The Dreaded Literature Review

Alan Adams, D.C., M.S.Ed., DACBN, of the Los Angeles College of Chiropractic (LACC) teaches a course "Power Reading and Research for Sports and Recreational Injuries." Take his class. He does us all a favor by condensing the knowledge and skills he has acquired as a teacher, researcher, and student. Dr. Adams is currently completing a Ph.D. at the University of Southern California.

Those of us who treat sports injuries used to find little in the library stacks to help us treat the athlete. Now, with the explosion of journals devoted to sports, we have the opposite problem. How should we tackle all the articles, literature reviews, case histories, and research? I hope to incite your interest in learning more about the process of critical reading and reasoning.

The very idea of professional literature makes me uneasy. There's the desire to be up-to-date, and on the other hand, the idea of having to read more and think more can be intimidating. You might think that the sentence, "Here are some research articles on ..." would delight me; more often than not I take it as a threat.

At this point a confession is in order: I'm not a power reader, in fact, if you need to classify me, I am more of a feeble reader. If you saw a late night ad for Dr. Adams' class, I would be in the "before" picture.

I fritter away the bulk of my professional reading time feeling guilty that I am not keeping up with the literature. The rest of the time I journal surf. (For you television junkies, journal surfing is like channel surfing except Sony hasn't invented a remote control for magazines.)

Dr. Adams offered me a way out. He has developed strategies for effective literature review assessment, library skills, and computer database skills. He describes chiropractic reference sources and bibliographies. He advises how to maintain your literature files and how to write your own research. He presents checklists on how to evaluate opinion articles as well as articles describing diagnosis and treatment descriptions ranging from single case studies to clinical trials.

Are your eyes beginning to glaze over? No problems, today we are going to look at literature reviews only. What follows is a taste of his class.

First, here is a checklist for evaluating the usefulness of a literature review:

Literature Review Checklist

1. Is the review interesting?

Abstract

1. Is the specific purpose of the review stated?
2. Is a clear description of the search methods given?
3. Is there a summary of the important findings of the review?
4. Is there an outline of the major conclusions and recommendations?

Introduction

1. Is a description of the sources cited and a process of identifying the relevant sources?

    

2. Is there a meticulous identification of the guidelines for inclusion and exclusion of the articles?

1. Is there an objective assessment of the validity of the included articles?

    

2. Is a description of the limitations of the results of the included articles given?

    

3. Was a critical analysis of any variation in the findings of the relevant studies performed?

    

4. Were the findings of the relevant studies combined appropriately?

1. Were the authors' conclusions supported by evidence?

    

2. Were specific directions for new research proposed?

1. Are the references relevant to the literature review?

   Let us see how useful this checklist can be in treating an athlete. Pick any subject that you know about. Now take a literature review that covers this area of expertise and apply the guidelines and see how the review does.

   If the review is clearly biased, see if you would have discovered that from reading the abstract. Ideally, you would uncover an impoverished search strategy resulting in a severely malnourished literature review.

   Net result: Further reading would be a waste of time.

   Action step: Hurl the review aside and get on with your life.

   Now take a look at another review; see if the author has a streak of rudeness. Let's hope the author has at least the courtesy you encounter during the third shift at an all-night gas station. In California that means you can decode every fifth word into English. Does the abstract tell you why it was written, how it was searched, what it found, and what the next step is? If not, grip it tightly and shred the thing into tattered bits. Reading can be aerobic you know.

   Reach into your stack and take down yet another review. Is the author covert in any way, with apparently something to hide? Look at the introduction and apply the Joe Friday "Dragnet" test -- "Just the facts, Ma'am."

   Can you decipher how the cited sources made it into the study? Using your background knowledge see if you recall relevant articles that should have been reviewed. See if you agree with the author's guidelines. See if the author took the time to spell out precisely how the sources were discovered and then selected. If, in your heart, you know that the author is trying to cut intellectual corners with a "Swiss cheese" approach to source selection, you know what to do: Deep six the offensive item and get yourself outdoors and be aerobic.

   Once again, take another review article and savage it. This time look at the "Findings" section. Let's assume that the full spectrum of relevant sources was assessed. Is the author too subjective in comparing and contrasting the sources? Can you find objective assessment of the validity of the sources? Is the reasoning compelling? Are you able to discover an illuminating pattern of clinical findings clearly referenced with any variations in the findings elegantly analyzed? Are you left with a clearer understanding of the problem even if you disagree with the author? If you fail to find these points, pulverize the miserable literature review.

   In closing, you must persist on this noble quest of discovering literature reviews that fulfill the above criteria. Some grunt work will be expected of you. Remember, it's not a job, it's an adventure.

John Charles Hannon, D.C.
San Luis Obispo, California