techniques while avoiding progression. This data is, of course, limited by the small number of mostly low-quality studies and should be interpreted with some caution. Nevertheless, these are considerations that repeatedly appear in the literature and, as such, warrant deeper investigation. In addition, and as outlined earlier, most studies are relatively old, and we urgently need better insight into how modern technologies, particularly longitudinal activity tracking and contemporaneous heart-rate feedback, might improve (or otherwise) adaptive pacing. Such longitudinal tracking would also enable activities and other behaviours (sleep, diet, stress) to be linked to bouts of PEM. Linking would enable a deeper insight into potential PEM triggers and mitigations that might be possible.

The PACE trial

We feel it would be remiss of us to not specifically address the PACE trial within this manuscript, as five of the 17 included studies resulted from the PACE trial [ 35 , 56 , 57 , 59 , 61 ]. There has been considerable discussion around the PACE trial, which has been particularly divisive and controversial [ 37 , 38 , 39 , 59 , 67 , 80 , 81 ]. In the PACE trial, GET and CBT were deemed superior to pacing by the authors. Despite its size and funding, the PACE trial has received several published criticisms and rebuttals. Notably, NICE's most recent ME/CFS guideline update removed GET and CBT as suggested treatment options, which hitherto had been underpinned by the PACE findings. While we will not restate the criticisms and rebuttals here, what is not in doubt, is that the PACE trial has dominated discussions of pacing, representing almost a third of all the studies in this review. However, the trial results were published over a decade ago, with the study protocol devised almost two decades ago [ 82 ]. The intervening time has seen a revolution in the development of mobile and wearable technology and an ability to remotely track activity and provide real-time feedback in a way which was not available at that time. Furthermore, there has been no substantive research since the PACE trial that has attempted such work. Indeed, possibly driven by the reported lack of effect of pacing in the PACE trial, this review has demonstrated the dearth of progress and innovation in pacing research since its publication. Therefore, regardless of its findings or criticisms, the pacing implementation in the PACE trial is dated, and there is an urgent need for more technologically informed approaches to pacing research.

Limitations of the current evidence

The first limitation to the literature included in this scoping review is that not all studies followed the minimum data set (MDS) of patient-reported outcome measures (PROMs) agreed upon by the British Association of CFS/ME Professionals (BACME) (fatigue, sleep quality, self-efficacy, pain/discomfort, anxiety/depression, mobility, activities of daily living, self-care, and illness severity) [ 83 , 84 ]. All but one study included in this review measured illness severity, most studies included fatigue and pain/discomfort, and some studies included assessments of anxiety/depression. There was a lack of quantitative assessment of sleep quality, self-efficacy, mobility, activities of daily living, and self-care. Therefore, studies did not consistently capture the diverse nature of the symptoms experienced, with crucial domains missing from the analyses. The MDS of PROMs were established in 2012 [ 83 , 84 ] and therefore, for studies published out prior to 2012, these are not applicable [ 35 , 49 , 51 , 53 , 54 ]. However, for the 12 studies carried out after this time, the MDS should have been considered elucidate the effects of pacing on ME/CFS. Importantly, despite PEM being a central characteristic of ME/CFS, only two studies included PEM as an outcome measure [ 55 , 60 ]. This may be because of the difficulty of accurately measuring fluctuating symptoms, as PEM occurs multiple times over a period of months, and therefore pre- to post- studies and cross-sectional designs cannot adequately capture PEM incidence. Therefore, it is likely studies opted for measuring general fatigue instead. More appropriate longitudinal study designs are required to track PEM over time to capture a more representative picture of PEM patterns. Secondly, reporting of participant characteristics was inadequate, but in the studies that did describe participants, characteristics were congruent with the epidemiological literature and reporting of ME/CFS populations (i.e., 60–65% female) [ 85 ]. Therefore, in this respect, studies included herein were representative samples. However, the lack of reporting of participant characteristics limits inferences we can draw concerning any population-related effects (i.e. whether older, or male, or European, or people referred by a national health service would be more or less likely to respond positively to pacing). Thirdly, comparison groups (where included) were not ideal, with CBT or GET sometimes used as comparators to pacing [ 35 ], and often no true control group included. Penultimately, there is a distinct lack of high-quality RCTs (as mentioned throughout this manuscript). Finally, in reference to the previous section, inferences from the literature are dated and do not reflect the technological capabilities of 2023.

Recommendations for advancement of the investigative area

It is clear from the studies included in this scoping review for the last decade or more, progress and innovation in pacing research have been limited. This is unfortunate for several reasons. People with ME/CFS or long COVID are, of course, invested in their recovery. From our patient and public involvement (PPI) group engagement, it is clear many are ahead of the research and are using wearable technology to track steps, heart rate, and, in some cases, heart rate variability to improve their own pacing practice. While the lack of progress in the research means this is an understandable response by patients, it is also problematic. Without underpinning research, patients may make decisions based on an individual report of trial-and-error approaches given the lack of evidence-based guidance.

A more technologically-informed pacing approach could be implemented by integrating wearable trackers [ 77 , 78 , 86 , 87 ] to provide participants with live updates on their activity and could be integrated with research-informed messaging aimed at supporting behaviour change, as has been trialled in other research areas [ 88 , 89 , 90 , 91 ]. However, more work is needed to evaluate how to incorporate wearable activity trackers and which metrics are most helpful.

A more technologically-informed approach could also be beneficial for longitudinal symptom tracking, particularly useful given the highly variable symptom loads of ME/CFS and episodic nature of PEM. This would overcome reliance on assessments at a single point in time (as the studies within this review conducted). Similarly, mobile health (mHealth) approaches also allow questionnaires to be digitised to make it easier for participants to complete if they find holding a pen or reading small font problematic [ 92 ]. Reminders and notifications can also be helpful for patients completing tasks [ 77 , 93 , 94 , 95 ]. This approach has the added advantage of allowing contemporaneous data collection rather than relying on pre- to post-intervention designs limited by recall bias. Future work must try to leverage these approaches, as unless we collect large data sets on symptoms and behaviours (i.e. activity, diet, sleep, and pharmacology) in people with conditions like ME/CFS we will not be able to leverage emerging technologies such as AI and machine learning to improve the support and care for people with these debilitating conditions. The key areas for research outline in the NICE guidelines (2021 update) speaks to this, with specific mention of improved self-monitoring strategies, sleep strategies, and dietary strategies, all of which can be measured using mHealth approaches, in a scalable and labour-inexpensive way.

The potential for existing pacing research to address the long COVID pandemic

There is now an urgent public health need to address long COVID, with over 200 million sufferers worldwide [ 30 ]. Given the analogous symptomology between ME/CFS and long COVID, and the lack of promising treatment and management strategies in ME/CFS, pacing remains the only strategy for managing long COVID symptoms. This is concerning as the quality of evidence to support pacing is lacking. Given long COVID has reached pandemic proportions, scalable solutions will be required. In this context, we propose that technology should be harnessed to a) deliver, but also b) evaluate, pacing. We recently reported on a just-in-time adaptive intervention to increase physical activity during the pandemic [ 78 ]. However, this method could be adapted to decrease or maintain physical activity levels (i.e., pacing) in long COVID. This method has the advantage of scalability and remote data collection, reducing resource commitments and participant burden, essential for addressing a condition with so many sufferers.

This review highlights the need for more studies concerning pacing in chronic fatiguing conditions. Future studies would benefit from examining pacing’s effect on symptomology and PEM with objectively quantified pacing, over a longer duration of examination, using the MDS. It is essential this is conducted as an RCT, given that in the case of long COVID, participants may improve their health over time, and it is necessary to determine whether pacing exerts an additional effect over time elapsing. Future studies would benefit from digitising pacing to support individuals with varying symptom severity and personalise support. This would improve accessibility and reduce selection bias, in addition to improving scalability of interventions. Finally, clinicians and practitioners should be cognisant of the strength of evidence reported in this review and should exert caution when promoting pacing in their patients, given the varying methods utilised herein.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Activity Pacing Questionnaire

Beck Anxiety Inventory

Beck Depression Inventory

Brief Coping Orientation to Problems Experienced Scale

Canadian Occupational Performance Measure

Centers for disease control and prevention

Chalder Fatigue Questionnaire

Checklist Individual Strength

Chronic Pain Coping Inventory

Cognitive behavioural therapy

Cochrane Central Register of Controlled Trials

DePaul symptom questionnaire

EuroQol five-dimensions, five-levels questionnaire

Graded exercise therapy

Hospital Anxiety and Depression Scale

Myalgic encephalomyelitis/chronic fatigue syndrome

Pain Self Efficacy Questionnaire

Pain Anxiety Symptoms Scale short version

Pain Numerical Rating Scale

Patient health questionnaire

Patient reported outcome measures

Physiotherapy Evidence Database

Perceived Stress Scale

Post exertional malaise

Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews

Randomised control trial

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Sanal-Hayes, N.E.M., Mclaughlin, M., Hayes, L.D. et al. A scoping review of ‘Pacing’ for management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): lessons learned for the long COVID pandemic. J Transl Med 21 , 720 (2023). https://doi.org/10.1186/s12967-023-04587-5

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• Myalgic encephalomyelitis
• Chronic fatigue syndrome
• Post-exertional malaise

Journal of Translational Medicine

ISSN: 1479-5876

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