advantages of using literature review

Advantages and disadvantages of literature review

This comprehensive article explores some of the advantages and disadvantages of literature review in research. Reviewing relevant literature is a key area in research, and indeed, it is a research activity in itself. It helps researchers investigate a particular topic in detail. However, it has some limitations as well.

What is literature review?

In order to understand the advantages and disadvantages of literature review, it is important to understand what a literature review is and how it differs from other methods of research. According to Jones and Gratton (2009) a literature review essentially consists of critically reading, evaluating, and organising existing literature on a topic to assess the state of knowledge in the area. It is sometimes called critical review.

A literature review is a select analysis of existing research which is relevant to a researcher’s selected topic, showing how it relates to their investigation. It explains and justifies how their investigation may help answer some of the questions or gaps in the chosen area of study (University of Reading, 2022).

A literature review is a term used in the field of research to describe a systematic and methodical investigation of the relevant literature on a particular topic. In other words, it is an analysis of existing research on a topic in order to identify any relevant studies and draw conclusions about the topic.

A literature review is not the same as a bibliography or a database search. Rather than simply listing references to sources of information, a literature review involves critically evaluating and summarizing existing research on a topic. As such, it is a much more detailed and complex process than simply searching databases and websites, and it requires a lot of effort and skills.

Advantages of literature review

Information synthesis

A literature review is a very thorough and methodical exercise. It can be used to synthesize information and draw conclusions about a particular topic. Through a careful evaluation and critical summarization, researchers can draw a clear and comprehensive picture of the chosen topic.

Familiarity with the current knowledge

According to the University of Illinois (2022), literature reviews allow researchers to gain familiarity with the existing knowledge in their selected field, as well as the boundaries and limitations of that field.

Creation of new body of knowledge

One of the key advantages of literature review is that it creates new body of knowledge. Through careful evaluation and critical summarisation, researchers can create a new body of knowledge and enrich the field of study.

Answers to a range of questions

Literature reviews help researchers analyse the existing body of knowledge to determine the answers to a range of questions concerning a particular subject.

Disadvantages of literature review

Time consuming

As a literature review involves collecting and evaluating research and summarizing the findings, it requires a significant amount of time. To conduct a comprehensive review, researchers need to read many different articles and analyse a lot of data. This means that their review will take a long time to complete.

Lack of quality sources

Researchers are expected to use a wide variety of sources of information to present a comprehensive review. However, it may sometimes be challenging for them to identify the quality sources because of the availability of huge numbers in their chosen field. It may also happen because of the lack of past empirical work, particularly if the selected topic is an unpopular one.

Descriptive writing

One of the major disadvantages of literature review is that instead of critical appreciation, some researchers end up developing reviews that are mostly descriptive. Their reviews are often more like summaries of the work of other writers and lack in criticality. It is worth noting that they must go beyond describing the literature.

Key features of literature review

Clear organisation

A literature review is typically a very critical and thorough process. Universities usually recommend students a particular structure to develop their reviews. Like all other academic writings, a review starts with an introduction and ends with a conclusion. Between the beginning and the end, researchers present the main body of the review containing the critical discussion of sources.

No obvious bias

A key feature of a literature review is that it should be very unbiased and objective. However, it should be mentioned that researchers may sometimes be influenced by their own opinions of the world.

Proper citation

One of the key features of literature review is that it must be properly cited. Researchers should include all the sources that they have used for information. They must do citations and provide a reference list by the end in line with a recognized referencing system such as Harvard.

To conclude this article, it can be said that a literature review is a type of research that seeks to examine and summarise existing research on a particular topic. It is an essential part of a dissertation/thesis. However, it is not an easy thing to handle by an inexperienced person. It also requires a lot of time and patience.

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Conducting a Literature Review

Benefits of conducting a literature review.

Steps in Conducting a Literature Review
Summary of the Process
Additional Resources
Literature Review Tutorial by American University Library
The Literature Review: A Few Tips On Conducting It by University of Toronto
Write a Literature Review by UC Santa Cruz University Library

While there might be many reasons for conducting a literature review, following are four key outcomes of doing the review.

Assessment of the current state of research on a topic . This is probably the most obvious value of the literature review. Once a researcher has determined an area to work with for a research project, a search of relevant information sources will help determine what is already known about the topic and how extensively the topic has already been researched.

Identification of the experts on a particular topic . One of the additional benefits derived from doing the literature review is that it will quickly reveal which researchers have written the most on a particular topic and are, therefore, probably the experts on the topic. Someone who has written twenty articles on a topic or on related topics is more than likely more knowledgeable than someone who has written a single article. This same writer will likely turn up as a reference in most of the other articles written on the same topic. From the number of articles written by the author and the number of times the writer has been cited by other authors, a researcher will be able to assume that the particular author is an expert in the area and, thus, a key resource for consultation in the current research to be undertaken.

Identification of key questions about a topic that need further research . In many cases a researcher may discover new angles that need further exploration by reviewing what has already been written on a topic. For example, research may suggest that listening to music while studying might lead to better retention of ideas, but the research might not have assessed whether a particular style of music is more beneficial than another. A researcher who is interested in pursuing this topic would then do well to follow up existing studies with a new study, based on previous research, that tries to identify which styles of music are most beneficial to retention.

Determination of methodologies used in past studies of the same or similar topics. It is often useful to review the types of studies that previous researchers have launched as a means of determining what approaches might be of most benefit in further developing a topic. By the same token, a review of previously conducted studies might lend itself to researchers determining a new angle for approaching research.

Upon completion of the literature review, a researcher should have a solid foundation of knowledge in the area and a good feel for the direction any new research should take. Should any additional questions arise during the course of the research, the researcher will know which experts to consult in order to quickly clear up those questions.

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Conducting a literature review: why do a literature review, why do a literature review.

How To Find "The Literature"
Found it -- Now What?

Besides the obvious reason for students -- because it is assigned! -- a literature review helps you explore the research that has come before you, to see how your research question has (or has not) already been addressed.

You identify:

core research in the field
experts in the subject area
methodology you may want to use (or avoid)
gaps in knowledge -- or where your research would fit in

It Also Helps You:

Publish and share your findings
Justify requests for grants and other funding
Identify best practices to inform practice
Set wider context for a program evaluation
Compile information to support community organizing

Great brief overview, from NCSU

Want To Know More?

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Last Updated: Apr 25, 2024 1:10 PM
URL: https://guides.lib.berkeley.edu/litreview

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

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

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

What are Literature Reviews?

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

Goals of Literature Reviews

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

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

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

What kinds of sources require a Literature Review?

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

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

Types of Literature Reviews

What kinds of literature reviews are written?

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

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

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

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

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

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

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

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

Literature Reviews in the Health Sciences

UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
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Last Updated: Sep 21, 2022 2:16 PM
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Methodology

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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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.

Prevent plagiarism. Run a free check.

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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McCombes, S. (2023, September 11). How to Write a Literature Review | Guide, Examples, & Templates. Scribbr. Retrieved September 23, 2024, from https://www.scribbr.com/dissertation/literature-review/

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Writing Tips

What is the Purpose of a Literature Review?

4-minute read

23rd October 2023

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

1. Provide a foundation for current research.

2. Define key concepts and theories.

3. Demonstrate critical evaluation.

4. Show how research and methodologies have evolved.

5. Identify gaps in existing research.

6. Support your argument.

Keep reading to enter the exciting world of literature reviews!

What is a Literature Review?

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

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

Provide a Foundation for Current Research

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

Define Key Concepts and Theories

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

Demonstrate Critical Evaluation

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

Show How Research and Methodologies Have Evolved

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

Identify Gaps in Existing Research

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

Support Your Argument

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

Literature Review Editing Services

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

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Writing an effective literature review

Lorelei lingard.

Schulich School of Medicine & Dentistry, Health Sciences Addition, Western University, London, Ontario Canada

In the Writer’s Craft section we offer simple tips to improve your writing in one of three areas: Energy, Clarity and Persuasiveness. Each entry focuses on a key writing feature or strategy, illustrates how it commonly goes wrong, teaches the grammatical underpinnings necessary to understand it and offers suggestions to wield it effectively. We encourage readers to share comments on or suggestions for this section on Twitter, using the hashtag: #how’syourwriting?

This Writer’s Craft instalment is the first in a two-part series that offers strategies for effectively presenting the literature review section of a research manuscript. This piece alerts writers to the importance of not only summarizing what is known but also identifying precisely what is not, in order to explicitly signal the relevance of their research. In this instalment, I will introduce readers to the mapping the gap metaphor, the knowledge claims heuristic, and the need to characterize the gap.

Mapping the gap

The purpose of the literature review section of a manuscript is not to report what is known about your topic. The purpose is to identify what remains unknown— what academic writing scholar Janet Giltrow has called the ‘knowledge deficit’ — thus establishing the need for your research study [ 1 ]. In an earlier Writer’s Craft instalment, the Problem-Gap-Hook heuristic was introduced as a way of opening your paper with a clear statement of the problem that your work grapples with, the gap in our current knowledge about that problem, and the reason the gap matters [ 2 ]. This article explains how to use the literature review section of your paper to build and characterize the Gap claim in your Problem-Gap-Hook. The metaphor of ‘mapping the gap’ is a way of thinking about how to select and arrange your review of the existing literature so that readers can recognize why your research needed to be done, and why its results constitute a meaningful advance on what was already known about the topic.

Many writers have learned that the literature review should describe what is known. The trouble with this approach is that it can produce a laundry list of facts-in-the-world that does not persuade the reader that the current study is a necessary next step. Instead, think of your literature review as painting in a map of your research domain: as you review existing knowledge, you are painting in sections of the map, but your goal is not to end with the whole map fully painted. That would mean there is nothing more we need to know about the topic, and that leaves no room for your research. What you want to end up with is a map in which painted sections surround and emphasize a white space, a gap in what is known that matters. Conceptualizing your literature review this way helps to ensure that it achieves its dual goal: of presenting what is known and pointing out what is not—the latter of these goals is necessary for your literature review to establish the necessity and importance of the research you are about to describe in the methods section which will immediately follow the literature review.

To a novice researcher or graduate student, this may seem counterintuitive. Hopefully you have invested significant time in reading the existing literature, and you are understandably keen to demonstrate that you’ve read everything ever published about your topic! Be careful, though, not to use the literature review section to regurgitate all of your reading in manuscript form. For one thing, it creates a laundry list of facts that makes for horrible reading. But there are three other reasons for avoiding this approach. First, you don’t have the space. In published medical education research papers, the literature review is quite short, ranging from a few paragraphs to a few pages, so you can’t summarize everything you’ve read. Second, you’re preaching to the converted. If you approach your paper as a contribution to an ongoing scholarly conversation,[ 2 ] then your literature review should summarize just the aspects of that conversation that are required to situate your conversational turn as informed and relevant. Third, the key to relevance is to point to a gap in what is known. To do so, you summarize what is known for the express purpose of identifying what is not known . Seen this way, the literature review should exert a gravitational pull on the reader, leading them inexorably to the white space on the map of knowledge you’ve painted for them. That white space is the space that your research fills.

Knowledge claims

To help writers move beyond the laundry list, the notion of ‘knowledge claims’ can be useful. A knowledge claim is a way of presenting the growing understanding of the community of researchers who have been exploring your topic. These are not disembodied facts, but rather incremental insights that some in the field may agree with and some may not, depending on their different methodological and disciplinary approaches to the topic. Treating the literature review as a story of the knowledge claims being made by researchers in the field can help writers with one of the most sophisticated aspects of a literature review—locating the knowledge being reviewed. Where does it come from? What is debated? How do different methodologies influence the knowledge being accumulated? And so on.

Consider this example of the knowledge claims (KC), Gap and Hook for the literature review section of a research paper on distributed healthcare teamwork:

KC: We know that poor team communication can cause errors. KC: And we know that team training can be effective in improving team communication. KC: This knowledge has prompted a push to incorporate teamwork training principles into health professions education curricula. KC: However, most of what we know about team training research has come from research with co-located teams—i. e., teams whose members work together in time and space. Gap: Little is known about how teamwork training principles would apply in distributed teams, whose members work asynchronously and are spread across different locations. Hook: Given that much healthcare teamwork is distributed rather than co-located, our curricula will be severely lacking until we create refined teamwork training principles that reflect distributed as well as co-located work contexts.

The ‘We know that …’ structure illustrated in this example is a template for helping you draft and organize. In your final version, your knowledge claims will be expressed with more sophistication. For instance, ‘We know that poor team communication can cause errors’ will become something like ‘Over a decade of patient safety research has demonstrated that poor team communication is the dominant cause of medical errors.’ This simple template of knowledge claims, though, provides an outline for the paragraphs in your literature review, each of which will provide detailed evidence to illustrate a knowledge claim. Using this approach, the order of the paragraphs in the literature review is strategic and persuasive, leading the reader to the gap claim that positions the relevance of the current study. To expand your vocabulary for creating such knowledge claims, linking them logically and positioning yourself amid them, I highly recommend Graff and Birkenstein’s little handbook of ‘templates’ [ 3 ].

As you organize your knowledge claims, you will also want to consider whether you are trying to map the gap in a well-studied field, or a relatively understudied one. The rhetorical challenge is different in each case. In a well-studied field, like professionalism in medical education, you must make a strong, explicit case for the existence of a gap. Readers may come to your paper tired of hearing about this topic and tempted to think we can’t possibly need more knowledge about it. Listing the knowledge claims can help you organize them most effectively and determine which pieces of knowledge may be unnecessary to map the white space your research attempts to fill. This does not mean that you leave out relevant information: your literature review must still be accurate. But, since you will not be able to include everything, selecting carefully among the possible knowledge claims is essential to producing a coherent, well-argued literature review.

Characterizing the gap

Once you’ve identified the gap, your literature review must characterize it. What kind of gap have you found? There are many ways to characterize a gap, but some of the more common include:

a pure knowledge deficit—‘no one has looked at the relationship between longitudinal integrated clerkships and medical student abuse’
a shortcoming in the scholarship, often due to philosophical or methodological tendencies and oversights—‘scholars have interpreted x from a cognitivist perspective, but ignored the humanist perspective’ or ‘to date, we have surveyed the frequency of medical errors committed by residents, but we have not explored their subjective experience of such errors’
a controversy—‘scholars disagree on the definition of professionalism in medicine …’
a pervasive and unproven assumption—‘the theme of technological heroism—technology will solve what ails teamwork—is ubiquitous in the literature, but what is that belief based on?’

To characterize the kind of gap, you need to know the literature thoroughly. That means more than understanding each paper individually; you also need to be placing each paper in relation to others. This may require changing your note-taking technique while you’re reading; take notes on what each paper contributes to knowledge, but also on how it relates to other papers you’ve read, and what it suggests about the kind of gap that is emerging.

In summary, think of your literature review as mapping the gap rather than simply summarizing the known. And pay attention to characterizing the kind of gap you’ve mapped. This strategy can help to make your literature review into a compelling argument rather than a list of facts. It can remind you of the danger of describing so fully what is known that the reader is left with the sense that there is no pressing need to know more. And it can help you to establish a coherence between the kind of gap you’ve identified and the study methodology you will use to fill it.

Acknowledgements

Thanks to Mark Goldszmidt for his feedback on an early version of this manuscript.

PhD, is director of the Centre for Education Research & Innovation at Schulich School of Medicine & Dentistry, and professor for the Department of Medicine at Western University in London, Ontario, Canada.

Harvey Cushing/John Hay Whitney Medical Library

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Steps in Conducting a Literature Review

What is a literature review?

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

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

Why is it important?

A literature review is important because it:

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

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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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The advantage of literature reviews for evidence-based practice

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What is it?

Literature reviews involve collecting information from literature that is already available, similar to a long essay. It is a written argument that builds a case from previous research (Machi and McEvoy, 2012). Every dissertation should include a literature review, but a dissertation as a whole can be a literature review. In this section we discuss literature reviews for the whole dissertation.

What are the benefits of a literature review?

There are advantages and disadvantages to any approach. The advantages of conducting a literature review include accessibility, deeper understanding of your chosen topic, identifying experts and current research within that area, and answering key questions about current research. The disadvantages might include not providing new information on the subject and, depending on the subject area, you may have to include information that is out of date.

How do I write it?

A literature review is often split into chapters, you can choose if these chapters have titles that represent the information within them, or call them chapter 1, chapter 2, ect. A regular format for a literature review is:

Introduction (including methodology)

This particular example is split into 6 sections, however it may be more or less depending on your topic.

Literature Reviews Further Reading

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Implementing evidence into practice requires nurses to identify, critically appraise and synthesise research. This may require a comprehensive literature review: this article aims to outline the approaches and stages required and provides a working example of a published review.

Are there different approaches to undertaking a literature review?

What stages are required to undertake a literature review.

The rationale for the review should be established; consider why the review is important and relevant to patient care/safety or service delivery. For example, Noble et al 's 4 review sought to understand and make recommendations for practice and research in relation to dialysis refusal and withdrawal in patients with end-stage renal disease, an area of care previously poorly described. If appropriate, highlight relevant policies and theoretical perspectives that might guide the review. Once the key issues related to the topic, including the challenges encountered in clinical practice, have been identified formulate a clear question, and/or develop an aim and specific objectives. The type of review undertaken is influenced by the purpose of the review and resources available. However, the stages or methods used to undertake a review are similar across approaches and include:

Formulating clear inclusion and exclusion criteria, for example, patient groups, ages, conditions/treatments, sources of evidence/research designs;

Justifying data bases and years searched, and whether strategies including hand searching of journals, conference proceedings and research not indexed in data bases (grey literature) will be undertaken;

Developing search terms, the PICU (P: patient, problem or population; I: intervention; C: comparison; O: outcome) framework is a useful guide when developing search terms;

Developing search skills (eg, understanding Boolean Operators, in particular the use of AND/OR) and knowledge of how data bases index topics (eg, MeSH headings). Working with a librarian experienced in undertaking health searches is invaluable when developing a search.

Once studies are selected, the quality of the research/evidence requires evaluation. Using a quality appraisal tool, such as the Critical Appraisal Skills Programme (CASP) tools, 5 results in a structured approach to assessing the rigour of studies being reviewed. 3 Approaches to data synthesis for quantitative studies may include a meta-analysis (statistical analysis of data from multiple studies of similar designs that have addressed the same question), or findings can be reported descriptively. 6 Methods applicable for synthesising qualitative studies include meta-ethnography (themes and concepts from different studies are explored and brought together using approaches similar to qualitative data analysis methods), narrative summary, thematic analysis and content analysis. 7 Table 1 outlines the stages undertaken for a published review that summarised research about parents’ experiences of living with a child with a long-term condition. 8

View inline

An example of rapid evidence assessment review

In summary, the type of literature review depends on the review purpose. For the novice reviewer undertaking a review can be a daunting and complex process; by following the stages outlined and being systematic a robust review is achievable. The importance of literature reviews should not be underestimated—they help summarise and make sense of an increasingly vast body of research promoting best evidence-based practice.

↵ Centre for Reviews and Dissemination . Guidance for undertaking reviews in health care . 3rd edn . York : CRD, York University , 2009 .
↵ Canadian Best Practices Portal. http://cbpp-pcpe.phac-aspc.gc.ca/interventions/selected-systematic-review-sites / ( accessed 7.8.2015 ).
Bridges J , et al
↵ Critical Appraisal Skills Programme (CASP). http://www.casp-uk.net / ( accessed 7.8.2015 ).
Dixon-Woods M ,
Shaw R , et al
Agarwal S ,
Jones D , et al
Cheater F ,

Twitter Follow Joanna Smith at @josmith175

Competing interests None declared.

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Literature Reviews

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

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

A literature review should:

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

From S age Research Methods

Purpose of a Literature Review

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

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

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

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

Limitations of a Literature Review

Some of the limitations of a literature review are:

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

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

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Literature Reviews
Getting Started

Literature Reviews: Getting Started

What is a literature review.

A literature review is an overview of the available research for a specific scholarly topic. Literature reviews summarize existing research to answer a review question, provide context for new research, or identify important gaps in the existing body of literature.

An incredible amount of academic literature is published each year; by some estimates nearly three million articles .

Sorting through and reviewing that literature can be complicated, so this Research Guide provides a structured approach to make the process more manageable.

THIS GUIDE IS AN OVERVIEW OF THE LITERATURE REVIEW PROCESS:

Getting Started (asking a research question | defining scope)
Choosing a Type of Review
Searching the Literature
Organizing the Literature
Writing the Literature Review (analyzing | synthesizing)

A literature search is a systematic search of the scholarly sources in a particular discipline. A literature review is the analysis, critical evaluation and synthesis of the results of that search. During this process you will move from a review of the literature to a review for your research. Your synthesis of the literature is your unique contribution to research.

WHO IS THIS RESEARCH GUIDE FOR?

— those new to reviewing the literature

— those that need a refresher or a deeper understanding of writing literature reviews

You may need to do a literature review as a part of a course assignment, a capstone project, a master's thesis, a dissertation, or as part of a journal article. No matter the context, a literature review is an essential part of the research process.

Literature Review Process

Purpose of a Literature Review

What is the purpose of a literature review.

A literature review is typically performed for a specific reason. Even when assigned as an assignment, the goal of the literature review will be one or more of the following:

To communicate a project's novelty by identifying a research gap

An overview of research issues , methodologies or results relevant to field
To explore the volume and types of available studies
To establish familiarity with current research before carrying out a new project
To resolve conflicts amongst contradictory previous studies

Reviewing the literature helps you understand a research topic and develop your own perspective.

A LITERATURE REVIEW IS NOT :

An annotated bibliography – which is a list of annotated citations to books, articles and documents that includes a brief description and evaluation for each entry
A literary review – which is a critical discussion of the merits and weaknesses of a literary work
A book review – which is a critical discussion of the merits and weaknesses of a particular book

Attribution

Thanks to Librarian Jamie Niehof at the University of Michigan for providing permission to reuse and remix this Literature Reviews guide.

Workshop Materials

Materials from OSU Literature Review Workshop
Last Updated: Sep 23, 2024 11:11 AM
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SOC 200 - Sims: How to Write a Lit Review

What are Literature Reviews?
How to Write a Lit Review
How to Choose a Topic
Finding the Literature

How to write a literature review

Below are the steps you should follow when crafting a lit review for your class assignment.

It's preferable if you can select a topic that you find interesting, because this will make the work seem less like work.
It's also important to select a topic that many researchers have already explored. This way, you'll actually have "literature" to "review."
Sometimes, doing a very general search and reading other literature reviews can reveal a topic or avenue of research to you.
It's important to gain an understanding of your topic's research history, in order to properly comprehend how and why the current (emerging) research exists.
One trick is to look at the References (aka Bibliographies aka Works Cited pages) of any especially relevant articles, in order to expand your search for those same sources. This is because there is often overlap between works, and if you're paying attention, one source can point you to several others.
One method is to start with the most recently-published research and then use their citations to identify older research, allowing you to piece together a timeline and work backwards.
Chronologically : discuss the literature in order of its writing/publication. This will demonstrate a change in trends over time, and/or detail a history of controversy in the field, and/or illustrate developments in the field.
Thematically : group your sources by subject or theme. This will show the variety of angels from which your topic has been studied. This method works well if you are trying to identify a sub-topic that has so far been overlooked by other researchers.
Methodologically : group your sources by methodology. For example, divide the literature into categories like qualitative versus quantitative, or by population or geographical region, etc.
Theoretically : group your sources by theoretical lens. Your textbook should have a section(s) dedicated to the various theories in your field. If you're unsure, you should ask your professor.
Are there disagreements on some issues, and consensus on others?
How does this impact the path of research and discovery?
Many articles will have a Limitations section, or a Discussion section, wherein suggestions are provided for next steps to further the research.
These are goldmines for helping you see a possible outlook of the situation.
Identifying any gaps in the literature that are of a particular interest to your research goals will help you justify why your own research should be performed.
Be selective about which points from the source you use. The information should be the most important and the most relevant.
Use direct quotes sparingly, and don't rely too heavily on summaries and paraphrasing. You should be drawing conclusions about how the literature relates to your own analysis or the other literature.
Synthesize your sources. The goal is not to make a list of summaries, but to show how the sources relate to one another and to your own analysis.
At the end, make suggestions for future research. What subjects, populations, methodologies, or theoretical lenses warrant further exploration? What common flaws or biases did you identify that could be corrected in future studies?
Common citation styles for sociology classes include APA and ASA.

Understanding how a literature review is structured will help you as you craft your own.

Below is information and example articles that you should review, in order to comprehend why they are written a certain way.

Below are some very good examples of Literature Reviews:

Cyberbullying: How Physical Intimidation Influences the Way People are Bullied

Use of Propofol and Emergence Agitation in Children

Eternity and Immortality in Spinoza's 'Ethics'

As you read these, take note of the sections that comprise the main structure of each one:

Introduction
Summarize sources
Synthesize sources

Below are some articles that provide very good examples of an "Introduction" section, which includes a "Review of the Literature."

Sometimes, there is both an Introduction section, and a separate Review of the Literature section (oftentimes, it simply depends on the publication)

Krimm, H., & Lund, E. (2021). Efficacy of online learning modules for teaching dialogic reading strategies and phonemic awareness. Language, Speech & Hearing Services in Schools, 52 (4), 1020-1030. https://doi.org/10.1044/2021_LSHSS-21-00011

Melfsen, S., Jans, T., Romanos, M., & Walitza, S. (2022). Emotion regulation in selective mutism: A comparison group study in children and adolescents with selective mutism. Journal of Psychiatric Research, 151 , 710-715. https://doi.org/10.1016/j.jpsychires.2022.05.040

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How to Read a Scholarly Article

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Things to consider when reading a scholarly article This helpful guide, from Meriam Library at California State University in Chico, explains what a scholarly article is and provides tips for reading them.

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How to read a scholarly article (YouTube) This tutorial, from Western University, quickly and efficiently describes how to read a scholarly article.
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Systematic Review
Open access
Published: 27 September 2024

Effectiveness of DL-3-n-butylphthalide in the treatment of poststroke cognitive impairment and its associated predictive cytokines: a systematic review and meta-analysis

Zhen Wang 1 , 2 na1 ,
Jiahui Wang 3 na1 ,
Jiajia Yun 1 na1 ,
Jun Song 2 ,
Qi Chen 4 ,
Deqiang Wang 5 &
Chao Ren 4 , 6

BMC Pharmacology and Toxicology volume 25 , Article number: 65 ( 2024 ) Cite this article

Metrics details

The efficacy of DL-3-n-butylphthalide (NBP) in the treatment of post-stroke cognitive impairment (PSCI) has been reported previously. However, the course of treatment that shows curative effect and cytokines predictive of the efficacy of NBP in the treatment of PSCI have not been systematically evaluated. This study aimed to assess the efficacy, course of treatment, and cytokines that can predict the effectiveness of NBP in treating poststroke cognitive impairment PSCI.

This study has been registered with PROSPERO (registration number CRD42024518768). Randomized controlled trial (RCT) data dated by November 12, 2023 were retrieved from the PubMed, Embase, Cochrane Library, Web of Science, Wanfang, CNKI, CSTJ, and SinoMed databases using medical subject terms combined with free words. The updated Cochrane RoB-I Risk of Bias tool was utilized for literature quality evaluation. Statistical analysis were carried out using Review Manager 5.4.1 software.

Thirty-eight original studies involving 5417 PSCI patients were analyzed. The results showed that NBP had a beneficial impact on cognitive function in PSCI patients when used alone or in combination therapy, as assessed by the Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scale. The effect sizes were significant for both monotherapy and combination therapy. Subgroup analyses based on treatment cycle indicated that NBP enhanced cognitive function in PSCI patients from 1 week after intervention: MMSE (SMD = 0.43, 95% CI [0.28, 0.58], P < 0.001), MoCA (SMD = 0.44, 95% CI [0.27, 0.61], P < 0.001). There was a cumulative enhancement in cognitive function within 6 months after NBP treatment based on the MoCA scores (SMD = 0.61, 95% CI [0.30, 0.91], P < 0.001). Furthermore, decreased levels of the cytokines Hs-CRP, TNF-α, IL-6, IL-8, Hcy, NSE, MDA, MMP-9, and Cys-C (SMD = −2.28, 95% CI [−2.97, 1.58], P < 0.001) and increased levels of BDNF, VEGF, and TIMP-1 (SMD = 2.80, 95% CI [1.66, 3.94], P < 0.001) were also predictive of treatment efficacy.

NBP plays a beneficial role in improving cognitive function in PSCI patients, and their prognoses could be predicted by serum cytokine levels. However, high-quality, multicenter, multisample, and RCTs are still needed to confirm the clinical validity of NBP due to its low methodological quality.

Peer Review reports

Introduction

Poststroke cognitive impairment (PSCI) is a common consequence following stroke, and is characterized by cognitive decline caused by stroke ranging from mild cognitive impairment to dementia [ 1 , 2 ]. PSCI is most frequently observed in the first year after stroke, affecting up to 60% of survivors. Approximately 44% of patients experience cognitive issues 26 months after stroke [ 3 , 4 ]. PSCI patients commonly exhibit cognitive deficits such as memory loss, attention issues, and linguistic function impairment. These challenges impact their daily performances, quality of life and capacity to resume work [ 5 ]. The expert consensus recommends the cholinesterase inhibitors donepezil, carboplatin, and galantamine; the N-methyl-D-aspartate (NMDA) receptor antagonist memantine; and the calcium antagonists nimodipine and olanzapine for the treatment of PSCI. However, there is inadequate evidence to support the efficacy of these medications in treatment [ 2 , 6 , 7 ]. Current clinical evidence for the use of medications to enhance cognitive function in PSCI patients is primarily derived from studies on Alzheimer’s disease, whereas there is a lack of convincing basic or clinical evidence supporting the ability of pharmacological treatments for PSCI to promote cognitive recovery [ 8 ].

DL-3-n-butylphthalide (NBP) is a synthetic molecule derived from l-3-n-butylphthalide isolated from celery seeds. It is a compound independently developed in China that not only improves the acute ischemic stroke symptoms but also aids the long-term recovery of patients [ 9 ]. Multiple clinical studies have indicated that NBP has protective effects on animal models of ischemic stroke [ 10 , 11 , 12 ]. The protective mechanism of NBP against ischemic stroke may involve various pathophysiological processes, such as anti-inflammatory effects, oxidation reduction [ 13 ], reduction in cerebral edema and blood‒brain barrier damage [ 14 ], decreased in neuronal apoptosis [ 15 ], prevention of thrombotic formation [ 16 ], and safeguarding of mitochondria [ 17 ]. A recent basic research indicated that, in addition to improving acute stroke symptoms, NBP might also promote cognitive recovery following stroke by reducing inflammation and oxidative stress [ 18 ]. The 2021 Expert Consensus on the Management of Cognitive Impairment after Stroke recommends the use of NBP as a pharmacologic treatment for PSCI with Class II, Level B evidence [ 2 ]. In 2022, Fan and colleagues conducted a meta-analysis to assess the therapeutic efficacy and safety of NBP against PSCI. The findings indicated that NBP effectively reduced neurological deficits symptoms and enhanced cognitive function and daily living abilities [ 19 ]. However, because most of the included original studies were randomized controlled trials (RCTs) with small sample sizes, and the simplistic search strategy might also cause incomplete data retrieval and publication bias. In addition, the meta-analysis did not specify the duration for which NBP affected patients with PSCI despite demonstrating the effectiveness of NBP in treating PSCI. Furthermore, there is a lack of objective indicators for predicting the efficacy of NBP in treating PSCI. The levels of serum cytokines such as IL-6, IL-8, CRP, MDA, BDNF, and Hcy [ 20 , 21 , 22 ] have been identified as biomarkers in studies, but there is inconsistency in whether changes of these cytokines are predictive of the therapeutic effect of NBP. Therefore, it is essential to systematically assess and analyze the clinical efficacy and time to act of NBP in treating PSCI, and to identify cytokines that can predict the effectiveness of NBP to provide a new evidence-based foundation for the clinical treatment of this disease.

Protocol and registration

This systematic review was conducted in accordance with the PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions [ 23 ]. This systematic review has been registered on the PROSPERO International prospective register of systematic reviews (ID CRD42024518768).

Data retrieval strategy

Data retrieval was conducted across eight databases: China National Knowledge Infrastructure (CNKI, https://www.cnki.net ), Wanfang Database ( https://www.wanfangdata.com ), China Science and Technology Journals Database (CSTJ, https://qikan.cqvip.com ), Chinese Biomedical Literature Service System (SinoMed, https://www.sinomed.ac.cn ), PubMed ( www.ncbi.nlm.hih.gov ), Embase ( www.embase.com ), Cochrane Library ( https://www.cochrane.com ), and Web of Science (WOS, https://www.webofscience.com ), using a combination of free words and the keywords “butylphthalide” and “poststroke cognitive impairment”. The dates of retrieved data ranged from the establishment of the database to November 12, 2023.

Inclusion criteria

Type of studies.

Eligible retrieved data were RCT studies on the improvement of cognitive function in PSCI patients using NBP.

Characteristics of the enrolled patients

Each study group in the publication contained between 30 and 90 patients diagnosed with PSCI. The average age of patients ranged between 35 and 73 years, with variable disease durations. All patients included in the analysis articles have signed written informed consent forms by themselves or their legal representatives when participating in relevant studies.

Interventions

All original studies included in the analysis administered NBP alone or in combination with other medications to the experiment group, whereas the control group received drugs such as donepezil, galantamine, memantine, olaxetan, and nimodipine as per expert consensus or only medications for the patients’ pre-existing diseases. The only variable that differed between the experiment and control groups in the original studies was the administration of NBP. All other variables were controlled to ensure that the dosage, duration of treatment, and duration of continuous treatment were the same for both groups.

Outcome indicators for the included literature

The outcome indicators should include the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scales for the assessment of cognitive function.

Exclusion criteria

Literatures lacking raw data, reviews or systematic reviews, duplicate literatures, studies of undetermined type or not conforming to RCT standards, studies with inconsistent content or outcome indicators, and those involving animal experiments were excluded.

Literature review and quality assessment

We organized the literatures retrieved from databases using Endnote X9. Two researchers initially independently screened the literature by reviewing the title, abstract, and authors to eliminate duplicate studies. They then downloaded the full text of the remaining literature for thorough examination, and determined their relevance to this study following the above criteria. The common literatures agreed by both researchers were included in this study. In the case of differing opinions, a third researcher was consulted.

Two researchers independently assessed the literature quality using the RCT evaluation tool recommended by the Cochrane RoB-I Handbook of Systematic Evaluation 5.1, which included seven criteria: generation of randomized sequences, concealment of the allocation scheme, blinding of participants and personnel, blinding of outcome assessment, completeness of outcome data, selective reporting of findings, and other sources of bias. The literature was assessed and classified into three categories according to the evaluation indicators provided: “high risk of bias,” “uncertain risk of bias,” and “low risk of bias”. A third researcher resolved any disagreements that occurred throughout the evaluation.

Data extraction

Data were extracted from qualified literature containing the following information: name of first author, publication year, research methods, sample size, age, sex, participant demographics, interventions, drug dosages, treatment duration, serum cytokines, and outcome indicators.

Statistical analysis

The gathered information was statistically analyzed using RevMan 5.4 software (Cochrane Collaboration). Relative risk (RR) was utilized for dichotomous variables, whereas mean difference (MD) or standardized mean difference (SMD) analysis was used for continuous variables. The 95% confidence intervals (CIs) were calculated for each effect size. Cochrane’s I 2 and P values were utilized to assess the heterogeneity of the studies included. In case of I 2 < 50% and P > 0.1, no statistical heterogeneity was found among the studies, and the fixed-effects model was employed for statistical analysis. P < 0.1 or I 2 > 50% indicated statistical heterogeneity among studies, the source of which should be investigated. If heterogeneity persisted and clinical results were consistent, a random-effects model was applied for statistical analysis. We conducted subgroup analyses based on varied interventions on the control group of different literature sources to address potential heterogeneity. We utilized SMD analysis for continuous variable studies. In case of the existence of potential heterogeneity caused by missing information and different intervention strategies in the original studies, which could not be eliminated, a random effects model was utilized. Funnel plots were used to analyze publication bias.

Literature screening

A total of 244 literatures were initially screened based on our methods, and 128 documents remained after removing duplicates using EndnoteX7. Next, 8 systematic reviews and 9 animal studies were excluded by reviewing the titles and abstracts, leaving 111 studies. After reviewing the full text, 55 studies were excluded for not conforming to the objective of this study, 6 for not meeting the outcome indicators, 8 for lacking data, and 4 for non-RCT. Ultimately, 38 remaining studies [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ] were included in this study after thorough assessment. Figure 1 illustrates the detailed literature screening process.

Flowchart for data screen and filter

Characteristics of the included literature

Our systematic evaluation comprised 38 RCTs published in Chinese-language between 2016 and 2023, involving 5417 individuals with PSCI. The average age of all patients varied between 35 and 73 years, and the duration of treatment ranged between 0.5 and 6 months. There were 30–90 patients in each treatment or control group in Each of 38 original trials. Twenty-seven studies utilized MMSE and 27 with MoCA to evaluate cognitive function as an outcome indicator. Fourteen studies compared the efficacy of NBP used alone with that of the standard treatment in the control group. Twenty-four studies compared the efficacy of NBP in combination with other drugs to that in the control group. Table 1 listed the features of all 38 investigations.

Methodological assessment of the included literature

Methodological assessment of the quality of the studies was performed (Supplementary Fig. 1 ). One study had a low risk of bias and was of relatively high quality. Twenty-seven studies had moderate risks of bias, and 10 studies had high risks of bias. Concerns were raised about the blinding process of these studies, as 36 out of 38 studies did not provide clear information regarding blinding. In addition, 10 studies provided insufficient information on randomization methods. Supplementary Fig. 2 illustrates the result of methodological assessments for each item.

Assessment of cognitive function

Eleven studies (Fan et al. [ 25 ]; Fan et al. [ 34 ]; Fu and Ba [ 37 ]; Huang [ 42 ]; Mao et al. [ 47 ]; Meng et al. [ 48 ]; Ni et al. [ 61 ]; Su [ 52 ]; Zhang, 2021 [ 56 ]; Zhang and Ye [ 27 ]; Zhan et al. [ 55 ]) that enrolled a total of 1264 PSCI patients reported the clinical efficacy of NBP monotherapy, as shown in Fig. 2 a. The control groups were all on baseline medication, and there was no significant heterogeneity in the results ( P = 0.12, I 2 = 36%). After combining the effect sizes using a fixed-effects model and performing a meta-analysis, we found that patients’ cognitive function significantly improved after NBP monotherapy as suggested by MMSE scores (SMD = 0.70, 95% CI [0.58,0.82], P < 0.00001). A funnel plot was drawn for the MMSE score of patients treated with NBP as monotherapy (Supplementary Fig. 3 ), where a slight asymmetry was found in the left and right region of scatter points, suggesting the possibility of publication bias. Sixteen studies, including 1446 patients with PSCI, reported the clinical effects of NBP combination therapy, as shown in Fig. 3 a. Subgroup analyses were performed according to the combination drug. The control group was treated with urinary kallidinogenase ( P = 0.50, I 2 = 0%) in three studies [ 41 , 44 , 53 ], with piracetam treatment ( P = 0.0001, I 2 = 85%) in four studies [ 28 , 47 , 57 , 59 ], with oxiracetam ( P = 0.004, I 2 = 88%) in two studies [ 39 , 54 ], with cyclozosin hydrochloride ( P = 0.02, I 2 = 71%) in four studies [ 29 , 32 , 35 , 60 ], and with edaravone [ 40 ], nimodipine [ 30 ], and idebenone [ 33 ] in one study each. Evaluation analyses were performed using a random-effects model, and the results showed a significant benefit of NBP as a combination therapy on MMSE scores (SMD U = 0.73, 95% CI [0.46, 1.00], P < 0.001; SMD P = 1.14, 95% CI [0.54, 1.73], P < 0.0002; SMD O = 2.42, 95% CI [1.29, 3.55], P < 0.0001; SMD C = 1.31, 95% CI [0.89, 1.72], P < 0.00001; SMD E = 5.54, 95% CI [4.67, 6.42], P < 0.00001; SMD N = 0.89, 95% CI [0.51, 1.26], P < 0.00001; SMD I = 0.44, 95% CI [−0.07, 0.95] P = 0.09).

Meta-analysis of cognitive assessment scale for NBP as monotherapy. a MMSE, b MoCA

Meta-analysis of cognitive assessment scale for NBP as combination therapy. a MMSE, b MoCA

Ten studies [ 25 , 27 , 34 , 36 , 37 , 48 , 51 , 52 , 56 , 61 ], comprising 1157 patients, reported the clinical effects of treatment with NBP alone, as shown in Fig. 2 b. Evaluation and analysis using a random-effects model with combined effect sizes demonstrated a significant benefit of NBP as a monotherapy in improving cognitive function in patients with PSCI in terms of MoCA scores (SMD = 0.93, 95% CI [0.74, 1.12], P < 0.00001). Seventeen studies, including 1550 patients, reported the clinical efficacy of NBP combination therapy for improving cognitive function in PSCI patients, as shown in Fig. 3 b. Subgroup analyses were conducted according to the interventions. The control group was treated with Oxiracetam ( P < 0.0001, I 2 = 85%) in five studies [ 43 , 45 , 46 , 54 , 58 ], with piracetam ( P = 0.45, I 2 = 0%) in two studies [ 57 , 59 ], with cyclazosin hydrochloride ( P < 0.00001, I 2 = 97%) in three studies [ 29 , 50 , 60 ], with eurycoma ( P = 0.50, I 2 = 0%) in three studies [ 41 , 43 , 53 ], with donepezil hydrochloride ( P = 0.25, I 2 = 24%) in two studies [ 24 , 31 ], and with Huperzine A [ 26 ] and Galanthamine [ 38 ] in one study each. We performed a meta-analysis using a random-effects model combining effect sizes, and the results demonstrated that NBP as a combination therapy had a statistically significant benefit in terms of the MoCA score (SMD O = 0.90, 95% CI [0.41,1.39], P = 0.0003; SMD P = 0.96, 95% CI [0.63,1.30], P < 0.00001; SMD C = 2.07, 95% CI [0.14,4.00], P = 0.04; SMD U = 0.82, 95% CI [0.55,1.10], P < 0.00001; SMD D = 0.91, 95% CI [0.62,1.19], P < 0.00001; SMD H = 2.03, 95% CI [1.55,2.52], P < 0.00001; SMD G = 1.49, 95% CI [1.00,1.97], P < 0.00001).

Assessment of the treatment course

Five studies [ 27 , 33 , 48 , 55 , 59 ], which included a total of 2340 C patients with PSCI, reported the clinical outcomes of the different courses of NBP treatment under the MMSE assessment, as shown in Fig. 4 a. One of these studies [ 27 ] reported the clinical effects of NBP treatment by MMSE scores on 1 day (SMD 1d = 0.10, 95% CI [−0.22, 0.42]), 2 days (SMD 2d = 0.03, 95% CI [−0.29, 0.35]), 3 days (SMD 3d = 0.10, 95% CI [−0.22, 0.42]), 7 days (SMD 7d = 0.51, 95% CI [0.19, 0.84]), 14 days (SMD 14d = 0.49, 95% CI [0.16, 0.81]), 30 days (SMD 30d = 0.73, 95% CI [0.40, 1.06]), and 90 days (SMD 90d = 0.52, 95% CI [0.19, 0.84]) from NBP treatment. In addition, the clinical effects of these different courses of treatment were summarized (SMD total = 0.35, 95% CI [0.15, 0.55], P = 0.0006), which ultimately showed that the patients’ cognitive function improved from day 7 of NBP treatment, and there was a cumulative improvement in cognitive function over the 3-month treatment course. Zhou et al. [ 59 ] reported clinical effects of NBP treatment by MMSE scores before treatment (SMD = −0.02, 95% CI [−0.46, 0.42]) and 7 days (SMD 7d = 0.58, 95% CI [0.13, 1.02]) and 14 days (SMD 14d = 1.43, 95% CI [0.94, 1.93]) from NBP treatment, which showed that patients started to show improvement in cognitive function from day 7, which was consistent with the results of Zhang’s group [ 27 ]. Men et al. [ 48 ] assessed patient’s cognitive function before treatment (SMD = 0.02, 95% CI [−0.30, 0.35]) and 30 days (SMD 30d = 0.81, 95% CI [0.47, 1.15]) and 90 days (SMD 90d = 0.94, 95% CI [0.59, 1.28]) from treatment, and the clinical effects of different courses of treatment were combined (SMD total = 0.59, 95% CI [0.02, 1.16], P = 0.04). The results demonstrated significant improvement in cognitive function on day 30 and day 90 of NBP treatment compared to pre-treatment, and the improvement was more pronounced on day 90 than that on day 30. Similar assessment was also performed in another study [ 55 ], which reported the cognitive function before treatment (SMD = 0.29, 95% CI [−0.15, 0.73]C), on day 30 of treatment(SMD 30d = 0.43, 95% CI [−0.01, 0.87]), and on day 90 of treatment (SMD 90d = 0.6 3, 95% CI [0.18, 1.08]). Meta-analysis showed that patient’s cognitive function improved on day 90 of treatment, but not on day 30 of treatment. In another study [ 33 ], it was found that patients’ cognitive function started to improve from day 56 of NBP treatment compared to pre-treatment (SMD 56d = 0.75, 95% CI [0.22, 1.27], P = 0.002).

Meta analysis of different treatment courses of NBP for cognitive assessment scale. a MMSE, b MoCA

Four studies [ 24 , 27 , 48 , 59 ] including a total of 2220 PSCI patients reported the clinical outcomes of different courses of NBP treatment as reflected by MoCA scoring (Fig. 4 b). One study [ 27 ] reported the clinical effects of NBP treatment at 1 day (SMD 1d = 0.01, 95% CI [−0.31, 0.33]), 2 days (SMD 2d = 0.01, 95% CI [−0.31, 0.33]), 3 days (SMD 3d = 0.01, 95% CI [−0.31, 0.33]), 7 days (SMD 7d = 0.4 0, 95% CI [0.08, 0.72]), 14 days (SMD 14d = 0.54, 95% CI [0.21, 0.86]), 30 days (SMD 30d = 0.59, 95% CI [0.26, 0.92]), and 90 days (SMD 90d = 0.72, 95% CI [0.39, 1.05]) from NBP treatment. We combined the clinical effects of these different courses of treatment (SMD total = 0.32, 95% CI [0.10, 0.55], P = 0 .005), and found that patients showed improvement in cognitive function from day 7 of NBP treatment and there was cumulative improvement in cognitive function over the 3-month treatment course. Consistently, another study [ 59 ] also reported improvement of patients’ cognitive functions from day 7 of NBP treatment (before treatment: SMD = 0.01, 95% CI [−0.42, 0.45], day 7: SMD 7d = 0.41, 95% CI [−0.03, 0.85], and day 14: SMD 14d = 1.09, 95% CI [0.62, 1.56]). Yao et al. [ 24 ] observed improved cognitive function after 30 days of NBP treatment and cumulative improvement in cognitive function over the treatment course of 6 months (before treatment: SMD = 0.19, 95% CI [−0.17, 0.55], 30 days: SMD 30d = 0.60, 95% CI [0.23, 0.96], 90 days: SMD 90d = 0.90, 95% CI [0.52, 1.27], 180 days: SMD 180d = 0.75, 95% CI [0.38, 1.12], combined: SMD total = 0.61, 95% CI [0.30, 0.91], P < 0.0001). Similarly, Meng et al. [ 48 ] reported improved cognitive function after day 30 of NBP treatment and cumulative improvement over a treatment course of 90 days (before treatment: SMD = −0.11, 95% CI [−0.44, 0.22], 30 days: SMD 30d = 0.72, 95% CI [0.39, 1.06], 90 days: SMD 90d = 0.71, 95% CI [0.38, 1.05]).

Serum cytokine assessment

Serum inflammatory factors.

Eight studies [ 29 , 31 , 38 , 39 , 40 , 49 , 56 , 61 ] comprising a total of 830 PSCI patients reported changes in serum levels of inflammatory factors HS-CRP [ 31 , 38 , 39 , 40 , 49 , 56 ], TNF-α [ 29 , 39 ], IL-6 [ 29 , 38 ], IL-8 [ 39 , 61 ] and Hcy [ 49 , 56 ] in the experimental group compared with the control group after NBP treatment (Fig. 5 a). Combined effect sizes revealed that patients’ serum levels of HS-CRP (SMD HS−CRP = −3.62, 95% CI [−5.16,−2.09], P < 0.001), TNF-α(SMD TNF−α = −3.09, 95% CI [−3.56,−2.61], P < 0.001), IL-6 (SMD IL−6 = −2.00, 95% CI [−3.04, −0.96], P = 0.0002), IL-8 (SMD IL−8 = −1.42, 95% CI [−2.82,−0.03], P = 0.05) and Hcy (SMD Hcy = −1.22, 95% CI [−1.73, −0.72], P < 0.001) were all significantly lower in the experimental group compared with the control group, suggesting that NBP treatment significantly reduced serum HS-CRP, TNF-α, IL-6, IL-8 and Hcy levels in patients with PSCI.

Meta analysis of serum factors before and after treatment. a Inflammatory factors, b Nutrient factors and enzymes, c Other serum factors

Other serum cytokines

Nine studies [ 29 , 31 , 32 , 39 , 41 , 50 , 55 , 56 ], which included a total of 876 PSCI patients, reported changes in serum levels of cytokines other than those mentioned above in the experimental group compared with the control group after treatment with NBP (Fig. 5 b and c), including BDNF [ 29 , 41 ], VEGF [ 55 ], SOD [ 41 , 50 ], TIMP-1 [ 32 ], NSE [ 29 , 31 , 39 , 54 ], MDA [ 41 ], and CyS-C [ 56 ]. After combining the effect sizes, we found significantly elevated levels of serum BDNF (SMD BDNF = 1.34, 95% CI [0.70, 1.98], P < 0.001), VEGF (SMD VEGF = 1.12, 95% CI [0.64, 1.59], P < 0.001), SOD (SMD SOD = 7.46, 95% CI [−3.77, 18.68], P = 0.19) and TIMP-1 (SMD TIMP−1 = 1.67, 95% CI [1.25, 2.09], P < 0.001) and significantly reduced levels of serum NSE (SMD NSE = −2.01, 95% CI [−2.44, −1.59], P < 0.001), MDA (SMD MDA = −1.84, 95% CI [−2.37, −1.31], P < 0.001) and CyS-C (SMD CyS−C = −0.74, 95% CI [−1.17, −0.31], P = 0.0007) in the experimental group compared with the control group.

Generalization of results

Our systematic evaluation included 38 randomized RCTs with a total of 5417 PSCI patients. Our investigation demonstrated that (1) NBP monotherapy or combination therapy enhanced cognitive function in individuals with PSCI, consistent with a previous study [ 19 ]; (2) NBP influenced the levels of certain cytokines in the blood while enhancing cognitive function in patients, which might be attributed to the antioxidant, anti-inflammatory, and antiapoptotic effects of NBP, the improvement of mitochondrial function, and the inhibition of neuronal apoptosis via pharmacological mechanisms [ 17 , 20 , 21 ]. (3) Previous studies have shown that NBP is useful in enhancing cognitive performance in individuals with PSCI, but there are no guidelines on the time to act of NBP treatment. Based on the individual differences in patients, our study suggested that the time to act of NBP is mostly 1 week for sensitive individuals, and can be longer for non-sensitive population. And once the response occurred, there is a cumulative improvement in cognitive function within 6 months of treatment. To our knowledge, these findings have not been reported previously.

Clinical implications

Currently, there is still a lack of standard guidelines on protocols for diagnosing and treating PSCI. Our study to some extent showed that NBP therapy, either used alone or in combination with other drugs, has a promising improvement effect on cognitive function in PSCI patients, although the time to act may vary depending on the sensibility of patients. Sensitive patients normally respond to NBP treatment within one week, which can be used to determine the sensibility of patients to NBP. In addition, cognition belongs to the high-energy functional areas of the brain, including memory, orientation, executive function, computation and attention. PSCI patients may have multiple cognitive impairments [ 22 ], for which MMSE and MoCA are often not sensitive enough to detect [ 62 ], or have a certain degree of delay in detection. Thus, these cognitive function assessment scales may not be sufficient enough for accurate early diagnosis of PSCI and timely response to therapeutic treatment. In addition, in our study, the serum levels of cytokines, including inflammatory factors (Hs-CRP, TNF-α, IL-6, and IL-8), growth factors (BDNF and VEGF), oxidative damage biomarkers (MDA and SOD), enzymes (NSE, MMP-9, Cys-C and TIMP-1), and metabolic biomarker (Hcy), significantly changed after NBP treatment. These changes might be related to the decline or improvement of cognitive function, which is consistent with the results of previous reports [ 1 , 22 ]. On the one hand, these changes might be related to the mechanism of action of NBP, and on the other hand, these cytokines might play an auxiliary role in the early diagnosis of PSCI and in accurate indication of the effectiveness of NBP treatment. However, whether changes in the serum levels of these cytokines coincide with the time to act of NBP has not been studied, which may shed some light on future clinical studies. Future studies may consider the use of multiple serum cytokines in combination with cognitive assessment scales for the early diagnosis of PSCI and the evaluation of the efficacy of NBP, to improve the accuracy of the diagnosis and prognosis of PSCI and to provide new ideas for personalized diagnosis and treatment of PSCI.

Second, NBP was originally extracted from celery seeds, and one of its mechanisms of action has been shown to improve cognitive impairment by enhancing cerebral hemodynamics [ 15 ]. The effective treatment of PSCI is related to the timely restoration of blood supply to the brain tissue [ 63 ]. The standard use of NBP for stroke patients is within 72 h after onset, but the time from onset to NBP intervention had not been explicitly mentioned in the original study included in our meta-analysis. Therefore, it is necessary to pay attention to the significance of timely treatment for early cognitive function recovery in PSCI patients in future research.

Implications for basic research

We here propose an overview of the potential mechanism of action of NBP. Previous researches have indicated that NBP may act as an antioxidant by enhancing the expression of brain-derived neurotrophic factors in the hippocampus, increasing SOD activity, suppressing the TLR-4/MyD 88/NF-κB signaling pathway to decrease microglial cell proliferation and proinflammatory mediator production [ 13 ], activating the Akt/Nrf2 signaling pathway and inhibiting the apoptotic cascade to enhance cognitive function in patients with PSCI [ 64 ]. These finding were consistent with our finding that decrease in peripheral serum inflammatory factors Hs-CRP, TNF-α, IL-6, and IL-8 and oxidation-related factor MDA, or increase in neurotrophic factors BDNF and VEGF occurred simultaneously with the improvement in cognitive function after NBP treatment, suggesting that cytokines might play certain roles in the development of PSCI and in the therapeutic mechanism of NBP on PSCI. Meanwhile, it also suggested that changes in peripheral serum cytokines might reflect central nervous system diseases, but the key mechanisms involved are still not well elucidated. In the future, it will be valuable to study both peripheral and central changes together to thoroughly investigate the development of PSCI and the cellular-molecular mechanisms of NBP treatment.

Strengths of the study

Previously, the majority of Meta-analysis studies explored the efficacy of butylphthalide in treating PSCI. In this study we have innovated on the following basis: (1) This study screened the blood indexes that changed before and after the treatment by NBP in PSCI patients from the studies included in the Meta-analysis, and mined biomarkers that can be used for both the diagnosis of PSCI and precise indication of the effect of NBP in the prevention and treatment of PSCI from multiple perspectives, which provides a new idea for personalized diagnosis and treatment of PSCI; (2) In the past, there has been no clear guideline on the time to act of NBP in treating PSCI. This issue was systematically summarized in this study, which will provide valuable guidance and reference in the clinical use of NBP in the future.

Limitations

In this study, we analyzed the clinical efficacy of NBP in the treatment of PSCI and found that several serum cytokines can be used as potential biomarkers for the prediction of its clinical effectiveness. However, our study has several limitations: (1) Despite rigorous searching and screening, the included literature in our study were all in Chinese, and the applicability of our findings to studies in non-Chinese regions needs to be further investigated. (2) In our meta-analysis, random-effects model was mostly used to combine the effect sizes, which made our final results inevitably affected by heterogeneity. (3) The underlying conditions of the patients in some of the studies that we included were unclear, and at the same time, there were variations in treatment courses in different studies, which had certain impacts on the outcome of drug treatment. (4) Due to the limited information provided by the original study, we only investigated the effect of NBP on cognitive function but not on patients’ ability to perform activities of daily living and the effect of drug side effects, which deserves further study in the future.

NBP has a positive effect on improving cognitive function in PSCI patients. According to the subtype analysis of different treatment courses, we found that NBP showed improvement effect on cognitive function as quick as 1 week from treatment, and patients’ cognitive function continuously improved within 6 months of treatment, which is important for guiding the clinical use of this drug. In addition, we also noticed altered serum cytokine levels of PSCI patients after NBP treatment. Reduced serum levels of Hs-CRP, TNF-α, IL-6, IL-8, Hcy, NSE, MDA, MMP-9, and Cys-C and elevated serum levels of BDNF and VEGF could reflect the effectiveness of NBP in the treatment of PSCI (Fig. 6 ). These cytokines might provide objective evidence for the early diagnosis of PSCI in clinical practice as well as a precise indication of the therapeutic effect of NBP. However, more high-quality RCTs are needed to further validate their effectiveness and feasibility.

Diagram of the mechanism of NBP treatment for PSCI

Data availability

No datasets were generated or analysed during the current study.

Kim KY, Shin KY, Chang KA. Potential biomarkers for Post-stroke Cognitive Impairment: a systematic review and Meta-analysis. Int J Mol Sci. 2022;23(2):602.

Article CAS PubMed PubMed Central Google Scholar

Wang K, Dong Q. Expert consensus on poststroke cognitive impairment management 2021. Chin J Stroke. 2021;16(4):376–389. https://doi.org/10.3969/j.issn.1673-5765.2021.04.011 . [In Chinese].

Ihle-Hansen H, Thommessen B, Wyller TB, Engedal K, Øksengård AR, Stenset V, et al. Incidence and subtypes of MCI and dementia 1 year after first-ever stroke in patients without pre-existing cognitive impairment. Dement Geriatr Cogn Disord. 2011;32(6):401–7.

Article PubMed Google Scholar

Lo JW, Crawford JD, Desmond DW, Godefroy O, Jokinen H, Mahinrad S, et al. Stroke and cognition (STROKOG) collaboration. Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups. Neurology. 2019;93(24):e2257–71.

Article PubMed PubMed Central Google Scholar

Fride Y, Adamit T, Maeir A, Ben Assayag E, Bornstein NM, Korczyn AD, et al. What are the correlates of cognition and participation to return to work after first ever mild stroke? Top Stroke Rehabil. 2015;22(5):317–25.

Article CAS PubMed Google Scholar

Sun JH, Tan L, Yu JT. Post-stroke cognitive impairment: epidemiology, mechanisms and management. Ann Transl Med. 2014;2:2305–5839.

Quinn TJ, Richard E, Teuschl Y, Gattringer T, Hafdi M, O’Brien JT, et al. European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment. Eur Stroke J. 2021;6(3):I–XXXVIII.

Brainin M, Tuomilehto J, Heiss WD, Bornstein NM, Bath PM, Teuschl Y, et al. Post Stroke Cognition Study Group. Post-stroke cognitive decline: an update and perspectives for clinical research. Eur J Neurol. 2015;22(2):229–38.

Wang S, Ma F, Huang L, Zhang Y, Peng Y, Xing C, et al. Dl-3-n-Butylphthalide (NBP): a Promising Therapeutic Agent for ischemic stroke. CNS Neurol Disord Drug Targets. 2018;17(5):338–47.

Yan CH, Feng YP, Zhang JT. Effects of Dl-3-n-butylphthalide on regional cerebral blood flow in right middle cerebral artery occlusion rats. Zhongguo Yao Li Xue Bao. 1998;19(2):117–20.

CAS PubMed Google Scholar

Liu XG, Feng YP. Protective effect of dl-3-n-butylphthalide on ischemic neurological damage and abnormal behavior in rats subjected to focal ischemia. Yao Xue Xue Bao. 1995;30(12):896–903.

Peng Y, Zeng X, Feng Y, Wang X. Antiplatelet and antithrombotic activity of L-3-n-butylphthalide in rats. J Cardiovasc Pharmacol. 2004;43(6):876–81.

Gao Y, Hu M, Niu X, Li M, Xu L, Xiao Y et al. Dl-3-n-Butylphthalide improves Neuroinflammation in mice with repeated cerebral ischemia-reperfusion Injury through the Nrf2-Mediated antioxidant response and TLR4/MyD88/NF-κB signaling pathway. Oxid Med Cell Longev. 2022;2022:8652741.

Chong ZZ, Feng YP. Dl-3-n-butylphthalide attenuates reperfusion-induced blood-brain barrier damage after focal cerebral ischemia in rats. Zhongguo Yao Li Xue Bao. 1999;20(8):696–700.

Xiong Z, Lu W, Zhu L, Zeng L, Shi C, Jing Z, et al. Dl-3-n-Butylphthalide treatment enhances hemodynamics and ameliorates memory deficits in rats with chronic cerebral hypoperfusion. Front Aging Neurosci. 2017;9:238.

Ye J, Zhai L, Zhang S, Zhang Y, Chen L, Hu L, et al. DL-3-n-butylphthalide inhibits platelet activation via inhibition of cPLA2-mediated TXA2 synthesis and phosphodiesterase. Platelets. 2015;26(8):736–44.

Yang LC, Li J, Xu SF, Cai J, Lei H, Liu DM, et al. L-3-n-butylphthalide promotes neurogenesis and neuroplasticity in cerebral ischemic rats. CNS Neurosci Ther. 2015;21(9):733–41.

Zhang H, Wang L, Yang Y, Cai C, Wang X, Deng L, et al. DL-3-n-butylphthalide (NBP) alleviates poststroke cognitive impairment (PSCI) by suppressing neuroinflammation and oxidative stress. Front Pharmacol. 2023;13:987293.

Fan X, Shen W, Wang L, Zhang Y. Efficacy and safety of DL-3-n-Butylphthalide in the treatment of Poststroke Cognitive Impairment: a systematic review and Meta-analysis. Front Pharmacol. 2022;12:810297.

Wang CY, Xu Y, Wang X, Guo C, Wang T, Wang ZY. Dl-3-n-Butylphthalide inhibits NLRP3 inflammasome and mitigates Alzheimer’s-Like Pathology via Nrf2-TXNIP-TrX Axis. Antioxid Redox Signal. 2019;30(11):1411–31.

Li L, Zhang B, Tao Y, Wang Y, Wei H, Zhao J, et al. DL-3-n-butylphthalide protects endothelial cells against oxidative/nitrosative stress, mitochondrial damage and subsequent cell death after oxygen glucose deprivation in vitro. Brain Res. 2009;1290:91–101.

Zhang X, Bi X. Post-stroke Cognitive Impairment: a review focusing on molecular biomarkers. J Mol Neurosci. 2020;70(8):1244–54.

Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162:777–84.

Yao JP, Zeng FX, Han QL. Explore the efficacy and safety of butylphthalide soft capsule combined with conventional therapy in improving cognitive impairment after stroke. J Qiqihar Univ Med. 2023;44(3):219–23. https://doi.org/10.3969/j.issn.1002-1256.2023.03.004 . [In Chinese].

Article Google Scholar

Fan WB, Li SF, Mao XF. Clinical efficacy of butylphthalide for vascular cognitive impairment. Cent South Pharm. 2012;10(8):630–2. https://doi.org/10.3969/j.issn.1672-2981.2012.08.019 . [In Chinese].

Xu YC. 50 cases of non dementia vascular cognitive impairment in ischemic stroke treated with a combination of huperzine A and butylphthalide orally.Shandong Medicine.2015;(47):108–9. https://doi.org/10.3969/j.issn.1002-266X.2015.47.043 . [In Chinese].

Zhang LN, An ZP. The effect of butylphthalide injection on cognitive function in patients with acute ischemic stroke. Shandong Med J. 2015;451–2. https://doi.org/10.3969/j.issn.1002-266X.2015.04.020 . [In Chinese].

Zhao L, Chen C. A study on the treatment of vascular cognitive impairment with butylphthalide. Chin J Med Clin Sci. 2014;7939–41. https://doi.org/10.11655/zgwylc2014.07.033 . [In Chinese].

Zhu ZF, Guo YM, Wang F. Analysis of the therapeutic effect of butylphthalide combined with citicoline sodium on cognitive impairment after stroke. Cardiovasc Dis J Integr Tradit Chin West Med (Electronic). 2021;9(13):57–9. [In Chinese]. https://doi.org/10.16282/j.cnki.cn11-9336/r.2021.13.036

Zeng XL, Zhu Y, Liu F. Observation on curative effect of butylphthalide combined with nimodipine in treating vascular cognitive impairment. J Mod Med Health. 2013;29(01):43–4. [In Chinese]. https://doi.org/10.3969/j.issn.1009-5519.2013.01.022

Article CAS Google Scholar

Chen SQ, Li BY, Su F. Effect of donepezil hydrochloride combined with butylphthalide in the treatment of patients with cognitive impairment after cerebral stroke. Clin Res Pract. 2020;5(22):29–31, 34. [In Chinese]. https://doi.org/10.19347/j.cnki.2096-1413.202022011

Duan P, Tian PF. The clinical efficacy of sodium butylphthalide chloride in the treatment of acute cerebral infarction with cognitive impairment. Practical Clin J Integr Traditional Chin Western Med. 2022;22(23):51–3, 65. [In Chinese]. https://doi.org/10.13638/j.issn.1671-4040.2022.23.015

Fan F. The clinical study in treatment of vascular dementia with butylphthalide and idebenone. Hebei: Hebei Medical University; 2016. [In Chinese]. https://doi.org/10.7666/d.D843957

Fan YK, Shang JQ, Chen XH. Effects of butyphthalide soft capsules on cognitive function of patients with acute ischemic stroke and its correlation analysis. Chin J New Drugs. 2018;27(8):905–9. [In Chinese].

Google Scholar

Fang F. Exploring the effect of the combination of butylphthalide and citicoline sodium in the treatment of cognitive impairment after stroke. China Practical Med. 2021;16(9):106–8. https://doi.org/10.14163/j.cnki.11-5547/r2021.09.043 . [In Chinese].

Fu HF, Yu D, Wang L. The effect of butylphthalide on cognitive function in mild ischemic stroke patients with moderate stenosis of the middle cerebral artery. Chin J Gerontol. 2019;39(9):2072–5. https://doi.org/10.3969/j.issn.1005-9202.2019.09.008 . [In Chinese].

Fu Y, Ba XH. Clinical study of Butylphthalide Soft capsules in the treatment of vascular cognitive impairment no Dementia after ischemic stroke. J Liaoning Med Univ. 2020;41(05):22–4. https://doi.org/10.13847/j.cnki.lnmu.2020.05.005 . [In Chinese].

Ge XM, Ning L. Effect and safety of butylphthalide soft capsule combined with galantamine in the treatment of mild vascular cognitive impairment after stroke.Diet Health.2022(24):73–6. https://doi.org/10.3969/j.issn.2095-8439.2022.24.018 . [In Chinese].

Guo Y, Du J. Effect of Butylphthalide combined with Oxiracetam on inflammatory factors and cognitive function in patients with Post-stroke Cognitive Impairment. Reflexology Rehabilitation Med. 2022;3(23):147–50. [In Chinese].

Ha C. Clinical efficacy of Butylphthalide Sequential Therapy for Acute Cerebral Infarction with Cognitive Impairment and its effects on high-sensitivity C-reactive protein (hs-CRP) levels. China J Pharm Econ. 2019;14(8):71–3, 77. [In Chinese]. https://doi.org/10.12010/j.issn.1673-5846.2019.08.016

Huang SS, Gong JF. Effect analysis and discussion of urekline combined with butylphthalide in the treatment of mild to moderate vascular cognitive impairment after acute ischemic stroke. Int J Med Data. 2022;4. https://doi.org/10.12208/j.ijmd2020220147 . [In Chinese].

Huang XD. Sequential therapy of butylphthalide for acute ischemic stroke with cognitive impairment: clinical observation of 68 cases. J China Prescription Drug. 2019;17(8):17–8. https://doi.org/10.3969/j.issn.1671-945X.2019.08.008 . [In Chinese].

Huang XQ, Ji HX. The clinical effect of olaxetan combined with butylphthalide in the treatment of mild cognitive impairment after stroke. Med J Commun. 2021;35(3):276–7. https://doi.org/10.19767/j.cnki.32-1412.2021.03.019 . [In Chinese].

Huang YH, Guan SB, Chen GH. Clinical effect of urinary kallidinogenase combined with Butylphthalide in the treatment of mild-moderate vascular cognitive impairment after Acute ischemic stroke. Clin Med Eng. 2022;29(5):651–2. https://doi.org/10.3969/j.issn.1674-4659.2022.05.0651 . [In Chinese].

Ji Z, Fan XB, He Y. Impact of Butylphthalide Combined with Oxiracetam on neurological function, cognitive function and quality of life of patients with cerebral infarction- induced Cognitive disorders. Practical J Cardiac Cereb Pneumal Vascular Disease. 2016;24(5):43–6. https://doi.org/10.3969/j.issn.1008-5971.2016.05.010 . [In Chinese].

Li W, Chen Y, Zhu XL. Effect of Butylphthalide combined with Oxiracetam on Cognitive Impairment in patients with Acute Cere-bral infarction. China Pharmacist. 2018;21(7):1202–04, 1213. [In Chinese]. https://doi.org/10.3969/j.issn.1008-049X.2018.07.018

Mao LJ, Guo F, Li HP. Effect of Butylphthalide Soft Capsule Combined with Cognitive Rehabilitation Training on patients after ischemic stroke. Henan Med Res. 2023;32(2):317–9. https://doi.org/10.3969/j.issn.1004-437X.2023.02-032 . [In Chinese].

Meng Y, Zhou HB, Shang FR. The clinical efficacy of butylphthalide injection in the treatment of cognitive impairment in middle-aged and young adults after ischemic stroke. Neural Injury Funct Reconstruction. 2019;14(5):256–7, 265. [In Chinese]. https://doi.org/10.16780/j.cnki.sjssgncj.2019.05.012

Mo Z. The therapeutic effect of piracetam combined with butylphthalide on cognitive impairment after stroke and its impact on hcy. Heilongjiang Med J. 2020;33(6):1344–5. https://doi.org/10.14035/j.cnki.hljyy.2020.06.053 . [In Chinese].

Shen LL. Study of butyphthalide in the treatment of new onset acute lacunar cerebral infarction complicated with mild cognitive impairment. Chin J Mod Drug Application. 2017;11(7):24–6. https://doi.org/10.14164/j.cnki.cn11-5581/r2017.07.010 . [In Chinese].

Shi ZR, Yang JJ. Effects of Butylphthalide injection on cognitive function and related potentials in ischemic stroke patients with cognitive impairment. J Int Psychiatry. 2020;47(3):536–9. [In Chinese].

Su JH. Observation of the therapeutic effect of butylphthalide on mild cognitive impairment in patients with acute cerebral infarction. J Community Med. 2017;15(10):21–3. [In Chinese].

Wang F, Bian FM, Luan TW. Analysis and exploration of the efficacy of combination therapy with urokinase and butylphthalide in the treatment of mild to moderate vascular cognitive impairment after acute ischemic stroke. Electron J Gen Stomatology. 2020;7(32):30–2. [In Chinese].

Yin KL, Wang J. Observation of the therapeutic effect of the combination of butylphthalide and olaxetan on vascular cognitive impairment after stroke and its effect on serum NSE and MMP-9. J Qiqihar Univ Med. 2018;39(2):171–3. https://doi.org/10.3969/j.issn.1002-1256.2018.02.021 . [In Chinese].

Zhan Y, Liu P, Xiao C, et al. Improving effect of butylphthalide on cognitive impairment in young and middle-aged cerebral infarction. Chin J New Drugs. 2017;26(13):1546–50. [In Chinese].

Zhang B, Ye C. The clinical efficacy of sequential treatment with butylphthalide in acute cerebral infarction with non dementia cognitive impairment. Chin J Integr Med Cardio/Cerebrovascular Disease. 2021;19(8):1371–4. https://doi.org/10.12102/j.issn.1672-1349.2021.08.032 . [In Chinese].

Zhao S. The efficacy of Butyphthalide combined with Piracetam in the treatment of cognitive impairment after cerebral infarction. Henan:Xinxiang Medical University; 2018. [In Chinese].

Zhou JC, Liu J, Liu XJ. Impact of Butylphthalide Soft capsules on Brain Neurotransmitter Level, neurological function and cognitive function in patients with cognitive dysfunction after Stroke. Clin Med Eng. 2023;30(9):1225–6. https://doi.org/10.3969/j.issn.1674-4659.2023.09.1225 . [In Chinese].

Zhou W, Zhang R, Zhou GY, et al. The effect of butylphthalide on mild cognitive impairment and neurological deficits in patients with acute cerebral infarction. J Ningxia Med Univ. 2016;38(10):1210–2. https://doi.org/10.16050/j.cnki.issn1674-6309.2016.10.033 . [In Chinese].

Chen YK. The effect of butylphthalide combined with citicoline sodium on cognitive impairment patients after stroke. Chin J Sci Technol Database (Citation Edition) Med Health.2021;11:0010–1. [In Chinese].

Ni F, Chen L, Wu XL. Evaluation of the effect of butylphthalide on cognitive impairment after stroke. Grand Doctor. 2021;12:60–2. [In Chinese].

Jokinen H, Melkas S, Ylikoski R, Pohjasvaara T, Kaste M, Erkinjuntti T, et al. Post-stroke cognitive impairment is common even after successful clinical recovery. Eur J Neurol. 2015;22(9):1288–94.

Wu S, Wu B, Liu M, Chen Z, Wang W, Anderson CS, et al. China Stroke Study collaboration. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol. 2019;18(4):394–405.

Qi Q, Xu J, Lv P, Dong Y, Liu Z, Hu M, et al. DL-3-n-butylphthalide alleviates vascular cognitive impairment induced by chronic cerebral hypoperfusion by activating the Akt/Nrf2 signaling pathway in the hippocampus of rats. Neurosci Lett. 2018;672:59–64.

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Acknowledgements

This work was supported by the Taishan Scholar Project (NO.tsqn202312392), the Science and Technology Development Plan Project of Shandong Geriatrics Society (LKJGG2021W126) and the Outstanding Young Talents Project in Health of Qilu and the youth talent training program from Qingdao medical college of Qingdao University (No. RZ2300002690).

This work was supported by the Taishan Scholar Project (NO. tsqn202312392), the Science and Technology Development Plan Project of Shandong Geriatrics Society (No. LKJGG2021W126) and the Outstanding Young Talents Project in Health of Qilu and the youth talent training program from Qingdao medical college of Qingdao University (No. RZ2300002690).

Author information

Zhen Wang, Jiahui Wang, and Jiajia Yun contributed equally to this work.

Authors and Affiliations

Special Education and Rehabilitation College, Binzhou Medical University, Yantai, China

Zhen Wang & Jiajia Yun

Department of Rehabilitation, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China

Zhen Wang & Jun Song

Central Laboratory, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China

Jiahui Wang

Department of Neurology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China

Qi Chen & Chao Ren

Department of Rehabilitation, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China

Deqiang Wang

Shandong Provincial Key Laboratory of Neuroimmune Interaction and Regulation, Yantai Yuhuangding Hospital, Yantai, China

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ZW: Writing—review & editing, Writing—original draft, Visualization, Validation, Resources, Methodology, Investigation, Data curation. JW: Writing—review & editing, Writing—original draft, Visualization, Validation, Software, Resources, Methodology, Investigation, Data curation. JY: Writing—review & editing, Writing—original draft, Validation, Supervision, Resources, Methodology, Investigation, Data curation. JS: Validation, Methodology, Investigation, Data curation. QC: Writing—review & editing, Software, Resources, Methodology, Data curation, Funding acquisition. DW: Writing—review & editing, Supervision, Project administration, Funding acquisition, Formal analysis, Conceptualization. CR: Writing—review & editing, Supervision, Project administration, Funding acquisition, Formal analysis, Conceptualization.

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Correspondence to Deqiang Wang or Chao Ren .

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Supplementary Material 1 Supplementary Fig. 1 Methodological quality of included studies

Supplementary material 2 supplementary fig. 2 distribution of the methodological quality of included studies, supplementary material 3 supplementary fig. 3 funnel plot of mmse score for nbp monotherapy, rights and permissions.

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Wang, Z., Wang, J., Yun, J. et al. Effectiveness of DL-3-n-butylphthalide in the treatment of poststroke cognitive impairment and its associated predictive cytokines: a systematic review and meta-analysis. BMC Pharmacol Toxicol 25 , 65 (2024). https://doi.org/10.1186/s40360-024-00793-z

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http://orcid.org/0000-0003-4123-9432 Meryem Hamdoune ,
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Abdellah Gantare
Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies , Settat , Morocco
Correspondence to Meryem Hamdoune; m.hamdoune{at}uhp.ac.ma

Background Digital health technologies (DHTs) play a crucial role in symptom management, particularly in palliative care, by providing patients with accessible tools to monitor and manage their symptoms effectively. The aim of this systematic review was to examine and synthesise the scientific literature on DHTs for symptom management in palliative oncology care.

Methods A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and meta-analyses from 2 June to 20 June 2024. Databases including Scopus, Web of Science, ScienceDirect, PubMed and the Cochrane Library were searched. Data were extracted using a standardised form based on the PICOTT (Population, Intervention, Comparison, Outcome, Type and Technology) framework. The quality of the included studies was assessed using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool during the selection process.

Results The systematic review included seven articles describing six DHTs from five countries: the UK, Kenya, Tanzania, the Netherlands and the USA. The findings of this comprehensive literature review elucidate four principal themes: the specific types of DHTs used for symptom management in palliative cancer care, their roles and advantages, as well as the factors that limit or promote their adoption by patients and healthcare professionals.

Conclusion The findings of this review give valuable insights into the ongoing discourse on integrating digital health solutions into palliative care practices, highlighting its potential role in enhancing symptom management within palliative cancer care and showcasing its possible benefits while also identifying key factors influencing their adoption among patients and healthcare professionals.

Palliative care
Symptoms and symptom management

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/spcare-2024-005107

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WHAT IS ALREADY KNOWN ON THIS TOPIC

Digital health is an expanding field that provides innovative solutions to enhance palliative care delivery through improved efficiency, accessibility and effectiveness.

WHAT THIS STUDY ADDS

This systematic review provides an overview of what digital health technologies are used for symptom management in palliative oncology care, their functions, benefits, efficiency as well as potential factors that influence their adoption by patients and healthcare professionals.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

The results of this review could be instrumental for policymakers, clinicians and health technology developers in the design, implementation and evaluation of appropriate and effective digital solutions for managing bothersome symptoms in palliative care patients with cancer.

Introduction

Digital health is a swiftly expanding field that presents dynamic opportunities for innovation and enhancements in health services. 1 It aims to enhance the efficiency, accessibility and effectiveness of healthcare by using digital technology to gather, analyse, manage and distribute health data. 1 Digital health technologies (DHTs) encompasses mobile health applications, electronic health records, telehealth, human-machine interaction, wearable sensors, artificial intelligence and other types of DHTs. 1 2

Digital health interventions are increasingly crucial for adults, children and young people undergoing cancer treatment and palliative care (PC). 2 3 Indeed, the WHO has advocated for 80% availability of accessible technologies to address non-communicable diseases, such as cancer. 4

According to the WHO’s Global Cancer Statistics report, 20 million new cancer cases and 9.7 million cancer deaths were recorded worldwide in 2022. 5 About 53.5 million people were estimated to be alive 5 years post-diagnosis. 6 Regional variations exist, with Africa and Asia experiencing higher death rates due to late-stage diagnosis. Europe reports 22.4% of global cancer cases and 20.4% of deaths, despite having only 9.6% of the world’s population. 5 Future projections indicate over 35 million new cancer cases will occur in 2050, with a 77% increase from the 20 million cases estimated in 2022. 5 Regionally, the most significant rise in incidence will occur in high and very high Human Development Index (HDI) countries, including China, with an additional 4.8 and 3.9 million cases, respectively. Lower HDI regions will see a 142% increase, from 0.8 million cases in 2022 to 2 million in 2050, while medium HDI countries, like India, will witness nearly a 100% increase, doubling from 2.4 million to 4.8 million cases. 5

In this regard, provision and accessibility of pain management and PC becomes highly required as pain is reported to be experienced by 55% of patients undergoing anticancer treatment and by 66% of patients who have advanced, metastatic or terminal disease. 7 Patients with advanced palliative cancer experience a range of symptoms, with the most distressing being pain, fatigue and anxiety. 8 Other common symptoms include loss of appetite, dyspnoea, constipation and nausea. 9

Pain is a frequently experienced and poorly managed symptom in patients with cancer. 10 11 More than two-thirds of patients will suffer from pain in the final stages of their cancer. 12 Pain significantly contributes to suffering and adversely affects their quality of life, often resulting in unplanned hospital admissions due to unmanaged symptoms. 10 13

PC aims to improve the quality of life for patients dealing with serious or life-threatening illnesses, such as cancer. 14 The WHO has reported that each year an estimated 56.8 million people are in need of PC, most of whom live in low- and middle-income countries. 15 While availability and access to this care varies. Overall, high-income countries, especially in Europe, over two-thirds of the countries, offer PC in both community or home-based care settings and in primary healthcare settings. 15 In contrast, in low-income countries, only 19% have PC available in primary healthcare settings and 10% in community or home settings. 15 A similar disparity exists in the Southeast Asia region, where 55% of countries report PC availability in primary healthcare settings, compared with 36% in community or home-based settings. 15

To improve accessibility and effective PC and pain management for patients with cancer, the use of technologies to facilitate this process is a growing area of interest for patients, caregivers and policymakers. Research suggests that remote symptom monitoring significantly enhances care for patients with palliative needs, leading to improved outcomes in cancer symptom management. 16 17 Electronic self-monitoring enables patients to track pain fluctuations and their connections to factors such as medication intake and daily activities. 11 16 Healthcare technologies facilitate effective self-management by providing organised data access for both patients and healthcare professionals. 18 These approaches not only aid in monitoring and controlling symptoms but also promote treatment adherence and expand healthcare accessibility across diverse patient populations. 19 No evidence to our knowledge has explored these technologies and their benefits in managing pain and different symptoms in palliative cancer care. This systematic review aims to fill this knowledge gap and offers a review of the adoption of these technologies and the evidence surrounding their effectiveness.

This systematic review aims to:

Identify the DHTs used to manage symptoms, particularly pain, in palliative cancer care.

Evaluate the advantages of DHTs in managing symptoms in patients with cancer requiring PC.

Explore the factors influencing the adoption of DHTs in palliative oncology care among patients and healthcare professionals.

Material and methods

Study design.

This systematic review aimed to identify DHTs used for symptoms management (especially pain) in PC patients with cancer, focusing on their effectiveness and the factors influencing their adoption by patients and healthcare professionals. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 2020 edition.

Search strategy

We conducted a comprehensive search through Scopus, Web of Science, ScienceDirect, PubMed and the Cochrane Library between 2 June 2024 and 20 June 2024, using the following keywords: (‘Palliative care’ OR ‘palliative cancer care’) AND (‘eHealth’ OR ‘digital health’) AND (‘pain management’ OR ‘symptom monitoring’). The PRISMA flow diagram illustrating the flow of information through the different phases of the review is included in figure 1 .

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Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram flow.

Inclusion and exclusion criteria

Inclusion criteria encompassed peer-reviewed articles employing qualitative, quantitative and mixed methods, and research focusing on DHTs for symptoms management in palliative oncology care. The search was limited to articles published (full text available) between 2013 and 2023 and restricted to English-language publications.

Exclusion criteria included non-peer-reviewed articles, conference abstracts, reviews, meta-analysis, research programmes and study protocols and articles not focused on DHTs used to manage symptoms in palliative oncology care.

Selection process

After searching all the databases and removing duplicates, we first screened the titles and abstracts of the identified studies to check their relevance to the topic, excluding those deemed irrelevant. Second, we obtained the full texts of studies that appeared to meet the inclusion criteria. The researchers then examined all the retrieved articles separately for relevance. Discrepancies were resolved through discussion and consensus.

Data extraction and quality assessment

Data were extracted using a standardised form based on the PICOT framework (Population, Intervention, Comparison, Outcome and Type). 20 To meet our research objective, we included a second ‘T’ (PICOTT) to denote the technology used.

The research team maintained rigour and avoided biases during data collection through the strict following of the clearly defined inclusion and exclusion criteria to curb selection bias, and the use of multiple databases to ensure comprehensive coverage and identification of all relevant studies. Additionally, to eliminate interpretation bias, a reading committee consisting of four members evaluated and synthesised the studies to guarantee an objective interpretation. Furthermore, to ensure intercoder reliability of data extraction, the research team members independently and concurrently analysed the included studies, and any discrepancies were resolved through discussion and consensus.

The final step of the selection process involved assessing the quality of the included studies with the Appraisal of Guidelines for Research & Evaluation (AGREE)II tool. Originally developed by Brouwers et al and updated in 2016 to enhance accuracy and neutrality, this tool includes 23 items distributed across six domains: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability and editorial independence. Every item is rated on a Likert scale from 1 (strongly disagree) to 7 (strongly agree). 21 The scores of the quality appraisal results from the selected studies are illustrated in table 1 .

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The scores of the quality appraisal results from the selected studies

Article selection

A total of seven papers adhered to the selection criteria and were included and examined in this study. The studies included originated from five countries: the UK, Kenya, Tanzania, the Netherlands and the USA. With two articles originating from the UK, two from the USA, two articles from the African region and one from the Netherlands. The studies were published in various years, including one from 2016 (Hochstenbach et al ), three from 2020 (Hackett et al , Ingram et al and Wilkie et al ), one from 2022 (Ho et al ) and one from 2023 (Cornetta et al ). Most papers focused on the development and testing of DHTs. 11 22–26 . Table 2 presents study characteristics relevant to the purpose of this review.

Characteristics of included studies

The results of this systematic literature review highlight the following themes: types of DHTs used to manage symptoms in palliative cancer care, their functions, their benefits and the factors influencing their adoption by patients and healthcare professionals.

Types of DHTs reported in the studies included

Mobile/web health applications.

PainCheck is an information and communication technology system designed to regularly assess and monitor pain in patients in the late stages of cancer. The system is the outcome of a significant research initiative (IMPACCT (Improving the Management of Pain From Advanced Cancer in the Community; ISRCTN registry No. 18281 271)) conducted in the UK. The software development team comprised three developers and a business analyst, all proficient in agile methodologies. Development adhered to the Disciplined Agile Delivery framework, a structured approach used by software developers to direct the creation of information and communication technology systems from initial conception through implementation to eventual retirement. The application questions are derived from the Brief Pain Inventory and the Coping Strategies Questionnaire. 10

Mobile Palliative Care Link

Mobile Palliative Care Link (mPCL) is a user-focused mobile/web application developed to enhance symptom management and quality of life for patients with cancer by facilitating remote, real-time symptom assessment and interdisciplinary care coordination. The mPCL was developed based on the African Palliative Care Outcome Scale and uses CommCare, a secure, cloud-based, open-source platform. It can be accessed via a native Android application or a web browser and supports both online and offline data collection in areas with limited connectivity. 23

A mobile application connected to a web application

It is a mobile phone and web-based self-management support application for patients and nurses that uses the Numerical Rating Scale. The application was developed as part of an iterative co-creative development process involving healthcare workers, patients, researchers and technical experts. 11

PAINRelieveIt

PAINRelieveIt is a web-based application for pain management that offers a systematic approach to improving cancer pain outcomes. The application equips patients with suitable language for reporting pain and provides clinicians with a clinical decision aid to facilitate the prescription of analgesics. It incorporates the McGill Pain Questionnaire, Pain Management Index and the Barriers Questionnaire-13 to enhance its effectiveness. 22

Digital platform

The palliative/end-of-life/assessment/care coordination/evidence-based programme.

Palliative/End-of-Life/Assessment/Care Coordination/Evidence-Based Programme (PEACE) is an interactive platform designed to improve PC by monitoring symptoms and supporting patients through technology-assisted condition management and care pathway protocols. It also alerts the PC team when intervention is required. 24

Cornetta et al 27 established a weekly follow-up programme to evaluate physical symptoms and distress in patients and their careers. Participants’ symptoms were initially evaluated at enrolment and then assessed weekly basis, through questions from the validated Africa Palliative Care Association Palliative Outcome Scale. 27

Key features of DHTs in palliative cancer care

The various functions of DHTs identified in this review are summarised in table 3 , which provides a detailed overview of each technology and its functions to managing symptoms in palliative cancer care.

Benefits of DHTs for symptoms management

Pain management.

The patients stressed the substantial value of the applications developed by Hochstenbach, Allsop and their team in assisting them with self-managing their pain and pain medication. 11 25 26 Furthermore, Cornetta et al 27 stated that a weekly monitoring programme makes it possible to adjust medication and facilitate refills. 27

Promote interdisciplinary care coordination

Ho and colleagues 23 mentioned that the mPCL seems to enhance interdisciplinary care coordination by allowing carers to interact with patients and their caregivers. It offers quick access to shared medical records and real-time responses at the point of care, ensuring timely symptom monitoring. It also records clinical interactions with patients after discharge and tracks longitudinal treatment decisions. 23

Improving care and support

The mPCL and PainCheck enhanced the speed and efficiency of care while tackling financial, transportation and other patient-specific challenges that are often present in traditional care settings. 23 Patients perceived these applications as a supportive resource. They no longer felt alone; instead, they felt engaged and integrated into the services. This led to a sense of reassurance, knowing that assistance was readily available when needed. 25 26

Remote symptom control

Having a common platform (mPCL) ensures that patients with milder symptoms can be triaged and treated more effectively as situations arise. On the other hand, it facilitates assessing symptoms, maintaining contact and remotely communicating with patients after their discharge from the hospital, which represents a significant improvement compared with the previous lack or scarcity of symptom management resources in the community. 23 In the same vein, PEACE has enabled the proactive and continuous monitoring of symptoms for hospice patients at home without increasing nurse visits, resulting in high overall satisfaction among patients, their families and staff. 24 While, Cornetta et al 27 have shown that telehospice can offer a temporary solution for PC to patients who lack access to PC services at home. 27

Factors influencing adoption of DHTs in palliative cancer care

Familiarity with technology.

Healthcare professionals’ knowledge, confidence, understanding and familiarity with information and communication technologies affected their own engagement, which subsequently influenced how much they encouraged and facilitated patient engagement. 23 25 26 One barrier to understanding and becoming familiar with the system was the workload, as patients in the trial were distributed across different clinical nurse specialists. Consequently, these healthcare professionals had limited opportunities to use and familiarise themselves with the system. 26 In this respect, Ingram et al 24 have pointed out that to improve the use of new technologies, it is imperative to employ just-in-time training methods for staff. 24

Availability of technological resources

Patients’ and healthcare providers’ access to e-Health technologies has also been influenced by limited access to technological resources such as phones, SIM cards, internet connection at home and not having a computer and handheld. Indeed, people who rarely used technology or computers, often lacked an internet connection or struggled with digital technology, found its use stressful and, as a result, were reluctant to incorporate it into their daily routine. 23 25 Therefore, leveraging patient technology platforms including tablets, televisions and smartphones could simplify this process and enhance adherence. 24

Ease of access and use

Participants in studies by Allsop et al 10 (2019) and Hackett et al 26 characterised the PainCheck system as straightforward, user-friendly, efficient and minimally intrusive. 25 26 Similarly, Hochstenbach et al reported that patients appreciated the mobile application’s ease of use and its range of features. 11 Additionally, Ho et al 23 found that despite some reported challenges, most providers deemed mPCL ‘easy to use’ and expressed a commitment to continue using it if it remained available. 23

Health professionals’ commitment

Patient engagement with PainCheck was further shaped by healthcare providers responsible for facilitating and monitoring patient interaction with the information and communication system. 25 In fact, some patients mentioned that nurses did not introduce them to PainCheck to avoid adding an unnecessary burden. 25 26 According to Hackett et al, 26 effective implementation and improved engagement of professionals and patients necessitate proactive support and collaboration between the research team and healthcare workers managing information and communication systems. 26 Moreover, the study by Hochstenbach et al (2023) emphasised that the follow-up and guidance provided by nurses, combined with their collaboration with attending physicians, were essential for improving patients’ experiences. 11 Similarly, Ho et al 23 reported that most clinicians demonstrated a keen enthusiasm in continuing to use mPCL and in sharing the application with their peers. They indicated that extending the application’s availability to patients across Tanzania could significantly enhance access to PC, especially in rural regions where services are scarce or non-existent. 23

Perceived usefulness of DHTs

Although digital technology enables healthcare professionals to contact patients online, they appeared sceptical about its ability to deliver the same level of personalised care as their traditional methods, notably telephone and face-to-face consultations. 26 Moreover, healthcare professionals voiced concerns about the scalability of their engagement with PainCheck, noting that using the system might add to their workload if they were managing a larger number of patients. 26 Wilkie et al 22 found that nurses who did not use the application mentioned that they had limited time to access the information, as they perceived it as optional since they were already familiar with their patients’ needs and preferences. 22 Additionally, participants in a study by Hochstenbach et al expressed similar concerns about the effectiveness of digital tools compared with traditional care methods. Despite their enthusiasm for the application, nurses viewed their new approach to work as a genuine challenge. It introduced new tasks, different responsibilities and unfamiliar technologies, which required an adjustment period. 11

Connectivity and software problems

Healthcare professionals have noted usability challenges such as the complexity of generating a clinical record for a newly registered patient and the requirement to promptly address real-time reminders or alerts for routine, non-urgent updates on a patient’s condition. 23 Patients also encountered several primary technological issues, including not receiving a diary, inability to record medications, lack of an updated graph and difficulty accessing information. 11 Furthermore, the application failed to document the initial pain assessment, which was essential for facilitating patient transfer and maintaining continuity of care. 11

This systematic review aimed to identify DHTs used for symptom management, especially pain, in PC for patients with cancer. It specifically focused on their effectiveness and the factors that influence their adoption by patients and healthcare professionals.

The literature review identified different types of DHTs used to manage bothersome symptoms, particularly pain, in palliative cancer care. The DHTs reported in the reviewed studies encompassed mobile/web health applications, digital platforms and telehospice. The mobile/web health applications consisted of PainCheck, 25 26 mPCL, 23 a mobile application connected to a web application, 11 and PAINRelieveIt. 22 PainCheck operated in the UK, mPCL was used in Tanzania, the mobile application connected to a web application was developed in the Netherlands and PainRelievIt was created in the USA.

The only digital platform identified was the PEACE 24 and was used in USA, while telehealth 27 was implemented in Kenya to evaluate physical symptoms and distress in patients and their careers.

The existing literature underscores the availability of a diverse array of DHTs for the effective management of symptoms in PC, with a particular emphasis on pain relief. For instance, Bhargava et al 16 created RELIEF, a remote self-reporting application designed for community patients requiring PC. The pilot feasibility study showed that RELIEF is a practical and well-accepted tool for monitoring patients care patients remotely by enabling regular symptom self-reporting. 16

The studies reviewed highlighted several key features of mobile/web health applications, including personalised pain management advice and real-time assessment of symptoms and quality of life. 11 23 25 26 These applications facilitate the documentation of users’ clinical interactions with patients and caregivers post-discharge, and they provide short message service capabilities for direct contact between patients or caregivers and clinicians during emergencies. 11 23 Additionally, they include a diary function that enables patients to monitor pain and side effects, allowing for regular reporting and sharing of pain data with health professionals. 11 22 23 25 26 Educational sessions within the applications offer essential information on pain management, while a clinical decision support tool assists clinicians in prescribing analgesics effectively. 11 22 23

Telehospice enables the remote assessment of physical symptoms and distress for both patients and caregivers through remote patient monitoring. 27 The digital platform ‘PEACE’ offers several key features, including video consultations with a nurse at the hospice centre, which facilitate direct communication and support for patients and their families. Additionally, this platform provides telephone interactions, allowing for convenient and timely access to care and information, ensuring that patients receive the assistance they need in a flexible manner. 24

The potential of DHTs for symptom management, particularly pain, in palliative patients with cancer was demonstrated in all reviewed studies. 11 22–27 The benefits included pain management, promoting interdisciplinary care coordination, improving care and support and remote symptom control. A systematic integrative review revealed that e-Health improved individualised care for patients in PC, increased their sense of security, enhanced symptom management and boosted their participation in care. 28 Zhou et al found that telephone follow-up is a practical alternative to hospital visits for patients with advanced cancer seeking symptom relief, significantly reducing the burden of travel. 29 Additionally, the use of web-based platforms to gather patient-reported outcomes has been linked to enhancements in health-related quality of life and overall survival, facilitated by proactive management of emerging symptoms. 30

The factors influencing the adoption of DHTs in palliative cancer care, identified in the articles selected for the systematic review, were familiarity with technology, availability of technological resources, ease of access and use, health professionals’ commitment, perceived usefulness of interventions and connectivity and software problems. A study carried out among digitally lagging nurses, aimed at identifying the factors influencing their adoption of health information technology, revealed that a negative attitude toward computer use and a lack of digital skills contributed to feelings of increased incompetence, leading to the postponement or avoidance of health information technologies both privately and professionally. 31 Similarly, Wicki et al 2 found that barriers to the acceptance of DHTs among PC patients included unfamiliarity, concerns about data security, errors in data interpretation and the loss of personal interaction due to artificial intelligence. 2

Strengths and limitations

Our systematic review exhibited several strengths, including rigorous adherence to well-defined inclusion and exclusion criteria to minimise selection bias, and the use of multiple databases to ensure comprehensive coverage of relevant studies. To reduce interpretation bias, a four-member reading committee provided objective analysis and synthesis of the data. Additionally, independent and concurrent data extraction by team members, with discrepancies resolved through discussion, ensured high intercoder reliability.

This study has also several limitations to consider. The systematic review misses relevant studies in non-English languages or those in less common databases. Additionally, it excludes studies published before 2013, potentially omitting important research. Moreover, the review does not include grey literature, such as reports, theses and conference papers, which can provide valuable insights and data not available in peer-reviewed journals. This omission introduces bias, as grey literature often contains unique findings and alternative perspectives that might be crucial for a comprehensive understanding of the topic.

Recommendations

Encourage the systematic integration of proven digital technologies into symptom management protocols for patients with cancer in PC.

Provide ongoing training for healthcare professionals in the use of digital technologies for symptom management, focusing on adapting these technologies to their clinical practices and providing the necessary technical support.

Ensure equitable access to digital technologies for all PC patients, considering possible economic and technological barriers.

Promote ongoing evaluation of the effectiveness, safety, and acceptability of DHTs for symptom management, considering feedback from patients and healthcare professionals.

Implications of the results for practice, policy and future research

For practice:

Our study provides a comprehensive list of available digital health technologies, assisting healthcare professionals in selecting the most suitable tools for managing symptoms in palliative patients with cancer. By identifying the specific functions of each technology, caregivers can adopt a more personalised and effective approach to monitoring and treating symptoms.

For policy:

Our research results can help policymakers develop strategies and policies to enhance the adoption of digital health technologies in PC. By gaining a deeper understanding of the factors that hinder adoption, policymakers can design targeted interventions to address these challenges.

For research:

Our study identifies not only current technologies and their functions, but also the barriers to their adoption. This information is invaluable in guiding future research, highlighting areas requiring technological innovation or in-depth study.

In conclusion, this systematic review emphasises the important role of DHTs in improving symptom management in palliative cancer care. The results highlighted the various DHTs and their advantages while identifying key factors that limit or promote their adoption by patients and healthcare professionals. This research offers valuable insights about incorporating digital health solutions into PC practices, highlighting the need for targeted strategies to promote adoption and optimise the integration of these technologies for better patient outcomes. By addressing both the potential benefits and the barriers to implementation, this study lays the groundwork for future initiatives aimed at enhancing the quality and accessibility of PC through innovative digital tools.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

Sasi R , et al
Amann M , et al
Begovic D ,
Salifu Y , et al
World Health Organization
Laversanne M ,
Sung H , et al
Gilbertson-White S ,
Aouizerat BE ,
Jahan T , et al
Van Lancker A ,
Van Hecke A , et al
Allsop MJ ,
Bennett MI , et al
Hochstenbach LMJ ,
Zwakhalen SMG ,
Courtens AM , et al
van den Beuken-van Everdingen MHJ ,
Joosten EAJ , et al
Haddou Rahou B , et al
Bhargava R ,
Keating B ,
Isenberg SR , et al
Vrancken Peeters NJMC ,
Koppert LB ,
Jager A , et al
Kuijpers W ,
Aaronson NK , et al
Lacey C , et al
Brouwers MC ,
Browman GP , et al
Wilkie DJ ,
Ezenwa MO , et al
Lambden K , et al
Shadbolt EL , et al
Johnson O ,
Taylor S , et al
Hackett J ,
Cornetta K ,
Nyariki S ,
Manji I , et al
Widberg C ,
Wiklund B ,
Zhou M , et al
Kris MG , et al
De Leeuw JA ,
Woltjer H ,

Contributors Designing the systematic review protocol and developing the search strategy: MH and KJ. Conducting the literature search, screening and data extraction: All authors. Performing the quality assessment of included studies: All authors. Contributing to the synthesis of results: All authors. Providing critical revisions and overseeing the writing and finalisation of the manuscript: All authors. MH is responsible for the overall content of the manuscript and acts as the guarantor.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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Advantages and disadvantages of literature review
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This paper discusses different types of literature reviews, such as systematic, semi-systematic and integrative reviews, and how to conduct and evaluate them in business research. It also provides practical tips and common pitfalls for using literature review as a research method.
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INTRODUCTION. Writing the literature review (LR) is often viewed as a difficult task that can be a point of writer's block and procrastination in postgraduate life.Disagreements on the definitions or classifications of LRs may confuse students about their purpose and scope, as well as how to perform an LR.Interestingly, at many universities, the LR is still an important element in any ...
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Results The systematic review included seven articles describing six DHTs from five countries: the UK, Kenya, Tanzania, the Netherlands and the USA. The findings of this comprehensive literature review elucidate four principal themes: the specific types of DHTs used for symptom management in palliative cancer care, their roles and advantages, as well as the factors that limit or promote their ...

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