The British School of Osteopathy

275 Borough High Street, London SE1 1JE

Critical Analysis and

Enquiry

Integration and Synthesis Phase

Learning Resource Pack 5
How to Write a Critical Literature Review

Produced by
Jo Dear, MSc, BSc (Hons)
Hilary Abbey, MSc, DO

Modified by
Amanda Samson, PhD, B.Ed
Melanie Wright, PhD, BSc (Hons)

BSO 2008
 COPYRIGHT

Apart from any fair dealing for the purposes of research, private study, criticism or
review, as permitted under the UK Copyright Designs and Patents Act, 1988, this
publication may not be reproduced, stored, or transmitted in any form or by any
means, without the prior permission in writing of the British School of Osteopathy,
or in the case of reprographic reproduction only in accordance with the terms of
the licences issued by the Copyright Licensing Agency in the UK, or in accordance
with the terms and licences issued by the appropriate Reproduction Rights
Organisation outside the UK. Enquires concerning reproduction outside the terms
stated here should be sent to the British School of Osteopathy.

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INTRODUCTION

This study guide is designed to help you to write a critical literature review (CLR)
on the specific, osteopathically relevant topic that you have described in your
Critical Analysis and Enquiry (CAE) Project Outline form. It provides a structure
which will be the basis of the CLR. The structure includes sections on providing a
rationale for your project topic/research questions, osteopathic relevance of the
project, critical appraisal of literature, including a justification for the chosen
research methodology of the project.

This study guide is divided into three main sections. The first section outlines the
required format and structure of the CLR. The second section provides guidelines
for the content of each section/subsection. The third section gives suggestions on
how to critically appraise a paper.

By the end of this study guide you should be able to structure and write a CLR that
includes the assessment of a number of research articles within an osteopathically
relevant health care context.

SECTION 1 THE FORMAT OF THE CLR

The CLR forms the first assessed piece of work for the M-level dissertation. The
CLR should be approximately 1,500 words in length (e.g. about 10- 12 sides of
A4). It must be word-processed to an appropriately professional standard and
properly referenced. The review should include the name of the person who has
agreed to supervise your CAE project in the header of the document.

The suggested format is: Approx. word count

Introduction 250 - 300 words

Description of topic
Rationale (ie justification for choice of topic)
Osteopathic relevance and context

Literature Search details 50 words

(incl. key words, MeSH terms and databases)
This can be tabulated1 see next section

Literature review of published research articles 1,000 words

(with at least 2 subheadings)
Sub-headings eg. relevant to topic content
Sub-headings - eg. relevant to methods of investigation

Summary and Conclusions 200 words

References approx. 20 in total

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Contents of a table are excluded from the word limit

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SECTION 2 CONTENT OF EACH SECTION OF THE CLR

The CLR should be written in the third person. It should be in a clear and easy to
read prose style and attention should be paid to the use of correct grammar and
punctuation and a spell check should be used, if necessary. The following
provides more details of what you should include under each section:

Introduction: Description (approx. 100 words)

This should include a clear description of your topic.

Introduction: Rationale and Osteopathic Relevance (approx. 150 words)

This section should provide a context and justification for the study and should
allow the reader to get a feel for how your project will add to and extend the body
of knowledge in the subject area. The rationale should also explain the osteopathic
relevance of your study. Your project should have some description of the
osteopathic theory underlying it, and/or should be clinically relevant. Provide some
details of the osteopathic background to the study and how its results might
contribute to future osteopathic practice.

This Introduction should include the answers to the following questions:

Why is this topic worth studying?
Why do osteopaths need to know about this?

Literature Search Details (approx. 50 words)

This section is included to give some indication of how easily sources of

information might be attained. Give details of which literature databases you
consulted (e.g. PubMed) and include a list of the keywords and MeSH headings
that you used and the number of relevant items that were listed as a result. You
may use the following table in your CLR to provide the details of your searches (if
you do use this table then its contents will be excluded from the word limit):

Databases Key words and MeSH No. of No. of relevant

searched Headings hits articles

Please note that CLRs must contain at least 15 to 20 citations in total of

which 75% (12-15) should be published research articles. Other citations can be
sourced from textbooks and unpublished research, such as previous BSO
dissertations.

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Searching for literature is an art and takes some practice. Try using a thesaurus to
find alternative words, and try putting in words in all permutations. If you are
unable to find sufficient published literature from osteopathic sources, you will
need to widen your search to include allied health disciplines such as medicine,
nursing, physiotherapy and chiropractic. If you are still unable to find enough
articles to critique, please discuss your project with one of the CAE team, as it may
be necessary to refine your project area or research question(s). For more
information about literature searching please see CAE LRP 2.

Literature Review (approx. 1000 words)

To create a concise review, it is important to arrange the literature review in

sections, with clear, descriptive sub-headings in a logical order. Issues should be
discussed theme by theme and not as a list of individual papers.

The amount of previous research available on your specific topic will vary a great
deal depending on the particular topic you decide upon. You should be able to
comment on some research in your topic area, although you may have to refer to
related professions (eg, medicine, nursing, chiropractic and physiotherapy etc.) or
to adjacent topic areas. It is unlikely that you will discover many papers that are
directly relevant to your project, so you may need to expand your search.

The markers will be looking for evidence of thorough searching, critical evaluation
and independent thought, so give some attention to the value of the research you
are reviewing, including good points, weak points and omissions. It is important
that at M-level you show evidence of your ability to critique papers.

Please consider the following points when writing the literature review:

- the literature should not be described in a list format and it should not be
organised by author. All the papers which discuss a particular aspect of the
topic should be mentioned under the appropriate sub-heading
- it should contain literature which either highlights contrasting views, or gaps in
current knowledge or areas of uncertainty (rather than supporting one viewpoint
in a descriptive or uncritical manner)
- it should describe relevant details of the research method used and the main
results obtained in each paper. It is not necessary to include full statistical
details but some indication should be given of whether appropriate tests were
used and appropriate probability levels set etc.
- it should include a critical assessment of the quality of the paper and therefore
the credibility of the results

- it should indicate the conclusions that can be drawn about the credibility of the
results and their implications

- it wont be possible to carry out a complete critique of every article since the
whole CLR is limited to 1,500 words

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Summary and Conclusions (approx. 200 words)

This should be a brief summary of the main reasons for conducting a study into
this topic with the most relevant findings from previous research. This section
should not be simply a list of bullet points.

In this section please indicate a future direction for your proposed project
i.e. in the form of a research question (which may have been refined since the
project outline was submitted).

References (no word limit)

The Reference list at the end of the CLR must be in Harvard style. All sources
cited in the text must be presented, in full, in the alphabetical order of the first
authors surname. Do not make separate sections for textbooks, journal articles or
unpublished material. Using other peoples work in your text but not referencing
them is plagiarism. Other material that is not directly cited in the text should be
placed in an alphabetical Bibliography following the Reference section.

It is essential that all sources should be properly referenced in the text and
included in the alphabetical reference list at the end of the review. For further
information please refer to the BSO Guide to Referencing.

SECTION 3 HOW TO CRITIQUE AN INDIVIDUAL PAPER

When critically appraising papers, you may find the attending the Journal Club
sessions useful and using the checklists by the Critical Appraisal Skills
Programme helpful. These checklists can be found at:
www.phru.nhs.uk/Pages/PHD/resources.htm

In preparing a review and critique for each paper you have obtained, it may be
helpful to make notes on the following questions, in preparation for integrating all
the papers into the final, combined literature review. It is useful to look at each
paper separately first but remember that in the final review you will not be
analysing each article separately by author, but grouping papers together under
the relevant sub-headings.

1. How is this research paper relevant to your topic? (ie. what question were these
researchers trying to answer?)

2. What is the value of this piece of research to osteopathy? (ie. what information
or knowledge does it add to or confirm? or what areas of controversy does it
identify for further investigation?)

3. What did these researchers do? (ie. method)

Who did they do it to? (ie. subjects)
How did they do it? (ie. design)
What did they find out? (ie. results)
What did they think it meant? (ie. conclusions and implications)

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4. What were the strengths of this piece of research? (ie. was it a large sample
size and indications of generalisability, well described and appropriate type of
intervention, sound methodology etc.)

5. What were the weaknesses of this piece of research? (ie. errors, bias, unclear
intervention, possible unrealistic conclusions etc.)

6. Could these weaknesses be remedied in future research? (ie. how might you
integrate any of their suggestions for improvements to the methodology, sample
selection etc. into your future research proposal?)

7. Have the results from this research paper been supported by evidence from
other studies? (ie. who has reported similar findings? or different findings?)

8. What is the value of this research paper to your proposed study?