difference research and review paper

Review Paper vs. Research Paper: Main Differences

Doing a paper is difficult, so learn the difference between a review paper vs. research paper, to determine which one is ideal for you.

A research paper and a review paper are two very specific types of papers. They have different motives, goals, and prerequisites. The elements found in research papers and review papers differ. The research paper is based on originality, therefore the paper takes into consideration the author’s original research, whereas the review paper is founded on an existing collection of knowledge. 

This article will walk you through the main differences between a review paper vs. research paper, allowing you to correctly determine which one is ideal for your work.

What is a review paper?

A review paper project tries to provide readers with an overview of an existing collection of knowledge by reviewing a book or an article and examining its content, structure, style, and statements. Reviews, such as peer reviews, can be used to examine and assess the work of other authors, rating the work by comparing it to the work of others. A review article is frequently written for a large readership, which is why it is usually brief. 

Review papers can be classified into three types:

• Narrative: a collection of and attempt to communicate all known information about a certain topic. It is based on research that has previously been completed and published. 
• Meta-analysis: a method of comparing and combining the findings of past research studies. It is done routinely to evaluate the efficacy of a particular initiative or method of treatment.
• Systematic: a search of all known scientific information on a topic to find a solution to a specific issue or problem. 

What is a research paper?

A research paper entails writing on research that has been performed by themselves, usually something new and done mostly from scratch since it has to be original research. It incorporates the research parameters, as well as the assessment, interpretation and important findings of the research. 

Writing a research paper involves several phases and different aspects, such as: selecting a topic, developing a hypothesis, conducting research, testing the hypothesis, drawing conclusions, and publishing a paper supporting or denying the hypothesis. 

Review paper vs. Research paper

Now that you have a basic understanding of both sorts of papers, it is time to compare and contrast the main differences between review paper vs. research paper.

These are the main differences, however, there may be others:

• A research paper is usually more detailed and thorough than a review paper.
• A research paper is usually peer-reviewed, but a review paper is not always.
• In general, a research paper is more formal than a review paper.
• A research paper’s tone is normally objective, but a review paper’s tone can be more subjective.
• A research paper is normally written in APA style, however, a review paper may be written in a different format.

Add visual impact to your posters with scientific illustrations and graphics

Using infographics and illustrations may assist to make dense information more accessible and understood, they can bring interest and engagement to a research study or presentation. Use Mind The Graph to turn your work into remarkable work.

Subscribe to our newsletter

Exclusive high quality content about effective visual communication in science.

Sign Up for Free

Try the best infographic maker and promote your research with scientifically-accurate beautiful figures

no credit card required

About Jessica Abbadia

Jessica Abbadia is a lawyer that has been working in Digital Marketing since 2020, improving organic performance for apps and websites in various regions through ASO and SEO. Currently developing scientific and intellectual knowledge for the community's benefit. Jessica is an animal rights activist who enjoys reading and drinking strong coffee.

Content tags

Educational resources and simple solutions for your research journey

What is the Difference Between Research Papers and Review Papers?

Researchers often have to write different types of articles, from review papers to review papers and more, each with its own purpose and structure. This makes it critical for students and researchers to understand the nuances of good writing and develop the skills required to write various kinds of academic text. With so many different types of academic writing to pursue – scholarly articles, commentaries, book reviews, case reports, clinical study reports – it is common for students and early career researchers to get confused. So in this article, we will explain what is a review paper and what is a research paper, while summarizing the similarities and difference between review papers and research papers.

Table of Contents

What is a Review Paper ?

A review paper offers an overview of previously published work and does not contain any new research findings. It evaluates and summarizes information or knowledge that is already available in various published formats like journals, books, or other publications, all of which is referred to as secondary literature. Well-written review papers play a crucial role in helping students and researchers understand existing knowledge in a specific field or a research topic they are interested in. By providing a comprehensive overview of previous studies, methodologies, findings, and trends, they help researchers identify gaps in a specific field of study opening up new avenues for future research.

What is a Research Paper ?

A research paper is based on original research and primary sources of data. Unlike review papers, researchers writing research papers need to report new findings derived from empirical research or experimentation. It requires the author to draw inferences or make assumptions based on experiments, surveys, interviews, or questionnaires employed to collect and analyze data. Research papers also typically follow the recommended IMRAD format, which includes an abstract, introduction, methodology, results, discussion, and conclusion. Through research papers, authors address a specific research question or hypothesis with the aim of contributing novel insights to the field.

Similarities between research papers and review papers

Research papers and review papers share several similarities, which makes it understandable that it is this pair of academic documents that are often most confused.

• Research papers and review papers are written by scholars and intended for an academic audience; they’re written with the aim of contributing to the existing body of knowledge in a particular field and can be published in peer reviewed journals.
• Both research papers and review papers require a comprehensive understanding of all the latest, relevant literature on a specific topic. This means authors must conduct a thorough review of existing studies, theories, and methodologies in their own subject and related areas to inform their own research or analysis.
• Research papers and review papers both adhere to specific formatting and citation styles dictated by the target journal. This ensures consistency and allows readers to easily locate and reference the sources cited in the papers.

These similarities highlight the rigorous, scholarly nature of both research papers and review papers, which requires both research integrity and a commitment to further knowledge in a field. However, these two types of academic writing are more different than one would think.

Differences between research papers and review papers

Though often used interchangeably to refer to academic content, research papers and review papers are quite different. They have different purposes, specific structure and writing styles, and citation formats given that they aim to communicate different kinds of information. Here are four key differences between research papers and review papers:

• Purpose: Review papers evaluate existing research, identify trends, and discuss the current state of knowledge on a specific topic; they are based on the study of previously published literature. On the other hand, research paperscontain original research work undertaken by the author, who is required to contribute new knowledge to the research field.
• Structure: Research papers typically follow a structured format, including key sections like the introduction, methods, results, discussion, and conclusion. Meanwhile, review papers may have a more flexible structure, allowing authors to organize the content based on thematic or chronological approaches. However, they generally include an introduction, main body discussing various aspects of the topic, and a conclusion.
• Methodology: Research papers involve the collection of data, experimentation, or analysis of existing data to answer specific research questions. However, review papers do not involve original data collection; instead, they extensively analyze and summarize existing studies, often using systematic literature review methods.
• Citation style: Research papers rely on primary sources to support and justify their own findings, emphasizing recent and relevant research. Review papers incorporate a wide range of primary and secondary sources to present a comprehensive overview of the topic and support the evaluation and synthesis of existing literature.

In summary, it’s important to understand the key differences between research papers and review papers. By mastering the art of writing both research papers and review papers, students and researchers can make more meaningful contributions to their chosen disciplines. All the best!

R Discovery is a literature search and research reading platform that accelerates your research discovery journey by keeping you updated on the latest, most relevant scholarly content. With 250M+ research articles sourced from trusted aggregators like CrossRef, Unpaywall, PubMed, PubMed Central, Open Alex and top publishing houses like Springer Nature, JAMA, IOP, Taylor & Francis, NEJM, BMJ, Karger, SAGE, Emerald Publishing and more, R Discovery puts a world of research at your fingertips.  

Try R Discovery Prime FREE for 1 week or upgrade at just US$72 a year to access premium features that let you listen to research on the go, read in your language, collaborate with peers, auto sync with reference managers, and much more. Choose a simpler, smarter way to find and read research – Download the app and start your free 7-day trial today !  

Related Posts

What is IMRaD Format in Research?

What is a Review Article? How to Write it?

Differences Between Review Paper and Research Paper

A research paper includes original work while a review paper includes the summary of existing work which explains or solves a specific problem. 

An integral part of a PhD dissertation or thesis is writing a research and review article, besides writing a thesis, proposal and synopsis. In addition, one also has to publish an article in a peer-reviewed journal which is indeed a tougher task, right!

Writing is an indispensable part of the doctorate degree and has significant value in honoring the same degree. A student when becoming a PhD candidate has to write a thesis statement, research proposal, synopsis of the doctorate, thesis, research article and review article, in chronological order.

If one fails to do so, they can’t get a degree. And that’s why writing is important. Nonetheless, students face problems while writing either research or review articles. 

Supportive evidence suggests that students actually don’t know the basic and major differences between either so fail to publish both article types. 

In the present piece of content, I will explain the importance of a review and research article as well as the differences between both. I am hoping that this article will add value to your knowledge and help you in your PhD. 

Stay tuned. 

What is a Review Paper? 

What is a research paper, review vs research paper: differences, research article vs review article- similarities:, wrapping up: .

A review chapter or review articles add value to the thesis as well as existing knowledge. Universities are usually recommended to write and publish it. From students’ perspectives, review writing frightens them. 

However, from a supervisors’ perspective, it should be precise, concise and nearly perfect. 

Review writing is a tedious, frustrating and time-consuming process that needs special attention. The reason why it should be nearly perfect is that it supports researchers’ original work. 

Technically, the review article comprises a summary of the existing research in a structured manner. Normally, it addresses the original research work and solves the existing problem by literature. 

However, it can’t solve any existing problem, it doesn’t need wet-lab experimentation. It only shows the existing state of understanding of a topic. Notedly, an expert of the subject, experienced person, professor and professional scientist can usually write a review. 

A research paper/article contributes original research or work of a researcher on the present topic, usually includes web lab work. Much like the review, a research article should be published in a peer-reviewed journal too. 

Research article writing takes too much time as it includes research work additionally. Comprehensive writing is required to explain the materials & methods section and results & outcomes while the elaborative explanation is sufficient to introduce a topic. 

Structurally a typical research article or paper has an introduction or background, Materials & Methods, Results & discussion and conclusion. 

Depending upon the requirement of the journal and the depth or concentration of the research, the length of the article may vary, however, ordinarily is between 2 to 8 pages. 

Much like the review article, an abstract and a list of references must be included in the article. 

In summary, the research paper provides new knowledge in the relevant field and solves an existing problem by it. 

Now quickly move to the important part of this article, what are the differences between the review and research paper? 

A review article is certainly a comprehensive, in-depth and extensively well-written piece of information covering summaries of already present knowledge. While the research article constitutes an elaborative introduction of the topic and an in-depth explanation of how the research was conducted. It contributes new knowledge.

A review is written based on the already existing information and so considered as a secondary source of information, while the research paper has original research work supported by already existing sources. 

In terms of length, a review article has an in-depth explanation and so are longer, normally, 10 to 20 pages whilst the research article has an elaborative explanation and to the point information on the problem, usually ranging from 2 to 8 pages.

The review article addresses the problem whilst the research article solves the problem, certainly. 

The conclusion of the review article supports the already present findings while the result of the research article is supported by the existing research work. 

The purpose of writing a research paper is to critically analyze already existing or previous work in the form of short summaries. And restricted to a specific topic. 

On the other side, the research article includes the author’s own work in detail

Structurally, the review article has a single heading or sometimes a conclusion at the end of the article whilst the research article has sections like an introduction to the topic, materials & methods, results, discussion and final interpretation. 

Steps in review article writing are,

• Topic finding 
• Searching relevant sources
• Summarising each source 
• Correlating them with the topic or problem
• Concluding the research.

Steps in research article writing are,

• Choosing a problem or gap in present findings
• Sample collection, experimentation and wet lab work
• Finding, collecting and organizing the data
• Correlating it with the present knowledge
• Stating results 
• Final interpretation.

Normally, a subject expert or experienced person can write a review article while any student, or person having the original research work can write a research article.

The review article defines or clarifies a problem, explains it by compiling previous investigations and suggests problem-solving strategies or options. On the other hand, the research article has an original problem-solving statement supported by various chapters and previous research. 

So the review article suggests possible outcomes to fill the knowledge gap while the research article provides evidence and new knowledge on how to fill the gap. 

Summary: 

Either document has been written for a different purpose which solves almost the same objective. Fortunately, there are several similarities in writing a research or review article. Hera re some,

Both have in-text citations, a references page, an abstract and contributors. Both also need a final conclusion too in order to address or solve a problem. 

Research or review articles can be submitted or published in peer-reviewed journals. 

Both require educational, professional, informal and research writing skills. 

Importantly, both articles must be plagiarism-free, copying isn’t recommended. 

Every PhD student must have written at least a single review and research article during their research or doctoral tenure to get an award. Achieving a successful publication needs critical writing skills and original research or findings. 

The major difference between either is that the review article has summed information that directs one towards solving a problem and so does not include original work. 

Whilst the research article actually proposes a way to solve a problem and so has original work.  

Dr. Tushar Chauhan is a Scientist, Blogger and Scientific-writer. He has completed PhD in Genetics. Dr. Chauhan is a PhD coach and tutor.

Share this:

• Share on Facebook
• Share on Twitter
• Share on Pinterest
• Share on Linkedin
• Share via Email

About The Author

Dr Tushar Chauhan

Related posts.

Difference between M.D vs PhD

Doctorate vs PhD- differences and similarities

Leave a comment cancel reply.

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

Notify me of follow-up comments by email.

Notify me of new posts by email.

Stack Exchange Network

Stack Exchange network consists of 183 Q&A communities including Stack Overflow , the largest, most trusted online community for developers to learn, share their knowledge, and build their careers.

Q&A for work

Connect and share knowledge within a single location that is structured and easy to search.

What is the difference between a review paper and a research paper?

I have been working on a review paper. After publication, how will it add on my academic research profile? When I will apply for MS or PHD admission, will it count as publication?

• publications
• review-articles

5 Answers 5

A review paper is likely also known as a "survey paper", where you read (i.e. survey) related works in the field and then comment on them. Usually, a review paper should be able to contribute a small amount of knowledge in its own right to the field by providing a taxonomy of work.

Another type of paper that reviews extensively related work but isn't actually a review paper is a "systematic review paper" in which you usually ask a meta-question about the field.

If it appears in a refereed, peer-reviewed journal, then yes, it is a publication. In fact, if done well, these works can often have pretty high impact and can be cited very frequently. However, as already noted, since they don't usually involve substantial original research they need to be augmented with traditional research papers. If a graduate student has only survey papers or systematic review papers, I'd wonder as a search committee reviewer if this student did nothing but read related work rather than working on research.

With respect to MS or PhD applications, I'd think that the fact that you have a publication at all is already a bonus point for you. Most students who apply to these programs don't have publications.

One important distinction should be made between papers in the humanities and the sciences. In the sciences, it would be much more important to have "original research" papers where new ground is broken. In the humanities, by contrast, the act of studying the existing literature and critically evaluating it may, in and of itself, be considered an act of research. (Similarly, in medicine, "meta-studies" in which the reports of various experiments are synthesized to produce overall results and recommendations may also be considered very important, although they augment direct clinical research, rather than substitute for it.)

I have limited experience regarding since I am still a graduate student but from what I understand, a review paper is also a research paper. However, unlike a piece of research, where you study the existing literature, develop research questions and hypotheses, collect data, run experiments/analysis and make inferences which accept or reject your hypotheses, a review article is a summarization and collation of existing articles in a given, specific research topic.

There has been some semi-formal writings on this already namely, this and this . The consensus, so far, seems to be that review articles make fine additions to your publication record but not as fine as articles where you actually did your own research.

I have little experience, because I am still an undergraduate student but from what I understand:

• Research paper: A paper in which results and discussion are derived from an experiment.
• Review paper: A paper in which results and discussion are not described.

• 4 Welcome to Academia SE. I have to disagree with your definitions. A research paper does not need to be based on an experiment (e.g., many mathematical papers). Also, a paper which does not describe (or derive) its results and discussions is just a very bad paper – this has nothing to do with the paper being a research or review paper. –  Wrzlprmft ♦ Commented Nov 26, 2014 at 15:19

I would describe a review paper as different from a research paper. A research paper is one's original work that may be researched scientifically or otherwise, but a review paper is where someone goes through work already done/researched and gives suggestions as per that field of research. The suggestions would be if the objective, goal, problem were met by the researcher. Whether the research is of value now or in future, solutions to the problem, what is interesting, etc.

• Welcome to Academia SE. You seem to be confusing a review paper with a peer review. The downvotes you are receiving are likely due to this, i.e., to indicate that your answer is wrong. Do not take them personally. –  Wrzlprmft ♦ Commented Oct 21, 2015 at 11:27

You must log in to answer this question.

Not the answer you're looking for browse other questions tagged publications review-articles ..

• Featured on Meta
• Bringing clarity to status tag usage on meta sites
• We've made changes to our Terms of Service & Privacy Policy - July 2024
• Announcing a change to the data-dump process

Hot Network Questions

• How does the Israeli administration of the Golan Heights affect its current non-Jewish population?
• Find a basis for this set of vectors
• Sci-fi/horror anthology TV episode featuring a man and a woman waking up and restarting events repeatedly
• Did Newton predict the deflection of light by gravity?
• Is it okay to mix accidentals when writing enharmonic notes in different parts?
• Sci-fi movie about a woman alone on a spaceship with an AI
• Birthday of combinatorial game product
• Concise zsh regular expression parameter expansion to replace the last match of a pattern
• nested enumerate behave strangely in beamer
• How to deal with a boss that is using non-related arguments in a dissent?
• Can you cast a non-cantrip spell using your action, and make a bonus action melee spell attack on the same turn?
• How can the Word be God and be with God simultaneously without creating the meaning of two Gods?
• Why do individuals with revoked master’s/PhD degrees due to plagiarism or misconduct not return to retake them?
• View coordinates of PDF on MacOS - pinlabel needed
• What is the lowest feasible depth for lightly-armed military submarines designed around the 1950s-60s?
• Can you continue a database log restore after putting an interim restore online?
• How much air escapes into space every day, and how long before it makes Earth air pressure too low for humans to breathe?
• What is the meaning of 'in the note'?
• What was I thinking when I drew this diagram?
• Automotive Controller LDO Failures
• Is there a recommended maximum depth for the content tree in Sitecore
• Variant of global failure of GCH
• What is the source for the teaching, ‘Shame is intelligence, intelligence shame’?
• efficiently reverse EISH to HSIE

• Trending Categories

• Selected Reading
• UPSC IAS Exams Notes
• Developer's Best Practices
• Questions and Answers
• Effective Resume Writing
• HR Interview Questions
• Computer Glossary

Difference between Research Paper and Review Paper

A research paper is written by students in which they have to conduct research on a given topic and then write the content. A review paper consists of reviews related to different articles that are already published. In this article, we will discuss the difference between a research paper and a review paper.

Research Paper

A research paper is an academic writing in which students have to collect information related to a given topic. They have to make an organized report regarding the subject which can include the research they have conducted or the research already done by other students. A peer review has to be conducted before publishing.

Steps to Write a Research Paper

Students have to follow the steps below to write a perfect research paper. These steps are discussed here.

The given assignment should be perfectly understood

Choose a topic, look for the sources of information.

• The thesis statement should be developed
• An outline of the research paper should be created

Write the first draft

Write the paragraphs properly, write the introduction, body text should be compelling, conclude the research paper, revise the research paper.

Before writing a research paper you have to understand the given assignment and then decide the specific tasks that you have to do to complete it. Here are the things that you need to do −

• Read the assignment and look for the topics that can create confusion
• Decide the length of the paper along with the options of formatting
• Make a bulleted list of all headings that you will add and then write about them
• Consider the deadline and decide the length of the research paper

Choose a topic about which you can get a large amount of content. The topic should be of your interest. You can do your own research or take help from research done by other people.

The next thing that you have to do is look for the sources from where you can get the information about the topic. Some of these sources can be discussions, books, journals, and websites. Look for the following −

• Heated debates
• Unique ideas
• Recent developments
• Overlooked but important topics

All these things will help you in devising questions related to your research topic.

Thesis statement should be developed

The next step is to develop a thesis statement which is an answer to the research question. Your answer should be supported by reasoning and pieces of evidence. The length of the thesis statement should be short and summarized.

Outline of the research paper should be created

Create an outline for the research which should include key topics, evidence, and arguments. They should be further divided into headings. This division will be helpful in writing the paper efficiently.

Write the first draft of the research paper with proper order and formatting. Your ideas should be clearly described and paragraphs should be ordered logically. You can start with the easiest or the most difficult topic. There can be situations where you have written a large amount of content for a topic. Rather than deleting it, take some part of it and paste it into another document which can be used later.

The paragraphs should be properly organized and it is better if you write each idea in a small and single paragraph. Each paragraph should not be more than three to four lines.

Now the time has come to write the introduction which should answer three questions related to your topics and these questions are what, why, and how.

This is the major part of your research paper and you may face difficulties in writing it. If you have created an outline, writing will be easy. The body text should be compelling so that the reader gets engaged in reading.

Write the conclusion of your research paper which should give a final touch to the content. Readers should understand the ways that you have used to write the paper. You can also include questions which your readers can try to answer.

Read the whole research paper and find if there is any spelling, grammatical, or factual mistakes. Check the structure of the paragraph and sentences. If there is a very long sentence, try to break it as it may become confusing for the readers.

Length of the Research Paper

The length of the research paper can be between 4,000 to 8,000 words. The minimum word count can be 2,000 and the maximum can go beyond 10,000 depending on the topic.

Review Papers

A review paper is an article which consists of surveys of the articles that are already published. No new experimental results are included in these articles. Other names of the review paper are literature review or review of literature. New conclusions can be drawn from the existing article. Review articles can explore new areas of research from the existing studies.

Steps to Write a Review Paper

Here are the steps that you have to follow to write a review paper.

Look for the aim of the article for which the review is to be written

Scope should be defined, look for the sources, choose title and keywords, topic should be introduced, critical discussion should be included, conclude the review paper.

Read the article and know about the aim and scope. All the articles do not accept reviews so you need to be very careful while choosing the article for which the review is to be written.

Find the research question and answer it with the aim of adding something new to the topic. The review should neither be too small nor too large. It should be managed easily.

You can look for the sources through search engines, books, and others. The search engines will provide a lot of sources which you can use to write the review.

Choose a proper title for your review article along with the keywords. The title will help to improve the number of views online. It will get more views if the correct readers view your article. The title should be concise, clear, and accurate and provide good information.

Write the introduction about the topic giving the reason for providing the review. The introduction should reach a large number of people which should also include non-specialists.

A critical discussion should also be included in the review paper. If the research topic is contradictory, a debate can also be included which should consist of arguments from both sides. The review paper should have the ability of resolving the conflict between contradictory studies.

A conclusion should be included at the end of the review paper. This should include the things that you have understood after studying the topic for which the review has been written.

Difference between Research paper and Review Paper

There are many differences between a research paper and a review paper and the table below includes them −

• Related Articles
• Difference between Descriptive Research and Experimental Research
• Differences between E-paper and LCD
• Difference Between Correlational and Experimental Research
• Difference between Case Study and Action Research
• Make a list of various uses of papers. Observe currency notes carefully. Do you find any difference between currency paper and the paper in your notebook? Find out where currency paper is made.
• What do you mean by Blue litmus paper and Red litmus paper?
• Recycling of Paper
• Paper Chromatography - Principle, Procedure, and Applications
• If we tear the paper and then recycle it, it turns into paper again. So, is the tearing of paper a reversible change?
• Difference between Research Papers and Technical Articles for Journal Publication
• Which of the following will produce the maximum friction?(a) rubbing of sand paper on glazed paper(b) rubbing of sand paper on glass table top(c) rubbing of sand paper on aluminium frame(d) rubbing of sand paper on sand paper
• What is Litmus Paper?
• What is filter paper?
• The Value of Paper
• Rock Paper and Scissor Game Using Tkinter

Kickstart Your Career

Get certified by completing the course

• Study resources
• Calendar - Graduate
• Calendar - Undergraduate
• Class schedules
• Class cancellations
• Course registration
• Important academic dates
• More academic resources
• Campus services
• IT services
• Job opportunities
• Safety & prevention
• Mental health support
• Student Service Centre (Birks)
• All campus services
• Calendar of events
• Latest news
• Media Relations
• Faculties, Schools & Colleges
• Arts and Science
• Gina Cody School of Engineering and Computer Science
• John Molson School of Business
• School of Graduate Studies
• All Schools, Colleges & Departments.
• Directories
• My Library account Renew books and more
• Book a study room or scanner Reserve a space for your group online
• Interlibrary loans (Colombo) Request books from external libraries
• Zotero (formerly RefWorks) Manage your citations and create bibliographies
• Article/Chapter Scan & Deliver Request a PDF of an article/chapter we have in our physical collection
• Contactless Book Pickup Request books, DVDs and more from our physical collection while the Library is closed
• WebPrint Upload documents to print on campus
• Course reserves Online course readings
• Spectrum Deposit a thesis or article
• Sofia Discovery tool
• Databases by subject
• Course Reserves
• E-journals via Browzine
• E-journals via Sofia
• Article/chapter scan
• Intercampus delivery of bound periodicals/microforms
• Interlibrary loans
• Spectrum Research Repository
• Special Collections & Archives
• Additional resources & services
• Subject & course guides
• Borrowing & renewing
• Open Educational Resources Guide
• Instructional Services
• General guides for users
• Ask a librarian
• Research Skills Tutorial
• Quick Things for Digital Knowledge
• Critical Toolkit for Navigating Information
• Bibliometrics & research impact guide
• Concordia University Press
• Copyright guide
• Copyright guide for thesis preparation
• Digital scholarship
• Digital preservation
• Open Access
• ORCiD at Concordia
• Research data management guide
• Scholarship of Teaching & Learning
• Systematic Reviews
• Borrow (laptops, tablets, equipment)
• Connect (netname, Wi-Fi, guest accounts)
• Desktop computers, software & availability maps
• Group study, presentation practice & classrooms
• Printers, copiers & scanners
• Technology Sandbox
• Visualization Studio
• Webster Library
• Vanier Library
• Grey Nuns Reading Room
• Study spaces
• Floor plans
• Book a group study room/scanner
• Room booking for academic events
• Exhibitions
• Librarians & staff
• Work with us
• Memberships & collaborations
• Indigenous Student Librarian program
• Wikipedian in residence
• Researcher in residence
• Feedback & improvement
• Annual reports & fast facts
• Strategic Plan 2016/21
• Library Services Fund
• Giving to the Library
• Policies & Code of Conduct
• My Library account
• Book a study room or scanner
• Interlibrary loans (Colombo)
• Zotero (formerly RefWorks)
• Article/Chapter Scan & Deliver
• Contactless Book Pickup
• Course reserves

Review vs. Research Articles

How can you tell if you are looking at a research paper, review paper or a systematic review  examples and article characteristics are provided below to help you figure it out., research papers.

A research article describes a study that was performed by the article’s author(s). It explains the methodology of the study, such as how data was collected and analyzed, and clarifies what the results mean. Each step of the study is reported in detail so that other researchers can repeat the experiment.

To determine if a paper is a research article, examine its wording. Research articles describe actions taken by the researcher(s) during the experimental process. Look for statements like “we tested,” “I measured,” or “we investigated.” Research articles also describe the outcomes of studies. Check for phrases like “the study found” or “the results indicate.” Next, look closely at the formatting of the article. Research papers are divided into sections that occur in a particular order: abstract, introduction, methods, results, discussion, and references.

Let's take a closer look at this research paper by Bacon et al. published in the International Journal of Hypertension :

Review Papers

Review articles do not describe original research conducted by the author(s). Instead, they give an overview of a specific subject by examining previously published studies on the topic. The author searches for and selects studies on the subject and then tries to make sense of their findings. In particular, review articles look at whether the outcomes of the chosen studies are similar, and if they are not, attempt to explain the conflicting results. By interpreting the findings of previous studies, review articles are able to present the current knowledge and understanding of a specific topic.

Since review articles summarize the research on a particular topic, students should read them for background information before consulting detailed, technical research articles. Furthermore, review articles are a useful starting point for a research project because their reference lists can be used to find additional articles on the subject.

Let's take a closer look at this review paper by Bacon et al. published in Sports Medicine :

Systematic Review Papers

A systematic review is a type of review article that tries to limit the occurrence of bias. Traditional, non-systematic reviews can be biased because they do not include all of the available papers on the review’s topic; only certain studies are discussed by the author. No formal process is used to decide which articles to include in the review. Consequently, unpublished articles, older papers, works in foreign languages, manuscripts published in small journals, and studies that conflict with the author’s beliefs can be overlooked or excluded. Since traditional reviews do not have to explain the techniques used to select the studies, it can be difficult to determine if the author’s bias affected the review’s findings.

Systematic reviews were developed to address the problem of bias. Unlike traditional reviews, which cover a broad topic, systematic reviews focus on a single question, such as if a particular intervention successfully treats a medical condition. Systematic reviews then track down all of the available studies that address the question, choose some to include in the review, and critique them using predetermined criteria. The studies are found, selected, and evaluated using a formal, scientific methodology in order to minimize the effect of the author’s bias. The methodology is clearly explained in the systematic review so that readers can form opinions about the quality of the review.

Let's take a closer look this systematic review paper by Vigano et al. published in Lancet Oncology :

Finding Review and Research Papers in PubMed

Many databases have special features that allow the searcher to restrict results to articles that match specific criteria. In other words, only articles of a certain type will be displayed in the search results. These “limiters” can be useful when searching for research or review articles. PubMed has a limiter for article type, which is located on the left sidebar of the search results page. This limiter can filter the search results to show only review articles.

© Concordia University

Maxwell Library | Bridgewater State University

Today's Hours: 

• Maxwell Library
• Scholarly Journals and Popular Magazines
• Differences in Research, Review, and Opinion Articles

Scholarly Journals and Popular Magazines: Differences in Research, Review, and Opinion Articles

• Where Do I Start?
• How Do I Find Peer-Reviewed Articles?
• How Do I Compare Periodical Types?
• Where Can I find More Information?

Research Articles, Reviews, and Opinion Pieces

Scholarly or research articles are written for experts in their fields. They are often peer-reviewed or reviewed by other experts in the field prior to publication. They often have terminology or jargon that is field specific. They are generally lengthy articles. Social science and science scholarly articles have similar structures as do arts and humanities scholarly articles. Not all items in a scholarly journal are peer reviewed. For example, an editorial opinion items can be published in a scholarly journal but the article itself is not scholarly. Scholarly journals may include book reviews or other content that have not been peer reviewed.

Empirical Study: (Original or Primary) based on observation, experimentation, or study. Clinical trials, clinical case studies, and most meta-analyses are empirical studies.

Review Article: (Secondary Sources) Article that summarizes the research in a particular subject, area, or topic. They often include a summary, an literature reviews, systematic reviews, and meta-analyses.

Clinical case study (Primary or Original sources): These articles provide real cases from medical or clinical practice. They often include symptoms and diagnosis.

Clinical trials ( Health Research): Th ese articles are often based on large groups of people. They often include methods and control studies. They tend to be lengthy articles.

Opinion Piece:  An opinion piece often includes personal thoughts, beliefs, or feelings or a judgement or conclusion based on facts. The goal may be to persuade or influence the reader that their position on this topic is the best.

Book review: Recent review of books in the field. They may be several pages but tend to be fairly short. 

Social Science and Science Research Articles

The majority of social science and physical science articles include

• Journal Title and Author
• Abstract 
• Introduction with a hypothesis or thesis
• Literature Review
• Methods/Methodology
• Results/Findings

Arts and Humanities Research Articles

In the Arts and Humanities, scholarly articles tend to be less formatted than in the social sciences and sciences. In the humanities, scholars are not conducting the same kinds of research experiments, but they are still using evidence to draw logical conclusions.  Common sections of these articles include:

• an Introduction
• Discussion/Conclusion
• works cited/References/Bibliography

Research versus Review Articles

• 6 Article types that journals publish: A guide for early career researchers
• INFOGRAPHIC: 5 Differences between a research paper and a review paper
• Michigan State University. Empirical vs Review Articles
• UC Merced Library. Empirical & Review Articles
• << Previous: Where Do I Start?
• Next: How Do I Find Peer-Reviewed Articles? >>
• Last Updated: Jan 24, 2024 10:48 AM
• URL: https://library.bridgew.edu/scholarly

Phone: 508.531.1392 Text: 508.425.4096 Email: [email protected]

Feedback/Comments

Privacy Policy

Website Accessibility

Follow us on Facebook Follow us on Twitter

• Trending Now
• Foundational Courses
• Data Science
• Practice Problem
• Machine Learning
• System Design
• DevOps Tutorial

Difference between Research Paper and Review Paper

Scholarly literature can be of different types. Many of them require researchers to perform an original study, whereas others are based on previously published research. Amateur researchers have quite a confusion understanding each type of scholarly literature and the difference between them.

Research Paper

When researchers partake in an original study or investigation of a unique topic, for example, a study of the prevalence of substance abuse in a specific community or geographical area, the findings of that study are presented as a research paper. The most essential component of a research paper is the analysis of the topic, evidence to support the study and the conclusion of the study. It can comprise of the answer to the reach question and may include a hypothesis, the resource requirement for the study and the method followed to reach the conclusion. The formatting of a research paper is fairly similar across all subjects and institutions, though it can vary from one region to another depending upon the pattern laid down by the publishing and educational bodies. This scholarly work is unique and bears no similarity to any other published work. Analysis of the data can vary from the use of software to authentic experiments.

Review Paper

Review papers are universal and can be focused upon a wide range of mediums, including articles in journals, books, magazines, and software. A review paper refers to the study and survey of a recently published Research paper on a specific topic or subject. For instance, climate change due to industrial waste has many scholarly Research paper. these papers can be reviewed by any other number of scholars for its merits. In order to write a review paper successfully, one needs to have knowledge of what other scholars have written on the subject and their thoughts on the subject, particularly in recent times. the reach papers act as a reference and source material for these review papers. These can be stimulating and extremely exhaustive with the intent for undertaking research by introducing challenging materials and facts. It should act as a summary of the original research paper with all its relevant literature on the topic.

Key differences between the Research paper and Review paper are given in the table below:

Please Login to comment...

Similar reads.

• Difference Between
• Write From Home

Improve your Coding Skills with Practice

What kind of Experience do you want to share?

• Interesting
• Scholarships
• UGC-CARE Journals

Research Paper Vs Review Paper | 50 Differences

50 Differences Between Research Article and a Review Article

A research paper is a piece of writing that reports facts, data, and other information on a specific topic. It is usually longer than a review paper and includes a detailed evaluation of the research. Whereas, a review paper is a shorter piece of writing that summarizes and evaluates the research on a specific topic. It is usually shorter than a research paper and does not include a detailed evaluation of the research. In this article, we have listed the 50 important differences between a review paper vs research article.

• A research paper is typically much longer than a review paper.
• A research paper is typically more detailed and comprehensive than a review paper.
• A research paper is typically more focused on a specific topic than a review paper.
• A research paper is typically more analytical and critical than a review paper.
• A research paper is typically more objective than a review paper.
• A research paper is typically written by one or more authors, while a review paper may be written by a single author.
• A research paper is typically peer-reviewed, while a review paper may not be.
• A research paper is typically published in a scholarly journal, while a review paper may be published in a variety of different publications.
• The audience for a research paper is typically other scholars, while the audience for a review paper may be the general public.
• The purpose of a research paper is typically to contribute to the scholarly literature, while the purpose of a review paper may be to provide an overview of the literature or to evaluate a particular research study.
• The structure of a research paper is typically more complex than the structure of a review paper.
• A research paper typically includes an abstract, while a review paper may not.
• A research paper typically includes a literature review, while a review paper may not.
• A research paper typically includes a methodology section, while a review paper may not.
• A research paper typically includes results and discussion sections, while a review paper may not.
• A research paper typically includes a conclusion, while a review paper may not.
• A research paper is typically organized around a central research question , while a review paper may be organized around a central theme.
• A research paper typically uses primary sources, while a review paper may use both primary and secondary sources.
• A research paper is typically based on empirical research, while a review paper may be based on either empirical or non-empirical research.
• A research paper is typically more formal than a review paper.
• A research paper is typically written in the third person, while a review paper may be written in the first person.
• A research paper typically uses formal language, while a review paper may use more informal language.
• A research paper is typically objective in tone, while a review paper may be more subjective in tone.
• A research paper typically uses APA style, while a review paper may use a different style.
• A research paper typically includes a title page, while a review paper may not.
• A research paper typically includes an abstract on the title page, while a review paper may not.
• A research paper typically includes keywords on the title page, while a review paper may not.
• A research paper typically includes an author note, while a review paper may not.
• A research paper is typically organized around a central research question, while a review paper may be organized around a central theme.
• A research paper is typically longer than a review paper.

I hope, this article would help you to know the differences between Research Paper and a Review Paper.

Also Read: What is a Research Design? Importance and Types

• Difference between
• evaluation review paper
• Research Paper

The Harsh Reality: Why Revoked Graduate Degrees Aren’t Easily Reclaimed?

Top 50 research institutions in india: nirf rankings 2024, top 35 scopus indexed journals in english literature, most popular, how to create graphical abstract, list of research topics in environmental engineering, indo-russian joint research call for proposals 2024, newly accepted scopus indexed journals june 2024, top 10 scopus indexed agronomy and crop science journals, indo-german research collaboration: joint call for proposals 2024, 10 trending ai tools for dynamic graph visualization, best for you, 24 best online plagiarism checker free – 2024, what is phd, popular posts, popular category.

• POSTDOC 317
• Interesting 257
• Journals 235
• Fellowship 133
• Research Methodology 102
• All Scopus Indexed Journals 93

Mail Subscription

iLovePhD is a research education website to know updated research-related information. It helps researchers to find top journals for publishing research articles and get an easy manual for research tools. The main aim of this website is to help Ph.D. scholars who are working in various domains to get more valuable ideas to carry out their research. Learn the current groundbreaking research activities around the world, love the process of getting a Ph.D.

Contact us: [email protected]

Google News

Copyright © 2024 iLovePhD. All rights reserved

• Artificial intelligence

Difference Between | Descriptive Analysis and Comparisons

Search form, difference between research paper and review paper.

Key Difference: The primary difference between a research paper and a review paper is that a research paper is based on the author’s original research and their analysis and interpretation of their research finishing, whereas a review paper collects and collates information on a particular topic from various different written publications.

A research paper involves writing about research that one has conducted themselves. It includes the parameters involved in the research as well as their analysis and interpretation of the research.

Writing a research paper involves many different steps such as selecting a topic, creating a hypothesis, doing research, testing the hypothesis, making conclusions, and writing a paper supporting or disproving the hypothesis.

A review paper, on the other hand, involves collection information from a variety of different sources. These sources can be primary or secondary. Primary sources can be people who have conducted research and have first hand information, whereas secondary sources are papers and documents that have covered the topic on hand.

A review paper collects and combines information from these various sources and presents in all in one place. The benefit of this that it makes information regarding a particular topic easier to find and reference. A student may be asked to support an argument or a hypothesis in a review paper by citing various works and sources of information.

Review papers can be categorized into three different types: -

• Narrative – which collects and attempts to explain any and all existing knowledge on a particular topic. It is based on research that is already conducted and published by someone else.
• Systematic – in which one searches all existing scientific literature on a topic and tries to find an answer to a particular question or problem.
• Meta-analysis – which compares and combines the findings of previously published studies. It is usually done in order to assess the effectiveness of an intervention or mode of treatment.

The job of a research paper is for one to be able to present new ideas and new information which can hep move science ahead, whereas a review paper allows one to combine ideas by collecting information from various sources, which makes information easier to find and refer to.

Comparison between Research Paper and Review Paper:

Add new comment

Copyright © 2024, Difference Between | Descriptive Analysis and Comparisons

"How Do I?" @JWULibrary

Sample Question

• JWU-Providence Library

Q. What's the difference between a research article and a review article?

• 35 about the library
• 29 articles & journals
• 1 Borrowing
• 8 citing sources
• 17 company & industry
• 11 computers
• 1 copyright compliance
• 5 countries & travel
• 2 course registration
• 50 databases
• 3 education
• 2 Interlibrary loan
• 5 job search
• 6 libguides
• 9 market research
• 25 my library account
• 12 requests
• 26 research basics
• 21 research topics
• 2 study rooms
• 16 technology
• 7 textbooks
• 42 university
• 3 video tutorial
• 1 writing_help

Answered By: Sarah Naomi Campbell Last Updated: Sep 07, 2018     Views: 215845

Watch this short video to learn about types of scholarly articles, including research articles and literature reviews!

Not in the mood for a video? Read on!

What's the difference between a research article and a review article?

Research articles , sometimes referred to as empirical  or primary sources , report on original research. They will typically include sections such as an introduction, methods, results, and discussion.

Here is a more detailed explanation of research articles .

Review articles , sometimes called literature reviews  or secondary sources , synthesize or analyze research already conducted in primary sources. They generally summarize the current state of research on a given topic.

Here is a more detailed explanation of review articles .

The video above was created by the Virginia Commonwealth University Libraries .

The defintions, and the linked detailed explanations, are paraphrased from the Publication Manual of the American Psychological Association , 6th ed .

The linked explanations are provided by the Mohawk Valley Community College Libraries .

Links & Files

• How do I find empirical articles in the library databases?
• Share on Facebook

Was this helpful? Yes 63 No 19

Comments (0)

Related topics.

• about the library
• articles & journals
• citing sources
• company & industry
• copyright compliance
• countries & travel
• course registration
• Interlibrary loan
• market research
• my library account
• research basics
• research topics
• study rooms
• video tutorial
• writing_help

Downcity Library:

111 Dorrance Street Providence, Rhode Island 02903

401-598-1121

Harborside Library:

321 Harborside Boulevard Providence, RI 02905

401-598-1466

• Location and Directions
• Off-Campus Access
• Staff Directory
• Student Employment
• Pay Bills and Fines
• Chat with a Librarian
• Course Reserves
• Interlibrary Loan (ILL)
• Study Rooms
• Research Appointment
• Culinary Museum

• Customer Reviews
• Extended Essays
• IB Internal Assessment
• Theory of Knowledge
• Literature Review
• Dissertations
• Essay Writing
• Research Writing
• Assignment Help
• Capstone Projects
• College Application
• Online Class

Literature Review vs Research Paper: What’s the Difference?

by  Antony W

June 26, 2024

This is a complete student’s guide to understanding literature review vs research paper.

We’ll teach you what they’re, explain why they’re important, state the difference between the two, and link you to our comprehensive guide on how to write them.

Literature Review Writing Help

Writing a literature review for a thesis, a research paper, or as a standalone assignment takes time. Much of your time will go into research, not to mention you have other assignments to complete. 

If you find writing in college or university overwhelming, get in touch with our literature review writers for hire at 25% discounts and enjoy the flexibility and convenience that comes with professional writing help. We’ll help you do everything, from research and outlining to custom writing and proofreading.

What is a Literature Review?

A literature review document is a secondary source of information that provides an overview of existing knowledge, which you can use to identify gaps or flaws in existing research. In literature review writing, students have to find and read existing publications such as journal articles, analyze the information, and then state their findings.

Credit: Pubrica

You’ll write a literature review to demonstrate your understanding on the topic, show gaps in existing research, and develop an effective methodology and a theoretical framework for your research project.

Your instructor may ask you to write a literature review as a standalone assignment. Even if that’s the case, the rules for writing a review paper don’t change.

In other words, you’ll still focus on evaluating the current research and find gaps around the topic.

Types of Literature Reviews

There are three types of review papers and they’re a follows:

 1. Meta-analysis

In meta-analysis review paper, you combine and compare answers from already published studies on a given subject.

2. Narrative Review

A narrative review paper looks into existing information or research already conducted on a given topic.

3. Systematic Review

You need to do three things if asked to write a systematic review paper.

First, read and understand the question asked. Second, look into research already conducted on the topic. Third, search for the answer to the question from the established research you just read.

What’s a Research Paper?

A research paper is an assignment in which you present your own argument, evaluation, or interpretation of an issue based on independent research.

In a research paper project, you’ll draw some conclusions from what experts have already done, find gaps in their studies, and then draw your own conclusions.

While a research paper is like an academic essay, it tends to be longer and more detailed.

Since they require extended research and attention to details, research papers can take a lot of time to write.

If well researched, your research paper can demonstrate your knowledge about a topic, your ability to engage with multiple sources, and your willingness to contribute original thoughts to an ongoing debate.

Types of Research Papers

 There are two types of research papers and they’re as follows:

 1. Analytical Research Papers

 Similar to analytical essay , and usually in the form of a question, an analytical research paper looks at an issue from a neutral point and gives a clear analysis of the issue.

Your goal is to make the reader understand both sides of the issue in question and leave it to them to decide what side of the analysis to accept.

Unlike an argumentative research paper, an analytical research paper doesn’t include counterarguments. And you can only draw your conclusion based on the information stretched out all through the analysis.

2. Argumentative Research Papers

In an argumentative research paper, you state the subject under study, look into both sides of an issue, pick a stance, and then use solid evidence and objective reasons to defend your position.

In   argumentative writing, your goal isn’t to persuade your audience to take an action. 

Rather, it’s to convince them that your position on the research question is more accurate than the opposing point of views.

Regardless of the type of research paper that you write, you’ll have to follow the standard outline for the assignment to be acceptable for review and marking.

Also, all research paper, regardless of the research question under investigation must include a literature review.

Literature Review vs Research Paper

The table below shows the differences between a literature review (review paper) and a research paper. 

Frequently Asked Questions

1. is there a literature review in a research paper.

A research paper assignment must include a literature review immediately after the introduction chapter.

The chapter is significant because your research work would otherwise be incomplete without knowledge of existing literature. 

2. How Many Literature Review Should Be in Research Paper?

Your research paper  should have only one literature review. Make sure you write the review based on the instructions from your teacher.

Before you start, check the required length, number of sources to summarize, and the format to use. Doing so will help you score top grades for the assignment. 

3. What is the Difference Between Research and Literature?

Whereas literature focuses on gathering, reading, and summarizing information on already established studies, original research involves coming up with new concepts, theories, and ideas that might fill existing gaps in the available literature.

4. How Long is a Literature Review?

How long a literature review should be will depend on several factors, including the level of education, the length of the assignment, the target audience, and the purpose of the review.

For example, a 150-page dissertation can have a literature review of 40 pages on average.

Make sure you talk to your instructor to determine the required length of the assignment.

5. How Does a Literature Review Look Like?

Your literature review shouldn’t be a focus on original research or new information. Rather, it should give a clear overview of the already existing work on the selected topic.

The information to review can come from various sources, including scholarly journal articles , government reports, credible websites, and academic-based books. 

About the author 

Antony W is a professional writer and coach at Help for Assessment. He spends countless hours every day researching and writing great content filled with expert advice on how to write engaging essays, research papers, and assignments.

• Aimlay Foundation
• Pharma Courses
• Become a Partner
• Medical Courses
• Life@Aimlay
• Web Stories

• Thesis Writing
• Law Admission
• Dissertation
• Honorary doctorate
• Educational Academy
• Management Courses
• Research Paper Writing
• YouTube Journal

PhD | Thesis Writing | Law Admission | Dissertation | Biography | Pharma | Honorary doctorate | Educational Academy | Management Courses | Research Paper Writing | YouTube Journal  

Difference Between Research Paper and Review Paper? 

• August 29, 2022
• Research Paper Writing , YouTube Journal
• No Comments

A research paper and a review paper writing are two different types of documents. They have different purposes, purposes, and requirements.  Research papers and review papers contain different information. The r esearch paper contains original research work by the author, while the review paper is based on an existing source of knowledge. 

In this blog, let’s discuss the differences between research and review paper writing . 

What are Research Papers?  

A research paper is a type of essay where the main purpose is that it should present new ideas and information to the audience. The author of the research paper must provide facts, figures, graphs, and other types of written information that can support his/her argument(s).  

Research papers can be written on any topic, but they must be connected with one or more disciplines. 

A good example is when science students write their research papers on cell division or DNA synthesis.  

What are Review Papers?  

A review paper writing aims to provide readers with an overview of an article or book by reviewing its content, structure, style, and arguments. Reviews can be used to evaluate other people’s work or to assess one’s own work by comparing it with another’s work (i.e., peer reviews). Review papers are usually shorter than research papers because they are intended for wider audiences. 

Understanding the Main Difference:  

Research papers and review papers are two different types of writing assignments you will encounter in your academic career. 

Research paper writing: The research paper is a written piece that is required to answer the question, “What do we know about this topic?” 

Review paper writing : The review paper is a written piece that is required to answer the question, “What do we not know about this topic?” 

More about Research Papers:  

• Research papers present essential information that has been gathered from many sources. 
• The writer must cite his sources for all ideas used in this article. This can be done by using bibliographies or footnotes at the end of each page of your paper. 
• A bibliography is a list of all sources used within your article; it should be placed at the end of your work or on an appendix page in the principal body.
• Footnotes cite specific puotes or references not found within the text itself. 
• They should also be placed at the end of your work. Or on an appendix page if used as part of your principal body. 

More about Review Papers : 

• Review papers have a special role in scientific literature. They are one of the most common papers and are often used to measure an individual’s scientific contributions. It provides a summary of current knowledge on the subject while identifying gaps in that knowledge, and it may also offer suggestions for future research. 
• Review papers are most often written by scientists publishing in peer-reviewed journals, although they can be written by anyone with access to relevant information about the subject matter.  
• Review papers usually include an introduction and background information about their topic. It is related to other subjects, discussion of previous work on the subject, and research methods used to gather data from studies.  
• Usually conducted by others who have studied the same thing, conclusions are supported by evidence from these studies and any additional information needed to understand their findings and draw conclusions from them. 

What is a Literature Review? Is it similar to Review Papers?  

A literature review is a scholarly document that discusses the current state of knowledge on a topic. It may evaluate existing research quality and determine which works should be included in an analysis or synthesis. 

• A literature review can be conducted by anyone interested in a particular topic area. But it is usually performed by someone with some knowledge or training.
• The primary purpose of a literature review is to provide background information about a topic. So that the author can develop the ideas for a research paper or report. For this to happen, you need to know what your audience wants. You also need to understand what your audience wants from you. 
• A literature review is a critique of current literature. A literature review is similar to a research paper , but it is not as long and detailed.  

The main difference is that a literature review typically focuses on only one or two specific topics. Whereas a research paper can be more broadly focused and may include multiple sections. 

How does a Review Paper help form a Research Paper?  

A review paper is a summary of previous research on a topic. It can be either an objective or subjective analysis.  

The purpose of the review is to summarize the findings of previous research. Also to determine whether the results are valid and reliable.   

This can be done by examining the research methods used in the studies and their design, measurement and statistical analysis. 

In addition to presenting information about a subject in its own right. Reviews also provide a context for future research by identifying areas that need to be addressed. Checks may be critical in identifying areas that require further investigation or discussion. They also help researchers focus their efforts on those areas that are most important to address.   

Tips for Writing Research paper and Review paper:  

A review paper has to be written. First, it includes the citations you might require while developing your research paper.  

While writing a research paper , you should inquire about every question that comes to your mind. And follow through with them appropriately. 

A review paper is not your final paper; it requires constant research and a table of contents, commonly known as the bibliography. With the help of a bibliography, you will have a clear list of items you need in-depth research. It will prevent you from getting confused and haphazard with your findings and research.  

A research paper is a piece of writing that tries to answer a specific question. A review paper is typically shorter than a research paper and focuses on one main point or idea.

Share this Article

Send your query, leave a reply cancel reply.

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

Aimlay is a Perfect Platform to Transform the Lives of Working Professionals

Be an exceptional working professional by completing your education with Aimlay

Aimlay is a top-notch Educational and Writing service platform for the last 14 years, exclusively for working professionals who are willing to discover their true potential by gaining higher education.

• 14 Hanover Street, Mayfair, London | Hooghly, West Bengal, India
• [email protected]

• English Editing Services
• Academic Peer Review Services
• Academic Plagiarism Checking
• Academic Translation Services
• Manuscript Formatting Services
• Testimonials

What is the difference between a research paper and a review paper?

• May 2, 2024
• Posted by: IRP Academy
• Category: Knowledge Base

A research paper entails original investigation, which can vary by field or topic (e.g., experiments, surveys, interviews, questionnaires). Authors are responsible for collecting, analyzing raw data, and conducting an original study. The paper’s foundation lies in the analysis and interpretation of this data.

A review article, distinct from original research, draws from existing published articles to summarize the literature on a topic, aiming to elucidate the current state of understanding. These articles typically fall into three categories:

A narrative review summarizes existing knowledge on a topic using all available published research. A systematic review seeks answers to specific questions in scientific literature. A meta-analysis consolidates and compares findings from previous studies, typically to evaluate intervention effectiveness or treatment modes.

Review papers are invaluable in scientific literature as they consolidate existing findings, allowing readers to grasp the knowledge on a topic without reading every published work. Well-written reviews, especially in medicine and healthcare, are popular and often featured in reputable journals. However, it’s essential to verify if your chosen journal accepts such articles. When published in a respected peer-reviewed journal , review articles often yield significant impact and garner numerous citations.

Let’s explore the key differences between a  research paper  and a  review paper :

• Research Paper : Presents original findings or results from a study conducted by the author.
• Review Paper : Summarizes and analyzes existing research on a specific topic, providing an overview of the current state of knowledge.
• Research Paper : Typically longer, more detailed, and comprehensive.
• Review Paper : Generally shorter, focusing on synthesizing existing information.
• Research Paper : Often more focused on a specific topic.
• Review Paper : Provides a broader overview of existing research across related areas.
• Research Paper : Analytical and critical, based on the author’s original research.
• Review Paper : Collects and collates information from various written publications.
• Research Paper : Contains novel research findings.
• Review Paper : Does not introduce new research; instead, it summarizes existing work.

Related Posts:

Leave a Reply Cancel reply

If you have any questions, please feel free to contact us.

“Thank you so much for your editing work”

“I am writing this email to sincerely appreciate the exceptional work you and your team have done on our manuscript. Kindly pass on our gratitude to every member of your team for their remarkable efforts. Rest assured, we will definitely be seeking your team’s expertise again in the future.” (English Academic Editing Service)

“Many thanks for the reviewing and the kind comments of the reviewer” (English Academic Editing Service)

“Many thanks for your excellent service” (English Academic Editing Service)

“Thank you very much for the very thorough and detailed correction of the manuscript. It’s very much improved” (English Academic Editing Service)

How to Write a Research Proposal: (with Examples & Templates)

Table of Contents

Before conducting a study, a research proposal should be created that outlines researchers’ plans and methodology and is submitted to the concerned evaluating organization or person. Creating a research proposal is an important step to ensure that researchers are on track and are moving forward as intended. A research proposal can be defined as a detailed plan or blueprint for the proposed research that you intend to undertake. It provides readers with a snapshot of your project by describing what you will investigate, why it is needed, and how you will conduct the research.  

Your research proposal should aim to explain to the readers why your research is relevant and original, that you understand the context and current scenario in the field, have the appropriate resources to conduct the research, and that the research is feasible given the usual constraints.  

This article will describe in detail the purpose and typical structure of a research proposal , along with examples and templates to help you ace this step in your research journey.  

What is a Research Proposal ?  

A research proposal¹ ,²  can be defined as a formal report that describes your proposed research, its objectives, methodology, implications, and other important details. Research proposals are the framework of your research and are used to obtain approvals or grants to conduct the study from various committees or organizations. Consequently, research proposals should convince readers of your study’s credibility, accuracy, achievability, practicality, and reproducibility.   

With research proposals , researchers usually aim to persuade the readers, funding agencies, educational institutions, and supervisors to approve the proposal. To achieve this, the report should be well structured with the objectives written in clear, understandable language devoid of jargon. A well-organized research proposal conveys to the readers or evaluators that the writer has thought out the research plan meticulously and has the resources to ensure timely completion.  

Purpose of Research Proposals  

A research proposal is a sales pitch and therefore should be detailed enough to convince your readers, who could be supervisors, ethics committees, universities, etc., that what you’re proposing has merit and is feasible . Research proposals can help students discuss their dissertation with their faculty or fulfill course requirements and also help researchers obtain funding. A well-structured proposal instills confidence among readers about your ability to conduct and complete the study as proposed.  

Research proposals can be written for several reasons:³  

• To describe the importance of research in the specific topic  
• Address any potential challenges you may encounter  
• Showcase knowledge in the field and your ability to conduct a study  
• Apply for a role at a research institute  
• Convince a research supervisor or university that your research can satisfy the requirements of a degree program  
• Highlight the importance of your research to organizations that may sponsor your project  
• Identify implications of your project and how it can benefit the audience  

What Goes in a Research Proposal?    

Research proposals should aim to answer the three basic questions—what, why, and how.  

The What question should be answered by describing the specific subject being researched. It should typically include the objectives, the cohort details, and the location or setting.  

The Why question should be answered by describing the existing scenario of the subject, listing unanswered questions, identifying gaps in the existing research, and describing how your study can address these gaps, along with the implications and significance.  

The How question should be answered by describing the proposed research methodology, data analysis tools expected to be used, and other details to describe your proposed methodology.   

Research Proposal Example  

Here is a research proposal sample template (with examples) from the University of Rochester Medical Center. 4 The sections in all research proposals are essentially the same although different terminology and other specific sections may be used depending on the subject.  

Structure of a Research Proposal  

If you want to know how to make a research proposal impactful, include the following components:¹  

1. Introduction  

This section provides a background of the study, including the research topic, what is already known about it and the gaps, and the significance of the proposed research.  

2. Literature review  

This section contains descriptions of all the previous relevant studies pertaining to the research topic. Every study cited should be described in a few sentences, starting with the general studies to the more specific ones. This section builds on the understanding gained by readers in the Introduction section and supports it by citing relevant prior literature, indicating to readers that you have thoroughly researched your subject.  

3. Objectives  

Once the background and gaps in the research topic have been established, authors must now state the aims of the research clearly. Hypotheses should be mentioned here. This section further helps readers understand what your study’s specific goals are.  

4. Research design and methodology  

Here, authors should clearly describe the methods they intend to use to achieve their proposed objectives. Important components of this section include the population and sample size, data collection and analysis methods and duration, statistical analysis software, measures to avoid bias (randomization, blinding), etc.  

5. Ethical considerations  

This refers to the protection of participants’ rights, such as the right to privacy, right to confidentiality, etc. Researchers need to obtain informed consent and institutional review approval by the required authorities and mention this clearly for transparency.  

6. Budget/funding  

Researchers should prepare their budget and include all expected expenditures. An additional allowance for contingencies such as delays should also be factored in.  

7. Appendices  

This section typically includes information that supports the research proposal and may include informed consent forms, questionnaires, participant information, measurement tools, etc.  

8. Citations  

Important Tips for Writing a Research Proposal  

Writing a research proposal begins much before the actual task of writing. Planning the research proposal structure and content is an important stage, which if done efficiently, can help you seamlessly transition into the writing stage. 3,5  

The Planning Stage  

• Manage your time efficiently. Plan to have the draft version ready at least two weeks before your deadline and the final version at least two to three days before the deadline.
• What is the primary objective of your research?  
• Will your research address any existing gap?  
• What is the impact of your proposed research?  
• Do people outside your field find your research applicable in other areas?  
• If your research is unsuccessful, would there still be other useful research outcomes?  

  The Writing Stage  

• Create an outline with main section headings that are typically used.  
• Focus only on writing and getting your points across without worrying about the format of the research proposal , grammar, punctuation, etc. These can be fixed during the subsequent passes. Add details to each section heading you created in the beginning.   
• Ensure your sentences are concise and use plain language. A research proposal usually contains about 2,000 to 4,000 words or four to seven pages.  
• Don’t use too many technical terms and abbreviations assuming that the readers would know them. Define the abbreviations and technical terms.  
• Ensure that the entire content is readable. Avoid using long paragraphs because they affect the continuity in reading. Break them into shorter paragraphs and introduce some white space for readability.  
• Focus on only the major research issues and cite sources accordingly. Don’t include generic information or their sources in the literature review.  
• Proofread your final document to ensure there are no grammatical errors so readers can enjoy a seamless, uninterrupted read.  
• Use academic, scholarly language because it brings formality into a document.  
• Ensure that your title is created using the keywords in the document and is neither too long and specific nor too short and general.  
• Cite all sources appropriately to avoid plagiarism.  
• Make sure that you follow guidelines, if provided. This includes rules as simple as using a specific font or a hyphen or en dash between numerical ranges.  
• Ensure that you’ve answered all questions requested by the evaluating authority.  

Key Takeaways   

Here’s a summary of the main points about research proposals discussed in the previous sections:  

• A research proposal is a document that outlines the details of a proposed study and is created by researchers to submit to evaluators who could be research institutions, universities, faculty, etc.  
• Research proposals are usually about 2,000-4,000 words long, but this depends on the evaluating authority’s guidelines.  
• A good research proposal ensures that you’ve done your background research and assessed the feasibility of the research.  
• Research proposals have the following main sections—introduction, literature review, objectives, methodology, ethical considerations, and budget.  

Frequently Asked Questions  

Q1. How is a research proposal evaluated?  

A1. In general, most evaluators, including universities, broadly use the following criteria to evaluate research proposals . 6  

• Significance —Does the research address any important subject or issue, which may or may not be specific to the evaluator or university?  
• Content and design —Is the proposed methodology appropriate to answer the research question? Are the objectives clear and well aligned with the proposed methodology?  
• Sample size and selection —Is the target population or cohort size clearly mentioned? Is the sampling process used to select participants randomized, appropriate, and free of bias?  
• Timing —Are the proposed data collection dates mentioned clearly? Is the project feasible given the specified resources and timeline?  
• Data management and dissemination —Who will have access to the data? What is the plan for data analysis?  

Q2. What is the difference between the Introduction and Literature Review sections in a research proposal ?  

A2. The Introduction or Background section in a research proposal sets the context of the study by describing the current scenario of the subject and identifying the gaps and need for the research. A Literature Review, on the other hand, provides references to all prior relevant literature to help corroborate the gaps identified and the research need.  

Q3. How long should a research proposal be?  

A3. Research proposal lengths vary with the evaluating authority like universities or committees and also the subject. Here’s a table that lists the typical research proposal lengths for a few universities.  

Q4. What are the common mistakes to avoid in a research proposal ?  

A4. Here are a few common mistakes that you must avoid while writing a research proposal . 7  

• No clear objectives: Objectives should be clear, specific, and measurable for the easy understanding among readers.  
• Incomplete or unconvincing background research: Background research usually includes a review of the current scenario of the particular industry and also a review of the previous literature on the subject. This helps readers understand your reasons for undertaking this research because you identified gaps in the existing research.  
• Overlooking project feasibility: The project scope and estimates should be realistic considering the resources and time available.   
• Neglecting the impact and significance of the study: In a research proposal , readers and evaluators look for the implications or significance of your research and how it contributes to the existing research. This information should always be included.  
• Unstructured format of a research proposal : A well-structured document gives confidence to evaluators that you have read the guidelines carefully and are well organized in your approach, consequently affirming that you will be able to undertake the research as mentioned in your proposal.  
• Ineffective writing style: The language used should be formal and grammatically correct. If required, editors could be consulted, including AI-based tools such as Paperpal , to refine the research proposal structure and language.  

Thus, a research proposal is an essential document that can help you promote your research and secure funds and grants for conducting your research. Consequently, it should be well written in clear language and include all essential details to convince the evaluators of your ability to conduct the research as proposed.  

This article has described all the important components of a research proposal and has also provided tips to improve your writing style. We hope all these tips will help you write a well-structured research proposal to ensure receipt of grants or any other purpose.  

References  

• Sudheesh K, Duggappa DR, Nethra SS. How to write a research proposal? Indian J Anaesth. 2016;60(9):631-634. Accessed July 15, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037942/  
• Writing research proposals. Harvard College Office of Undergraduate Research and Fellowships. Harvard University. Accessed July 14, 2024. https://uraf.harvard.edu/apply-opportunities/app-components/essays/research-proposals  
• What is a research proposal? Plus how to write one. Indeed website. Accessed July 17, 2024. https://www.indeed.com/career-advice/career-development/research-proposal  
• Research proposal template. University of Rochester Medical Center. Accessed July 16, 2024. https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/pediatrics/research/documents/Research-proposal-Template.pdf  
• Tips for successful proposal writing. Johns Hopkins University. Accessed July 17, 2024. https://research.jhu.edu/wp-content/uploads/2018/09/Tips-for-Successful-Proposal-Writing.pdf  
• Formal review of research proposals. Cornell University. Accessed July 18, 2024. https://irp.dpb.cornell.edu/surveys/survey-assessment-review-group/research-proposals  
• 7 Mistakes you must avoid in your research proposal. Aveksana (via LinkedIn). Accessed July 17, 2024. https://www.linkedin.com/pulse/7-mistakes-you-must-avoid-your-research-proposal-aveksana-cmtwf/  

Paperpal is a comprehensive AI writing toolkit that helps students and researchers achieve 2x the writing in half the time. It leverages 21+ years of STM experience and insights from millions of research articles to provide in-depth academic writing, language editing, and submission readiness support to help you write better, faster.  

Get accurate academic translations, rewriting support, grammar checks, vocabulary suggestions, and generative AI assistance that delivers human precision at machine speed. Try for free or upgrade to Paperpal Prime starting at US$19 a month to access premium features, including consistency, plagiarism, and 30+ submission readiness checks to help you succeed.  

Experience the future of academic writing – Sign up to Paperpal and start writing for free!  

Related Reads:

How to write a phd research proposal.

• What are the Benefits of Generative AI for Academic Writing?
• How to Avoid Plagiarism When Using Generative AI Tools
• What is Hedging in Academic Writing?  

How to Write Your Research Paper in APA Format

The future of academia: how ai tools are changing the way we do research, you may also like, how to write your research paper in apa..., how to choose a dissertation topic, how to write an academic paragraph (step-by-step guide), maintaining academic integrity with paperpal’s generative ai writing..., research funding basics: what should a grant proposal..., how to write an abstract in research papers..., how to write dissertation acknowledgements, how to structure an essay, leveraging generative ai to enhance student understanding of....

• Introduction
• Conclusions
• Article Information

In some articles, the number of cases and/or sample sizes might not coincide with those provided in the original study owing to the R package, which recalculates the percentage. We were interested in keeping the estimate provided; therefore, we modified numbers accordingly. A1 indicates the question “Have you experienced tinnitus?”; A2, “Have you experienced tinnitus for more than 5 minutes?”; A3, “Have you experienced tinnitus during the last months”?; A4, “During the last months, have you experienced tinnitus which lasts for more than 5 minutes?”; A5, assessment of tinnitus through a specific scale; A6, assessment of tinnitus via other tinnitus definitions; BG, Bulgaria; DE, Germany; ES, Spain; FR, France; GR, Greece; IE, Ireland; IT, Italy; LV, Latvia; PL, Polonia; PT, Portugal; RO, Romania; THI, Tinnitus Handicap Inventory; TQ, Tinnitus Questionnaire; and TSCHQ, Tinnitus Sample Case History Questionnaire.

a This study had 2 populations; the second population is indicated by “b.”

In some articles, the number of cases and/or sample sizes might not coincide with those provided in the original study owing to the R package, which recalculates the percentage. We were interested in keeping the estimate provided; therefore, we modified numbers accordingly. BG indicates Bulgaria; DE, Germany; ES, Spain; FR, France; GR, Greece; IE, Ireland; IT, Italy; LV, Latvia; PL, Polonia; PT, Portugal; RO, Romania; S1, “Are you bothered by your tinnitus?”; S2, “How much are you bothered by your tinnitus?”; S3, “Does your tinnitus interfere with sleep and concentration?”; S4, assessment of tinnitus severity through a specific scale; S5, assessment of tinnitus severity via other definitions of tinnitus severity; THI, Tinnitus Handicap Inventory; and TQ, Tinnitus Questionnaire.

eFigure 1. Flow Chart of the Present Systematic Review

eFigure 2. Forest Plot of Tinnitus Prevalence in Children and Adolescents, by Different Definition Classes of Any Tinnitus

eFigure 3. Forest Plot of Any Tinnitus Prevalence, by Age Group

eFigure 4. Funnel Plot for Publication Bias

eFigure 5. Forest Plot of Incidence Rate per 100,000 Person-Years of Any Tinnitus in Adults (Both Sexes)

eTable 1. Search String Used for the Umbrella and the Traditional Reviews

eTable 2. List of Articles Excluded and Reasons of Exclusion

eTable 3. List of and Reason for Exclusion of the 24 Eligible Studies Excluded From the Meta-analysis

eTable 4. Definitions of Any, Severe, Chronic, and Diagnosed Tinnitus Used in the Systematic Review

eTable 5. Characteristics of the 89 Studies Included in the Meta-analysis

eTable 6. Prevalence of Any Tinnitus and Severe Tinnitus per Continent and Globally

eReferences.

• Error in Open Access Status JAMA Neurology Correction February 1, 2023

See More About

Select your interests.

Customize your JAMA Network experience by selecting one or more topics from the list below.

• Academic Medicine
• Acid Base, Electrolytes, Fluids
• Allergy and Clinical Immunology
• American Indian or Alaska Natives
• Anesthesiology
• Anticoagulation
• Art and Images in Psychiatry
• Artificial Intelligence
• Assisted Reproduction
• Bleeding and Transfusion
• Caring for the Critically Ill Patient
• Challenges in Clinical Electrocardiography
• Climate and Health
• Climate Change
• Clinical Challenge
• Clinical Decision Support
• Clinical Implications of Basic Neuroscience
• Clinical Pharmacy and Pharmacology
• Complementary and Alternative Medicine
• Consensus Statements
• Coronavirus (COVID-19)
• Critical Care Medicine
• Cultural Competency
• Dental Medicine
• Dermatology
• Diabetes and Endocrinology
• Diagnostic Test Interpretation
• Drug Development
• Electronic Health Records
• Emergency Medicine
• End of Life, Hospice, Palliative Care
• Environmental Health
• Equity, Diversity, and Inclusion
• Facial Plastic Surgery
• Gastroenterology and Hepatology
• Genetics and Genomics
• Genomics and Precision Health
• Global Health
• Guide to Statistics and Methods
• Hair Disorders
• Health Care Delivery Models
• Health Care Economics, Insurance, Payment
• Health Care Quality
• Health Care Reform
• Health Care Safety
• Health Care Workforce
• Health Disparities
• Health Inequities
• Health Policy
• Health Systems Science
• History of Medicine
• Hypertension
• Images in Neurology
• Implementation Science
• Infectious Diseases
• Innovations in Health Care Delivery
• JAMA Infographic
• Law and Medicine
• Leading Change
• Less is More
• LGBTQIA Medicine
• Lifestyle Behaviors
• Medical Coding
• Medical Devices and Equipment
• Medical Education
• Medical Education and Training
• Medical Journals and Publishing
• Mobile Health and Telemedicine
• Narrative Medicine
• Neuroscience and Psychiatry
• Notable Notes
• Nutrition, Obesity, Exercise
• Obstetrics and Gynecology
• Occupational Health
• Ophthalmology
• Orthopedics
• Otolaryngology
• Pain Medicine
• Palliative Care
• Pathology and Laboratory Medicine
• Patient Care
• Patient Information
• Performance Improvement
• Performance Measures
• Perioperative Care and Consultation
• Pharmacoeconomics
• Pharmacoepidemiology
• Pharmacogenetics
• Pharmacy and Clinical Pharmacology
• Physical Medicine and Rehabilitation
• Physical Therapy
• Physician Leadership
• Population Health
• Primary Care
• Professional Well-being
• Professionalism
• Psychiatry and Behavioral Health
• Public Health
• Pulmonary Medicine
• Regulatory Agencies
• Reproductive Health
• Research, Methods, Statistics
• Resuscitation
• Rheumatology
• Risk Management
• Scientific Discovery and the Future of Medicine
• Shared Decision Making and Communication
• Sleep Medicine
• Sports Medicine
• Stem Cell Transplantation
• Substance Use and Addiction Medicine
• Surgical Innovation
• Surgical Pearls
• Teachable Moment
• Technology and Finance
• The Art of JAMA
• The Arts and Medicine
• The Rational Clinical Examination
• Tobacco and e-Cigarettes
• Translational Medicine
• Trauma and Injury
• Treatment Adherence
• Ultrasonography
• Users' Guide to the Medical Literature
• Vaccination
• Venous Thromboembolism
• Veterans Health
• Women's Health
• Workflow and Process
• Wound Care, Infection, Healing

Others Also Liked

• Download PDF
• X Facebook More LinkedIn

Jarach CM , Lugo A , Scala M, et al. Global Prevalence and Incidence of Tinnitus : A Systematic Review and Meta-analysis . JAMA Neurol. 2022;79(9):888–900. doi:10.1001/jamaneurol.2022.2189

Manage citations:

© 2024

• Permissions

Global Prevalence and Incidence of Tinnitus : A Systematic Review and Meta-analysis

• 1 Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
• 2 GROW–School for Oncology and Developmental Biology, Department of Epidemiology, Maastricht University Medical Centre, Maastricht, the Netherlands
• 3 Care and Public Health Research Institute–School for Public Health and Primary Care, Department of Epidemiology, Maastricht University Medical Centre, Maastricht, the Netherlands
• 4 Laboratory of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
• 5 National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
• 6 Division of Clinical Neuroscience, Hearing Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
• 7 School of Medicine, University Vita-Salute San Raffaele, Milan, Italy
• 8 Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
• 9 School of Medicine and Surgery, Department of Otorhinolaryngology, University of Milan–Bicocca, Milan, Italy
• 10 Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
• Correction Error in Open Access Status JAMA Neurology

Question   What is the global prevalence and incidence of tinnitus?

Findings   This systematic review and meta-analysis estimated that the annual incidence of tinnitus is approximately 1%, with 14% of adults experiencing any tinnitus and 2% experiencing a severe form of it. The prevalence of tinnitus did not differ by sex, but increased prevalence was associated with increasing age, with any tinnitus being present in 10% of young adults, 14% of middle-aged adults, and 24% of older adults.

Meaning   This study suggests that the global burden of tinnitus is large, similar to migraine and pain, and the lack of effective treatment options justifies a major investment in research in this area.

Importance   To date, no systematic review has taken a meta-analytic approach to estimating the prevalence and incidence of tinnitus in the general population.

Objective   To provide frequency estimates of tinnitus worldwide.

Data Sources   An umbrella review followed by a traditional systematic review was performed by searching PubMed-MEDLINE and Embase from inception through November 19, 2021.

Study Selection   Research data from the general population were selected, and studies based on patients or on subgroups of the population with selected lifestyle habits were excluded. No restrictions were applied according to date, age, sex, and country.

Data Extraction and Synthesis   Relevant extracted information included type of study, time and location, end point, population characteristics, and tinnitus definition. The study followed the Meta-analysis of Observational Studies in Epidemiology ( MOOSE ) reporting guideline.

Main Outcomes and Measures   Pooled prevalence estimates of any tinnitus, severe tinnitus, chronic tinnitus, and diagnosed tinnitus as well as incidence of tinnitus were obtained using random-effects meta-analytic models; heterogeneity between studies was controlled using the χ 2 test, and inconsistency was measured using the I 2 statistic.

Results   Among 767 publications, 113 eligible articles published between 1972 and 2021 were identified, and prevalence estimates from 83 articles and incidence estimates from 12 articles were extracted. The pooled prevalence of any tinnitus among adults was 14.4% (95% CI, 12.6%-16.5%) and ranged from 4.1% (95% CI, 3.7%-4.4%) to 37.2% (95% CI, 34.6%-39.9%). Prevalence estimates did not significantly differ by sex (14.1% [95% CI, 11.6%-17.0%] among male individuals; 13.1% [95% CI, 10.5%-16.2%] among female individuals), but increased prevalence was associated with age (9.7% [95% CI, 7.4%-12.5%] among adults aged 18-44 years; 13.7% [95% CI, 11.0%-17.0%] among those aged 45-64 years; and 23.6% [95% CI, 19.4%-28.5%] among those aged ≥65 years; P  < .001 among age groups). The pooled prevalence of severe tinnitus was 2.3% (95% CI, 1.7%-3.1%), ranging from 0.5% (95% CI, 0.3%-0.7%) to 12.6% (95% CI, 11.1%-14.1%). The pooled prevalence of chronic tinnitus was 9.8% (95% CI, 4.7%-19.3%) and the pooled prevalence of diagnosed tinnitus was 3.4% (95% CI, 2.1%-5.5%). The pooled incidence rate of any tinnitus was 1164 per 100 000 person-years (95% CI, 479-2828 per 100 000 person-years).

Conclusions and Relevance   Despite the substantial heterogeneity among studies, this comprehensive systematic review on the prevalence and incidence of tinnitus suggests that tinnitus affects more than 740 million adults globally and is perceived as a major problem by more than 120 million people, mostly aged 65 years or older. Health policy makers should consider the global burden of tinnitus, and greater effort should be devoted to boost research on tinnitus.

The term tinnitus comes from the Latin word tinnire , which means “to ring.” Individuals experiencing tinnitus report an unspecified acoustic sound like ringing, but also buzzing, clicking, pulsations, and other noises. 1 Tinnitus is considered a symptom of an underlying condition, rather than a disease, and it refers to the perception of sounds in the head or ears when no corresponding external sounds are present. 2 , 3 A severe form of tinnitus is associated with hearing loss, thus impairing quality of life. 4 , 5

Today there is no globally accepted categorization of tinnitus, although different attempts have been made. 6 Moreover, evidence on the frequency (ie, prevalence and incidence) of tinnitus among the general population is still scant. The difficulties in obtaining adequate data are due to the multifactorial etiology of tinnitus, its associated disorders, the various characteristics of the symptoms, and the subjective nature of any assessment of tinnitus. 7

The very few longitudinal studies on tinnitus hamper any accurate estimate of its incidence. Moreover, the prevalence of tinnitus, which is estimated as either point prevalence, period prevalence, or lifetime prevalence, 8 ranges widely, partly because of the lack of standardization in its assessment, illustrated in a systematic review in which McCormack et al 3 attempted to identify and collect data on the global prevalence of tinnitus.

Since that last review on the prevalence of tinnitus, the literature on tinnitus has increased by at least 30%. An update of the evidence, which also includes pediatric tinnitus, is now necessary. We conducted a systematic review to identify the relevant publications in the scientific literature on the frequency of tinnitus at a global level, using an original search method. 9

This systematic review and meta-analysis is based on 2 subsequent literature searches on the prevalence and incidence of tinnitus. The first search was an umbrella review: a systematic review to identify published meta-analyses, pooled analyses, and systematic reviews providing data on the prevalence or incidence of tinnitus. The second search was a traditional review of original publications: a systematic review of all original articles on the prevalence or incidence of tinnitus to update the results identified in the umbrella review. A review protocol was registered in advance on PROSPERO (registration number: CRD42021283684). The study followed the Meta-analysis of Observational Studies in Epidemiology ( MOOSE ) reporting guideline.

We conducted an umbrella review to systematically collect existing evidence on the prevalence and incidence of tinnitus. We searched in PubMed-MEDLINE and Embase for all systematic reviews or meta-analyses published from inception through November 19, 2021, that had the word tinnitus in the title (eTable 1 in the Supplement ). We retrieved 310 reviews from PubMed and 346 from Embase. After checking for duplicates using EndNote, version X7 (Clarivate), we excluded protocols, scoping reviews, case studies or animal model studies, and articles that were not in English. After applying our inclusion criteria (ie, reporting data on the prevalence or incidence of tinnitus), we excluded 369 reviews as not relevant, ending up with 15 publications. We added 1 study that we were aware of that followed our eligibility criteria but was not identified by our search string because it was not classified as a review. From each of these 16 relevant systematic reviews, we extracted the citations of all the original articles providing data on the prevalence and incidence of tinnitus, collecting 284 original studies in total.

We included only articles in English, based on samples representative of the general population, and with estimates specifically of tinnitus. Reports, letters to the editor, book chapters, conference proceedings, dissertations, and theses were not considered. We excluded studies based on patients or on subgroups of the population with selected lifestyle habits or other characteristics (eg, musicians or people regularly exposed to noise). No restrictions were applied regarding the date of publication, age, sex, and country. Two researchers (C.M.J. and M.S.) independently checked for eligibility. Any disagreement was resolved by discussion; in case of disagreement, a third reviewer (A.L.) helped to reach consensus. The umbrella review yielded 93 eligible original articles.

We then conducted a traditional review to check any relevant articles in the literature that might not have been identified through the umbrella review. We searched articles in PubMed-MEDLINE and Embase published from inception through November 19, 2021, using a string that included a combination of the words tinnitus , prevalence , and incidence in the title. From 245 publications, we checked for duplicates and retrieved 154 unique references. After excluding articles identified in the umbrella review (n = 45), other duplicates (n = 15), and noneligible articles (n = 78), we obtained 16 new records. To these, we added 2 other references retrieved from other sources that we knew followed our eligibility criteria. All the articles excluded from both the umbrella and the traditional review, as well as the reasons for exclusion, are listed in eTable 2 in the Supplement .

We used a standardized form in Excel 2016 (Microsoft Corp) to extract data from each article identified. Relevant information included first author, year of publication, journal, type of study, time and location, end point (prevalence and/or incidence), other information (country and sample size), population characteristics (sex and age group), and tinnitus definition. Data were blindly extracted by 2 independent reviewers (C.M.J. and M.S.). Any disagreement was resolved by discussion, or with the help of a third reviewer (A.L.). Each prevalence estimate was extracted and classified by age group: children (≥17 years), young adults (18-44 years), middle-aged adults (45-64 years), older adults (≥65 years), and all adults (≥18 years).

If, while extracting, we came across summary tables that gave additional relevant citations, these were evaluated using the same inclusion and exclusion criteria. This evaluation led to 2 additional eligible articles, yielding a final total of 113 eligible articles. Among these, 24 articles were not included in the extraction for meta-analysis because their results were already included in other more complete or more recent articles (eTable 3 in the Supplement ). We extracted prevalence or incidence estimates from 89 articles.

The pooled prevalence and incidence of any tinnitus and severe tinnitus were calculated overall for children, adolescents, and adults and separately by tinnitus definition (eTable 4 in the Supplement ). For any tinnitus in adults, we identified 6 possible classes of definitions (A1-A6), and for severe tinnitus, we identified 5 possible classes (S1-S5). For children and adolescents, classes either had the word tinnitus in the question asked (any tinnitus or severe tinnitus) or had a phrase, such as “noises in your ears” (any noises or severe noises). Other possible definitions were chronic tinnitus or diagnosed tinnitus.

Pooled estimates were obtained using random-effects meta-analytic models to take account of the heterogeneity of the estimates. Heterogeneity among studies was controlled using the χ 2 test, and inconsistency was measured using the I 2 statistic, which represents the proportion of total variation associated with between-study variance, with higher values denoting a greater degree of heterogeneity. Stratified analyses by selected individual-level characteristics (eg, sex and age) and country-specific characteristics (eg, continent, gross domestic product [GDP], and latitude of the main city) were performed to detect possible sources of heterogeneity. The quality of the studies was not assessed because it was beyond the scope of meta-analyses on disease frequency. Because most prevalence and incidence estimates were provided without 95% CIs, we recalculated all the 95% CIs from the raw data given in the original articles. All P values were from 2-sided tests and results were deemed statistically significant at P  < .05.

All statistical analyses were performed using the R Studio software, version 1.4.1717 (R Group for Statistical Computing), particularly the “meta” and “metaphor” packages. To assess publication bias, we examined the funnel plots visually and applied the Egger test for funnel plot asymmetry.

Among 767 publications (384 reviews, 284 identified original publications, 94 articles from the traditional review, and 5 articles known by the authors), 113 eligible articles published between 1972 and 2021 were identified. We extracted prevalence estimates from 83 articles and incidence estimates from 12 articles. eFigure 1 in the Supplement shows the flowchart of study selection. Details on country, age group, and tinnitus definition in the 89 eligible articles included in meta-analyses are summarized in eTable 5 in the Supplement .

The pooled prevalence estimate of any tinnitus among adults ( Figure 1 ) 4 , 7 , 10 - 49 was 14.4% (95% CI, 12.6%-16.5%; 55 studies; I 2  = 100%). Among all studies, the estimates ranged from 4.1% (95% CI, 3.7%-4.4%) to 37.2% (95% CI, 34.6%-39.9%). The prevalence of any tinnitus did not differ according to the definitions (test for subgroup differences, χ 2 5  = 8.60; P  = .13 among strata): the prevalence of those who were asked “Have you experienced tinnitus?” (A1) was 17.5% (95% CI, 14.0%-21.8%; 12 studies; I 2  = 100%); for those who were asked if they had experienced tinnitus “for more than 5 minutes?” (A2), it was 13.7% (95% CI, 10.7%-17.4%; 9 studies; I 2  = 100%); for those who were asked “Have you experienced tinnitus during the last months?” (A3), it was 14.2% (95% CI, 10.0%-19.8%; 7 studies; I 2  = 100%); for those who were asked “During the last months, have you experienced tinnitus which lasts for more than 5 minutes?” (A4), it was 16.0% (95% CI, 13.1%-19.4%; 18 studies; I 2  = 99%); for those assessing tinnitus through a specific scale (A5), it was 9.3% (95% CI, 3.2%-24.1%; 3 studies; I 2  = 100%); and for those who were asked about other tinnitus definitions (A6), it was 9.6% (95% CI, 6.3%-14.3%; 6 studies; I 2  = 100%).

The pooled prevalence of any tinnitus among children and adolescents (eFigure 2 in the Supplement ) was 13.6% (95% CI, 8.5%-21.0%; 27 studies; I 2  = 100%). Among all studies, this prevalence ranged from 0.7% (95% CI, 0.6%-0.8%) to 66.9% (95% CI, 62.6%-71.0%). The prevalence of any tinnitus among children and adolescents was heterogeneous in strata of tinnitus definition classes ( P  = .01 among strata); for those who were in a study in which the word “tinnitus” was not present in the question (any noises), the prevalence was 20.4% (95% CI, 14.4%-28.0%; 18 studies; I 2  = 99%), and for those who were in a study in which it was present (any tinnitus), it was 5.6% (95% CI, 2.0%-14.8%; 9 studies; I 2  = 100%).

The pooled prevalence of any tinnitus was 9.7% (95% CI, 7.4%-12.5%; 22 studies; I 2  = 100%) among young adults, 13.7% (95% CI, 11.0%-17.0%; 30 studies; I 2  = 100%) among middle-aged adults, and 23.6% (95% CI, 19.4%-28.5%; 31 studies; I 2  = 99%) among older adults (eFigure 3 in the Supplement ). For adults, the pooled prevalence for any tinnitus was 14.1% (95% CI, 11.6%-17.0%; 32 studies; I 2  = 100%) among male individuals and 13.1% (95% CI, 10.5%-16.2%; 30 studies; I 2  = 100%) among female individuals ( P  = .62 between strata; Table 1 ).

Any tinnitus in adults significantly differed by continents, ranging from 5.2% (95% CI, 4.7%-5.7%; 1 study) in Africa to 21.9% (95% CI, 20.2%-23.8%; 1 study) in South America ( P  < .001 among strata; Table 1 ). The presence of tinnitus did not differ among per-capita GDP tertiles (<$4100, 14.3% [95% CI, 11.2%-18.0%]; $4100-$5200, 13.8% [95% CI, 11.0%-17.1%]; and >$5200, 15.6% [95% CI, 12.3%-19.5%]; P  = .74 among strata), but it differed according to latitude of the main city (<40°, 15.0% [95% CI, 11.5%-19.4%]; 40°-51°, 11.7% [95% CI, 9.4%-14.5%]; and ≥52°, 17.0% [95% CI, 14.4%-19.9%]; P  = .03 among strata).

The pooled prevalence of severe tinnitus among adults was 2.3% (95% CI, 1.7%-3.1%; 34 studies; I 2  = 99%) ( Figure 2 ). 4 , 7 , 10 - 13 , 16 , 17 , 21 , 25 , 28 - 30 , 32 , 33 , 36 , 37 , 40 , 43 , 44 , 46 , 49 Among all studies, the pooled prevelance ranged from 0.5% (95% CI, 0.3%-0.7%) to 12.6% (95% CI, 11.1%-14.1%). Severity of tinnitus among adults differed with the tinnitus definition classes ( P  < .001 among strata). For those who were asked “Are you bothered by your tinnitus?” (S1), the pooled prevalence of severe tinnitus was 6.4% (95% CI, 4.2%-9.6%; 7 studies; I 2  = 100%); for those who were asked “How much are you bothered by your tinnitus?” (S2), it was 1.3% (95% CI, 1.1%-1.7%; 21 studies; I 2  = 93%); for those who were asked “Does your tinnitus interfere with sleep and concentration?” (S3), the only study identified a prevalence of 3.0% (95% CI, 2.5%-3.6%); for those asked about tinnitus severity assessed on a validated scale (S4), the pooled prevalence was 2.9% (95% CI, 0.9%-9.2%; 3 studies; I 2  = 99%); and for those asked about other tinnitus severity definitions (S5), it was 7.3% (95% CI, 5.4%-9.9%; 2 studies; I 2  = 100%).

The pooled prevalence of severe tinnitus among children and adolescents was 2.7% (95% CI, 0.8%-8.4%; 10 studies; I 2  = 99%) ( Table 2 ). The pooled prevalence of severe tinnitus was 0.4% (95% CI, 0.3%-0.7%; 2 studies; I 2  = 0%) for young adults, 2.7% (95% CI, 1.6%-4.7%; 3 studies; I 2  = 97%) for middle-aged adults, and 6.9% (95% CI, 2.6%-17.4%; 4 studies; I 2  = 99%) for the older adults. The pooled prevalence of severe tinnitus was 2.3% (95% CI, 1.1%-4.6%; 8 studies; I 2  = 100%) for male individuals and 2.7% (95% CI, 1.7%-4.3%; 7 studies; I 2  = 99%) for female individuals ( P  = .66 among strata).

Severity among adults significantly differed by continent, ranging from 0.8% (95% CI, 0.6%-1.0%; 1 study) in Africa to 3.3% (95% CI, 1.2%-8.8%; 4 studies; I 2  = 99%) in North America ( P  < .001 among strata) ( Table 2 ). The prevalence of severe tinnitus did not differ significantly by per capita GDP tertile (1.7% [95% CI, 1.1%-2.7%] for <$4100; 2.7% [95% CI, 1.6%-4.3%] for $4100-$5200; and 3.0% [95% CI, 1.5%-5.9%] for >$5200; P  = .29 among strata) or by latitude (2.6% [95% CI, 1.5%-4.6%] for <40°; 1.9% [95% CI, 1.1%-3.1%] for 40°-51°; and 2.4% [95% CI, 1.4%-4.0%] for ≥52°; P  = .65 among strata). Pooled prevalence estimates of any tinnitus and severe tinnitus per continent are listed in eTable 6 in the Supplement .

Converting our pooled prevalence estimates to absolute numbers, we found that there were 749 million adults (95% CI, 655-858 million adults) worldwide with any tinnitus and 120 million adults (95% CI, 88-177 million adults) with severe tinnitus. Using continent-specific estimates, we found that the resulting numbers would not change substantially (any tinnitus: 746 million people [95% CI, 537-1039 million people]; severe tinnitus: 140 million people [95% CI, 92-237 million people]).

A possible publication bias emerged for the prevalence of any tinnitus and for the prevalence of severe tinnitus ( P  < .001 for the Egger test; eFigure 4 in the Supplement ). For adults, the pooled prevalence of diagnosed tinnitus was 3.4% (95% CI, 2.1%-5.5%; 3 studies; I 2  = 99%), and the pooled prevalence of chronic tinnitus, defined as tinnitus occurring most or all of the time or persisting for months, was 9.8% (95% CI, 4.7%-19.3%; 3 studies; I 2  = 99%).

Of 89 studies, 12 provided information on incidence estimates ( Table 3 ). 14 , 15 , 23 , 46 , 50 - 57 These longitudinal studies came from 7 countries (ie, Australia, Germany, Sweden, Switzerland, Taiwan, UK, and US) and were published from 2002 to 2019. Annual incidence rates ranged substantially from 54 to 3914 per 100 000 person-years. The pooled annual incidence rate of any tinnitus, based on the crude estimate of the 6 studies among adults (with both sexes combined), is 1164 per 100 000 person-years (95% CI, 479-2828 per 100 000 person-years) (eFigure 5 in the Supplement ).

To our knowledge, this systematic review provides the most comprehensive and up-to-date evidence on the prevalence and incidence of tinnitus worldwide among adults and children or adolescents, summarizing estimates from 89 original studies. For the first time, we provide pooled estimates of tinnitus; based on our data, approximately 14% of the world population have experienced tinnitus, and more than 2% have severe tinnitus. The prevalence of tinnitus is similar for both sexes, and increases in prevalence are associated with increasing age. Heterogeneous estimates have been reported by the few studies that provide data on the incidence of tinnitus. The pooled annual incidence rate approaches 1%.

The various cross-sectional studies providing data on the frequency of tinnitus used a wide variety of assessment methods. 3 , 58 , 59 We therefore classified the questions about any tinnitus into 6 groups and about severe tinnitus into 5 groups. Despite the substantial heterogeneity of estimates in the classes of any tinnitus, we did not find statistically significant differences in its prevalence across classes. This finding suggests that, at least for any tinnitus, not all the variability is explained by different definitions, and other factors might explain the prevalence of any tinnitus better at the population level.

Concomitantly, our findings suggest that data on tinnitus among children or adolescents are more prone to different interpretations of the question used to assess tinnitus. One possible reason could be that children are more frequently asked about tinnitus without specifically mentioning the name of the symptom. Other researchers have suggested that children might report the presence of noise to please the interviewers. 60 Despite the increasing number of studies on the subject, tinnitus remains an unrecognized problem that is inadequately assessed in the pediatric population. 61

We found differences in terms of any tinnitus and severe tinnitus in association with age, confirming the increasing prevalence of the symptom with age. 7 , 10 , 11 In particular, whereas the prevalence of any tinnitus among older adults was close to 2.5 times higher than among young adults, the prevalence of severe tinnitus among older adults was almost 20 times higher than among young adults. This finding suggests that tinnitus is a particular disorder of older people. 8

The literature is not unanimous about whether there is any association between sex and tinnitus. McCormack and colleagues 3 generally reported a higher prevalence of any tinnitus among men than women, whereas Biswas and colleagues 12 found a higher prevalence of bothersome tinnitus among women than men. The latter is consistent with previous findings of an association between severe tinnitus and suicidal attempts among women but not among men. 4 In our comprehensive review, pooling findings from a vast scientific literature, we did not find any significant difference according to sex for either any tinnitus or severe tinnitus.

As previously noted, 8 information is scant on the differences in tinnitus prevalence among countries, and we were only partially able to fill the gap. In fact, Africa, Oceania, and South America are not well represented. We found only 2 studies on the prevalence of any tinnitus and 2 studies on the prevalence of severe tinnitus from Africa and South America combined, covering more than 1.7 billion people. This finding may, to some extent, be due to the fact that, by protocol, we did not include articles that were not in English. Pooled estimates for any tinnitus from the other continents were somehow similar—between 13% and 15%—whereas differences were larger for pooled estimates for severe tinnitus—between 1.8% and 3.3%.

In addition to country-specific population characteristics, including lifestyle and dietary habits, 7 mental health conditions, 1 or ethnicity, 13 variations in the prevalence of tinnitus between countries and continents could be explained by different exposures and etiologies. Recently, it has been evidenced by means of genetic epidemiology studies 50 , 62 - 64 and genomic studies 65 , 66 that tinnitus is hereditary. Although common variants have been associated with broad tinnitus definitions, such as “any” tinnitus, it appears that rare variants are more associated with severe tinnitus. 65 , 66 Thus, differences in population genetics could be associated with the large discrepancies in the prevalence of severe tinnitus, as for instance in South America. However, more efforts are needed to investigate the association of genetics with any tinnitus or severe tinnitus across different countries and continents. In a European survey, Biswas et al 12 found that the prevalence of tinnitus was greater in countries from the eastern European region than in western Europe, with Bulgaria reaching a prevalence for any tinnitus of 28.3% and Romania with a prevalence for severe tinnitus peaking at 4.2%. This finding is consistent with a greater prevalence of hearing loss among individuals in these countries, according to the Global Burden of Disease study. 67 It is possible that less active work-related preventive measures against occupational noise exposure or limited access to rehabilitation for hearing loss by means of hearing aids may cause such disparities across Europe. In contrast, the low frequency of acoustic neuromas and head injuries and traumas among individuals with tinnitus is unlikely to explain such variety across countries and continents. 68 - 70 Other risk factors could also underlie such differences in prevalence. However, only a handful of case-control and longitudinal studies have investigated the potential causal relationship to tinnitus, most of which focus on hearing-related conditions. 14 , 15 Thus, a comprehensive picture of the association of nonauditory etiologies with any tinnitus or severe tinnitus is required.

Our results do indicate that differences arise when using multiple definitions to assess tinnitus. For future research, therefore, we recommend using a standardized questionnaire for assessing the prevalence of tinnitus, to make better comparisons between different surveys, identifying more solid estimates of tinnitus in various countries worldwide. We acknowledge, however, that no single question can address the multidimensional properties of tinnitus that are critical for its assessment (duration [acute or chronic], temporality [intermittent or constant], and severity [negligible or impactful]). Thus, our suggestion is to systematically use the questions given by a consortium of experts available in multiple languages. 58

For children specifically, a large difference was clear between questionnaires that mentioned the term tinnitus and those that did not; we conclude that future surveys addressing children and adolescents must state clearly the name of the disorder in their questions—with an explanation—as the high prevalence of tinnitus might be a result of the participants not recognizing the extraordinary nature of the symptom being investigated.

An association has been hypothesized between socioeconomic status and tinnitus. 16 , 54 Although with all the limitations of an ecological analysis, 71 , 72 we found no association between per-capita GDP and tinnitus prevalence.

Tinnitus has been reported to have a seasonal pattern, where it is worse in the winter than in the summer. 73 Thus, the hours of sunlight per day or certain temperatures might be associated with the onset or severity of tinnitus. Countries with their main city at an intermediate latitude (40°-51°) had the lowest prevalence and the lowest severity of tinnitus. Future analytical studies should investigate this issue in more detail.

In this meta-analysis, we defined as eligible only studies based on samples representative of the general population, excluding subgroups of the population exposed to selected risk factors, such as veterans and musicians. In these 2 particular populations, the prevalence of tinnitus was reported with a point estimate of 31% among veterans 74 and 26% among musicians, 75 much higher than among the general adult population. These 2 subpopulations might therefore be targeted for specific interventions to prevent or limit exposure to noise and, consequently, to reduce tinnitus and other hearing conditions.

There is a paucity of articles on the incidence of tinnitus: of 113 eligible articles, only 12 provided data on the incidence of tinnitus, although many cohorts were available with tinnitus assessed at follow-up. The incidence rates differed by up to 2 orders of magnitude in various studies. Although estimates stratified by sex are frequently provided, information is limited on incident cases by age group.

This study has some limitations, including the classification of tinnitus into 6 groups of questions for any tinnitus (A1-A6) and 5 groups for severe tinnitus (S1-S5). Although inspired by the 8 different categories for tinnitus identified by McCormack et al, 3 our classification has not been validated and is therefore subject to the interpretation of the researchers who used it. Moreover, we cannot exclude a possible publication bias regarding the prevalence of both any tinnitus and severe tinnitus.

The strengths of the study include the original method used to identify relevant articles, which involves an umbrella review as well as a traditional review. 9 This method has already been shown to be both effective and efficient in the identification of relevant articles in other recent systematic reviews. 76 - 78 Thus, we were able to include almost twice the number of articles included in the most comprehensive review of the literature published before the present one, 3 including, in our opinion, at least 11 articles that could have been retrieved by McCormack and colleagues 3 but were not in that review. Thus, to our knowledge, this is the most comprehensive review conducted to date because it considers a larger publication period (between 1972 and 2021) and is not limited to adults but also includes children and adolescents.

To our knowledge, this is the first meta-analysis on the frequency of tinnitus. Generalizing our estimates to the whole global population, one can infer that more than 740 million people experience tinnitus and more than 120 million people worldwide have a severe form of tinnitus. Such estimates place tinnitus at an order of magnitude similar to the leading causes of years lived with disability, namely, hearing loss, followed by migraine, low back pain, and neck pain. 67 Health authorities and research institutions, such as the Global Burden of Disease, should consider this prevalence and play a leading role in funding, ultimately to boost research on tinnitus and improve the care and the lives of patients with tinnitus.

Accepted for Publication: June 13, 2022.

Published Online: August 8, 2022. doi:10.1001/jamaneurol.2022.2189

Correction: This article was corrected on November 7, 2022, to update to CC-BY open access status.

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2022 Jarach CM et al. JAMA Neurology .

Corresponding Author: Silvano Gallus, PhD, Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy ( [email protected] ).

Author Contributions: Ms Jarach and Dr Galllus had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Jarach, Lugo, Cederroth, Odone, Garavello, Schlee, Gallus.

Acquisition, analysis, or interpretation of data: Jarach, Scala, van den Brandt, Odone, Schlee, Langguth, Gallus.

Drafting of the manuscript: Jarach, Scala, Schlee, Gallus.

Critical revision of the manuscript for important intellectual content: Jarach, Lugo, van den Brandt, Cederroth, Odone, Garavello, Schlee, Langguth, Gallus.

Statistical analysis: Jarach, Scala.

Obtained funding: Cederroth, Schlee, Gallus.

Supervision: van den Brandt, Odone, Garavello, Schlee, Gallus.

Conflict of Interest Disclosures: Dr Cederroth reported being a member of the British Tinnitus Association’s Professional Advisers’ Committee and the American Tinnitus Association’s Scientific Advisory Board. Dr Schlee reported receiving grants from the European Union’s Horizon 2020 Research and Innovation Programme grant agreement during the conduct of the study. Dr Langguth reported receiving grants from European Union Unification of Treatments and Interventions for Tinnitus Patients during the conduct of the study; receiving personal fees from Neuromod and Schwabe outside the submitted work; and serving as chair of the Tinnitus Research Initiative, a nonprofit organization. No other disclosures were reported.

Funding/Support: The work of Drs Lugo, Langguth, and Gallus and Mr Scala, is partially supported by Unification of Treatments and Interventions for Tinnitus Patients–UNITI project, which has received funding from the European Union's Horizon 2020 Research and Innovation Programme (grant agreement 848261). The work of Ms Jarach and Drs Cederroth and Gallus is partially supported by Tinnitus Genetic and Environmental Risks–TIGER project, which has received funding from the European Union’s Horizon 2020 Research and Innovation Programme (grant agreement GNP-182). The study is also supported by AIT ONLUS Associazione Italiana Tinnitus.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Information: Data and R scripts that support the findings of this study and materials are available from the corresponding author on request.

• Register for email alerts with links to free full-text articles
• Access PDFs of free articles
• Manage your interests
• Save searches and receive search alerts

• Systematic review
• Open access
• Published: 07 August 2024

Models and frameworks for assessing the implementation of clinical practice guidelines: a systematic review

• Nicole Freitas de Mello   ORCID: orcid.org/0000-0002-5228-6691 1 , 2 ,
• Sarah Nascimento Silva   ORCID: orcid.org/0000-0002-1087-9819 3 ,
• Dalila Fernandes Gomes   ORCID: orcid.org/0000-0002-2864-0806 1 , 2 ,
• Juliana da Motta Girardi   ORCID: orcid.org/0000-0002-7547-7722 4 &
• Jorge Otávio Maia Barreto   ORCID: orcid.org/0000-0002-7648-0472 2 , 4  

Implementation Science volume  19 , Article number:  59 ( 2024 ) Cite this article

499 Accesses

6 Altmetric

Metrics details

The implementation of clinical practice guidelines (CPGs) is a cyclical process in which the evaluation stage can facilitate continuous improvement. Implementation science has utilized theoretical approaches, such as models and frameworks, to understand and address this process. This article aims to provide a comprehensive overview of the models and frameworks used to assess the implementation of CPGs.

A systematic review was conducted following the Cochrane methodology, with adaptations to the "selection process" due to the unique nature of this review. The findings were reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Electronic databases were searched from their inception until May 15, 2023. A predetermined strategy and manual searches were conducted to identify relevant documents from health institutions worldwide. Eligible studies presented models and frameworks for assessing the implementation of CPGs. Information on the characteristics of the documents, the context in which the models were used (specific objectives, level of use, type of health service, target group), and the characteristics of each model or framework (name, domain evaluated, and model limitations) were extracted. The domains of the models were analyzed according to the key constructs: strategies, context, outcomes, fidelity, adaptation, sustainability, process, and intervention. A subgroup analysis was performed grouping models and frameworks according to their levels of use (clinical, organizational, and policy) and type of health service (community, ambulatorial, hospital, institutional). The JBI’s critical appraisal tools were utilized by two independent researchers to assess the trustworthiness, relevance, and results of the included studies.

Database searches yielded 14,395 studies, of which 80 full texts were reviewed. Eight studies were included in the data analysis and four methodological guidelines were additionally included from the manual search. The risk of bias in the studies was considered non-critical for the results of this systematic review. A total of ten models/frameworks for assessing the implementation of CPGs were found. The level of use was mainly policy, the most common type of health service was institutional, and the major target group was professionals directly involved in clinical practice. The evaluated domains differed between the models and there were also differences in their conceptualization. All the models addressed the domain "Context", especially at the micro level (8/12), followed by the multilevel (7/12). The domains "Outcome" (9/12), "Intervention" (8/12), "Strategies" (7/12), and "Process" (5/12) were frequently addressed, while "Sustainability" was found only in one study, and "Fidelity/Adaptation" was not observed.

Conclusions

The use of models and frameworks for assessing the implementation of CPGs is still incipient. This systematic review may help stakeholders choose or adapt the most appropriate model or framework to assess CPGs implementation based on their specific health context.

Trial registration

PROSPERO (International Prospective Register of Systematic Reviews) registration number: CRD42022335884. Registered on June 7, 2022.

Peer Review reports

Contributions to the literature

Although the number of theoretical approaches has grown in recent years, there are still important gaps to be explored in the use of models and frameworks to assess the implementation of clinical practice guidelines (CPGs). This systematic review aims to contribute knowledge to overcome these gaps.

Despite the great advances in implementation science, evaluating the implementation of CPGs remains a challenge, and models and frameworks could support improvements in this field.

This study demonstrates that the available models and frameworks do not cover all characteristics and domains necessary for a complete evaluation of CPGs implementation.

The presented findings contribute to the field of implementation science, encouraging debate on choices and adaptations of models and frameworks for implementation research and evaluation.

Substantial investments have been made in clinical research and development in recent decades, increasing the medical knowledge base and the availability of health technologies [ 1 ]. The use of clinical practice guidelines (CPGs) has increased worldwide to guide best health practices and to maximize healthcare investments. A CPG can be defined as "any formal statements systematically developed to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" [ 2 ] and has the potential to improve patient care by promoting interventions of proven benefit and discouraging ineffective interventions. Furthermore, they can promote efficiency in resource allocation and provide support for managers and health professionals in decision-making [ 3 , 4 ].

However, having a quality CPG does not guarantee that the expected health benefits will be obtained. In fact, putting these devices to use still presents a challenge for most health services across distinct levels of government. In addition to the development of guidelines with high methodological rigor, those recommendations need to be available to their users; these recommendations involve the diffusion and dissemination stages, and they need to be used in clinical practice (implemented), which usually requires behavioral changes and appropriate resources and infrastructure. All these stages involve an iterative and complex process called implementation, which is defined as the process of putting new practices within a setting into use [ 5 , 6 ].

Implementation is a cyclical process, and the evaluation is one of its key stages, which allows continuous improvement of CPGs development and implementation strategies. It consists of verifying whether clinical practice is being performed as recommended (process evaluation or formative evaluation) and whether the expected results and impact are being reached (summative evaluation) [ 7 , 8 , 9 ]. Although the importance of the implementation evaluation stage has been recognized, research on how these guidelines are implemented is scarce [ 10 ]. This paper focused on the process of assessing CPGs implementation.

To understand and improve this complex process, implementation science provides a systematic set of principles and methods to integrate research findings and other evidence-based practices into routine practice and improve the quality and effectiveness of health services and care [ 11 ]. The field of implementation science uses theoretical approaches that have varying degrees of specificity based on the current state of knowledge and are structured based on theories, models, and frameworks [ 5 , 12 , 13 ]. A "Model" is defined as "a simplified depiction of a more complex world with relatively precise assumptions about cause and effect", and a "framework" is defined as "a broad set of constructs that organize concepts and data descriptively without specifying causal relationships" [ 9 ]. Although these concepts are distinct, in this paper, their use will be interchangeable, as they are typically like checklists of factors relevant to various aspects of implementation.

There are a variety of theoretical approaches available in implementation science [ 5 , 14 ], which can make choosing the most appropriate challenging [ 5 ]. Some models and frameworks have been categorized as "evaluation models" by providing a structure for evaluating implementation endeavors [ 15 ], even though theoretical approaches from other categories can also be applied for evaluation purposes because they specify concepts and constructs that may be operationalized and measured [ 13 ]. Two frameworks that can specify implementation aspects that should be evaluated as part of intervention studies are RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) [ 16 ] and PRECEDE-PROCEED (Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development) [ 17 ]. Although the number of theoretical approaches has grown in recent years, the use of models and frameworks to evaluate the implementation of guidelines still seems to be a challenge.

This article aims to provide a complete map of the models and frameworks applied to assess the implementation of CPGs. The aim is also to subside debate and choices on models and frameworks for the research and evaluation of the implementation processes of CPGs and thus to facilitate the continued development of the field of implementation as well as to contribute to healthcare policy and practice.

A systematic review was conducted following the Cochrane methodology [ 18 ], with adaptations to the "selection process" due to the unique nature of this review (details can be found in the respective section). The review protocol was registered in PROSPERO (registration number: CRD42022335884) on June 7, 2022. This report adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 19 ] and a completed checklist is provided in Additional File 1.

Eligibility criteria

The SDMO approach (Types of Studies, Types of Data, Types of Methods, Outcomes) [ 20 ] was utilized in this systematic review, outlined as follows:

Types of studies

All types of studies were considered for inclusion, as the assessment of CPG implementation can benefit from a diverse range of study designs, including randomized clinical trials/experimental studies, scale/tool development, systematic reviews, opinion pieces, qualitative studies, peer-reviewed articles, books, reports, and unpublished theses.

Studies were categorized based on their methodological designs, which guided the synthesis, risk of bias assessment, and presentation of results.

Study protocols and conference abstracts were excluded due to insufficient information for this review.

Types of data

Studies that evaluated the implementation of CPGs either independently or as part of a multifaceted intervention.

Guidelines for evaluating CPG implementation.

Inclusion of CPGs related to any context, clinical area, intervention, and patient characteristics.

No restrictions were placed on publication date or language.

Exclusion criteria

General guidelines were excluded, as this review focused on 'models for evaluating clinical practice guidelines implementation' rather than the guidelines themselves.

Studies that focused solely on implementation determinants as barriers and enablers were excluded, as this review aimed to explore comprehensive models/frameworks.

Studies evaluating programs and policies were excluded.

Studies that only assessed implementation strategies (isolated actions) rather than the implementation process itself were excluded.

Studies that focused solely on the impact or results of implementation (summative evaluation) were excluded.

Types of methods

Not applicable.

All potential models or frameworks for assessing the implementation of CPG (evaluation models/frameworks), as well as their characteristics: name; specific objectives; levels of use (clinical, organizational, and policy); health system (public, private, or both); type of health service (community, ambulatorial, hospital, institutional, homecare); domains or outcomes evaluated; type of recommendation evaluated; context; limitations of the model.

Model was defined as "a deliberated simplification of a phenomenon on a specific aspect" [ 21 ].

Framework was defined as "structure, overview outline, system, or plan consisting of various descriptive categories" [ 21 ].

Models or frameworks used solely for the CPG development, dissemination, or implementation phase.

Models/frameworks used solely for assessment processes other than implementation, such as for the development or dissemination phase.

Data sources and literature search

The systematic search was conducted on July 31, 2022 (and updated on May 15, 2023) in the following electronic databases: MEDLINE/PubMed, Centre for Reviews and Dissemination (CRD), the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Epistemonikos, Global Health, Health Systems Evidence, PDQ-Evidence, PsycINFO, Rx for Change (Canadian Agency for Drugs and Technologies in Health, CADTH), Scopus, Web of Science and Virtual Health Library (VHL). The Google Scholar database was used for the manual selection of studies (first 10 pages).

Additionally, hand searches were performed on the lists of references included in the systematic reviews and citations of the included studies, as well as on the websites of institutions working on CPGs development and implementation: Guidelines International Networks (GIN), National Institute for Health and Care Excellence (NICE; United Kingdom), World Health Organization (WHO), Centers for Disease Control and Prevention (CDC; USA), Institute of Medicine (IOM; USA), Australian Department of Health and Aged Care (ADH), Healthcare Improvement Scotland (SIGN), National Health and Medical Research Council (NHMRC; Australia), Queensland Health, The Joanna Briggs Institute (JBI), Ministry of Health and Social Policy of Spain, Ministry of Health of Brazil and Capes Theses and Dissertations Catalog.

The search strategy combined terms related to "clinical practice guidelines" (practice guidelines, practice guidelines as topic, clinical protocols), "implementation", "assessment" (assessment, evaluation), and "models, framework". The free term "monitoring" was not used because it was regularly related to clinical monitoring and not to implementation monitoring. The search strategies adapted for the electronic databases are presented in an additional file (see Additional file 2).

Study selection process

The results of the literature search from scientific databases, excluding the CRD database, were imported into Mendeley Reference Management software to remove duplicates. They were then transferred to the Rayyan platform ( https://rayyan.qcri.org ) [ 22 ] for the screening process. Initially, studies related to the "assessment of implementation of the CPG" were selected. The titles were first screened independently by two pairs of reviewers (first selection: four reviewers, NM, JB, SS, and JG; update: a pair of reviewers, NM and DG). The title screening was broad, including all potentially relevant studies on CPG and the implementation process. Following that, the abstracts were independently screened by the same group of reviewers. The abstract screening was more focused, specifically selecting studies that addressed CPG and the evaluation of the implementation process. In the next step, full-text articles were reviewed independently by a pair of reviewers (NM, DG) to identify those that explicitly presented "models" or "frameworks" for assessing the implementation of the CPG. Disagreements regarding the eligibility of studies were resolved through discussion and consensus, and by a third reviewer (JB) when necessary. One reviewer (NM) conducted manual searches, and the inclusion of documents was discussed with the other reviewers.

Risk of bias assessment of studies

The selected studies were independently classified and evaluated according to their methodological designs by two investigators (NM and JG). This review employed JBI’s critical appraisal tools to assess the trustworthiness, relevance and results of the included studies [ 23 ] and these tools are presented in additional files (see Additional file 3 and Additional file 4). Disagreements were resolved by consensus or consultation with the other reviewers. Methodological guidelines and noncomparative and before–after studies were not evaluated because JBI does not have specific tools for assessing these types of documents. Although the studies were assessed for quality, they were not excluded on this basis.

Data extraction

The data was independently extracted by two reviewers (NM, DG) using a Microsoft Excel spreadsheet. Discrepancies were discussed and resolved by consensus. The following information was extracted:

Document characteristics : author; year of publication; title; study design; instrument of evaluation; country; guideline context;

Usage context of the models : specific objectives; level of use (clinical, organizational, and policy); type of health service (community, ambulatorial, hospital, institutional); target group (guideline developers, clinicians; health professionals; health-policy decision-makers; health-care organizations; service managers);

Model and framework characteristics : name, domain evaluated, and model limitations.

The set of information to be extracted, shown in the systematic review protocol, was adjusted to improve the organization of the analysis.

The "level of use" refers to the scope of the model used. "Clinical" was considered when the evaluation focused on individual practices, "organizational" when practices were within a health service institution, and "policy" when the evaluation was more systemic and covered different health services or institutions.

The "type of health service" indicated the category of health service where the model/framework was used (or can be used) to assess the implementation of the CPG, related to the complexity of healthcare. "Community" is related to primary health care; "ambulatorial" is related to secondary health care; "hospital" is related to tertiary health care; and "institutional" represented models/frameworks not specific to a particular type of health service.

The "target group" included stakeholders related to the use of the model/framework for evaluating the implementation of the CPG, such as clinicians, health professionals, guideline developers, health policy-makers, health organizations, and service managers.

The category "health system" (public, private, or both) mentioned in the systematic review protocol was not found in the literature obtained and was removed as an extraction variable. Similarly, the variables "type of recommendation evaluated" and "context" were grouped because the same information was included in the "guideline context" section of the study.

Some selected documents presented models or frameworks recognized by the scientific field, including some that were validated. However, some studies adapted the model to this context. Therefore, the domain analysis covered all models or frameworks domains evaluated by (or suggested for evaluation by) the document analyzed.

Data analysis and synthesis

The results were tabulated using narrative synthesis with an aggregative approach, without meta-analysis, aiming to summarize the documents descriptively for the organization, description, interpretation and explanation of the study findings [ 24 , 25 ].

The model/framework domains evaluated in each document were studied according to Nilsen et al.’s constructs: "strategies", "context", "outcomes", "fidelity", "adaptation" and "sustainability". For this study, "strategies" were described as structured and planned initiatives used to enhance the implementation of clinical practice [ 26 ].

The definition of "context" varies in the literature. Despite that, this review considered it as the set of circumstances or factors surrounding a particular implementation effort, such as organizational support, financial resources, social relations and support, leadership, and organizational culture [ 26 , 27 ]. The domain "context" was subdivided according to the level of health care into "micro" (individual perspective), "meso" (organizational perspective), "macro" (systemic perspective), and "multiple" (when there is an issue involving more than one level of health care).

The "outcomes" domain was related to the results of the implementation process (unlike clinical outcomes) and was stratified according to the following constructs: acceptability, appropriateness, feasibility, adoption, cost, and penetration. All these concepts align with the definitions of Proctor et al. (2011), although we decided to separate "fidelity" and "sustainability" as independent domains similar to Nilsen [ 26 , 28 ].

"Fidelity" and "adaptation" were considered the same domain, as they are complementary pieces of the same issue. In this study, implementation fidelity refers to how closely guidelines are followed as intended by their developers or designers. On the other hand, adaptation involves making changes to the content or delivery of a guideline to better fit the needs of a specific context. The "sustainability" domain was defined as evaluations about the continuation or permanence over time of the CPG implementation.

Additionally, the domain "process" was utilized to address issues related to the implementation process itself, rather than focusing solely on the outcomes of the implementation process, as done by Wang et al. [ 14 ]. Furthermore, the "intervention" domain was introduced to distinguish aspects related to the CPG characteristics that can impact its implementation, such as the complexity of the recommendation.

A subgroup analysis was performed with models and frameworks categorized based on their levels of use (clinical, organizational, and policy) and the type of health service (community, ambulatorial, hospital, institutional) associated with the CPG. The goal is to assist stakeholders (politicians, clinicians, researchers, or others) in selecting the most suitable model for evaluating CPG implementation based on their specific health context.

Search results

Database searches yielded 26,011 studies, of which 107 full texts were reviewed. During the full-text review, 99 articles were excluded: 41 studies did not mention a model or framework for assessing the implementation of the CPG, 31 studies evaluated only implementation strategies (isolated actions) rather than the implementation process itself, and 27 articles were not related to the implementation assessment. Therefore, eight studies were included in the data analysis. The updated search did not reveal additional relevant studies. The main reason for study exclusion was that they did not use models or frameworks to assess CPG implementation. Additionally, four methodological guidelines were included from the manual search (Fig.  1 ).

PRISMA diagram. Acronyms: ADH—Australian Department of Health, CINAHL—Cumulative Index to Nursing and Allied Health Literature, CDC—Centers for Disease Control and Prevention, CRD—Centre for Reviews and Dissemination, GIN—Guidelines International Networks, HSE—Health Systems Evidence, IOM—Institute of Medicine, JBI—The Joanna Briggs Institute, MHB—Ministry of Health of Brazil, NICE—National Institute for Health and Care Excellence, NHMRC—National Health and Medical Research Council, MSPS – Ministerio de Sanidad Y Política Social (Spain), SIGN—Scottish Intercollegiate Guidelines Network, VHL – Virtual Health Library, WHO—World Health Organization. Legend: Reason A –The study evaluated only implementation strategies (isolated actions) rather than the implementation process itself. Reason B – The study did not mention a model or framework for assessing the implementation of the intervention. Reason C – The study was not related to the implementation assessment. Adapted from Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71 . For more information, visit:

According to the JBI’s critical appraisal tools, the overall assessment of the studies indicates their acceptance for the systematic review.

The cross-sectional studies lacked clear information regarding "confounding factors" or "strategies to address confounding factors". This was understandable given the nature of the study, where such details are not typically included. However, the reviewers did not find this lack of information to be critical, allowing the studies to be included in the review. The results of this methodological quality assessment can be found in an additional file (see Additional file 5).

In the qualitative studies, there was some ambiguity regarding the questions: "Is there a statement locating the researcher culturally or theoretically?" and "Is the influence of the researcher on the research, and vice versa, addressed?". However, the reviewers decided to include the studies and deemed the methodological quality sufficient for the analysis in this article, based on the other information analyzed. The results of this methodological quality assessment can be found in an additional file (see Additional file 6).

Documents characteristics (Table  1 )

The documents were directed to several continents: Australia/Oceania (4/12) [ 31 , 33 , 36 , 37 ], North America (4/12 [ 30 , 32 , 38 , 39 ], Europe (2/12 [ 29 , 35 ] and Asia (2/12) [ 34 , 40 ]. The types of documents were classified as cross-sectional studies (4/12) [ 29 , 32 , 34 , 38 ], methodological guidelines (4/12) [ 33 , 35 , 36 , 37 ], mixed methods studies (3/12) [ 30 , 31 , 39 ] or noncomparative studies (1/12) [ 40 ]. In terms of the instrument of evaluation, most of the documents used a survey/questionnaire (6/12) [ 29 , 30 , 31 , 32 , 34 , 38 ], while three (3/12) used qualitative instruments (interviews, group discussions) [ 30 , 31 , 39 ], one used a checklist [ 37 ], one used an audit [ 33 ] and three (3/12) did not define a specific instrument to measure [ 35 , 36 , 40 ].

Considering the clinical areas covered, most studies evaluated the implementation of nonspecific (general) clinical areas [ 29 , 33 , 35 , 36 , 37 , 40 ]. However, some studies focused on specific clinical contexts, such as mental health [ 32 , 38 ], oncology [ 39 ], fall prevention [ 31 ], spinal cord injury [ 30 ], and sexually transmitted infections [ 34 ].

Usage context of the models (Table  1 )

Specific objectives.

All the studies highlighted the purpose of guiding the process of evaluating the implementation of CPGs, even if they evaluated CPGs from generic or different clinical areas.

Levels of use

The most common level of use of the models/frameworks identified to assess the implementation of CPGs was policy (6/12) [ 33 , 35 , 36 , 37 , 39 , 40 ]. In this level, the model is used in a systematic way to evaluate all the processes involved in CPGs implementation and is primarily related to methodological guidelines. This was followed by the organizational level of use (5/12) [ 30 , 31 , 32 , 38 , 39 ], where the model is used to evaluate the implementation of CPGs in a specific institution, considering its specific environment. Finally, the clinical level of use (2/12) [ 29 , 34 ] focuses on individual practice and the factors that can influence the implementation of CPGs by professionals.

Type of health service

Institutional services were predominant (5/12) [ 33 , 35 , 36 , 37 , 40 ] and included methodological guidelines and a study of model development and validation. Hospitals were the second most common type of health service (4/12) [ 29 , 30 , 31 , 34 ], followed by ambulatorial (2/12) [ 32 , 34 ] and community health services (1/12) [ 32 ]. Two studies did not specify which type of health service the assessment addressed [ 38 , 39 ].

Target group

The focus of the target group was professionals directly involved in clinical practice (6/12) [ 29 , 31 , 32 , 34 , 38 , 40 ], namely, health professionals and clinicians. Other less related stakeholders included guideline developers (2/12) [ 39 , 40 ], health policy decision makers (1/12) [ 39 ], and healthcare organizations (1/12) [ 39 ]. The target group was not defined in the methodological guidelines, although all the mentioned stakeholders could be related to these documents.

Model and framework characteristics

Models and frameworks for assessing the implementation of cpgs.

The Consolidated Framework for Implementation Research (CFIR) [ 31 , 38 ] and the Promoting Action on Research Implementation in Health Systems (PARiHS) framework [ 29 , 30 ] were the most commonly employed frameworks within the selected documents. The other models mentioned were: Goal commitment and implementation of practice guidelines framework [ 32 ]; Guideline to identify key indicators [ 35 ]; Guideline implementation checklist [ 37 ]; Guideline implementation evaluation tool [ 40 ]; JBI Implementation Framework [ 33 ]; Reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework [ 34 ]; The Guideline Implementability Framework [ 39 ] and an unnamed model [ 36 ].

Domains evaluated

The number of domains evaluated (or suggested for evaluation) by the documents varied between three and five, with the majority focusing on three domains. All the models addressed the domain "context", with a particular emphasis on the micro level of the health care context (8/12) [ 29 , 31 , 34 , 35 , 36 , 37 , 38 , 39 ], followed by the multilevel (7/12) [ 29 , 31 , 32 , 33 , 38 , 39 , 40 ], meso level (4/12) [ 30 , 35 , 39 , 40 ] and macro level (2/12) [ 37 , 39 ]. The "Outcome" domain was evaluated in nine models. Within this domain, the most frequently evaluated subdomain was "adoption" (6/12) [ 29 , 32 , 34 , 35 , 36 , 37 ], followed by "acceptability" (4/12) [ 30 , 32 , 35 , 39 ], "appropriateness" (3/12) [ 32 , 34 , 36 ], "feasibility" (3/12) [ 29 , 32 , 36 ], "cost" (1/12) [ 35 ] and "penetration" (1/12) [ 34 ]. Regarding the other domains, "Intervention" (8/12) [ 29 , 31 , 34 , 35 , 36 , 38 , 39 , 40 ], "Strategies" (7/12) [ 29 , 30 , 33 , 35 , 36 , 37 , 40 ] and "Process" (5/12) [ 29 , 31 , 32 , 33 , 38 ] were frequently addressed in the models, while "Sustainability" (1/12) [ 34 ] was only found in one model, and "Fidelity/Adaptation" was not observed. The domains presented by the models and frameworks and evaluated in the documents are shown in Table  2 .

Limitations of the models

Only two documents mentioned limitations in the use of the model or frameworks. These two studies reported limitations in the use of CFIR: "is complex and cumbersome and requires tailoring of the key variables to the specific context", and "this framework should be supplemented with other important factors and local features to achieve a sound basis for the planning and realization of an ongoing project" [ 31 , 38 ]. Limitations in the use of other models or frameworks are not reported.

Subgroup analysis

Following the subgroup analysis (Table  3 ), five different models/frameworks were utilized at the policy level by institutional health services. These included the Guideline Implementation Evaluation Tool [ 40 ], the NHMRC tool (model name not defined) [ 36 ], the JBI Implementation Framework + GRiP [ 33 ], Guideline to identify key indicators [ 35 ], and the Guideline implementation checklist [ 37 ]. Additionally, the "Guideline Implementability Framework" [ 39 ] was implemented at the policy level without restrictions based on the type of health service. Regarding the organizational level, the models used varied depending on the type of service. The "Goal commitment and implementation of practice guidelines framework" [ 32 ] was applied in community and ambulatory health services, while "PARiHS" [ 29 , 30 ] and "CFIR" [ 31 , 38 ] were utilized in hospitals. In contexts where the type of health service was not defined, "CFIR" [ 31 , 38 ] and "The Guideline Implementability Framework" [ 39 ] were employed. Lastly, at the clinical level, "RE-AIM" [ 34 ] was utilized in ambulatory and hospital services, and PARiHS [ 29 , 30 ] was specifically used in hospital services.

Key findings

This systematic review identified 10 models/ frameworks used to assess the implementation of CPGs in various health system contexts. These documents shared similar objectives in utilizing models and frameworks for assessment. The primary level of use was policy, the most common type of health service was institutional, and the main target group of the documents was professionals directly involved in clinical practice. The models and frameworks presented varied analytical domains, with sometimes divergent concepts used in these domains. This study is innovative in its emphasis on the evaluation stage of CPG implementation and in summarizing aspects and domains aimed at the practical application of these models.

The small number of documents contrasts with studies that present an extensive range of models and frameworks available in implementation science. The findings suggest that the use of models and frameworks to evaluate the implementation of CPGs is still in its early stages. Among the selected documents, there was a predominance of cross-sectional studies and methodological guidelines, which strongly influenced how the implementation evaluation was conducted. This was primarily done through surveys/questionnaires, qualitative methods (interviews, group discussions), and non-specific measurement instruments. Regarding the subject areas evaluated, most studies focused on a general clinical area, while others explored different clinical areas. This suggests that the evaluation of CPG implementation has been carried out in various contexts.

The models were chosen independently of the categories proposed in the literature, with their usage categorized for purposes other than implementation evaluation, as is the case with CFIR and PARiHS. This practice was described by Nilsen et al. who suggested that models and frameworks from other categories can also be applied for evaluation purposes because they specify concepts and constructs that may be operationalized and measured [ 14 , 15 , 42 , 43 ].

The results highlight the increased use of models and frameworks in evaluation processes at the policy level and institutional environments, followed by the organizational level in hospital settings. This finding contradicts a review that reported the policy level as an area that was not as well studied [ 44 ]. The use of different models at the institutional level is also emphasized in the subgroup analysis. This may suggest that the greater the impact (social, financial/economic, and organizational) of implementing CPGs, the greater the interest and need to establish well-defined and robust processes. In this context, the evaluation stage stands out as crucial, and the investment of resources and efforts to structure this stage becomes even more advantageous [ 10 , 45 ]. Two studies (16,7%) evaluated the implementation of CPGs at the individual level (clinical level). These studies stand out for their potential to analyze variations in clinical practice in greater depth.

In contrast to the level of use and type of health service most strongly indicated in the documents, with systemic approaches, the target group most observed was professionals directly involved in clinical practice. This suggests an emphasis on evaluating individual behaviors. This same emphasis is observed in the analysis of the models, in which there is a predominance of evaluating the micro level of the health context and the "adoption" subdomain, in contrast with the sub-use of domains such as "cost" and "process". Cassetti et al. observed the same phenomenon in their review, in which studies evaluating the implementation of CPGs mainly adopted a behavioral change approach to tackle those issues, without considering the influence of wider social determinants of health [ 10 ]. However, the literature widely reiterates that multiple factors impact the implementation of CPGs, and different actions are required to make them effective [ 6 , 46 , 47 ]. As a result, there is enormous potential for the development and adaptation of models and frameworks aimed at more systemic evaluation processes that consider institutional and organizational aspects.

In analyzing the model domains, most models focused on evaluating only some aspects of implementation (three domains). All models evaluated the "context", highlighting its significant influence on implementation [ 9 , 26 ]. Context is an essential effect modifier for providing research evidence to guide decisions on implementation strategies [ 48 ]. Contextualizing a guideline involves integrating research or other evidence into a specific circumstance [ 49 ]. The analysis of this domain was adjusted to include all possible contextual aspects, even if they were initially allocated to other domains. Some contextual aspects presented by the models vary in comprehensiveness, such as the assessment of the "timing and nature of stakeholder engagement" [ 39 ], which includes individual engagement by healthcare professionals and organizational involvement in CPG implementation. While the importance of context is universally recognized, its conceptualization and interpretation differ across studies and models. This divergence is also evident in other domains, consistent with existing literature [ 14 ]. Efforts to address this conceptual divergence in implementation science are ongoing, but further research and development are needed in this field [ 26 ].

The main subdomain evaluated was "adoption" within the outcome domain. This may be attributed to the ease of accessing information on the adoption of the CPG, whether through computerized system records, patient records, or self-reports from healthcare professionals or patients themselves. The "acceptability" subdomain pertains to the perception among implementation stakeholders that a particular CPG is agreeable, palatable or satisfactory. On the other hand, "appropriateness" encompasses the perceived fit, relevance or compatibility of the CPG for a specific practice setting, provider, or consumer, or its perceived fit to address a particular issue or problem [ 26 ]. Both subdomains are subjective and rely on stakeholders' interpretations and perceptions of the issue being analyzed, making them susceptible to reporting biases. Moreover, obtaining this information requires direct consultation with stakeholders, which can be challenging for some evaluation processes, particularly in institutional contexts.

The evaluation of the subdomains "feasibility" (the extent to which a CPG can be successfully used or carried out within a given agency or setting), "cost" (the cost impact of an implementation effort), and "penetration" (the extent to which an intervention or treatment is integrated within a service setting and its subsystems) [ 26 ] was rarely observed in the documents. This may be related to the greater complexity of obtaining information on these aspects, as they involve cross-cutting and multifactorial issues. In other words, it would be difficult to gather this information during evaluations with health practitioners as the target group. This highlights the need for evaluation processes of CPGs implementation involving multiple stakeholders, even if the evaluation is adjusted for each of these groups.

Although the models do not establish the "intervention" domain, we thought it pertinent in this study to delimit the issues that are intrinsic to CPGs, such as methodological quality or clarity in establishing recommendations. These issues were quite common in the models evaluated but were considered in other domains (e.g., in "context"). Studies have reported the importance of evaluating these issues intrinsic to CPGs [ 47 , 50 ] and their influence on the implementation process [ 51 ].

The models explicitly present the "strategies" domain, and its evaluation was usually included in the assessments. This is likely due to the expansion of scientific and practical studies in implementation science that involve theoretical approaches to the development and application of interventions to improve the implementation of evidence-based practices. However, these interventions themselves are not guaranteed to be effective, as reported in a previous review that showed unclear results indicating that the strategies had affected successful implementation [ 52 ]. Furthermore, model domains end up not covering all the complexity surrounding the strategies and their development and implementation process. For example, the ‘Guideline implementation evaluation tool’ evaluates whether guideline developers have designed and provided auxiliary tools to promote the implementation of guidelines [ 40 ], but this does not mean that these tools would work as expected.

The "process" domain was identified in the CFIR [ 31 , 38 ], JBI/GRiP [ 33 ], and PARiHS [ 29 ] frameworks. While it may be included in other domains of analysis, its distinct separation is crucial for defining operational issues when assessing the implementation process, such as determining if and how the use of the mentioned CPG was evaluated [ 3 ]. Despite its presence in multiple models, there is still limited detail in the evaluation guidelines, which makes it difficult to operationalize the concept. Further research is needed to better define the "process" domain and its connections and boundaries with other domains.

The domain of "sustainability" was only observed in the RE-AIM framework, which is categorized as an evaluation framework [ 34 ]. In its acronym, the letter M stands for "maintenance" and corresponds to the assessment of whether the user maintains use, typically longer than 6 months. The presence of this domain highlights the need for continuous evaluation of CPGs implementation in the short, medium, and long term. Although the RE-AIM framework includes this domain, it was not used in the questionnaire developed in the study. One probable reason is that the evaluation of CPGs implementation is still conducted on a one-off basis and not as a continuous improvement process. Considering that changes in clinical practices are inherent over time, evaluating and monitoring changes throughout the duration of the CPG could be an important strategy for ensuring its implementation. This is an emerging field that requires additional investment and research.

The "Fidelity/Adaptation" domain was not observed in the models. These emerging concepts involve the extent to which a CPG is being conducted exactly as planned or whether it is undergoing adjustments and adaptations. Whether or not there is fidelity or adaptation in the implementation of CPGs does not presuppose greater or lesser effectiveness; after all, some adaptations may be necessary to implement general CPGs in specific contexts. The absence of this domain in all the models and frameworks may suggest that they are not relevant aspects for evaluating implementation or that there is a lack of knowledge of these complex concepts. This may suggest difficulty in expressing concepts in specific evaluative questions. However, further studies are warranted to determine the comprehensiveness of these concepts.

It is important to note the customization of the domains of analysis, with some domains presented in the models not being evaluated in the studies, while others were complementarily included. This can be seen in Jeong et al. [ 34 ], where the "intervention" domain in the evaluation with the RE-AIM framework reinforced the aim of theoretical approaches such as guiding the process and not determining norms. Despite this, few limitations were reported for the models, suggesting that the use of models in these studies reflects the application of these models to defined contexts without a deep critical analysis of their domains.

Limitations

This review has several limitations. First, only a few studies and methodological guidelines that explicitly present models and frameworks for assessing the implementation of CPGs have been found. This means that few alternative models could be analyzed and presented in this review. Second, this review adopted multiple analytical categories (e.g., level of use, health service, target group, and domains evaluated), whose terminology has varied enormously in the studies and documents selected, especially for the "domains evaluated" category. This difficulty in harmonizing the taxonomy used in the area has already been reported [ 26 ] and has significant potential to confuse. For this reason, studies and initiatives are needed to align understandings between concepts and, as far as possible, standardize them. Third, in some studies/documents, the information extracted was not clear about the analytical category. This required an in-depth interpretative process of the studies, which was conducted in pairs to avoid inappropriate interpretations.

Implications

This study contributes to the literature and clinical practice management by describing models and frameworks specifically used to assess the implementation of CPGs based on their level of use, type of health service, target group related to the CPG, and the evaluated domains. While there are existing reviews on the theories, frameworks, and models used in implementation science, this review addresses aspects not previously covered in the literature. This valuable information can assist stakeholders (such as politicians, clinicians, researchers, etc.) in selecting or adapting the most appropriate model to assess CPG implementation based on their health context. Furthermore, this study is expected to guide future research on developing or adapting models to assess the implementation of CPGs in various contexts.

The use of models and frameworks to evaluate the implementation remains a challenge. Studies should clearly state the level of model use, the type of health service evaluated, and the target group. The domains evaluated in these models may need adaptation to specific contexts. Nevertheless, utilizing models to assess CPGs implementation is crucial as they can guide a more thorough and systematic evaluation process, aiding in the continuous improvement of CPGs implementation. The findings of this systematic review offer valuable insights for stakeholders in selecting or adjusting models and frameworks for CPGs evaluation, supporting future theoretical advancements and research.

Availability of data and materials

Abbreviations.

Australian Department of Health and Aged Care

Canadian Agency for Drugs and Technologies in Health

Centers for Disease Control and

Consolidated Framework for Implementation Research

Cumulative Index to Nursing and Allied Health Literature

Clinical practice guideline

Centre for Reviews and Dissemination

Guidelines International Networks

Getting Research into Practice

Health Systems Evidence

Institute of Medicine

The Joanna Briggs Institute

Ministry of Health of Brazil

Ministerio de Sanidad y Política Social

National Health and Medical Research Council

National Institute for Health and Care Excellence

Promoting action on research implementation in health systems framework

Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

International Prospective Register of Systematic Reviews

Reach, effectiveness, adoption, implementation, and maintenance framework

Healthcare Improvement Scotland

United States of America

Virtual Health Library

World Health Organization

Medicine I of. Crossing the Quality Chasm: A New Health System for the 21st Century. 2001. Available from: http://www.nap.edu/catalog/10027 . Cited 2022 Sep 29.

Field MJ, Lohr KN. Clinical Practice Guidelines: Directions for a New Program. Washington DC: National Academy Press. 1990. Available from: https://www.nap.edu/read/1626/chapter/8 Cited 2020 Sep 2.

Dawson A, Henriksen B, Cortvriend P. Guideline Implementation in Standardized Office Workflows and Exam Types. J Prim Care Community Heal. 2019;10. Available from: https://pubmed.ncbi.nlm.nih.gov/30900500/ . Cited 2020 Jul 15.

Unverzagt S, Oemler M, Braun K, Klement A. Strategies for guideline implementation in primary care focusing on patients with cardiovascular disease: a systematic review. Fam Pract. 2014;31(3):247–66. Available from: https://academic.oup.com/fampra/article/31/3/247/608680 . Cited 2020 Nov 5.

Article   PubMed   Google Scholar  

Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10(1):1–13. Available from: https://implementationscience.biomedcentral.com/articles/10.1186/s13012-015-0242-0 . Cited 2022 May 1.

Article   Google Scholar  

Mangana F, Massaquoi LD, Moudachirou R, Harrison R, Kaluangila T, Mucinya G, et al. Impact of the implementation of new guidelines on the management of patients with HIV infection at an advanced HIV clinic in Kinshasa, Democratic Republic of Congo (DRC). BMC Infect Dis. 2020;20(1):N.PAG-N.PAG. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=146325052&amp .

Browman GP, Levine MN, Mohide EA, Hayward RSA, Pritchard KI, Gafni A, et al. The practice guidelines development cycle: a conceptual tool for practice guidelines development and implementation. 2016;13(2):502–12. https://doi.org/10.1200/JCO.1995.13.2.502 .

Killeen SL, Donnellan N, O’Reilly SL, Hanson MA, Rosser ML, Medina VP, et al. Using FIGO Nutrition Checklist counselling in pregnancy: A review to support healthcare professionals. Int J Gynecol Obstet. 2023;160(S1):10–21. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85146194829&doi=10.1002%2Fijgo.14539&partnerID=40&md5=d0f14e1f6d77d53e719986e6f434498f .

Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015;3(1):1–12. Available from: https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-015-0089-9 . Cited 2020 Nov 5.

Cassetti V, M VLR, Pola-Garcia M, AM G, J JPC, L APDT, et al. An integrative review of the implementation of public health guidelines. Prev Med reports. 2022;29:101867. Available from: http://www.epistemonikos.org/documents/7ad499d8f0eecb964fc1e2c86b11450cbe792a39 .

Eccles MP, Mittman BS. Welcome to implementation science. Implementation Science BioMed Central. 2006. Available from: https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-1-1 .

Damschroder LJ. Clarity out of chaos: Use of theory in implementation research. Psychiatry Res. 2020;1(283):112461.

Handley MA, Gorukanti A, Cattamanchi A. Strategies for implementing implementation science: a methodological overview. Emerg Med J. 2016;33(9):660–4. Available from: https://pubmed.ncbi.nlm.nih.gov/26893401/ . Cited 2022 Mar 7.

Wang Y, Wong ELY, Nilsen P, Chung VC ho, Tian Y, Yeoh EK. A scoping review of implementation science theories, models, and frameworks — an appraisal of purpose, characteristics, usability, applicability, and testability. Implement Sci. 2023;18(1):1–15. Available from: https://implementationscience.biomedcentral.com/articles/10.1186/s13012-023-01296-x . Cited 2024 Jan 22.

Moullin JC, Dickson KS, Stadnick NA, Albers B, Nilsen P, Broder-Fingert S, et al. Ten recommendations for using implementation frameworks in research and practice. Implement Sci Commun. 2020;1(1):1–12. Available from: https://implementationsciencecomms.biomedcentral.com/articles/10.1186/s43058-020-00023-7 . Cited 2022 May 20.

Glasgow RE, Vogt TM, Boles SM. *Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322. Available from: /pmc/articles/PMC1508772/?report=abstract. Cited 2022 May 22.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Asada Y, Lin S, Siegel L, Kong A. Facilitators and Barriers to Implementation and Sustainability of Nutrition and Physical Activity Interventions in Early Childcare Settings: a Systematic Review. Prev Sci. 2023;24(1):64–83. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85139519721&doi=10.1007%2Fs11121-022-01436-7&partnerID=40&md5=b3c395fdd2b8235182eee518542ebf2b .

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions. version 6. Cochrane; 2022. Available from: https://training.cochrane.org/handbook. Cited 2022 May 23.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372. Available from: https://www.bmj.com/content/372/bmj.n71 . Cited 2021 Nov 18.

M C, AD O, E P, JP H, S G. Appendix A: Guide to the contents of a Cochrane Methodology protocol and review. Higgins JP, Green S, eds Cochrane Handb Syst Rev Interv. 2011;Version 5.

Kislov R, Pope C, Martin GP, Wilson PM. Harnessing the power of theorising in implementation science. Implement Sci. 2019;14(1):1–8. Available from: https://implementationscience.biomedcentral.com/articles/10.1186/s13012-019-0957-4 . Cited 2024 Jan 22.

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):1–10. Available from: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-016-0384-4 . Cited 2022 May 20.

JBI. JBI’s Tools Assess Trust, Relevance & Results of Published Papers: Enhancing Evidence Synthesis. Available from: https://jbi.global/critical-appraisal-tools . Cited 2023 Jun 13.

Drisko JW. Qualitative research synthesis: An appreciative and critical introduction. Qual Soc Work. 2020;19(4):736–53.

Pope C, Mays N, Popay J. Synthesising qualitative and quantitative health evidence: A guide to methods. 2007. Available from: https://books.google.com.br/books?hl=pt-PT&lr=&id=L3fbE6oio8kC&oi=fnd&pg=PR6&dq=synthesizing+qualitative+and+quantitative+health+evidence&ots=sfELNUoZGq&sig=bQt5wt7sPKkf7hwKUvxq2Ek-p2Q#v=onepage&q=synthesizing=qualitative=and=quantitative=health=evidence& . Cited 2022 May 22.

Nilsen P, Birken SA, Edward Elgar Publishing. Handbook on implementation science. 542. Available from: https://www.e-elgar.com/shop/gbp/handbook-on-implementation-science-9781788975988.html . Cited 2023 Apr 15.

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):1–15. Available from: https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-4-50 . Cited 2023 Jun 13.

Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65–76. Available from: https://pubmed.ncbi.nlm.nih.gov/20957426/ . Cited 2023 Jun 11.

Bahtsevani C, Willman A, Khalaf A, Östman M, Ostman M. Developing an instrument for evaluating implementation of clinical practice guidelines: a test-retest study. J Eval Clin Pract. 2008;14(5):839–46. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=105569473&amp . Cited 2023 Jan 18.

Balbale SN, Hill JN, Guihan M, Hogan TP, Cameron KA, Goldstein B, et al. Evaluating implementation of methicillin-resistant Staphylococcus aureus (MRSA) prevention guidelines in spinal cord injury centers using the PARIHS framework: a mixed methods study. Implement Sci. 2015;10(1):130. Available from: https://pubmed.ncbi.nlm.nih.gov/26353798/ . Cited 2023 Apr 3.

Article   PubMed   PubMed Central   Google Scholar  

Breimaier HE, Heckemann B, Halfens RJGG, Lohrmann C. The Consolidated Framework for Implementation Research (CFIR): a useful theoretical framework for guiding and evaluating a guideline implementation process in a hospital-based nursing practice. BMC Nurs. 2015;14(1):43. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=109221169&amp . Cited 2023 Apr 3.

Chou AF, Vaughn TE, McCoy KD, Doebbeling BN. Implementation of evidence-based practices: Applying a goal commitment framework. Health Care Manage Rev. 2011;36(1):4–17. Available from: https://pubmed.ncbi.nlm.nih.gov/21157225/ . Cited 2023 Apr 30.

Porritt K, McArthur A, Lockwood C, Munn Z. JBI Manual for Evidence Implementation. JBI Handbook for Evidence Implementation. JBI; 2020. Available from: https://jbi-global-wiki.refined.site/space/JHEI . Cited 2023 Apr 3.

Jeong HJJ, Jo HSS, Oh MKK, Oh HWW. Applying the RE-AIM Framework to Evaluate the Dissemination and Implementation of Clinical Practice Guidelines for Sexually Transmitted Infections. J Korean Med Sci. 2015;30(7):847–52. Available from: https://pubmed.ncbi.nlm.nih.gov/26130944/ . Cited 2023 Apr 3.

GPC G de trabajo sobre implementación de. Implementación de Guías de Práctica Clínica en el Sistema Nacional de Salud. Manual Metodológico. 2009. Available from: https://portal.guiasalud.es/wp-content/uploads/2019/01/manual_implementacion.pdf . Cited 2023 Apr 3.

Australia C of. A guide to the development, implementation and evaluation of clinical practice guidelines. National Health and Medical Research Council; 1998. Available from: https://www.health.qld.gov.au/__data/assets/pdf_file/0029/143696/nhmrc_clinprgde.pdf .

Health Q. Guideline implementation checklist Translating evidence into best clinical practice. 2022.

Google Scholar  

Quittner AL, Abbott J, Hussain S, Ong T, Uluer A, Hempstead S, et al. Integration of mental health screening and treatment into cystic fibrosis clinics: Evaluation of initial implementation in 84 programs across the United States. Pediatr Pulmonol. 2020;55(11):2995–3004. Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L2005630887&from=export . Cited 2023 Apr 3.

Urquhart R, Woodside H, Kendell C, Porter GA. Examining the implementation of clinical practice guidelines for the management of adult cancers: A mixed methods study. J Eval Clin Pract. 2019;25(4):656–63. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=137375535&amp . Cited 2023 Apr 3.

Yinghui J, Zhihui Z, Canran H, Flute Y, Yunyun W, Siyu Y, et al. Development and validation for evaluation of an evaluation tool for guideline implementation. Chinese J Evidence-Based Med. 2022;22(1):111–9. Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L2016924877&from=export .

Breimaier HE, Halfens RJG, Lohrmann C. Effectiveness of multifaceted and tailored strategies to implement a fall-prevention guideline into acute care nursing practice: a before-and-after, mixed-method study using a participatory action research approach. BMC Nurs. 2015;14(1):18. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=103220991&amp .

Lai J, Maher L, Li C, Zhou C, Alelayan H, Fu J, et al. Translation and cross-cultural adaptation of the National Health Service Sustainability Model to the Chinese healthcare context. BMC Nurs. 2023;22(1). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85153237164&doi=10.1186%2Fs12912-023-01293-x&partnerID=40&md5=0857c3163d25ce85e01363fc3a668654 .

Zhao J, Li X, Yan L, Yu Y, Hu J, Li SA, et al. The use of theories, frameworks, or models in knowledge translation studies in healthcare settings in China: a scoping review protocol. Syst Rev. 2021;10(1):13. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792291 .

Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med. 2012;43(3):337–50. Available from: https://pubmed.ncbi.nlm.nih.gov/22898128/ . Cited 2023 Apr 4.

Phulkerd S, Lawrence M, Vandevijvere S, Sacks G, Worsley A, Tangcharoensathien V. A review of methods and tools to assess the implementation of government policies to create healthy food environments for preventing obesity and diet-related non-communicable diseases. Implement Sci. 2016;11(1):1–13. Available from: https://implementationscience.biomedcentral.com/articles/10.1186/s13012-016-0379-5 . Cited 2022 May 1.

Buss PM, Pellegrini FA. A Saúde e seus Determinantes Sociais. PHYSIS Rev Saúde Coletiva. 2007;17(1):77–93.

Pereira VC, Silva SN, Carvalho VKSS, Zanghelini F, Barreto JOMM. Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews. Heal Res Policy Syst. 2022;20(1):13. Available from: https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-022-00815-4 . Cited 2022 Feb 21.

Grimshaw J, Eccles M, Tetroe J. Implementing clinical guidelines: current evidence and future implications. J Contin Educ Health Prof. 2004;24 Suppl 1:S31-7. Available from: https://pubmed.ncbi.nlm.nih.gov/15712775/ . Cited 2021 Nov 9.

Lotfi T, Stevens A, Akl EA, Falavigna M, Kredo T, Mathew JL, et al. Getting trustworthy guidelines into the hands of decision-makers and supporting their consideration of contextual factors for implementation globally: recommendation mapping of COVID-19 guidelines. J Clin Epidemiol. 2021;135:182–6. Available from: https://pubmed.ncbi.nlm.nih.gov/33836255/ . Cited 2024 Jan 25.

Lenzer J. Why we can’t trust clinical guidelines. BMJ. 2013;346(7913). Available from: https://pubmed.ncbi.nlm.nih.gov/23771225/ . Cited 2024 Jan 25.

Molino C de GRC, Ribeiro E, Romano-Lieber NS, Stein AT, de Melo DO. Methodological quality and transparency of clinical practice guidelines for the pharmacological treatment of non-communicable diseases using the AGREE II instrument: A systematic review protocol. Syst Rev. 2017;6(1):1–6. Available from: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-017-0621-5 . Cited 2024 Jan 25.

Albers B, Mildon R, Lyon AR, Shlonsky A. Implementation frameworks in child, youth and family services – Results from a scoping review. Child Youth Serv Rev. 2017;1(81):101–16.

Download references

Acknowledgements

Not applicable

This study is supported by the Fundação de Apoio à Pesquisa do Distrito Federal (FAPDF). FAPDF Award Term (TOA) nº 44/2024—FAPDF/SUCTI/COOBE (SEI/GDF – Process 00193–00000404/2024–22). The content in this article is solely the responsibility of the authors and does not necessarily represent the official views of the FAPDF.

Author information

Authors and affiliations.

Department of Management and Incorporation of Health Technologies, Ministry of Health of Brazil, Brasília, Federal District, 70058-900, Brazil

Nicole Freitas de Mello & Dalila Fernandes Gomes

Postgraduate Program in Public Health, FS, University of Brasília (UnB), Brasília, Federal District, 70910-900, Brazil

Nicole Freitas de Mello, Dalila Fernandes Gomes & Jorge Otávio Maia Barreto

René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, 30190-002, Brazil

Sarah Nascimento Silva

Oswaldo Cruz Foundation - Brasília, Brasília, Federal District, 70904-130, Brazil

Juliana da Motta Girardi & Jorge Otávio Maia Barreto

You can also search for this author in PubMed   Google Scholar

Contributions

NFM and JOMB conceived the idea and the protocol for this study. NFM conducted the literature search. NFM, SNS, JMG and JOMB conducted the data collection with advice and consensus gathering from JOMB. The NFM and JMG assessed the quality of the studies. NFM and DFG conducted the data extraction. NFM performed the analysis and synthesis of the results with advice and consensus gathering from JOMB. NFM drafted the manuscript. JOMB critically revised the first version of the manuscript. All the authors revised and approved the submitted version.

Corresponding author

Correspondence to Nicole Freitas de Mello .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

13012_2024_1389_moesm1_esm.docx.

Additional file 1: PRISMA checklist. Description of data: Completed PRISMA checklist used for reporting the results of this systematic review.

Additional file 2: Literature search. Description of data: The search strategies adapted for the electronic databases.

13012_2024_1389_moesm3_esm.doc.

Additional file 3: JBI’s critical appraisal tools for cross-sectional studies. Description of data: JBI’s critical appraisal tools to assess the trustworthiness, relevance, and results of the included studies. This is specific for cross-sectional studies.

13012_2024_1389_MOESM4_ESM.doc

Additional file 4: JBI’s critical appraisal tools for qualitative studies. Description of data: JBI’s critical appraisal tools to assess the trustworthiness, relevance, and results of the included studies. This is specific for qualitative studies.

13012_2024_1389_MOESM5_ESM.doc

Additional file 5: Methodological quality assessment results for cross-sectional studies. Description of data: Methodological quality assessment results for cross-sectional studies using JBI’s critical appraisal tools.

13012_2024_1389_MOESM6_ESM.doc

Additional file 6: Methodological quality assessment results for the qualitative studies. Description of data: Methodological quality assessment results for qualitative studies using JBI’s critical appraisal tools.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ .

Reprints and permissions

About this article

Cite this article.

Freitas de Mello, N., Nascimento Silva, S., Gomes, D.F. et al. Models and frameworks for assessing the implementation of clinical practice guidelines: a systematic review. Implementation Sci 19 , 59 (2024). https://doi.org/10.1186/s13012-024-01389-1

Download citation

Received : 06 February 2024

Accepted : 01 August 2024

Published : 07 August 2024

DOI : https://doi.org/10.1186/s13012-024-01389-1

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Implementation
• Practice guideline
• Evidence-Based Practice
• Implementation science

Implementation Science

ISSN: 1748-5908

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

Information

• Author Services

Initiatives

You are accessing a machine-readable page. In order to be human-readable, please install an RSS reader.

All articles published by MDPI are made immediately available worldwide under an open access license. No special permission is required to reuse all or part of the article published by MDPI, including figures and tables. For articles published under an open access Creative Common CC BY license, any part of the article may be reused without permission provided that the original article is clearly cited. For more information, please refer to https://www.mdpi.com/openaccess .

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive positive feedback from the reviewers.

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

Original Submission Date Received: .

• Active Journals
• Find a Journal
• Proceedings Series
• For Authors
• For Reviewers
• For Editors
• For Librarians
• For Publishers
• For Societies
• For Conference Organizers
• Open Access Policy
• Institutional Open Access Program
• Special Issues Guidelines
• Editorial Process
• Research and Publication Ethics
• Article Processing Charges
• Testimonials
• Preprints.org
• SciProfiles
• Encyclopedia

Article Menu

• Subscribe SciFeed
• Recommended Articles
• Google Scholar
• on Google Scholar
• Table of Contents

Find support for a specific problem in the support section of our website.

Please let us know what you think of our products and services.

Visit our dedicated information section to learn more about MDPI.

JSmol Viewer

An influencing factors analysis of road traffic accidents based on the analytic hierarchy process and the minimum discrimination information principle.

1. Introduction

2. literature review, 2.1. study on road traffic accident influencing factors, 2.1.1. research on human-related factors, 2.1.2. research on vehicle-related factors, 2.1.3. research on road-related factors, 2.1.4. research on environment-related factors, 2.2. influencing factors analysis based on the analytic hierarchy process, 3.1. the subjective data, 3.2. the objective data, 4.1. analytic hierarchy process calculation steps, 4.2. principle of minimum discrimination information, 5. hierarchical model and weight calculation of influencing factors, 5.1. hierarchical model of road traffic accident influencing factors, 5.2. weight calculation of road traffic accident influencing factors, 5.2.1. analytic hierarchy process determines the subjective weight, 5.2.2. data normalization determines the objective weight, 5.2.3. the principle of minimum discrimination information determines the comprehensive weight, 5.2.4. weight, its rank, and weight difference of road traffic accident influencing factors, 6. discussion, 6.1. hierarchical model of influencing factors, 6.2. subjective and objective weight difference, 6.3. causative factors, 6.3.1. first-level causative factors, 6.3.2. second-level causative factors, 6.3.3. third-level causative factors, 7. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

• WHO. Global Health Estimates 2019: Deaths by Cause, Age, Sex, by Country and by Region, 2000–2019 ; WHO: Geneva, Switzerland, 2019. [ Google Scholar ]
• WHO. Powered Two-and Three-Wheeler Safety: A Road Safety Manual for Decisionmakers and Practitioners ; WHO: Geneva, Switzerland, 2022. [ Google Scholar ]
• Zhang, H.; Wu, C.; Yan, X.; Qiu, T.Z. The effect of fatigue driving on car following behavior. Transp. Res. Part F 2016 , 43 , 80–89. [ Google Scholar ] [ CrossRef ]
• Chen, Y.; Wang, K.; Lu, J.J. Feature selection for driving style and skill clustering using naturalistic driving data and driving behavior questionnaire. Accid. Anal. Prev. 2023 , 185 , 107022. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Rodwell, D.; Watson-Brown, N.; Bates, L. Perceptions of novice driver education needs; Development of a scale based on the Goals for driver education using young driver and parent samples. Accid. Anal. Prev. 2023 , 191 , 107190. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Verhaegen, P. Liability of older drivers in collisions. Ergonomics 1995 , 38 , 499–507. [ Google Scholar ] [ CrossRef ]
• Pitta, L.S.R.; Quintas, J.L.; Trindade, I.O.A.; Belchior, P.; da Silva Duarte Gameiro, K.; Gomes, C.M.; Nóbrega, O.T.; Camargos, E.F. Older drivers are at increased risk of fatal crash involvement: Results of a systematic review and meta-analysis. Arch. Gerontol. Geriatr. 2021 , 95 , 104414. [ Google Scholar ] [ CrossRef ]
• Yu, Z.; Qu, W.; Ge, Y. Trait anger causes risky driving behavior by influencing executive function and hazard cognition. Accid. Anal. Prev. 2022 , 177 , 106824. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Su, Z.; Woodman, R.; Smyth, J.; Elliott, M. The relationship between aggressive driving and driver performance: A systematic review with meta-analysis. Accid. Anal. Prev. 2023 , 183 , 106972. [ Google Scholar ] [ CrossRef ]
• Abdel-Aty, M.A.; Abdelwahab, H.T. Exploring the relationship between alcohol and the driver characteristics in motor vehicle accidents. Accid. Anal. Prev. 2000 , 32 , 473–482. [ Google Scholar ] [ CrossRef ]
• Escamilla, C.; Bele, M.A.; Picó, A.; Rojo, J.M.; Mateu-Moll, J. A psychological profile of drivers convicted of driving under the influence of alcohol. Transp. Res. Part F 2023 , 95 , 380–390. [ Google Scholar ] [ CrossRef ]
• Strohl, K.P.; Blatt, J.; Council, F.; Georges, K.; Kiley, J.; Kurrus, R.; MacCartt, A.T.; Merritt, S.L.; Pack, A.I.; Rogus, S.; et al. Drowsy Driving and Automobile Crashes: Reports and Recommendations ; DOT HS 1998, 808 707, III-30; National Center on Sleep Disorders Research & National Highway Traffic Safety Administration: Washington, DC, USA, 1998. [ Google Scholar ]
• Watling, C.N.; Home, M. Hazard perception performance and visual scanning behaviours: The effect of sleepiness. Transp. Res. Part F 2022 , 90 , 243–251. [ Google Scholar ] [ CrossRef ]
• Tefft, B.C. Prevalence of motor vehicle crashes involving drowsy drivers, United States, 1999–2008. Accid. Anal. Prev. 2012 , 45 , 180–186. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Shao, Y.; Shi, X.; Zhang, Y.; Zhang, Y.; Xu, Y.; Chen, W.; Ye, Z. Adaptive forward collision warning system for hazmat truck drivers: Considering differential driving behavior and risk levels. Accid. Anal. Prev. 2023 , 191 , 107221. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Palk, G.; Freeman, J.; Kee, A.G.; Steinhardt, D.; Davey, J. The prevalence and characteristics of self-reported dangerous driving behaviours among a young cohort. Transp. Res. Part F 2011 , 14 , 147–154. [ Google Scholar ] [ CrossRef ]
• Zhu, T.; Qin, D.; Jia, W. Examining the associations between urban bus drivers’ rule violations and crash frequency using observational data. Accid. Anal. Prev. 2023 , 187 , 107074. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ospina-Mateus, H.; Quintana Jiménez, L.; López-Valdés, F.J. Analyzing traffic conflicts and the behavior of motorcyclists at unsignalized three-legged and four-legged intersections in Cartagena, Colombia. Accid. Anal. Prev. 2023 , 191 , 107222. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Zhang, F.; Ji, Y.; Lv, H.; Ma, X. Analysis of factors influencing delivery e-bikes’ red-light running behavior: A correlated mixed binary logit approach. Accid. Anal. Prev. 2021 , 152 , 105977. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Oviedo-Trespalacios, O.; Rubie, E.; Haworth, N. Risky business: Comparing the riding behaviours of food delivery and private bicycle riders. Accid. Anal. Prev. 2022 , 177 , 106820. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Wang, X.; Chen, J.; Quddus, M.; Zhou, W.; Shen, M. Influence of familiarity with traffic regulations on delivery riders’ e-bike crashes and helmet use: Two mediator ordered logit models. Accid. Anal. Prev. 2021 , 159 , 106277. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Qian, Q.; Shi, J. Comparison of injury severity between E-bikes-related and other two-wheelers-related accidents: Based on an accident dataset. Accid. Anal. Prev. 2023 , 190 , 107189. [ Google Scholar ] [ CrossRef ]
• Jensen, S.U. Pedestrian safety in Denmark. Transp. Res. Rec. 1999 , 1674 , 61–69. [ Google Scholar ] [ CrossRef ]
• Haleem, K.; Alluri, P.; Gan, A. Analyzing pedestrian crash injury severity at signalized and non-signalized locations. Accid. Anal. Prev. 2015 , 81 , 14–23. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Zeng, Q.; Wang, Q.; Zhang, K.; Wong, S.C.; Xu, P. Analysis of the injury severity of motor vehicle–pedestrian crashes at urban intersections using spatiotemporal logistic regression models. Accid. Anal. Prev. 2023 , 189 , 107119. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Blower, D.; Green, P.; Matteson, A. Condition of trucks and truck crash involvement: Evidence from the large truck crash causation study. Transp. Res. Rec. J. Transp. Res. Board 2010 , 2194 , 21–28. [ Google Scholar ] [ CrossRef ]
• Schoor, O.V.; Niekerk, J.L.; Grobbelaar, B. Mechanical failures as a contributing cause to motor vehicle accidents—South Africa. Accid. Anal. Prev. 2001 , 33 , 713–721. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Solah, M.S.; Hamzah, A.; Ariffin, A.H.; Paiman, N.F.; Hamid, I.A.; Wahab, M.A.F.A.; Jawi, Z.M.; Osman, M.R. Private vehicle roadworthiness in Malaysia from the vehicle inspection perspective article history. J. Soc. Automot. Eng. Malays. 2017 , 1 , 262–271. [ Google Scholar ]
• Haq, M.T.; Ampadu, V.-M.K.; Ksaibati, K. An investigation of brake failure related crashes and injury severity on mountainous roadways in Wyoming. J. Saf. Res. 2023 , 84 , 7–17. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Quimby, A.R. Comparing UK and European drivers on speed and speeding issues: Some results from SARTRE 3 survey. In Behavioural Research in Road Safety: Fifteenth Seminar ; Department for Transport: London, UK, 2005; pp. 49–68. ISBN 1904763618. [ Google Scholar ]
• Varet, F.; Apostolidis, T.; Granié, M.-A. Social value, normative features and gender differences associated with speeding and compliance with speed limits. J. Saf. Res. 2023 , 84 , 182–191. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Hu, W.; Cicchino, J.B. Effects of a rural speed management pilot program in Bishopville, Maryland, on public opinion and vehicle speeds. J. Saf. Res. 2023 , 85 , 278–286. [ Google Scholar ] [ CrossRef ]
• Wang, Y.; Tu, H.; Sze, N.N.; Li, H.; Ruan, X. A novel traffic conflict risk measure considering the effect of vehicle weight. J. Saf. Res. 2022 , 80 , 1–13. [ Google Scholar ] [ CrossRef ]
• Bunn, T.L.; Liford, M.; Turner, M.; Bush, A. Driver injuries in heavy vs. light and medium truck local crashes, 2010–2019. J. Saf. Res. 2022 , 83 , 26–34. [ Google Scholar ] [ CrossRef ]
• Afghari, A.P.; Vos, J.; Farah, H.; Papadimitriou, E. “I did not see that coming”: A latent variable structural equation model for understanding the effect of road predictability on crashes along horizontal curves. Accid. Anal. Prev. 2023 , 187 , 107075. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Elvik, R. International transferability of accident modification functions for horizontal curves. Accid. Anal. Prev. 2013 , 59 , 487–496. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Wen, H.; Ma, Z.; Chen, Z.; Luo, C. Analyzing the impact of curve and slope on multi-vehicle truck crash severity on mountainous freeways. Accid. Anal. Prev. 2023 , 181 , 106951. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ma, Y.; Wang, F.; Chen, S.; Xing, G.; Xie, Z.; Wang, F. A dynamic method to predict driving risk on sharp curves using multi-source data. Accid. Anal. Prev. 2023 , 191 , 107228. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ma, Z.; Lu, X.; Chien, S.I.-J.; Hu, D. Investigating factors influencing pedestrian injury severity at intersections. Traffic Inj. Prev. 2018 , 19 , 159–164. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Das, S.; Dutta, A.; Geedipally, S.R. Applying bayesian data mining to measure the effect of vehicular defects on crash severity. J. Transp. Saf. Secur. 2021 , 13 , 605–621. [ Google Scholar ] [ CrossRef ]
• DiLorenzo, T.; Yu, X. Use of ice detection sensors for improving winter road safety. Accid. Anal. Prev. 2023 , 191 , 107197. [ Google Scholar ] [ CrossRef ]
• Abdel-Aty, M.; Devarasetty, P.C.; Pande, A. Safety evaluation of multilane arterials in Florida. Accid. Anal. Prev. 2009 , 41 , 777–788. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Zhang, Z.; Akinci, B.; Qian, S. Inferring heterogeneous treatment effects of work zones on crashes. Accid. Anal. Prev. 2022 , 177 , 106811. [ Google Scholar ] [ CrossRef ]
• Islam, M.; Hosseini, P.; Jalayer, M. An analysis of single-vehicle truck crashes on rural curved segments accounting for unobserved heterogeneity. J. Saf. Res. 2022 , 80 , 148–159. [ Google Scholar ] [ CrossRef ]
• Uddin, M.; Huynh, N. Injury severity analysis of truck-involved crashes under different weather conditions. Accid. Anal. Prev. 2020 , 141 , 105529. [ Google Scholar ] [ CrossRef ]
• Yasanthi, R.G.N.; Babak Mehran, B.; Alhajyaseen, W.K.M. A reliability-based weather-responsive variable speed limit system to improve the safety of rural highways. Accid. Anal. Prev. 2022 , 177 , 106831. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Abdel-Atya, M.; Al-Ahad, E.; Huang, H.; Choic, K. A study on crashes related to visibility obstruction due to fog and smoke. Accid. Anal. Prev. 2011 , 43 , 1730–1737. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Batouli, G.; Guo, M.; Janson, B.; Marshall, W. Analysis of pedestrian-vehicle crash injury severity factors in Colorado 2006–2016. Accid. Anal. Prev. 2020 , 148 , 105782. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• AlGhamdi, A.S. Experimental evaluation of fog warning system. Accid. Anal. Prev. 2007 , 39 , 1065–1072. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Bee, F. At Least 40 Vehicles Crash in Dense Fog on Highway 198. Available online: http://www.fresnobee.com/news/local/article129797864.html (accessed on 19 July 2017).
• Das, A.; Ali Ghasemzadeh, A.; Ahmed, M.M. Analyzing the effect of fog weather conditions on driver lane-keeping performance using the SHRP2 naturalistic driving study data. J. Saf. Res. 2019 , 68 , 71–80. [ Google Scholar ] [ CrossRef ]
• Saaty, T.L. A scaling method for priorities in hierarchical structures. J. Math. Psychol. 1977 , 15 , 234–281. [ Google Scholar ] [ CrossRef ]
• Huang, Y.; Bian, L. A Bayesian network and analytic hierarchy process based personalized recommendations for tourist attractions over the Internet. Expert Syst. Appl. 2009 , 36 , 933–943. [ Google Scholar ] [ CrossRef ]
• Ma, H.; Li, S.; Chan, C.-S. Analytic Hierarchy Process (AHP)-based assessment of the value of non- World Heritage Tulou: A case study of Pinghe County, Fujian Province. Tour. Manag. Perspect. 2018 , 26 , 67–77. [ Google Scholar ] [ CrossRef ]
• Badea, A.; Prostean, G.; Goncalves, G.; Allaoui, H. Assessing risk factors in collaborative supply chain with the analytic hierarchy process (AHP). Procedia-Soc. Behav. Sci. 2014 , 124 , 114–123. [ Google Scholar ] [ CrossRef ]
• Ignaccolo, M.; Inturri, G.; García-Melón, M.; Giuffrida, N.; Le Pira, M.; Torrisi, V. Combining Analytic Hierarchy Process (AHP) with role-playing games for stakeholder engagement in complex transport decisions. Transp. Res. Procedia 2017 , 27 , 500–507. [ Google Scholar ] [ CrossRef ]
• Ha, J.S.; Seong, P.H. A method for risk-informed safety significance categorization using the analytic hierarchy process and bayesian belief networks. Reliab. Eng. Syst. Saf. 2004 , 83 , 1–15. [ Google Scholar ] [ CrossRef ]
• Abrahamsen, E.B.; Milazzo, M.F.; Selvik, J.T.; Asche, F.; Abrahamsen, H.B. Prioritising investments in safety measures in the chemical industry by using the Analytic Hierarchy Process. Reliab. Eng. Syst. Saf. 2020 , 198 , 106811. [ Google Scholar ] [ CrossRef ]
• Guo, X.; Kapucu, M. Assessing social vulnerability to earthquake disaster using rough analytic hierarchy process method: A case study of Hanzhong City, China. Saf. Sci. 2020 , 125 , 104625. [ Google Scholar ] [ CrossRef ]
• Zhao, D.; Wang, Z.-R.; Song, Z.-Y.; Guo, P.-K.; Cao, X.-Y. Assessment of domino effects in the coal gasification process using Fuzzy Analytic Hierarchy Process and Bayesian Network. Saf. Sci. 2020 , 130 , 104888. [ Google Scholar ] [ CrossRef ]
• Kumar, A.; Sinha, P.K. Human error control in railways. Jordan J. Mech. Ind. Eng. 2008 , 2 , 183–190. [ Google Scholar ]
• Larue, G.S.; Naweed, A.; Rodwell, D. The road user, the pedestrian, and me: Investigating the interactions, errors and escalating risks of users of fully protected level crossings. Saf. Sci. 2018 , 110 , 80–88. [ Google Scholar ] [ CrossRef ]
• Sangiorgio, V.; Mangini, A.M.; Precchiazzi, I. A new index to evaluate the safety performance level of railway transportation systems. Saf. Sci. 2020 , 131 , 104921. [ Google Scholar ] [ CrossRef ]
• Paltrinieri, N.; Landucci, G.; Molag, M.; Bonvicini, S.; Spadoni, G.; Cozzani, V. Risk reduction in road and rail LPG transportation by passive fire protection. J. Hazard Mater. 2009 , 167 , 332–344. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Mearns, K.; Yule, S. The role of national culture in determining safety performance: Challenges for the global oil and gas industry. Saf. Sci. 2009 , 47 , 777–785. [ Google Scholar ] [ CrossRef ]
• Ghaleh, S.; Omidvari, M.; Nassiri, P.; Momeni, M.; Lavasani, S.M.M. Pattern of safety risk assessment in road fleet transportation of hazardous materials (oil materials). Saf. Sci. 2019 , 116 , 1–12. [ Google Scholar ] [ CrossRef ]
• Karahalios, H. The contribution of risk management in ship management: The case of ship collision. Saf. Sci. 2014 , 63 , 104–114. [ Google Scholar ] [ CrossRef ]
• Yoo, K.E.; Choi, Y.C. Analytic hierarchy process approach for identifying relative importance of factors to improve passenger security checks at airports. J. Air Transp. Manag. 2006 , 12 , 135–142. [ Google Scholar ] [ CrossRef ]
• Manca, D.; Brambilla, S. A methodology based on the Analytic Hierarchy Process for the quantitative assessment of emergency preparedness and response in road tunnels. Transp. Policy 2011 , 18 , 657–664. [ Google Scholar ] [ CrossRef ]
• Ahlström, C.; Raimondas Zemblys, R.; Finér, S.; Kircher, K. Alcohol impairs driver attention and prevents compensatory strategies. Accid. Anal. Prev. 2023 , 184 , 107010. [ Google Scholar ] [ CrossRef ]
• Schlueter, D.A.; Austerschmidt, K.L.; Schulz, P.; Beblo, T.; Driessen, M.; Kreisel, S.; Toepper, M. Overestimation of on-road driving performance is associated with reduced driving safety in older drivers. Accid. Anal. Prev. 2023 , 187 , 107086. [ Google Scholar ] [ CrossRef ]
• Hassan, A.; Lee, C.; Cramer, K.; Lafreniere, K. Analysis of driver characteristics, self-reported psychology measures and driving performance measures associated with aggressive driving. Accid. Anal. Prev. 2023 , 188 , 107097. [ Google Scholar ] [ CrossRef ]
• National Bureau of Statistics of China. Available online: https://www.stats.gov.cn/sj/ndsj/2023/indexch.htm (accessed on 13 June 2024).
• Saaty, T.L. How to make a decision: The analytic hierarchy process. Eur. J. Oper. Res. 1990 , 48 , 9–26. [ Google Scholar ] [ CrossRef ]
• Saaty, T.L. Multicriteria Decision Making: The Analytic Hierarchy Process ; McGraw-Hill, RSW Publishing: Pittsburgh, PA, USA, 1980. [ Google Scholar ]
• Chang, L.; Chen, W. Data mining of tree-based models to analyze freeway accident frequency. J. Saf. Res. 2005 , 36 , 365–375. [ Google Scholar ] [ CrossRef ]
• Naik, B.; Tung, L.W.; Zhao, S.; Khattak, A.J. Weather impacts on single-vehicle truck crash injury severity. J. Saf. Res. 2016 , 58 , 57–65. [ Google Scholar ] [ CrossRef ]
• Knapp, K.; Kroeger, D.; Giese, K. Mobility and Safety Impacts of Winter Storm Events in a Freeway Environment ; Center for Transportation Research and Education, Iowa State University: Ames, IA, USA, 2000. [ Google Scholar ]
• Claret, P.L.; del Castillo, J.D.; Moleón, J.J.; Cavanillas, A.B.; Martín, M.G.; Vargas, R.G. Age and sex differences in the risk of causing vehicle collisions in Spain, 1990 to 1999. Accid. Anal. Prev. 2003 , 35 , 261–272. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Md Isa, M.H.; Abu Bakar, S.; Hamzah, A.; Ariffin, A.H.; Mohd Nazri, N.N.; Mohamad Hashim, M.S. Investigating motorcycle turn signal behaviors in mixed- traffic environments. In Recent Trends in Manufacturing and Materials towards Industry 4.0 ; Springer: Singapore, 2021; pp. 711–722. [ Google Scholar ]
• Clarke, D.D.; Ward, P.; Bartle, C.; Truman, W. Killer crashes: Fatal road traffic accidents in the UK. Accid. Anal. Prev. 2010 , 42 , 764–770. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Park, J.; Abdel-Aty, M.; Wang, J.H. Time series trends of the safety effects of pavement resurfacing. Accid. Anal. Prev. 2017 , 101 , 78–86. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Zhai, X.; Huang, H.; Sze, N.N.; Song, Z.; Hon, K.K. Diagnostic analysis of the effects of weather condition on pedestrian crash severity. Accid. Anal. Prev. 2019 , 122 , 318–324. [ Google Scholar ] [ CrossRef ]
• Retting, R.A.; Weinstein, H.B.; Solomon, M.G. Analysis of motor-vehicle crashes at stop signs in four US cities. J. Saf. Res. 2003 , 34 , 485–489. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Xie, X.; Nikitas, A.; Liu, H. A study of fatal pedestrian crashes at rural low-volume road intersections in southwest China. Traffic. Inj. Prev. 2018 , 19 , 298–304. [ Google Scholar ] [ CrossRef ]
• Zhang, Q.; Xu, L.; Yan, Y.; Li, G.; Qiao, D.; Tian, J. Distracted driving behavior in patients with insomnia. Accid. Anal. Prev. 2023 , 183 , 106971. [ Google Scholar ] [ CrossRef ]

Share and Cite

Zeng, Y.; Qiang, Y.; Zhang, N.; Yang, X.; Zhao, Z.; Wang, X. An Influencing Factors Analysis of Road Traffic Accidents Based on the Analytic Hierarchy Process and the Minimum Discrimination Information Principle. Sustainability 2024 , 16 , 6767. https://doi.org/10.3390/su16166767

Zeng Y, Qiang Y, Zhang N, Yang X, Zhao Z, Wang X. An Influencing Factors Analysis of Road Traffic Accidents Based on the Analytic Hierarchy Process and the Minimum Discrimination Information Principle. Sustainability . 2024; 16(16):6767. https://doi.org/10.3390/su16166767

Zeng, Youzhi, Yongkang Qiang, Ning Zhang, Xiaobao Yang, Zhenjun Zhao, and Xiaoqiao Wang. 2024. "An Influencing Factors Analysis of Road Traffic Accidents Based on the Analytic Hierarchy Process and the Minimum Discrimination Information Principle" Sustainability 16, no. 16: 6767. https://doi.org/10.3390/su16166767

Article Metrics

Article access statistics, further information, mdpi initiatives, follow mdpi.

Subscribe to receive issue release notifications and newsletters from MDPI journals

Grab your spot at the free arXiv Accessibility Forum

Help | Advanced Search

Statistics > Applications

Title: difference-in-differences for health policy and practice: a review of modern methods.

Abstract: Difference-in-differences (DiD) is the most popular observational causal inference method in health policy, employed to evaluate the real-world impact of policies and programs. To estimate treatment effects, DiD relies on the "parallel trends assumption", that on average treatment and comparison groups would have had parallel trajectories in the absence of an intervention. Historically, DiD has been considered broadly applicable and straightforward to implement, but recent years have seen rapid advancements in DiD methods. This paper reviews and synthesizes these innovations for medical and health policy researchers. We focus on four topics: (1) assessing the parallel trends assumption in health policy contexts; (2) relaxing the parallel trends assumption when appropriate; (3) employing estimators to account for staggered treatment timing; and (4) conducting robust inference for analyses in which normal-based clustered standard errors are inappropriate. For each, we explain challenges and common pitfalls in traditional DiD and modern methods available to address these issues.

Submission history

Access paper:.

• Other Formats

References & Citations

• Google Scholar
• Semantic Scholar

BibTeX formatted citation

Bibliographic and Citation Tools

Code, data and media associated with this article, recommenders and search tools.

• Institution

arXivLabs: experimental projects with community collaborators

arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website.

Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them.

Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs .

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• Current issue
• For authors
• New editors
• BMJ Journals

You are here

• Volume 57, Issue 18
• Resistance training prescription for muscle strength and hypertrophy in healthy adults: a systematic review and Bayesian network meta-analysis
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• http://orcid.org/0000-0003-3955-3174 Brad S Currier 1 ,
• Jonathan C Mcleod 1 ,
• Laura Banfield 2 ,
• Joseph Beyene 3 ,
• Nicky J Welton 4 ,
• Alysha C D'Souza 1 ,
• Joshua A J Keogh 1 ,
• Lydia Lin 1 ,
• Giulia Coletta 1 ,
• Antony Yang 1 ,
• Lauren Colenso-Semple 1 ,
• Kyle J Lau 1 ,
• Alexandria Verboom 1 ,
• http://orcid.org/0000-0002-1956-4098 Stuart M Phillips 1
• 1 Department of Kinesiology , Faculty of Science, McMaster University , Hamilton , Ontario , Canada
• 2 Health Sciences Library , McMaster University , Hamilton , Ontario , Canada
• 3 Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University , Hamilton , Ontario , Canada
• 4 Population Health Sciences, Bristol Medical School, University of Bristol , Bristol , UK
• Correspondence to Dr Stuart M Phillips, Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada; phillis{at}mcmaster.ca

Objective To determine how distinct combinations of resistance training prescription (RTx) variables (load, sets and frequency) affect muscle strength and hypertrophy.

Data sources MEDLINE, Embase, Emcare, SPORTDiscus, CINAHL, and Web of Science were searched until February 2022.

Eligibility criteria Randomised trials that included healthy adults, compared at least 2 predefined conditions (non-exercise control (CTRL) and 12 RTx, differentiated by load, sets and/or weekly frequency), and reported muscle strength and/or hypertrophy were included.

Analyses Systematic review and Bayesian network meta-analysis methodology was used to compare RTxs and CTRL. Surface under the cumulative ranking curve values were used to rank conditions. Confidence was assessed with threshold analysis.

Results The strength network included 178 studies (n=5097; women=45%). The hypertrophy network included 119 studies (n=3364; women=47%). All RTxs were superior to CTRL for muscle strength and hypertrophy. Higher-load (>80% of single repetition maximum) prescriptions maximised strength gains, and all prescriptions comparably promoted muscle hypertrophy. While the calculated effects of many prescriptions were similar, higher-load, multiset, thrice-weekly training (standardised mean difference (95% credible interval); 1.60 (1.38 to 1.82) vs CTRL) was the highest-ranked RTx for strength, and higher-load, multiset, twice-weekly training (0.66 (0.47 to 0.85) vs CTRL) was the highest-ranked RTx for hypertrophy. Threshold analysis demonstrated these results were extremely robust.

Conclusion All RTx promoted strength and hypertrophy compared with no exercise. The highest-ranked prescriptions for strength involved higher loads, whereas the highest-ranked prescriptions for hypertrophy included multiple sets.

PROSPERO registration number CRD42021259663 and CRD42021258902.

• weight lifting
• muscle, skeletal

Data availability statement

Data are available upon reasonable request.

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/bjsports-2023-106807

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

WHAT IS ALREADY KNOWN ON THIS TOPIC

Resistance training with varying numbers of variables (load, sets, weekly frequency) potently increases muscle strength and mass.

Resistance training prescription involves multiple variables, but the optimal resistance training prescription remains contentious.

Network meta-analysis allows simultaneous comparisons between multiple resistance training prescriptions.

WHAT THIS STUDY ADDS

This network meta-analysis is the largest synthesis of resistance training prescription data from randomised trials.

All resistance training prescriptions are better than no exercise for strength and hypertrophy in healthy adults.

The top-ranked prescriptions for strength were characterised by higher loads and the top-ranked prescriptions for hypertrophy were characterised by multiple sets.

All resistance training prescriptions increased strength and hypertrophy, suggesting that healthy adults can adopt a resistance training prescription of their choice and preference.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

Since all protocols increased strength and hypertrophy, rather than determining an ‘optimal’ protocol, future work could determine minimal ‘doses’ of resistance exercise and practices to promote engagement and adherence in this health-promoting form of exercise

Introduction

Skeletal muscle is critical for numerous functional and metabolic processes essential to good health. Resistance training (RT), muscle contraction against external weight, potently increases muscle strength and mass (hypertrophy), improves physical performance, provides a myriad of metabolic-health benefits and combats chronic disease risk. 1–4 Although endogenous biological and physiological factors are pertinent to maximising RT-induced skeletal muscle adaptations, 5 6 RT programming variables can affect RT adaptations. 7–13 Therefore, a RT prescription (RTx) should be determined appropriately. Each RTx is comprised of a distinct combination of RT variables, and the most-studied RTx variables include the load lifted per repetition, sets per exercise (generally involving a single RT manoeuvre or muscle group) and weekly frequency (the number of RT sessions completed per week).

Guideline developers rely on systematic reviews and meta-analyses for determining recommendations, as these study designs are, in most cases, the most robust forms of evidence. 14 Indeed, various meta-analyses have provided seminal evidence on the univariate impact of load, 15–18 sets 19–22 or frequency 23–27 to improve muscle strength, mass and physical function. However, these univariate analyses limit RT guideline development because individual RT variables are neither mutually exclusive nor prescribed independently; rather, several variables are collectively inherent to any RTx. Comparisons between multivariate RT prescriptions are needed to advance optimal RTx guidelines.

Pairwise meta-analyses are methodologically constrained to only comparing two RTxs. 28 Several RTxs are conceivable, and multiple pairwise meta-analyses are unlikely to yield congruent insights. Network meta-analysis (NMA) expands on pairwise meta-analysis by permitting the simultaneous comparison of multiple treatments. 29 NMA leverages direct and indirect evidence to produce enhanced effect estimates between all treatments, even when some comparisons have never been tested in randomised trials. 30 Additionally, NMA permits the rank-ordering of all included treatments and the incorporation of data from multi-arm trials. 28 Within exercise science, NMA has been used to compare different types of exercise 31–34 ; within RT, NMA has only been used to compare different load doses. 35 Importantly, NMA can compare several multivariate RTxs.

The purpose of this systematic review and NMA was to determine how different RTxs affect muscle strength, hypertrophy and physical function in healthy adults. Specifically, we sought to compare distinct combinations of RTx variables—load, sets and frequency—and non-exercising control groups. For each outcome, we used NMA to integrate data from randomised trials.

Protocol and registration

This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension statement for network meta-analyses (PRISMA-NMA) 36 and Cochrane Handbook for Systematic Reviews of Interventions. 37 The PRISMA-NMA checklist is provided in online supplemental appendix 1 . This review combines NMAs registered in the International Prospective Register of Systematic Reviews ( https://www.crd.york.ac.uk/prospero/ ).

Supplemental material

Eligibility criteria.

The eligibility criteria are detailed in table 1 . Only trials that included healthy adults ≥18 years old, were randomised, compared at least 2 of 13 unique conditions ( box 1 ), and measured muscle strength, size and/or physical function were included. Physical function was subdivided into three domains: mobility, the ability to physically move; balance, the ability to maintain a body position during a task; and gait speed, the time taken to locomote over a given distance. Trials that included athletes, persons with comorbidities or military persons; spanned <6 weeks; involved unsupervised RT (eg, home-based exercise); were reported in a non-English language; or were non-randomised were excluded.

• View inline

Study inclusion and exclusion criteria

Description of predefined conditions

Condition acronym – condition description

CTRL – non-exercise control.

LS1 – lower load, single set/exercise, 1 day/week day/week resistance training.

LS2 – lower load, single set/exercise, 2 days/week days/week resistance training.

LS3 – lower load, single set/exercise, ≥3 days/week resistance training.

LM1 – lower load, multiple sets/exercise, 1 day/week day/week resistance training.

LM2 – lower load, multiple sets/exercise, 2 days/week days/week resistance training.

LM3 – lower load, multiple sets/exercise, ≥3 days/week resistance training.

HS1 – higher load, single set/exercise, 1 day/week day/week resistance training.

HS2 – higher load, single set/exercise, 2 days/week days/week resistance training.

HS3 – higher load, single set/exercise, ≥3 days/week resistance training.

HM1 – higher load, multiple sets/exercise, 1 day/week day/week resistance training.

HM2 – higher load, multiple 2 sets/exercise, 2 days/week days/week resistance training.

HM3 – higher load, multiple sets/exercise, ≥3 days/week resistance training.

Condition coding framework

Arms of included studies were classified as 1 of 12 RTxs or non-exercise control (CTRL). Each RTx was classified based on the load, set and frequency prescription ( box 1 ). RTxs were denoted with a three-character acronym—XY#—where X is load (H, ≥80% one-repetition maximum (1RM); L, <80% 1RM); Y is sets (M, multiset; S, single-set); and # is the weekly frequency (3, ≥3 days/week; 2, 2 days/week; 1, 1 day/week), respectively. For example, HM2 denotes higher-load, multiset, twice-weekly RT within this framework. CTRL was comprised of subjects who received no intervention.

Search strategy

MEDLINE, Embase, Emcare, SPORTDiscus, CINAHL and Web of Science were systematically searched until 7 February 2022. Multiple experts developed the search strategy, which included subject headings and keywords specific to the research question and each database. No language nor study design limits were used in the search strategy. The complete search strategy is provided in online supplemental appendix 2 . Relevant systematic reviews ( online supplemental appendix 3 ) were manually selected, and the references were scrutinised for eligibility.

Study selection and data extraction

All records underwent title/abstract screening by two independent reviewers, with discrepancies resolved by a third reviewer. The full text of potentially eligible reports was then assessed for inclusion by two independent reviewers, with discrepancies resolved by a third reviewer. Reports deemed eligible for inclusion then underwent data extraction.

Data from included studies were extracted independently by pairs of reviewers, with any discrepancies resolved by consensus with a third reviewer (BSC or JCM). Extracted data included study and participant characteristics, RTx details and measurements of muscle strength and/or size ( online supplemental appendix 4 ). Measures of mobility, balance and/or gait speed were extracted when the mean participant age was ≥55 years old. Authors of studies with missing data were contacted twice with a request for the missing data. The systematic review software Covidence (Veritas Health Innovation, Melbourne, Australia. Available at www.covidence.org ) was used for record screening and data extraction.

Mean change from baseline and SD change (SD change ) from baseline were the outcomes of interest and extracted when reported. When unreported, SD was calculated with SEs, CIs, p values or t-statistics, 37 and SD change was imputed from pre-SD and post-SD values with a correlation coefficient of 0.5. 35 RT loads reported as repetition maximum (RM) were converted to a percentage of one-repetition maximum (%1RM) with the equation: %1RM=100−(RM(2.5)). 38 The highest-ranked measurement was extracted, per predetermined hierarchy ( online supplemental appendix 5 ), when multiple measurements were reported for a single outcome (eg, MRI and ultrasonography for muscle size). The longest period that all conditions were unchanged from baseline was analysed when the outcome(s) of interest were measured at multiple time points. 37 Cohorts randomised separately but reported together (eg, young and old 39 ) were analysed independently. Within-group outcomes reported by participant sex were grouped by condition. 37 40

Risk of bias

Reviewers independently evaluated the within-study risk of bias using the Cochrane Risk of Bias V.2.0. tool. 41 Signalling questions and criteria were followed to inform the risk of bias appraisals for the intention-to-treat effect. Articles were assessed in duplicate at the strength and hypertrophy outcome level for bias: (1) arising from the randomisation process, (2) due to deviations from intended interventions, (3) due to missing outcome data, (4) in the measurement of the outcome and (5) in the selection of reported result. Every domain was determined to be of high, moderate (some concerns) or low risk of bias, and studies were subsequently given an overall classification of high, moderate or low risk of bias. Any disagreement was resolved by consensus (BSC and JCM).

Statistical analysis

Standardised mean differences (SMD), adjusted for small-sample size bias, 42 were calculated as the summary statistic because each outcome was measured with various tools. 37 The direction of effect was standardised to analyse mobility, gait speed and balance to ensure consistency of desirable outcomes. 43 When multiple studies compared two conditions, random-effects pairwise meta-analyses were conducted to identify comparison-level heterogeneity, publication bias, outliers and influential cases. 40 44 To account for within-trial correlations in multi-arm trials (≥3 conditions), the SE in the base/reference arm was calculated as the square root of the covariance between calculated effects, 45 assuming a correlation of 0.5 between effect sizes. 46

NMA integrated all direct evidence, with one network constructed for each outcome. NMA models were fitted within a Bayesian framework using Markov chain Monte Carlo methods. 47 Four chains were run with non-informative priors. There were 50 000 iterations per chain; the first 20 000 were discarded as burn-in iterations. Values were collected with a thinning interval of 10. Convergence was evaluated by visual inspection of trace plots 48 and the potential scale reduction factor. Both fixed-effects and random-effects models were fit, and the more parsimonious model was used for analysis. 49 Model fit was assessed with the deviance information criterion (DIC) and posterior mean residual deviance. 49 50 Heterogeneity was assessed by examining the between-study SD (τ) and 95% credible intervals (95% CrI). Global inconsistency was assessed by comparing model fit, DIC and variance parameters between the NMA model and an unrelated mean effects (UME) model. 51 Local inconsistency was assessed with the node-splitting method, 52 and inconsistency was considered to be detected when the Bayesian p value<0.05. Forest plots and league tables were generated to display relative effects. Surface under the cumulative ranking curve values were used to rank-order each condition from top-to-bottom; additionally, the probability of each condition ranking in the top three was calculated as a percentage of the area under the curve. NMA results were presented as posterior SMD and 95% CrI, interpreted as a range in which a parameter lies with a 95% probability. 53

Confidence in recommendations

The robustness of recommendations was assessed with threshold analysis. 47 54 Several factors, including bias and sampling error, can influence NMA results. Threshold analysis determines how much the included evidence could change—for any reason—before treatment recommendations differ and identifies the subsequent treatment recommendation. 55 Identifying the robustness of results with threshold analysis permits guideline developers to have appropriate confidence levels in the reported recommendations.

Sensitivity analysis and network meta-regression

Sensitivity analyses were conducted to explore the impact of outliers, influential cases and sources of network inconsistency on model fit, relative effects and treatment rankings. The first sensitivity analysis excluded studies identified during pairwise meta-analyses and node-splitting, and the second sensitivity analysis excluded node(s) comprised of only one study. Network meta-regression (NMR), assuming independent treatment interactions, 56 was performed to determine if additional factors improved model fit and altered treatment effects. NMR covariates included age, training status, the proportion of females, duration, volitional fatigue, relative weekly volume load, outcome measurement tool, outcome measurement region and publication year. Missing data on covariates were managed through multivariate imputation by chained equations (n imputations=20). 57 NMR is detailed in online supplemental appendix 12 .

All analyses were performed in R V.4.0.4 using the packages: ‘esc’, 58 to calculate SMD; ‘dmetar’, 40 to conduct pairwise meta-analyses and assess comparison-level heterogeneity; ‘multinma’, 47 to conduct NMA, NMR and consistency testing; ‘nmathresh’, 54 to perform thresholding; and ‘mice’, 59 to perform multiple imputation. Figures were created with multinma , 47 metafor 60 ggplot2 , 61 and GraphPad Prism (V.9.1.0 for Windows, GraphPad Software, San Diego, California, USA, www.graphpad.com ). All code was made publicly available (see Data Sharing Statement).

Equity, diversity and inclusion statement

Our author group comprises various disciplines, career stages and genders. Data collection, analysis and reporting methods were not altered based on regional, educational or socioeconomic differences of the community in which the included studies were conducted. The only consistently reported equity, diversity and inclusion-relevant variable on which we have analysed the data is biological sex.

Included studies

The systematic search yielded 16 880 records after duplicates were removed. Following title/abstract screening, 1051 full texts were assessed for inclusion. A total of 192 articles were included in this review ( figure 1 ). Characteristics of included studies are detailed in the online supplemental appendix 6 .

• Download figure
• Open in new tab
• Download powerpoint

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of study selection.

Network geometry

Network geometry for strength is displayed in figure 2A . The strength NMA (178 studies, n=5097) included 13 conditions and 32 direct comparisons. The three largest nodes were CTRL (n=1321), LM3 (n=1133) and LM2 (n=710), and the three smallest nodes were HM1 (n=54), LS1 (n=34), and HS1 (n=13). The most common comparisons were LM3 versus CTRL (51 studies), HM3 versus LM3 (32 studies), HM3 versus CTRL (30 studies) and LM2 versus CTRL (30 studies).

Network geometry for all available studies evaluating strength (A) and hypertrophy (B). Each node represents a unique condition, and the size of each node is proportional to the sample size per condition. Each edge represents direct evidence, and the width of each edge is proportional to the number of studies comparing connected nodes. Resistance training prescriptions are denoted with a three-character acronym—XY#—where X is load (H, ≥80% 1-repetition maximum (1RM); L, <80% 1 RM); Y is sets (M, multiset; S, single-set); and # is the weekly frequency (3, ≥3 days/week; 2, 2 days/week; 1, 1 day/week), respectively. For example, ‘HM2’ denotes higher-load, multiset, twice-weekly training. CTRL, non-exercising control group.

Network geometry for hypertrophy is displayed in figure 2B . The hypertrophy NMA (119 studies, n=3364) included 11 conditions—no studies included HS1 or LS1—and 24 direct comparisons. The three largest nodes were CTRL (n=847), LM3 (n=810) and LM2 (n=548), and the three smallest nodes were HS3 (n=60), HS2 (n=21) and HM1 (n=11). The most common comparisons were LM3 versus CTRL (35 studies), HM3 versus LM3 (22 studies), LM2 versus CTRL (18 studies) and HM3 versus CTRL (17 studies).

Within-study risk of bias was moderate–high for both strength and hypertrophy outcomes. In the strength network, 22%, 67% and 1% of studies had a high, moderate or low risk of bias, respectively. In the hypertrophy network, 18%, 82% and 0% of studies had a high, moderate or low risk of bias, respectively. Study-level risk of bias assessments for both strength and hypertrophy is detailed in online supplemental appendix 7 .

RTxs versus CTRL

The relative effect of each RTx compared with CTRL on muscle strength is displayed in figure 3A . The posterior SMD for all prescriptions ranged from 0.75 to 1.60, with the largest relative effect from HM3 (1.60 (1.38 to 1.82)). Compared with CTRL, the relative effect of LS1 (0.75 (−0.16 to 1.68)) and HS1 (0.79 (−0.88 to 2.45)) were the only comparisons that the 95% CrI crossed zero.

Forest plots displaying network estimates for relative effects of resistance training prescriptions versus non-exercising control for strength (A) and hypertrophy (B). Each resistance training prescription (RTx) is denoted with a three-character acronym—XY#—where X is load (H, ≥80% 1-repetition maximum (1RM); L, <80% 1 RM); Y is sets (M, multiset; S, single-set); and # is the weekly frequency (3, ≥3 days/week; 2, 2 days/week; 1, 1 day/week), respectively. For example, ‘HM2’ denotes higher-load, multiset, twice-weekly training. CTRL, non-exercising control; SMD, standardised mean difference; 95% CrI, 95% credible interval.

The relative effect of each RTx compared with CTRL on muscle hypertrophy is displayed in figure 3B . The posterior SMD for all RTx ranged from 0.10 to 0.66, with the largest relative effect from HM2 (0.66 (0.47 to 0.85)). Compared with CTRL, the relative effect of HS2 (0.10 (-0.57 to 0.80)), HS3 (0.34 (−0.02 to 0.71)) and HM1 (0.40 (−0.35 to 1.17)) were the only comparisons that the 95% CrI crossed zero.

Comparing RTxs

The relative effects from all 133 network comparisons for muscle strength and hypertrophy are displayed in table 2 . For comparisons between RTxs (ie, not CTRL), the 95% CrI excluded zero for 13.6% (9/66) and 2.2% (1/45) of comparisons in the strength and hypertrophy NMA, respectively. For muscle strength, there was a 95% probability that HM2 yields a larger relative effect than LS1, LS2, LS3, LM2 and LM3 and that HM3 yields a larger relative effect than LS2, LS3, LM2 and LM3. There was a 95% probability for muscle hypertrophy that HM2 yields a larger relative effect than LS3.

League table of all relative effects

Ranking conditions

Figure 4 displays the probability that each condition would rank in the top three best interventions for muscle strength and hypertrophy, such that scores closer to 100% indicate a greater chance of ranking in the top three. HM3 (85.5%), HM2 (83.5%) and HM1 (60.5%) were most likely to rank in the top three for muscle strength. HM2 (86.9%), LM1 (48.7%) and LM2 (48.3%) were most likely to rank in the top three for muscle hypertrophy. CTRL was the only condition with a 0% chance for strength and hypertrophy. Posterior rankings and distribution curves for all conditions are reported in the online supplemental appendix 8 .

Probability for each condition ranking in the top three most effective for strength (A) and hypertrophy (B). Scores closer to 100% indicate a greater chance of being ranked in the top three. Resistance training prescriptions are denoted with a three-character acronym—XY#—where X is load (H, ≥80% 1-repetition maximum (1RM); L, <80% 1 RM); Y is sets (M, multiset; S, single-set); and # is the weekly frequency (3, ≥3 days/week; 2, 2 days/week; 1, 1 day/week), respectively. For example, ‘HM2’ denotes higher-load, multiset, twice-weekly training. CTRL, non-exercising control group.

Network inconsistency

Model fit outputs and node-splitting plots are reported in the online supplemental appendix 9 . In the strength network, the UME model (DIC=402.3) was not meaningfully different than the random-effects NMA model (DIC=400.8). Node-splitting was performed on 29 comparisons; the only significant difference was LM1 versus HM1 (p<0.01). In the hypertrophy network, the UME model (DIC=143.1) was meaningfully different than the random-effects NMA model (DIC=137.8). Node-splitting was performed on 22 comparisons; the only significant difference was LS2 versus CTRL (p<0.01).

Threshold analysis

Threshold analysis results for strength and hypertrophy are shown in online supplemental appendix 10 . HM3 was the top-ranked condition for strength; however, 65 comparisons indicated some sensitivity to the level of uncertainty and potential biases in the evidence. The revised top-ranked strength condition was HM2 in 92% (60/65) or HM1 in 8% (5/65) of comparisons. HM2 was the top-ranked condition for hypertrophy, and this finding was robust. Two comparisons indicated some sensitivity to the level of uncertainty and potential biases in the evidence, and HM1 was the revised top-ranked condition in both cases.

Sensitivity analyses

Sensitivity analysis results are displayed in the online supplemental appendix 11 . For both the strength and hypertrophy NMAs, the second sensitivity analysis (discussed herein) most improved model fit. The strength network included 155 studies (n=4397) and 11 conditions (LS1 and HS1 excluded). The relative effects for all RTx versus CTRL were tempered, such that posterior SMDs ranged from 0.77 to 1.49, with the largest relative effect from HM2 (1.49 (1.29 to 1.70)) and smallest from LS3 (0.77 (0.56 to 0.98)). The 95% CrI for each RTx versus CTRL excluded zero. There was a 95% probability that HM2 yields larger relative effects than LS2, LS3, LM1, LM2, LM3 and HS3; that HM3 was superior to LS2, LS3, LM1, LM2 and LM3; and that LM2 was superior to LS3. HM2 (99.9%) and HM3 (95.7%) remained most likely to rank in the top three for muscle strength.

The hypertrophy network included 115 studies (n=3240) and 9 conditions (HS2 and HM1 excluded). The relative effect for each RTx versus CTRL was roughly unchanged, with the largest relative effect from HM2 (0.59 (0.39 to 0.78)) and the smallest from HS3 (0.30 (−0.05 to 0.66)). Between prescriptions, there was a 95% probability that LM2 was superior to LS3. HM2 (82.8%) and LM2 (80.4%) remained most likely to rank in the top three for muscle hypertrophy.

Network meta-regression

Network meta-regression results are displayed in the online supplemental appendix 12 . Model fit was not meaningfully different than the unadjusted model for all covariates, except relative weekly volume load, which worsened model fit. Age, training status, proportion of females, duration, volitional fatigue, relative weekly volume load, outcome measurement tool, outcome measurement region and publication year did not yield any obvious modifying effect on the relative effect for each RTx versus CTRL, and data-sparse nodes reduced estimate precision.

Physical function

Physical function results are reported in the online supplemental appendix 13 . Few studies assessed mobility (25 studies, n=859, age (mean)=68 years), gait speed (15 studies, n=488, 68 years) and balance/flexibility (11 studies, n=323, 68 years). Compared with CTRL, there was a 95% probability that LM2, LM3 and HM3 improved mobility and gait speed, while HM3 was the only condition that improved balance/flexibility ( figure 5 ). No differences were found between RT prescriptions for any physical function outcome.

Forest plots displaying network estimates for relative effects of resistance training prescriptions versus non-exercising control for mobility (A), gait speed (B) and balance/flexibility. Each resistance training prescription (RTx) is denoted with a three-character acronym—XY#—where X is load (H, ≥80% 1-repetition maximum (1RM); L, <80% 1 RM); Y is sets (M, multiset; S, single-set); and # is the weekly frequency (3, ≥3 days/week; 2, 2 days/week; 1, 1 day/week), respectively. For example, ‘HM2’ denotes higher-load, multiset, twice-weekly training. CTRL, non-exercising control; SMD, standardised mean difference; 95% CrI, 95% credible interval.

Twelve distinct RT prescriptions and non-exercising control groups were compared using network meta-analysis to determine their effect on gains in muscle strength, hypertrophy and improvements in physical function in healthy adults. Compared with no exercise, most load, sets and frequency combinations increased muscle strength and hypertrophy, indicating that several RTx resulted in beneficial skeletal muscle adaptations. RT with higher loads characterised the top-ranked strength prescriptions, and RT with multiple sets characterised the top-ranked hypertrophy prescriptions. A diverse range of RT prescriptions improved physical function, but evidence scarcity limited insights. Guideline developers and practitioners may consider these results when forming recommendations and prescribing RT for healthy adults.

Network meta-analysis has previously been used to compare different types of exercise 31–34 and doses of RT load. 35 In the NMA by Lopez et al , 35 23 (n=582) and 24 (n=604) studies were included in the strength and hypertrophy networks, respectively. The present strength (178 studies, n=5097) and hypertrophy (119 studies, n=3364) networks were much larger, and this is likely attributable to Lopez et al 35 excluding studies not including RT to momentary muscular failure and our more comprehensive search strategy (2629 35 vs 16 880 records identified). This NMA, to our knowledge, represents the largest synthesis of RT data from randomised trials.

All loads, sets and frequency combinations increased muscle strength and size compared with CTRL. There was a 95% probability that RT with at least two sets or two sessions per week increased strength ( figure 3A ), and training with at least two sets and two sessions per week resulted in hypertrophy ( figure 3B ). Considering only the lower credible interval limit, each RTx induced at least a moderate (SMD>0.47) and small (SMD>0.16) increase in muscle strength and mass, respectively. Such certainty is not possible for all prescriptions, though, because the 95% CrI crossed zero for two RTx for strength (HS1 and LS1) and three RTx for hypertrophy (HM1, HS2 and HS3), meaning these prescriptions might increase, not change or decrease muscle strength and size. However, we posit that this is unlikely to represent an ineffectiveness of those particular RTx and that imprecise network estimates confound these findings. These strength (HS1 and LS1) and hypertrophy (HM1, HS2 and HS3) nodes included <60 participants and contributed little direct evidence ( figure 2 ). Within each study testing these prescriptions, strength increased significantly compared with CTRL/baseline in all cases and hypertrophy increased from baseline in most cases. Those prescribing RT can be confident that all RTxs increased strength and hypertrophy compared with no exercise.

Network comparisons suggest that most RT prescriptions were comparable for strength and hypertrophy. The 95% CrI contained zero for a striking 91% (101/111) of all between-RTx comparisons ( table 2 ). Nine of the 10 comparisons that did not contain zero were between HM2 or HM3 and a lower-load RTx for strength, suggesting higher-load, multiset programmes caused the largest strength gains. This result remained after sensitivity analyses ( online supplemental appendix 11 ) and aligned with previous meta-analyses that found higher-load RT yields the largest strength gains. 17 18 35 A critical point for practitioners is that lower-load RT prescriptions increase strength compared with no exercise. All RT prescriptions may comparably promote muscle hypertrophy, and the influence of load was less apparent. The lack of importance of load for hypertrophy is supported by other analyses, 16 17 35 62 but performing RT to momentary muscular failure (fatigue) has been posited as a key component for RT-induced hypertrophy with lower loads. 62 Network meta-regression for exercise ‘failure’ (fatigue) did not improve model fit nor substantially alter network estimates, suggesting that lifting to fatigue does not suitably explain the observed hypertrophic response. Our finding in this domain agrees with previous work, 63 suggesting that untrained individuals still achieve large gains in skeletal muscle mass without performing RT to failure. Performing RT to momentary muscular failure may, however, be increasingly important for trained individuals. 13 For both strength and hypertrophy, though, there was a large credible interval surrounding the non-significant effect estimate for many comparisons between RTxs, so a wide range of different effects are possible for these comparisons. The available evidence does not permit definitive, statistically valid conclusions about the equivalency of each RTx, despite most comparisons between RTxs not being statistically significantly different from each other.

Prescriptions for RT with higher loads were more likely to rank in the top three for strength than all lower-load prescriptions, and RT prescriptions with multiple sets per exercise were most likely to rank in the top three for hypertrophy ( figure 4 ). Rankings are sensitive to uncertainties within the network, 28 but posterior ranking credible intervals supported higher-load, multiset programmes being the highest-ranked for strength and multiple sets or multiple sessions being the highest-ranked for hypertrophy. Notably, sets and frequency are major components of RT volume, a key factor for hypertrophy. 21 64–66 The probability of each condition ranking in the top three was calculated because the top-ranked RTx does not necessarily reflect the best intervention for all individuals. 67 Personal preferences, including disliking higher loads or time constraints, including an inability to train more than once weekly, can be observed while still benefiting from RT. In our view, especially given the low participation rates in RT, practitioners should not avoid prescribing, nor should individuals be discouraged from completing non-top-ranked RTx. While all prescriptions increased muscle strength and mass, the top-ranked prescriptions involved higher loads for strength and higher volume for hypertrophy. We do not know how these RTx affect relevant health outcomes. Some data suggest that health benefits exist with low time commitment (30–60 min/week) to RT and greater time commitment with reduced health benefits. 4 68

Ours is the first review to assess confidence in RTx recommendations with threshold analysis. Several factors can influence NMA results, 55 and the robustness of treatment recommendations should be considered when interpreting results. Previous methods to evaluate the confidence of meta-analytical findings do not consider how potentially influencing factors can change treatment recommendations 55 69 70 or are not yet developed for Bayesian NMA. 71 Threshold analysis determines how much the available evidence could change before recommendations differ and identifies a new top-ranked treatment. 54 55 Sixty-five direct comparisons were identified that could potentially impact the recommendation of HM3 as the top-ranked strength treatment; however, the revised treatment recommendation was HM2 in 60 of these cases and HM1 in the other five cases ( online supplemental appendix 10 ), suggesting that performing RT with higher loads and multiple sets/exercise are robust recommendation for optimising RT-induced strength gains. The top-ranked RTx for hypertrophy—HM2—was sensitive to the uncertainty of only two comparisons, and HM1 was the revised recommendation because both comparisons were from the same multi-arm study. 72 Furthermore, 127 of the 161 direct comparisons would need to change by more than four SDs to alter HM2 as the top recommendation for hypertrophy. The optimised recommendations of higher load, multiple-set programmes for strength and HM2 for hypertrophy were extremely robust.

Current guidelines collectively advise healthy adults to complete RT at least twice weekly. 10–12 73 The results herein support these recommendations and should not deter practitioners from promoting existing guidelines to improve strength and hypertrophy, nor do these results contradict the effectiveness of guidelines incorporating additional RTx variables, such as rest intervals and contraction type and velocity. 10 12 However, our results support RT at less than recommended often-cited levels for enhancing strength and hypertrophy. Most individuals do not meet current guidelines, and RTx complexities may impede the adoption of RT. Minimal-dose approaches have been proposed to reduce barriers to RT, 74 and our results strongly support the WHO’s claim, ‘Doing some activity is better than none’. 73 While others attempt to optimise RTx, 75 we propose that, for most adults, regularly engaging in any RTx is more important than training to optimise strength and hypertrophy outcomes. Our analysis found multiple RTx comparable for healthy adults to increase muscle strength and mass. Thus, adults should engage in RT, even if they cannot meet existing recommendations.

Limitations

Risk of bias was frequently introduced by protocol deviations, randomisation procedures and selection of the reported result for both outcomes ( online supplemental appendix 7 ). All three domains were regularly rated “Some concerns” because participants were aware of the intervention, appropriate analyses to estimate the effect of assignment were not performed and randomisation, concealment and prespecified analysis procedures were rarely reported. Double-blinding RT is unfeasible, but the remaining issues are prevalent and reoccurring in RT research. 76 Researchers should preregister analysis plans and report randomisation procedures to reduce bias.

Several limitations require acknowledgement and consideration when interpreting the findings of this review. Well-trained elite athletes/military persons and individuals with chronic disease were excluded, so the results should be translated to these populations with caution and additional insights. 13 77–79 Mobility, gait speed and balance/flexibility findings should also be interpreted with caution due to the limited evidence available, which could be attributed to including only healthy older (>55 year) adults (eg, not frail). The coding framework for RT prescriptions prevented the inclusion of periodized RT programmes overlapping conditions (eg, loads ranging from 60–90% 1RM) from being captured in the network. Initially, our objective was to further divide the load and set prescriptions; however, this yielded sparse, disconnected networks, violating a critical assumption of NMA. 49 The continuous RTx variables investigated herein (load, sets, frequency) were classified categorically, so future work could use dose-response/model-based NMA methods to explore these RTx variables as continuous predictors. 80 81 Several acute RT variables were not factored into the included RT prescriptions (eg, inter-set rest, time under tension, repetition velocity, volitional fatigue, tempo); where possible, NMR was used to explore if these factors improved model fit and altered effects. Results from NMR are correlative, however, and should be interpreted cautiously. 82 Nonetheless, many variables (inter-set rest, tempo, time under tension) were reported too infrequently for inclusion as covariates. Calculating the relative weekly volume load (ie, load × repetitions/set × number of sets × number of exercises × weekly frequency), which should impact results, 21 also required approximations that hindered model fit. The principle of specificity 17 (ie, the similarity between training and testing movement) and approximations of muscle mass (, 83 eg, lean mass) could infringe on transitivity assumptions 37 when integrating results from multiple studies and NMR with the covariates measurement tool and region were imperfect solutions. Including one measurement per outcome for each study may limit the totality of evidence captured by this review, so future methodological work could explore the integration of multiple correlated effect sizes in NMA, as in recent pairwise meta-analyses. 63 84 Increasingly, within-subject models are used due to their increased statistical power. 85 To our knowledge, however, no methods are available to account for the additional correlation when including within-subject and between-subject comparisons in NMA. With consideration for these limitations, guideline developers and practitioners can obtain meaningful insights from this analysis.

This NMA represents the largest synthesis of RTx data from randomised trials. Most RTx increased muscle strength and mass compared with no exercise. Top-ranked prescriptions for muscle strength were characterised by lifting heavier loads, and multiple sets characterised top-ranked prescriptions for muscle hypertrophy. Guideline developers and practitioners should encourage the adoption of RT since all RTx can increase muscle strength and mass in healthy adults. The effects on health outcomes of various RTx remain largely unknown.

Ethics statements

Patient consent for publication.

Not applicable.

Acknowledgments

The authors thank Alicia Wong for assistance with the risk of bias assessments. Components of this review were presented, in abstract form, at Europhysiology 2022, the 2022 Canadian Society for Exercise Physiology and the 2023 American College of Sports Medicine conferences.

• Phillips SM ,
• Lim C , et al
• Mcleod JC ,
• Phillips SM
• Shailendra P ,
• Baldock KL ,
• Li LSK , et al
• Joanisse S ,
• McKendry J , et al
• Currier BS , et al
• Tarpenning KM ,
• Feigenbaum MS ,
• Franklin BA
• Morton RW ,
• Colenso-Semple L ,
• Medicine. A
• American College of Sports Medicine position stand
• American College of
• Fragala MS ,
• Cadore EL ,
• Dorgo S , et al
• Schoenfeld B ,
• Grgic J , et al
• Wackerhage H ,
• Schoenfeld BJ
• Schoenfeld BJ ,
• Ogborn D , et al
• Schoene D ,
• Ralston GW ,
• Kilgore L ,
• Wyatt FB , et al
• LeMura LM ,
• Davies TB , et al
• Kneffel Z ,
• Murlasits Z ,
• Reed J , et al
• Caldwell DM
• Thorlund K ,
• Ioannidis JPA
• Wang T-G , et al
• Danielewicz A , et al
• Sibley KM ,
• Thomas SM ,
• Veroniki AA , et al
• Radaelli R ,
• Taaffe DR , et al
• Salanti G ,
• Caldwell DM , et al
• Higgins JPT
• Sterne JAC ,
• Savović J ,
• Page MJ , et al
• Hedges LV ,
• McKellar SR , et al
• Balduzzi S ,
• Schwarzer G
• Franchini AJ ,
• Ades AE , et al
• Borenstein M
• Phillippo D
• Salcher-Konrad M ,
• Dias S , et al
• Sutton AJ ,
• Spiegelhalter DJ ,
• Carlin BP , et al
• Welton NJ ,
• Sutton AJ , et al
• Hespanhol L ,
• Vallio CS ,
• Costa LM , et al
• Phillippo DM ,
• Welton NJ , et al
• Dias S et al
• Ellington EH ,
• Bastille‐Rousseau G ,
• Austin C , et al
• ↵ Groothuis-Oudshoorn, mice: multivariate imputation by chained equations in R . J Stat Soft 2011 ; 45 : 1 – 67 . doi:10.18637/jss.v045.i03 OpenUrl
• Viechtbauer W
• Vieira JG ,
• Trybulski R , et al
• Orazem J , et al
• Figueiredo VC ,
• de Salles BF ,
• Kassiano W ,
• Costa BDV , et al
• Carvalho L ,
• Junior RM ,
• Barreira J , et al
• Mbuagbaw L ,
• Rochwerg B ,
• Jaeschke R , et al
• Kawakami R ,
• Honda T , et al
• Brignardello-Petersen R ,
• Alexander PE , et al
• Schünemann HJ ,
• Murad MH , et al
• Nikolakopoulou A ,
• Higgins JPT ,
• Papakonstantinou T , et al
• Tavares LD ,
• de Souza EO ,
• Ugrinowitsch C , et al
• Hamilton DL ,
• Duchateau J ,
• Stragier S ,
• Baudry S , et al
• Makaruk H ,
• Starzak M ,
• Płaszewski M , et al
• Peterson MD ,
• Plotnikoff RC
• Pollock ML ,
• Franklin BA ,
• Balady GJ , et al
• Cipriani A ,
• Furukawa TA , et al
• Bennetts M , et al
• Orwoll ES ,
• Peters KE ,
• Hellerstein M , et al
• Tanner-Smith EE ,
• MacInnis MJ ,
• McGlory C ,
• Gibala MJ , et al

Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1

Twitter @brad_currier, @mackinprof

BSC and JCM contributed equally.

Contributors BSC and JCM contributed equally to this paper. BSC, JCM and SMP conceived the review. BSC, JCM and LB designed and executed the systematic search. BSC, JCM, ACD, SMP, JAJK, LL, GC, LC-S, KJL and AV screened articles and extracted data. BSC, JCM, AY and AW completed within-study risk of bias assessments. BSC and JCM conducted the statistical analysis with assistance from JB and NJW. BSC, JCM and SMP drafted the manuscript. All authors critically revised the manuscript. All authors approved the submission of this manuscript. SMP accepts full responsibility for the work and/or the conduct of the study, had access to the data and controlled the decision to publish.

Funding No funding was received for this review. BSC is supported by an Alexander Graham Bell Canada Graduate Scholarship-Doctoral. JCM is supported by an Ontario Graduate Scholarship. NJW was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. ACD and JAJK are supported by a Canadian Graduate Scholarship – Master’s Program offered by the Natural Sciences and Engineering Research Council. SMP is supported by the Canada Research Chairs programme.

Competing interests SMP reports grants or research contracts from the US National Dairy Council, Canadian Institutes for Health Research, Dairy Farmers of Canada, Roquette Freres, Ontario Centre of Innovation, Nestle Health Sciences, Myos, National Science and Engineering Research Council and the US NIH during the conduct of the study; personal fees from Nestle Health Sciences, non-financial support from Enhanced Recovery, outside the submitted work. SMP has patents licensed to Exerkine but reports no financial gains from any patent or related work. The remaining authors report no competing interests.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Linked Articles

• Editorial Just start and keep training! What is the best resistance training prescription for strength and hypertrophy? Pascal Edouard João Pedro Nunes Jérôme Koral Jane S Thornton Joanne L Kemp Thomas Gronwald British Journal of Sports Medicine 2023; 57 1161-1162 Published Online First: 05 Jul 2023. doi: 10.1136/bjsports-2023-107234

Read the full text or download the PDF: