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Clinical Update
Writingnarrativeliteraturereviewsfor
peer-reviewedjournals:secretsof
thetrade
a
BartN.Green,DC,MSEd,DACBSP ,
ClaireD.Johnson,DC,MSEd,DACBSPb,
AlanAdams,DC,MS,MSEd,DACBNc
aAssociate Editor, National University of Health Sciences. bEditor, National University of Health Sciences.
cVice President of Academic Affairs and Program Development, Texas Chiropractic College
Submitrequests for reprints to: Dr. Bart Green, National University of Health Sciences, 200 E. Roosevelt Rd,
Lombard, IL 60148, bgreen@nuhs.edu
Sources of support: This article is reprinted with permission. Its original citation is: Green BN, Johnson CD,
Adams A. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Sports
Chiropr Rehabil 2001;15:5–19.
ABSTRACT
Objective: To describe and discuss the process used to write a narrative review of the literature for publication in
a peer-reviewed journal. Publication of narrative overviews of the literature should be standardized to increase
their objectivity.
Background: In the past decade numerous changes in research methodology pertaining to reviews of the literature
have occurred. These changes necessitate authors of review articles to be familiar with current standards in the
publication process.
Methods: Narrative overview of the literature synthesizing the findings of literature retrieved from searches of
computerized databases, hand searches, and authoritative texts.
Discussion: An overview of the use of three types of reviews of the literature is presented. Step by step instructions
for how to conduct and write a narrative overview utilizing a ‘best-evidence synthesis’ approach are discussed,
starting with appropriate preparatory work and ending with how to create proper illustrations. Several resources
for creating reviews of the literature are presented and a narrative overview critical appraisal worksheet is
included. A bibliography of other useful reading is presented in an appendix.
Conclusion: Narrative overviews can be a valuable contribution to the literature if prepared properly. New and
experienced authors wishing to write a narrative overview should find this article useful in constructing such a
paper and carrying out the research process. It is hoped that this article will stimulate scholarly dialog amongst
colleagues about this research design and other complex literature review methods. (J Chiropr Med 2006;5:101–
117)
Key Indexing Terms: Review Literature; Authorship; Peer Review, research; Manuscripts; Meta-
analysis
0899-3467/Clinical Update/1002-049$3.00/0 101
JOURNAL OF CHIROPRACTIC MEDICINE
Copyright © 2006 by National University of Health Sciences
Volume5 • Number3 • Fall2006
INTRODUCTION reviews also provide information for decision mak-
ers and are used by researchers to identify, justify
Background and refine hypotheses and to recognize and avoid
pitfalls in previous research.1,8 Additionally, reviews
The purpose of this article is to describe and discuss of the literature provide a basis for validating as-
the research design known as a review of the litera- 9
sumptions, provide insight into the dynamics un-
ture and to delineate how to write a particular vari- 10
derlying the findings of other studies and may
ety of this research design, the narrative overview of offer more conclusive results than a single primary
the literature. Another intention of this article is to 11
research study. Depending on the variety of litera-
provide educational information and assistance for ture review, they may provide a very high level of
those who have not yet published a literature re- evidence for making clinical practice decisions.
view and to decrease potential author frustration
that can arise during the peer review process. It is One of the cautions that one must consider with
important to note that the general classification of literature reviews is the bias that is often associated
’literature review’ has three varieties: narrative re- with them.10,11,12,13 As an author, it is important to
view, qualitative systematic review and quantitative attempt to reduce bias as much as possible through
systematic review. Each will be addressed in this appropriate writing and research techniques. An in-
article. However, the primary focus of this article crease in objectivity leads to improved utility and
will be on the writing of a narrative review. credibility in publications.14 While certain criteria
1
for literature reviews have been published, little
Aliterature review is a type of research article pub- has been accomplished in terms of standardizing
lished in a professional peer-reviewed journal. The and verifying the validity of the criteria pro-
purpose of a literature review is to objectively report posed.1,14 Indeed, many changes have taken place
the current knowledge on a topic and base this in recent years regarding publication standards for
1 10,12
summary on previously published research. A lit- literature reviews andit is important for authors
erature review provides the reader with a compre- to keep current with these changes. This paper
hensive overview and helps place that information clearly states the minimum acceptable criteria they
into perspective.2 pertain to narrative overviews of the literature.
The literature review research design is different METHODS
from other research designs because rather than Information used to write this paper was collected
patients, data to write the report are collected from from the sources listed in table 1.
3,4
the published literature. These full length articles
provide a new conclusion to the literature, not the DISCUSSION
brief summary of literature that is given typically in
the introduction or discussion sections of other re- Three Varieties of Reviews of the Literature
search designs.2,5 In creating a literature review, the
author searches through the literature, retrieves nu- The three basic types of literature reviews are nar-
merous sources of information and synthesizes the rative reviews, qualitative systematic reviews, and
2,3,6
findings of all relevant sources into one article.
Thus, a vast amount of information is brought to- Table 1
gether and written in a manner in which the reader Sources Used for This Overview
can clearly understand the topic. • MEDLINEsearch1966–January2001.Keywords:
Review of the Literature; Authorship; Meta-analysis;
There are several reasons to read reviews of the Narrative overview.
• CINAHL search from 1982 to December 2000. Key
literature. For the clinician, they can save valuable words: Review of the Literature; Authorship;
time when reviewing or searching for information Meta-analysis; Narrative overview.
about patient care by condensing a great amount of • Hand searches of the references of retrieved
literature.
1,6,7 • Personal and college libraries searching for texts
information into a few pages. The clinician can
read one paper instead of sifting through the whole onresearchmethodsandliteraturereviews.
of the literature to find the answer to a clinical • Discussions with experts in the field of reviews of
the literature.
question; the author of the literature review has • Personal experience participating in and writing
already done most of this work for him. Literature several reviews of the literature.
102
Fall2006 • Number3 • Volume5
quantitative systematic reviews (meta-analyses). author to determine which of these two paths to
The amount of clinical evidence afforded by each of take when writing the article.
these designs increases as the methods employed to
conduct them become more detailed and elaborate. There are many good reasons to write a quality
In this section, the emphasis will be placed on nar- narrative overview. Narrative overviews are useful
rative reviews, since they are the subject of this educational articles since they pull many pieces of
article; a brief description of qualitative and quanti- information together into a readable format. They
tative systematic reviews will also be given. are helpful in presenting a broad perspective on a
topic and often describe the history or development
2,10
Narrative Literature Review of a problem or its management. Faculty like to
use overviews in the classroom because they are
There are three types of narrative reviews of the often more up to date than textbooks, provide a
literature: editorials, commentaries, and overview single source for students to read from, and expose
articles.4,15 students to peer reviewed literature. Narrative over-
views are also used as educational articles to bring
practitioners up to date with certain clinical proto-
Editorials, typically written by the editor of the jour- cols.7,11 Some journals, publish quizzes related to
nal or an invited guest, may be a narrative review if such articles; these quizzes can be submitted to
the author retrieves and synthesizes information regulating boards for continuing education credit.
about a particular topic for the reader. Usually these
types of narrative reviews are based upon a short, Often discussing theory and context, narrative over-
select and narrowly focused review of only a few views can serve to provoke thought and contro-
15
papers. However, editorials may be no more than versy. For this reason, these reviews may be an
the editor’s comments regarding a current issue of excellent venue for presenting philosophical per-
the journal or a current event in health care. There- spectives in a balanced manner. Philosophical ar-
fore, editorials do not automatically qualify as nar- ticles can be excellent for stimulating scholarly dia-
rative reviews. log amongst readers. Readers can participate in this
process by writing to the letters to the editor section
Commentaries may also be written as a narrative of the journal and present their opinions and critical
review, however they are typically written with a appraisal. The letters to the editor section can be a
4 dynamic part of a journal; several times in the his-
particular opinion being expressed. In these articles
research methodology is usually not presented and tory of health care tremendous insight into patient
the author’s synthesis of the articles demonstrates management and research design has been pre-
7
bias. Commentaries are usually shorter than a full sented in this forum.
length review article and it is expected that the Authors of narrative overviews are often acknowl-
author possesses expertise in the content area of the edged experts in the field and have conducted re-
commentary. In short, a commentary is a biased 6,7,15,18
narrative review that draws upon the wisdom of the search themselves. Editors sometimes solicit
commentator. Usually the purpose of a commentary narrative overviews from specific authors in order to
18
is to provoke scholarly dialog among the readers of bring certain issues to light. Authors must be care-
the journal. ful to avoid a common pitfall of the overview de-
sign, which is to present an opinion oriented argu-
ment based upon a myriad of references,3 rather
Narrative overviews, also known as an unsystematic than objective conclusions based upon the literature
16
narrative reviews, are comprehensive narrative syn- reviewed. For this reason, some studies have deter-
theses of previously published information. The de- mined that some experts are less likely to adhere to
tails of how to prepare this type of article are pre- high levels of methodological rigor when writing
sented in this paper. This type of literature review 14
these papers than non-experts. Therefore, wheth-
reports the author’s findings in a condensed format er one is a novice or expert, the critical factor in
that typically summarizes the contents of each ar- writing a good narrative review is to use good meth-
1
ticle. Some researchers suggest that a proper narra- ods.
tive overview should critique each study in-
cluded,2,17 but other authors write that this is not Once quite common, overviews are slowly falling
necessarily a property of overviews.1 It is up to the into disfavor in some journals due to a lack of
103
Volume5 • Number3 • Fall2006
systematic methods that should be employed to Qualitative Systematic Literature Review
construct them.11,19 Rarely have the methods used
in creating the paper been divulged to the A systematic review is a type of literature review
1,10,11 that employs detailed, rigorous and explicit meth-
reader, which is a problem identified as early
20 4,22,23
as 1987. Usually the number of sources employed ods. A detailed search of the literature based
4,10
to find the literature are incomplete, possibly upon a focused question or purpose is the hallmark
4,22
creating an insignificant knowledge base from of a systematic review. Since the review is struc-
which to draw a conclusion. In this rather unsys- tured around a focused clinical question, it allows
tematic approach, selection of information from the researcher to develop criteria that determine if a
primary articles is usually subjective, lacks explicit research publication should be included or excluded
22,23
criteria for inclusion and leads to a biased re- in the final synthesis. Step-by-step methodology
view.4,7,10,13,16 The author’s interpretation and syn- used in the research is described. Authors of system-
thesis of information should take into account ma- atic reviews attempt to obtain all original (primary)
jor differences between studies, such as if patients research studies published on the topic under study
samples in one study are completely different than bysearching in multiple databases, performing hand
4
in another or that research designs are not compa- searches and contacting authors of previously pub-
rable.3,7 Without identifying these differences, one lished research. Additionally, authors will attempt
takes the risk of providing faulty conclusions or to locate articles that may not have been published
incorrect information. All of these potential pitfalls because the results of the study did not support the
are avoidable if the author is aware of them and research hypothesis.1,4,22,23
takes the appropriate steps to avoid them.
Each paper is reviewed in a systematic and consis-
In the past, many reviews of the literature were tent manner, usually by several independent re-
constructed based upon the personal papers of the viewers, and usually rated using a scoring system by
author, creating a bias that was slanted to what that the authors.1,4,23 Each piece of evidence drawn from
author found interesting or controversial.3 When a paper for the literature review is extracted in the
this occurs it is difficult to discern if the author has same fashion to help decrease the bias that occurs
constructed an objective review of the literature or a when this information extraction is done subjec-
lengthy commentary. Biased writers will draw con- tively, such as in a narrative overview.22 Authors
clusions based more on opinion than data, which is create data, or evidence tables, in order to tease out
13,16 the differences in the results of different studies.24
not a truthful representation of the research.
Often times this faulty synthesis is then repeated by These reviews of the literature are called qualitative
other authors and the mistakes are handed down because the process by which the individual studies
from one study to the next,1 thus perpetuating the are integrated includes a summary and critique of
errors. The aforementioned problems related to lit- the findings derived from systematic methods, but
erature reviews are a potential danger in health care does not statistically combine the results of all of the
22,24
if readers make patient health care decisions based studies reviewed.
13,18
upon faulty reviews.
Because of the rigorous methods employed in con-
While narrative overviews are great papers to read ducting qualitative systematic reviews, they are a
to keep up to date, receive continuing education more powerful evidence-based source to garner
credits, or challenge your way of thinking, they are clinical information than narrative reviews, case re-
not a form of evidence that should be used fre- ports, case series, and poorly conducted cohort stud-
21
quently when making decisions about how to solve ies.
specific clinical patient problems. Narrative over-
views are one of the weakest forms of evidence to Quantitative Systematic Literature
use for making clinical decisions in regard to patient Review (Meta-analyses)
21 primarily because they deal more with
care,
broader issues than focused clinical problems. Addi- A systematic review that critically evaluates each
tionally, there is a higher degree of bias involved in paper and statistically combines the results of the
overviews than some other research designs.21,22 studies is called a quantitative systematic review of
Nevertheless, narrative overviews constitute an im- the literature, also known as a meta-analy-
portant component in the literature base. sis.1,10,22,23,24 Introduced in 1976, meta-analyses
104
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