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Top 20 MCQs on literature review with answers

MCQs on literature review : The primary purpose of literature review is to facilitate detailed background of the previous studies to the readers on the topic of research.

In this blog post, we have published 20 MCQs on Literature Review (Literature Review in Research) with answers.

20 Multiple Choice Questions on Literature Review

1. Literature is a 

Written Record

Published Record

Unpublished Record

All of these

2. Which method of literature review involves a non-statistical method to present data having the feature of systematic Method too?

Narrative Method

Systematic Method

Meta-Analysis Method of Literature Review

Meta-Synthesis Method of Literature Review

3. Comparisons of non-statistical variables are performed under which method of literature review?

4. Literature review is not similar to

Annotated Bibliography 

5. APA Style, MLA Style, Chicago Manual, Blue Book, OSCOLA are famously known as

Citation Manuals

Directories

Abbreviation Manuals

6. Literature collected is reviewed and preferably arranged 

Alphabetically

Chronologically

None of these

7. Literature collected for review includes

Primary and Secondary Sources

Secondary and Tertiary Sources

Primary and Tertiary Sources

8. Literature includes

Previous Studies

Scholarly publications

Research Findings

9. No time frame is set to collect literature in which of the following method of compiling reviews?

Traditional Method

10. Which method of the literature review is more reliable for drawing conclusions of each individual researcher for new conceptualizations and interpretations?

11. The main purpose of finalization of research topics and sub-topics is

Collection of Literature

Collection of Questions

Collection of Statistics

Collection of Responses

12. Literature review is basically to bridge the gap between

Newly established facts

Previously established facts

Facts established time to time

Previous to current established facts

13. The last step in writing the literature review is 

Developing a Final Essay

Developing a Coherent Essay

Developing a Collaborated Essay

Developing a Coordinated Essay

14. The primary purpose of literature review is to facilitate detailed background of 

Present Studies

Previous studies

Future Studies

15. Narrative Literature Review method is also known as 

Advanced Method

Scientific Method

16. Which method of literature review starts with formulating research questions?

17. Which method of literature review involves application of clinical approach based on a specific subject.

18. Which literature review involves timeline based collection of literature for review

19. Which method of literature review involves application of statistical approach?

20. Which literature review method involves conclusions in numeric/statistical form?

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• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates, and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

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See an example

Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models, and methods?
• Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

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To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

Scribbr slides are free to use, customize, and distribute for educational purposes.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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Literature Review: What is a literature review?

• What is a literature review?
• Finding the literature
• Guidebooks on the literature review
• Examples of literature reviews

What exactly is a literature review?

A literature review is a summary and critical analysis of the literature on your topic. It is an opportunity for you to identify trends and point out gaps in the literature. Preparing a literature review requires in-depth reading, as well as identification of major methods and failings in the field.

When you undertake a literature review, you first need to identify a research question and then seek to answer this question by searching for and analyzing relevant literature using a systematic approach. This review should then lead you to the development of new insights that are only possible when each piece of relevant information is seen in the context of other information (Aveyard 6). 

Why write a literature review?

Literature reviews are important because they summarize the literature that is available on any one topic. They make sense of a body of research and present an analysis of the available literature so that the reader does not have to access each individual document included in the review (Aveyard  6 ).  In an age when the proliferation of information makes it impossible to know all the literature relevant to a topic or problem,  reviews of existing literature are becoming increasingly important (Moss 209).

In the beginning of a project, a literature review should be undertaken to help you learn more about your topic. It can help you determine if research on the topic is needed and worthwhile, narrow down the topic so you are moving from a general idea to something focused and researchable, and determine the direction for your research so you are building on previous work or filling a gap in the literature ( Leavy  56).

Strategies for writing a literature review

An effective literature review will persuade readers of the need to address a particular question in a particular way. Conversely, without a literature review, the rationale for a study is  frequently less compelling, and the findings are less likely to make an impact on the field. (Mandra sec. 7.2)

• Why is your question important?  Justify it.
• What have others said about this topic?  Organize their work thematically.
• How will you build on or extend previously existing research?  Evaluate & critique it.

Ask yourself these questions in order to evaluate the literature: what are the advantages, limitations, and challenges of pursuing one research method over another?  ​In your literature  review, you can c ategorize  and  class ify  the literature. Summarize the overall theme. What connections exist between the various works? Do you agree with their methods and/or findings? Do they all agree with each other, or is there some disagreement? Where does your project fit and why is it important?

Additionally, try to locate recent research on your  topic so that your review is up to date. A good literature review will also consider landmark studies on the topic, whic h is to say that it may be written by a foundational author who is well known for their work on the topic. Once you've identified one or more seminal authors, see if they have any theories about the topic that can help you frame your approach ( Leavy  57).

Aveyard, Helen. Doing a Literature Review in Health and Social Care: A Practical Guide . 2nd ed. Maidenhead: McGraw-Hill/Open UP, 2010.

Mandra, Meghan McGlinn, and Cheryl Mason Bolick. The Wiley Handbook of Social Studies Research . Chichester, [England]: Wiley Blackwell, 2017.

Leavy, Patricia. Research Design: Quantitative, Qualitative, Mixed-Methods, Arts-Based, and Community-Based Participatory Research Approaches . New York: The Gulford Press, 2017.

Moss, Pamela A., and Edward H. Haertel. “Engaging Methodological Pluralism.” Handbook of Research on Teaching , edited by Drew H. Gitomer and Courtney A. Bell, 5th Edition ed. Washington, DC: American Educational Research Association, 2016. 127–248.

• Next: Finding the literature >>
• Last Updated: Nov 7, 2022 8:32 AM
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Article Contents

Introduction, main educational benefits, conclusions, acknowledgements, ethics statements, educational benefits of writing multiple-choice questions (mcqs) with evidence-based explanation.

• Article contents
• Figures & tables
• Supplementary Data

Faiz Tuma, Educational benefits of writing multiple-choice questions (MCQs) with evidence-based explanation, Postgraduate Medical Journal , Volume 98, Issue 1156, February 2022, Pages 77–78, https://doi.org/10.1136/postgradmedj-2021-139876

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Facilitating learning has been the focus of extensive research to identify efficient strategies and activities. Solving problems and learning through questions have been widely used to enhance active learning by exposure to inquiry or problem for which answers are needed. The process involves memory retrieval, understanding, application and critical thinking skills. However, writing questions involves all the above learning strategies at a deeper level and broader application. Writing is a commonly known tool of thinking and learning. 1   2 Writing questions provides the additional learning skills of analysing, evaluating and creating knowledge.

The educational and learning value of writing questions is well established. 3   4 Writing multiple-choice question (MCQ) style was significantly positively correlated with test grades. 5 Cognitive strategies of writing questions about study topics result in better comprehension and test results. 6 Teaching by encouraging learners to write questions as a form of inquiry is mostly done to enhance further learning. The benefits of this style of teaching are well discussed in the literature. 7 However, this educational practice can be taken a step further by teaching to write formal questions in the format of well-structured MCQs with providing evidence-based explanations. MCQs are ubiquitously used in medical education for formative and summative assessment. 8 The process of writing MCQs includes the challenges of creating vetted questions in higher-order learning activities. The learning benefits of writing formal MCQ style of questions with evidence-based explanations are many. They involve all the known benefits of generating inquiry questions plus several additional benefits. There are limited reports in the literature describing generating MCQs in medical education. 7 Hence, the aim of this article is to review and summarise the learning benefits of writing formal MCQs with evidence-based explanations drawn from the available literature and the authors' experience.

Developing scholarly writing skills

Scholarly writing requires a special style and writing format that be developed with deliberate practicing and learning the specifics of the skills. 9 Writing is considered one of the most powerful ways of learning and thinking. In writing, learners self-regulate, refine and enhance learning skills and critical thinking. 10 Writing MCQs that can be used publicly by other learners or programmes is a highly scholarly educational activity. With this objective in mind, writing requires scholarly tone and precision. Learning these skills will be acquired and enhanced by producing and revising the ultimate product under supervision with feedback.

Reviewing the literature and using evidence-based knowledge

Writing MCQs requires a thorough literature review to provide sound evidence and exclude misconceptions. 11 A literature review provides a valuable learning experience to develop searching skills, critical appraisal skills, and constructing the evidence on sound research principles. A significant amount and high-quality information will be reviewed. Selecting controversial topics or new updates for the questions is key to maximise learning through literature review and evidence-based practice.

Developing teaching skills

Writing MCQs with the aim of providing teaching points and sharing knowledge will inspire learners to develop and refine their teaching skills. Teaching activities are well recognised as a valuable and efficient learning strategies. Besides enhancing learning from a different perspective, writing questions can connect and correlate between learning and assessment. 12 The combined use of learning and assessment enhances engagement and active learning, ultimately maximising learning quality and efficiency. Participating in regional or national efforts to build questions library or banks can enhance the educational benefits of writing MCQs.

Evaluating learning

In addition to its learning benefits, writing questions can be used as an evaluation of learner's knowledge at various levels. 13 It assesses several learning competencies and requires minimal effort from the evaluator. 14 Writing simple factual information-based MCQs measures memorisation and understanding, while writing scenario-based MCQs measure competencies of higher cognitive skills such as applying, analysing, evaluating and creating. The later competencies are difficult to assess with other assessment methods. MCQs of scenarios derived from the clinical practice and training experiences enable evaluating clinical performance that may not be possible to evaluate objectively with other means.

Verifying and validating own knowledge

The exercise of writing questions enhances enforcing knowledge after verifying and evaluating the content. 12   15 Learning is turned into an active process by examining and evaluating information to consolidate, clarify or modify learners' knowledge. Functioning at higher cognitive learning of analysing and evaluating knowledge can be enhanced through this exercise. Choosing topics of common use in the clinical practice to solidify learning will foster mastering these essential topics.

Broadening the scope of knowledge

Writing formal MCQs requires a broader and deeper knowledge acquisition. Comprehensive knowledge is necessary to tackle various potential pertinent educational points and present them accurately and clearly. Writing MCQs requires exploring the studied topics extensively and learning actively. This benefit is especially important for learning topics of limited availability in clinical practice, and to fill gaps in learning.

Enhancing knowledge application

Writing MCQs was used as a stimulus for clinical learning. 16 Using clinical scenarios to generate questions and provide a variety of potential solutions will stimulate learners to build skills in applying knowledge and solving problems. Learners will practise critical appraisal and review various solutions and management options for the particular scenarios of the questions. The exercise also increases curiosity for learning and identifying potential clinical applications/situations that can be used to generate questions.

Additional benefits

There are several other practical and academic benefits of writing MCQs that are less obvious. Some of these benefits are improving confidence, enhancing adult learning style, sharing knowledge and knowledge transfer and focusing on learning concepts and principles more than learning factual information. Final year medical students felt more confident after practised question generation. 17 Also, MCQs can be generated in group learning activities and have additional group learning benefits. 7

It is important to realise that the quality and value of potential benefits depend on the quality of the produced MCQs and the efforts put into the activity. Beginner learners may start with a more superficial level (factual information questions) then gradually ascend in the quality ladder to higher levels (applying, evaluating or creating) when competencies are achieved at the lower levels. Thus, unless otherwise specified, high quality, scenario-based, problem-solving and upper-levels cognitive skills based MCQs should be the ultimate goal of this activity. It is also important to review and approve the MCQs by experts before publicising them for use by other learners.

The benefits of writing MCQs are multiple at various levels of learning. This valuable learning exercise is underused. There is an inherent difficulty in proving its educational benefits objectively due to the complexity of the learning process and the limitation of assessment tools. Other than grades and learners' satisfaction, measuring long-term learning, quality of learning, clinical application and effects on learning skills are challenging to measure. These points should be considered in using and evaluating this educational activity and need to be addressed in future research.

Learners and educators who inspired and used the concept.

Patient consent for publication

Not required.

Cowen   VS , Kaufman   D , Schoenherr   L . A review of creative and expressive writing as a pedagogical tool in medical education . Med Educ   2016 ; 50 : 311 – 9 . http://dx.doi.org/10.1111/medu.12878  

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Walsh   JL , Harris   BHL , Smith   PE . Single best answer question-writing tips for clinicians . Postgrad Med J   2017 ; 93 : 76 – 81 . http://dx.doi.org/10.1136/postgradmedj-2015-133893  

Moss   F . Writing is an essential communication skill: let's start teaching it . Postgrad Med J   2015 ; 91 : 301 – 2 . http://dx.doi.org/10.1136/postgradmedj-2015-133556  

Nguyen   LT , Ikeda   M . The effects of ePortfolio-based learning model on student self-regulated learning . Active Learning in Higher Education   2015 ; 16 : 197 – 209 . http://dx.doi.org/10.1177/1469787415589532

Jobs   A , Twesten   C , Göbel   A , et al.  . Question-writing as a learning tool for students--outcomes from curricular exams . BMC Med Educ   2013 ; 13 : 89 . http://dx.doi.org/10.1186/1472-6920-13-89  

Papinczak   T , Peterson   R , Babri   AS , et al.  . Using student-generated questions for student-centred assessment . Assessment & Evaluation in Higher Education   2012 ; 37 : 439 – 52 . http://dx.doi.org/10.1080/02602938.2010.538666

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Schimmelfing   LC , Persky   AM . Activating prior knowledge using multiple-choice question distractors . Med Educ   2020 ; 54 : 925 – 31 . http://dx.doi.org/10.1111/medu.14162  

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Baerheim   A , Meland   E . Medical students proposing questions for their own written final examination: evaluation of an educational project . Med Educ   2003 ; 37 : 734 – 8 . http://dx.doi.org/10.1046/j.1365-2923.2003.01578.x  

FT contributed to conceptualisation, writing, editing, finalising, submitting and responsible for the entire content.

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

None declared.

Not commissioned; externally peer reviewed.

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Multiple Choice Questions

Research methodology.

University Library

Write a literature review.

• Examples and Further Information

1. Introduction

Not to be confused with a book review, a literature review surveys scholarly articles, books and other sources (e.g. dissertations, conference proceedings) relevant to a particular issue, area of research, or theory, providing a description, summary, and critical evaluation of each work. The purpose is to offer an overview of significant literature published on a topic.

2. Components

Similar to primary research, development of the literature review requires four stages:

• Problem formulation—which topic or field is being examined and what are its component issues?
• Literature search—finding materials relevant to the subject being explored
• Data evaluation—determining which literature makes a significant contribution to the understanding of the topic
• Analysis and interpretation—discussing the findings and conclusions of pertinent literature

Literature reviews should comprise the following elements:

• An overview of the subject, issue or theory under consideration, along with the objectives of the literature review
• Division of works under review into categories (e.g. those in support of a particular position, those against, and those offering alternative theses entirely)
• Explanation of how each work is similar to and how it varies from the others
• Conclusions as to which pieces are best considered in their argument, are most convincing of their opinions, and make the greatest contribution to the understanding and development of their area of research

In assessing each piece, consideration should be given to:

• Provenance—What are the author's credentials? Are the author's arguments supported by evidence (e.g. primary historical material, case studies, narratives, statistics, recent scientific findings)?
• Objectivity—Is the author's perspective even-handed or prejudicial? Is contrary data considered or is certain pertinent information ignored to prove the author's point?
• Persuasiveness—Which of the author's theses are most/least convincing?
• Value—Are the author's arguments and conclusions convincing? Does the work ultimately contribute in any significant way to an understanding of the subject?

3. Definition and Use/Purpose

A literature review may constitute an essential chapter of a thesis or dissertation, or may be a self-contained review of writings on a subject. In either case, its purpose is to:

• Place each work in the context of its contribution to the understanding of the subject under review
• Describe the relationship of each work to the others under consideration
• Identify new ways to interpret, and shed light on any gaps in, previous research
• Resolve conflicts amongst seemingly contradictory previous studies
• Identify areas of prior scholarship to prevent duplication of effort
• Point the way forward for further research
• Place one's original work (in the case of theses or dissertations) in the context of existing literature

The literature review itself, however, does not present new primary scholarship.

• Next: Examples and Further Information >>

Creative Commons Attribution 3.0 License except where otherwise noted.

Land Acknowledgement

The land on which we gather is the unceded territory of the Awaswas-speaking Uypi Tribe. The Amah Mutsun Tribal Band, comprised of the descendants of indigenous people taken to missions Santa Cruz and San Juan Bautista during Spanish colonization of the Central Coast, is today working hard to restore traditional stewardship practices on these lands and heal from historical trauma.

The land acknowledgement used at UC Santa Cruz was developed in partnership with the Amah Mutsun Tribal Band Chairman and the Amah Mutsun Relearning Program at the UCSC Arboretum .

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Answer these Reviewing the Literature MCQs and see how sharp is your knowledge of Reviewing the Literature. Scroll down and let's start!

1: Which of the following is a reason to undertake a systematic review of the literature?

A.   Being able to access important ‘grey’ literature

B.   Increasing the transparency of a review

C.   Being able to reach older yet still important contributions

D.   Enhancing creativity and intuition

2: What is the function of a Boolean operator?

A.   To identify a particular type of publication

B.   To broaden the scope of a search on a particular subject

C.   To delineate the scope and depth of research results

D.   To have a programme that can operate within the Google platform

3: Which of these is NOT an advantage of using a library?

A.   To obtain print information that is available but difficult to access elsewhere

B.   To access working papers ahead of print

C.   To have experts to help

D.   To identify adjacent material that might be of interest/use on a related topic

4: Which of the following is a scholarly database?

A.   Detox

B.   Protocol

C.   ABI Complete

D.   ReQuest

E.   All of these

5: A checklist of a literature review would NOT include which of the following key items?

A.   The topic and scope clearly identified

B.   A clear understanding of the relevant terms and concepts

C.   Material from as far back as it is possible to obtain

D.   Research conceptualized/reordered in such a way that new perspectives are generated

6: Which of the following statements would NOT define a main purpose of a literature review?

A.   To learn from previous research in order to be in a position to ask focused questions

B.   To provide a context for the research that is to be undertaken

C.   To show volume of research that has been conducted on a particular topic

D.   To clearly indicate what the new research will add to what is already known

7: Which of the following questions links to the key criterion of ‘authorship’, used for evaluating sources of information?

A.   When was the source created and last updated?

B.   Is the source authoritative and therefore credible?

C.   What motivations have led to the creation of the work?

D.   Is there sufficient information/data/analysis offered to make the paper rigorous?

8: A critical literature review requires the researchers to ______.

A.   Be negative about the literature they read

B.   Highlight the reasons why previous research was misguided or poorly conducted

C.   Select literature they find easy to criticise

D.   Evaluate the contribution of previous research in the light of a new research questions

9: It can be useful to begin a literature review with a brief research statement. Of the statements below, which would you NOT expect to see?

A.   What is the topic of the research?

B.   How does this project relate to past research in the field?

C.   What methodological approaches should be excluded?

D.   Why a given body of literature is relevant to the research

10: What is a citation search?

A.   It traces all the publications of a particular author over time.

B.   It traces key authors of journal articles or books to previous or future related work in relation to a particular topic.

C.   It traces articles on a particular topic from books as opposed to journal articles.

D.   It calculates the impact factor for a journal.

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A literature review requires:

Correct option is d. all of the above.

what is a vedic literature ?

Students also viewed

OLMES: A Standard for Language Model Evaluations

• Tafjord, Oyvind
• Kuehl, Bailey
• Haddad, Dany
• Dodge, Jesse
• Hajishirzi, Hannaneh

Progress in AI is often demonstrated by new models claiming improved performance on tasks measuring model capabilities. Evaluating language models in particular is challenging, as small changes to how a model is evaluated on a task can lead to large changes in measured performance. There is no common standard setup, so different models are evaluated on the same tasks in different ways, leading to claims about which models perform best not being reproducible. We propose OLMES, a completely documented, practical, open standard for reproducible LLM evaluations. In developing this standard, we identify and review the varying factors in evaluation practices adopted by the community - such as details of prompt formatting, choice of in-context examples, probability normalizations, and task formulation. In particular, OLMES supports meaningful comparisons between smaller base models that require the unnatural "cloze" formulation of multiple-choice questions against larger models that can utilize the original formulation. OLMES includes well-considered recommendations guided by results from existing literature as well as new experiments investigating open questions.

• Computer Science - Computation and Language;
• Computer Science - Artificial Intelligence

• Systematic Review
• Open access
• Published: 18 June 2024

Comparison of clinical efficacy of robot-assisted and freehand core decompression in the treatment of osteonecrosis of the femoral head: a systematic review and meta-analysis

• Wensi Ouyang 1 , 2 ,
• Guimei Guo 1 , 2 ,
• Tianpei Jiang 1 ,
• Changwei Zhao 1 , 2 &
• Xiaoling Zhou 1 , 2  

BMC Musculoskeletal Disorders volume  25 , Article number:  476 ( 2024 ) Cite this article

Metrics details

At present, the core decompression (CD) has become the main surgical procedure for the treatment of osteonecrosis of the femoral head (ONFH); however, the CD surgery requires high operator experience and repeated fluoroscopy increases the radiation damage to patients, and medical staff. This article compares the clinical efficacy of robot-assisted and freehand CD for ONFH by meta-analysis.

Computer searches of PubMed, Web of Science, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, WanFang, and Chinese BioMedical Literature Database were conducted from the time of database inception to November 15, 2023. The literature on the clinical efficacy of robot-assisted and freehand CD in the treatment of ONFH was collected. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and strictly evaluated the quality of the included literature. Outcome measures encompassed operative duration, intraoperative blood loss volume, frequency of intraoperative fluoroscopies, visual analog scale (VAS) score, Harris hip score (HHS), complications, and radiographic progression. Data synthesis was carried out using Review Manager 5.4.1 software. The quality of evidence was evaluated according to Grades of Recommendation Assessment Development and Evaluation (GRADE) standards.

Seven retrospective cohort studies involving 355 patients were included in the study. The results of meta-analysis showed that in the robot-assisted group, the operative duration (MD = -17.60, 95% CI: -23.41 to -11.78, P  < 0.001), intraoperative blood loss volume (MD = -19.98, 95% CI: -28.84 to -11.11, P  < 0.001), frequency of intraoperative fluoroscopies (MD = -6.60, 95% CI: -9.01 to -4.20, P  < 0.001), and ΔVAS score (MD = -0.45, 95% CI: -0.67 to -0.22, P  < 0.001) were significantly better than those in the freehand group. The GRADE evidence evaluation showed Δ VAS score as low quality and other indicators as very low quality. There was no significant difference in the terms of ΔHHS (MD = 0.51, 95% CI: -1.34 to 2.35, P  = 0.59), complications (RR = 0.30, 95% CI: 0.03 to 2.74, P  = 0.29), and radiographic progression (RR = 0.50, 95% CI: 0.25 to 1.02, P  = 0.06) between the two groups.

There is limited evidence showing the benefit of robot-assisted therapy for treatment of ONFH patients, and much of it is of low quality. Therefore, caution should be exercised in interpreting these results. It is recommended that more high-quality studies be conducted to validate these findings in future studies.

Systematic review registration

https://www.crd.york.ac.uk/prospero/ #recordDetails, CRD42023420593.

Peer Review reports

Introduction

Osteonecrosis of the femoral head (ONFH) represents a significant orthopedic enigma, as its exact pathogenesis remains elusive, making its treatment a considerable challenge for orthopedic surgeons [ 1 – 2 ]. Alarming data suggest that without timely intervention, over 90% of ONFH cases will culminate in the collapse of the femoral head within five years [ 3 – 4 ]. Consequently, when many patients seek their initial consultation, the integrity of the hip joint is already compromised to the point where hip replacement becomes inevitable [ 5 – 6 ]. This progression places a considerable strain on patients and imposes a profound socioeconomic burden [ 7 ]. Therefore, the imperative lies in devising strategies to preemptively address ONFH before the onset of femoral head collapse, thereby decelerating the disease’s trajectory and postponing the need for joint replacement.

Core decompression (CD) has established itself as a pivotal therapeutic strategy in the clinical management of ONFH [ 8 – 9 ]. Traditional CD relies heavily on the expertise of the surgeon, aided by multiple fluoroscopic imaging under X-ray, to meticulously target and decompress the necrotic zone. Nevertheless, this method is not devoid of risks. There is the ever-present danger of inadvertently puncturing the cartilage or damaging blood vessels and neuromuscular structures during the procedure [ 10 – 11 ]. The advent and assimilation of robotic navigation technology into clinical orthopedics introduces a promising alternative, touting advantages such as enhanced precision, reduced reliance on fluoroscopy, and bolstered patient safety [ 12 – 13 ]. However, the development of robot-assisted technology is still in its infancy, and its clinical efficacy and safety are still uncertain. Hence, this meta-analysis aimed to determine whether the robot-assisted CD technique offers an advantage in clinical efficacy compared with the X-ray freehand CD technique.

Methods and materials

Protocol registration.

This systematic review and meta-analysis was structured in adherence to the guidelines of the Cochrane Handbook for Systematic Reviews and was reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [ 14 ]. The meta-analysis was registered on the PROSPERO platform under the identifier CRD42023420593.

Search strategy

Collaboratively, two authors (W.S.O.Y. and G.M.G.) embarked on a comprehensive exploration of four English electronic databases (PubMed, Web of Science, Embase, and Cochrane Library) and four Chinese databases (Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, WanFang, and Chinese BioMedical Literature Database) covering their inception to November 15, 2023. Search terms embraced “robotic”, “robot positioning”, “navigated”, “osteonecrosis of the femoral head”, “femur head necrosis”, “ONFH”, and “FHN”. The search strategy amalgamated theme-based terms with free-text words customized to each database’s specifications. Additionally, to ensure a comprehensive search, references from the included articles were scanned for any other potentially relevant studies. Only articles in English and Chinese were included. The specific PubMed search algorithm was: (((robotic [Title/Abstract]) OR (robot positioning [Title/Abstract]) OR (navigated [Title/Abstract]) AND (osteonecrosis of the femoral head [Mesh]) OR ((femur head necrosis [Title/Abstract])) OR (ONFH [Title/Abstract])) OR (FHN [Title/Abstract]). A thorough breakdown of the search methodologies employed is available in Supplementary Material 1 .

Eligibility criteria

Research Types: Published randomized controlled trial studies and retrospective cohort studies.

Participants: Inclusion involved patients diagnosed with ONFH based on recognized criteria. Staging references were the Association Research Circulation Osseous stages, Ficat stages, and Steinberg stages [ 15 , 16 , 17 ]. No restrictions were imposed based on demographic factors such as age, gender, ethnicity, geographical location, or the study’s origin.

Interventions: Control group: CD therapy by freehand under X-ray fluoroscopy. Intervention group: CD therapy assisted by robotic positioning system.

Type of outcome measures: Included studies were required to include one of the following outcomes: operative duration, intraoperative blood loss volume, frequency of intraoperative fluoroscopies, visual analog scale (VAS) score, Harris hip score (HHS), complications, and radiographic progression.

Exclusion criteria

Literature with overlapping data or duplicate publications.

Literature reviews, case reports, animal experiments, basic experimental studies, letters, and review articles.

Primary or relevant outcome indicators are unavailable.

Data extraction

Titles and abstracts of the gathered studies were meticulously scrutinized by two independent reviewers (W.S.O.Y. and T.P.J.). A thorough reading of the full-text articles ensued to determine alignment with both inclusion and exclusion criteria. Any discordance was resolved through in-depth discussions and, if necessary, in collaboration with a third reviewer (X.L.Z.) to reach a unanimous decision. Two authors (W.S.O.Y. and G.M.G.) employed a systematic data extraction template to mine essential study features, encompassing title, publication year, lead author, country, study design, sample size, treatment strategies, treatment duration, primary outcome measures, and follow-up time. Key outcomes were extracted separately by two other reviewers (C.W.Z. and X.L.Z.) for data synthesis. A collaborative consensus approach was adopted in data extraction discrepancies between reviewers, involving all reviewers.

Literature quality assessment

The methodological quality of each included randomized controlled trial study was separately assessed by two review authors (W.S.O.Y. and G.M.G.) by using the Cochrane Risk of Bias tool [ 18 ]. All included retrospective studies underwent a rigorous quality assessment utilizing the Newcastle-Ottawa Scale (NOS). This scale evaluates pivotal aspects such as the selection of study populations, the comparison of study cohorts, and the methods employed for outcome assessments [ 19 ]. If the two researchers disagree, it can be resolved by consulting a third reviewer author (C.W.Z.).

Quality of evidence assessment

We used the principles of the Grades of Recommendation Assessment Development and Evaluation (GRADE) system to assess the quality of the body of evidence associated with outcomes [ 20 ]. Developed to grade the overall certainty of a body of evidence, this approach incorporates six main domains: limitation in study design, risk of bias, inconsistency of results, indirectness, imprecision, and publication bias [ 21 ]. Two review authors (W.S.O.Y. and G.M.G.) separately assessed each domain for each selected outcome. If the two researchers disagree, it can be resolved by consulting a third reviewer author (C.W.Z.). We documented all decisions regarding up- or down-grading the certainty of evidence to ensure transparency.

Statistical analysis

Statistical computations were executed using the Review Manager 5.4.1 software (provided by the Cochrane Collaboration, Oxford, UK). The Risk Ratio (RR) was employed for binary data, while the Mean Difference (MD) served for continuous data types. Both metrics were accompanied by a 95% Confidence Interval (CI) to encapsulate the effect magnitude when juxtaposing treatment and control groups. Inherent heterogeneity was assessed using the χ 2 test and quantified by the I 2 value. An I 2 value of ≤ 50% coupled with P  ≥ 0.1 suggested homogeneity across studies, warranting the application of a fixed-effects model. Conversely, an I 2 value surpassing 50% alongside P  ≤ 0.1 indicated significant heterogeneity, prompting the utilization of a random-effects model.

Search results

Out of an initial pool of 276 potential articles concerning robot-assisted CD treatment for ONFH, 165 duplicates were identified and removed. Subsequent screenings based on titles and abstracts eliminated another 56 articles, while 38 more were excluded following full-text reviews and criteria assessment. Consequently, this meta-analysis incorporated seven articles [ 22 , 23 , 24 , 25 , 26 , 27 , 28 ] (Fig.  1 ).

Literature screening process and results

Study characteristics

In the selected studies, 355 adult ONFH patients were documented. Among them, 183 were in the freehand group, and 172 were in the robot-assisted group. Every included study specified clear criteria for inclusion and exclusion, and consistent baseline data was observed across the freehand and robot-assisted cohorts (Table  1 ). Regarding financial support, four out of the seven studies [ 23 , 24 , 25 , 26 ] were funded by governmental bodies or professional entities, whereas the remaining 3 [ 22 , 27 – 28 ] did not specify their funding source.

Demographic and staging

A total of 355 patients were included in the systematic review and meta-analysis. The age of the patients enrolled in these included studies ranging from 34.5 to 53.0. The included studies had a minimum follow-up of 6 months. The study of the longest follow-up came from China, where Li’s study [ 25 ] reported a 28-year result. Three kinds of diagnostic standards were utilized in all of the studies. Among them, Four studies [ 22 , 24 – 25 , 28 ] followed ARCO classification, 2 studies [ 26 – 27 ] reported data on the basis of Ficat classification, and the left 1 study [ 23 ] used the steinberg staging system.

Bias risk assessment

Included seven literature articles [ 22 , 23 , 24 , 25 , 26 , 27 , 28 ] were all retrospective cohort studies, with no randomized controlled studies. According to the NOS assessment, there were four literature [ 23 , 24 , 25 , 28 ] scores of eight and the remaining three literature [ 22 , 26 – 27 ] scores of seven (additional data in Supplementary Material 1 : Table S1 ).

Meta-analysis outcomes

Operative duration.

All seven studies [ 22 , 23 , 24 , 25 , 26 , 27 , 28 ] comprising 355 patients compared operative duration across both groups. Significant heterogeneity was observed ( P  < 0.00001, I 2  = 98%), necessitating the application of a random effects model. The results signified that the operative duration was statistically shorter in the robot-assisted group (MD = -17.60, 95% CI: -23.41 to -11.78, P  < 0.001) (Fig.  2 ). Sensitivity analysis was then conducted by individually excluding each study. The outcome remained consistent, reinforcing the stability of the meta-analysis results (additional data in Supplementary Material 1 : Table S2 ).

Forest plot of the meta-analysis comparing the operative duration

Intraoperative blood loss volume

Out of the studies, 6 [ 22 , 23 , 24 , 25 , 26 , 27 ], with a collective patient count of 335, provided data regarding intraoperative blood loss volume. A notable heterogeneity was recorded ( P  < 0.00001, I 2  = 97%), warranting the use of a random effects model. The data revealed a statistically significant reduction in intraoperative blood loss volume for the robot-assisted group (MD = -19.98, 95% CI: -28.84 to -11.11, P  < 0.001) (Fig.  3 ). A sensitivity analysis, excluding individual studies, was executed, which reasserted the stability of the derived results from the meta-analysis (additional details in Supplementary Material 1 : Table S3 ).

Forest plot of the meta-analysis comparing the intraoperative blood loss volume

Frequency of intraoperative fluoroscopies

The frequency of intraoperative fluoroscopies between the groups was reported from the five studies [ 22 , 24 , 25 , 26 , 27 ] of 304 patients. Significant heterogeneity was observed ( P  < 0.00001, I 2  = 98%), prompting the utilization of a random effects model. The analysis indicated a statistically significant reduction in the frequency of intraoperative fluoroscopies for the robot-assisted group (MD = -6.60, 95% CI: -9.01 to -4.20, P  < 0.001) (Fig.  4 ). A sensitivity analysis, where each study was individually excluded, confirmed the stability of the meta-analysis results (additional details in Supplementary Material 1 : Table S4 ).

Forest plot of the meta-analysis comparing the frequency of intraoperative fluoroscopies

Out of five studies [ 22 , 23 , 24 , 25 , 28 ] that included 252 participants, the change in VAS score was reported from baseline to the last follow-up. Minimal heterogeneity was found ( P  = 0.24, I 2  = 28%), allowing the use of a fixed effect model. The analysis highlighted a significant difference in ΔVAS score, favoring the robot-assisted group (MD = -0.45, 95% CI: -0.67 to -0.22, P  < 0.001) (Fig.  5 ).

Forest plot of the meta-analysis comparing the ΔVAS score

Seven studies [ 22 , 23 , 24 , 25 , 26 , 27 , 28 ], comprising 355 participants, detailed the changes in the HHS from baseline to the last follow-up. Notable heterogeneity was observed ( P  = 0.006, I 2  = 67%), necessitating a random effects model. Interestingly, no significant difference in ΔHHS was detected (MD = 0.51, 95% CI: -1.34 to 2.35, P  = 0.59) (Fig.  6 ). To further analyze the stability of the results, we made sensitivity analyses and excluded each study from the analysis. Excluding other studies, the meta-analysis result indicated that the data analysis was stable. After excluding Liu’s study [ 23 ], the heterogeneity changed significantly ( P  = 0.15, I 2  = 39%). This suggested that this study may have been the source of heterogeneity in ΔHHS data (additional details in Supplementary Material 1 : Table S5 ).

Forest plot of the meta-analysis comparing the ΔHHS

Complications

Only two studies [ 23 , 27 ] with 94 participants reported complications between the groups. In Liu’s study [ 23 ], one instance of deep vein thrombosis in the freehand group was noted, while Luo J’s study [ 27 ] documented a single case of wound infection, also in the freehand group. A fixed effect model was utilized given the low heterogeneity ( P  = 0.86, I 2  = 0%). The results did not show any statistical significance concerning complications (RR = 0.30, 95% CI: 0.03 to 2.74, P  = 0.29) (Fig.  7 ).

Forest plot of the meta-analysis comparing the complications

Radiographic progression

Four studies [ 22 , 25 , 27 – 28 ] that included 293 hips reported radiographic progression between the groups. Minimal heterogeneity was found ( P  = 0.65, I 2  = 0%), allowing the use of a fixed effect model. The results did not show any statistical significance concerning radiographic progression (RR = 0.50, 95% CI: 0.25 to 1.02, P  = 0.06) (Fig.  8 ).

Forest plot of the meta-analysis comparing the radiographic progression

GRADE evaluation

Based on the principles of the GRADE evaluation, we evaluated the quality of the evidence provided via the operative duration, intraoperative blood loss volume, frequency of intraoperative fluoroscopies, and Δ VAS score. Table S6 shows that, except for Δ VAS score which was classified as low in quality, the others were evaluated as very low quality.

Summary of evidence

In this analysis of seven retrospective studies with a collective of 355 patients, we aimed to discern the efficacy and safety of robot-assisted CD in the management of ONFH. Our findings reveal that the robot-assisted group offers a superior approach over the freehand group in various aspects such as operative duration, intraoperative blood loss volume, frequency of intraoperative fluoroscopies, and ΔVAS score; the differences were statistically significant. However, no meaningful differences emerged between the two groups when evaluating parameters like ΔHHS, complications, and radiographic progression.

Analysis of findings

One salient benefit of employing robot-assisted CD for ONFH treatment is the observed reduction in operative duration. This is attributed to robot-assisted techniques that utilize advanced digital technology which harnesses marker points on the robotic arm, preoperative CT reconstruction data, and intraoperative X-ray fluoroscopic images. Combining these resources empowers surgeons to meticulously plan their surgical pathway, ascertain the optimal nail entry point with a single guide needle measurement, and perform all surgical tasks via a minimally invasive incision. Not only does this significantly cut down the operative duration [ 22 , 25 ], but it also diminishes the patient’s intraoperative incision exposure time, consequently lowering the risk of joint infections. However, we must not overlook the observed heterogeneity. Potential causes include the relatively nascent adoption of robot-assisted CD by specific research centers, the consequent surgical inexperience, and differing calculations of surgery time among centers. Some research facilities consider the operative duration from skin disinfection, which typically necessitates an extended preoperative preparation [ 25 , 27 ], while others [ 28 ] start the clock at the skin incision. Such inconsistencies can inadvertently skew the research outcomes.

Another pivotal metric for gauging surgical safety and quality is the intraoperative blood loss volume. Excessive intraoperative bleeding during femoral head surgery elevates the risks of perioperative complications, prolongs hospital stay, and subsequently hikes up hospitalization expenses. As highlighted by Liu’s study [ 23 ], orthopedic robotic systems stand out for their precision. These robotic aids enable surgeons to meticulously plan their paths and pinpoint targets accurately, minimizing damage to the blood vessels and surrounding tissues during surgery.

Our analysis underscores the advantages of robot-assisted groups in managing ONFH. Evident benefits include shortened operative duration, reduced intraoperative blood loss volume, and a significant reduction in the frequency of intraoperative fluoroscopies. Considering the often-underplayed radiation risks in orthopedic surgery, the latter is especially crucial. Freehand group necessitates multiple uses of C-arm fluoroscopy to achieve desired results, inadvertently increasing radiation exposure for both healthcare professionals and patients. With accumulating radiation exposure, risks such as compromised immunity, heightened susceptibility to blood disorders, and cancer become paramount concerns [ 29 , 30 , 31 ]. Tian’s study [ 22 ] suggested that robot-assisted techniques can enable intraoperative femoral drilling in a three-dimensional view by matching preoperative three-dimensional reconstructed images with intraoperative X-ray images. Similarly, Luo’s study [ 26 ] indicated that the intraoperative use of robot-assisted techniques can reduce the frequency of intraoperative fluoroscopies, which has some clinical application prospects.

For early-stage ONFH patients, the typical manifestation is hip pain, making the VAS score a pertinent gauge for patient outcomes. Simultaneously, the HHS remains a benchmark for postoperative hip function assessment. Our comparative analysis, grounded in statistical evaluation of the difference between preoperative and subsequent follow-up VAS score and HHS [ 32 ], indicates that robot-assisted CD’s minimally invasive nature, which involves smaller incisions and minimal collateral tissue damage, can effectively attenuate postoperative pain, as evidenced in Luo J’s study [ 27 ]. The lack of discernable difference in ΔHHS might be attributed to its inherently subjective nature. Patient perceptions and experiences can introduce biases, suggesting the need for more extensive, rigorous studies to validate these findings. In theory, robotic surgery can reduce the number of medical injuries by positioning the procedure more precisely. While robot-assisted CD emerges as a promising advancement in ONFH management, further rigorous studies are imperative for a more comprehensive understanding and potential wider clinical adoption.

For the patient, delaying the collapse of the femoral head is the primary principle in the treatment of ONFH. Tian’s study indicated that robot-assisted therapy could improve the success rate of core decompression and effectively reduce the collapse rate of early- and mid-stage ONFH [ 22 ]. Meanwhile, in the final follow-up observation, it was found that most of the patients in the robot-assisted therapy group had intact femoral head morphology. Li’s study concluded that robot-assisted techniques are effective in improving surgical accuracy and minimizing damage to cortical bone [ 25 ]. Even when judgments about radiographic progression were made, there was considerable subjectivity. This also emphasizes the importance of intervention concealment and implementation of blinding.

The quality of the included studies was evaluated using the GRADE system, which adopts a highly structured approach to classify the level of evidence and clearly presents the evaluation items in itemized lists so that clinicians can understand the effectiveness and feasibility of the treatment measures on their own and then make clinical decisions. Among the metrics in this study, the Δ VAS score was rated as low quality, the operative duration, intraoperative blood loss volume, and frequency of intraoperative fluoroscopies were rated as very low quality. The reasons may be related to the fact that the included studies were all non-randomized controlled trials, large heterogeneity among some studies, and publication bias. Hence, there is still a need to include higher quality studies to improve the level of evidence in the future. In the clinical management of patients with ONFH, there is still a need for a comprehensive assessment of the patient’s overall condition in order to make scientific clinical decisions.

Limitations

This systematic review aimed to determine the effectiveness of robot-assisted CD in managing ONFH. The results suggest that robot-assisted CD holds promise in offering a better treatment approach when compared to freehand CD. However, there are several limitations to consider. Robot-assisted CD, a relatively newer procedure, lacks high-quality randomized controlled trials to validate its efficacy. The included studies were cohort reviews, and the overall evidence grade from these studies is relatively low. Second, the meta-analysis considered only seven studies, pointing to potential search deficiencies and limited sample size. Non-Chinese and English articles were not included, which might have further biased our study. Third, Different levels of familiarity with robotic navigation techniques among operators could introduce significant heterogeneity in some of the data and possible bias in the study results. Finally, the included studies were conducted in China, which may affect the reliability of the conclusions. However, we still hope that more physicians will participate in this study.

Future directions

To better understand robot-assisted CD’s efficacy, addressing these limitations in future research is crucial. Given the surge in robot-assisted technology in medicine, it would also be beneficial to continuously offer training opportunities to budding physicians. More holistic future research could focus on patient quality of life, fracture risk, and patient satisfaction to ensure more reliable outcomes. Meanwhile, with the development of computer technology, artificial intelligence, and mechanical manufacturing, robot-assisted technology will continue to evolve to improve the safety and effectiveness of surgery. Although more relevant, high-quality research is lacking, there is clinical value in advancing continued research in robot-assisted technology.

We conclude that there is inadequate evidence to regularly recommend robot-assisted therapy for the treatment of patients with ONFH. In future studies, higher-quality research will be needed to better define robot-assisted therapy as a treatment option for ONFH.

Data availability

All data generated or analysed during this study are included in this published article [and its supplementary information files].

Abbreviations

• Core decompression

Confidence interval

Grades of Recommendation Assessment Development and Evaluation

Harris hip score

Mean difference

Newcastle-Ottawa Scale

• Osteonecrosis of the femoral head

Visual analog scale

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All authors contributed to the writing of the manuscript. Wensi Ouyang: First author, designed the study, article writing, article selection, literature quality assessment, and data collation. Guimei Guo: Second author, article writing, article selection, literature quality assessment, and statistical analysis. Tianpei Jiang: Third author, data collation, article modification, investigation, and statistical analysis. Changwei Zhao: Correspondent author, article revision, data collation, literature quality evaluation, and article review. Xiaoling Zhou: Correspondent author, article revision, article selection, article modification, and data collation. All authors read and approved the final manuscript.

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Ouyang, W., Guo, G., Jiang, T. et al. Comparison of clinical efficacy of robot-assisted and freehand core decompression in the treatment of osteonecrosis of the femoral head: a systematic review and meta-analysis. BMC Musculoskelet Disord 25 , 476 (2024). https://doi.org/10.1186/s12891-024-07592-x

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Psychological wellbeing with music therapy: the moderating role of health awareness, and strategic health management in post Covid-19 era

• Yang Liu 1 , 2  

BMC Psychology volume  12 , Article number:  355 ( 2024 ) Cite this article

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Psychological problems are common among the people of every community. These psychological issues are leading people to mental health issues. Human well-being is required to be improved appropriately for the better health of the public. The objective of this research is to determine the influence of music therapy on the sustainable psychological well-being of the Chinese community. Furthermore, this research determines that moderating role of health awareness and strategic health management between music therapy and sustainable psychological well-being.

The research used a sample of 384 collected with a random sampling method. For data collection, a cross-sectional method was adopted to collect data on a Likert scale questionnaire. The Health Awareness Scale, Music Therapy Scale, Sustainable Health Management Scale and Sustainable Psychological Wellbeing Scale was used in this research.

The findings of the research highlighted that there is a significant and positive influence of music therapy on the sustainable psychological well-being of the Chinese community. This research also concluded that there is a significant and positive moderating role of health awareness and strategic health management between music therapy and sustainable psychological well-being. The findings of this research are new and novel in the literature on psychological well-being.

This research has some theoretical and practical implications to advance the literature and practice for sustainable psychological well-being respectively. In clinical practice, music therapy can be effectively used to improve the psychological well-being of individuals with sustainability. The information related to health awareness and practice for strategic health management is also necessary for the clinical patients to improve their psychological well-being.

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Introduction

Mental issues are common in modern society because people are depressed and they have different concerns. Indeed, people in the past also faced mental health-related issues that were disturbing for them to improve their behavior and learning [ 16 ]. The better way to deal with people’s mental issues is to provide them with appropriate treatment on time. Mental health issues should be treated on time because when these issues would not treat on time, people may face significant problems in their life [ 37 ]. The behavior of mentally ill people is different from that of normal people, and this distinction is disturbing for people. The available resource for health improvement is required for people to get better treatment. Different kinds of clinical treatment are available for those people who are mentally not well [ 1 ]. However, they are required to take interesting initiatives to improve their health in a better way. The mental health of the public helps them to perform better in their routine life.

Indeed, there are different clinical treatments for people who are facing mental health issues [ 34 ]. However, music therapy is an emerging concept in Western countries regarding mental health issues. People who are facing mental health issues are required to get better clinical treatment to improve their health status [ 20 ]. However, many patients don’t rely on the significance and outcomes of mental health with clinical treatment. The stability of mental health issues for the public is required to be improved over time [ 3 ]. The success of people towards mental health stability helps them to enjoy life. The Chinese community is in large numbers in the world, and there are many mental health issues reported in this community. People who are facing mental health issues are required to get clinical treatment effectively. However, it is also noted that people have very limited information related to mental health issues.

[ 35 ] reported that physical therapy helps to improve the psychological well-being of people. Psychosocial well-being is defined as the state of mental, emotional, and social health of an individual. It is a broad concept that encompasses various aspects of human life, including personal growth, happiness, life satisfaction, self-esteem, social functioning, and a sense of purpose in life. The study [ 19 ] highlighted that people who do not have effective treatment, face problems in the long term. However [ 7 ], reported that the mental health issues for the people should be maintained in time to ensure that their performance would be improved [ 12 ]. asserted that therapy with modern music can guarantee the successful mental treatment of people [ 5 ]. also highlighted that music therapy should be used appropriately to improve the health behavior of the people. In the meanwhile [ 25 ], asserted that music therapy has been less discussed from the perspective of sustainable psychological well-being, as earlier studies only focused on the role of music therapy in mental health improvement briefly. Furthermore, health awareness and strategic health management are critical factors but are not discussed widely in the existing body of literature.

Due to workload, social pressure, following the norms, and psychological illness, the Chinese community face problems related to psychological well-being. It is problematic for them to make good decision in bad psychological condition. On the other hand, health management is necessary for the public to improve their mental and physical health. The appropriate mental health is required for the individuals to perform their tasks in the better way. However, the individuals who are good in managing their health, it is appropriate for them to improve their health strategically. Hence, health management is considered as critical factor for improving mental health and psychological well-being. Therefore, the objective of this research is to determine the influence of music therapy on the sustainable psychological well-being of the Chinese community. Furthermore, this research determines that moderating role of health awareness and strategic health management between music therapy and sustainable psychological well-being. The research used a sample of 384 collected with a random sampling method. For data collection, the cross-sectional method was adopted to collect data on the Likert scale questionnaire. The findings of this research are new and novel in the literature on psychological well-being. This research has some theoretical and practical implications to advance the literature and practice for sustainable psychological well-being respectively. This research also has some limitations that are required to be addressed by future studies.

Review of literature

Theoretical underpinning.

Psychodynamics theory explains that the relationship between human behavior and emotions is influenced by their psychology [ 6 ]. It is necessary to influence human behavior for the right working, but this behavior is reported to be improved with psychological improvement. Human emotions are key to their performance and way of sustainability. The behavior studies highlight that human behavior is required to be improved. In this way, Psychodynamics theory significantly highlights that the underlying human emotions can be triggered with the psychological empowerment that is necessary for advancing their behavior in the right direction [ 40 ]. Access to human behavior and emotions for better psychological well-being is necessary for their emotional treatment. In modern times, different kinds of psychological treatments are recommended for human behavior to influence their understanding in the right way. Furthermore, Psychodynamics theory focuses on human emotions and other influencing drivers that are supporting to improve human behavior in a significant way. The right to work for human emotions can improve human being performance for better living standards. Access to human behavior and emotions by way of influencing drivers can improve human emotions in the right direction. By the underpinning of Psychodynamics theory, this research has considered music therapy as the influencing factor for sustainable psychological well-being as the dependent variable.

Hypotheses development

Music therapy is considered one of the critical ways to improve human behavior and emotions. Human emotions are positively and significantly influenced when human behavior is different [ 39 ]. The advancement of human behavior and psychology is helpful for them to perform well in different situations. There are different kinds of cases for people who are struggling with psychological well-being, and the people are required to improve their behavior and learning. The learning of cultural environment and cultural music can facilitate the people for their better psychological advancement [ 17 ]. Human emotions are related to their behavior, and people can improve their health when they have cultural associations. Music is considered the food of the soul, and it has relatable sentiments according to the living standards of the people that are motivating the people to deal with people better. Sometimes, there are negative and sometimes there are positive emotions influenced by music and culture. Human beings have different natures, and everyone has a different set of perceptions for their understanding [ 36 ]. However, every culture has a specific set of music, and the people belonging to this culture have a different set of mentality and culture. Access of people towards cultural information is possible through music. Indeed, people newly introduced to any culture also can get their critical information from their shared culture [ 23 ]. The accessibility to cultural understanding and information is improving the living standard of people concerning their cultural association. Music therapy is used almost in every culture for better human emotion development. The modern way of treatment is supported by music therapy, and based on this therapy people have relatable things to study [ 30 ]. The association of culture with music can’t be neglected, and it historically proved that every culture has a different set of music with relatable performances. Indeed, music performance and cultural awareness for music therapy are possible that can assist people to get a better understanding of their cultural values [ 21 ]. The relatable information to culture can promote cultural understanding for people and they can get a better approach towards sustainable psychology. Indeed, the role of music is critical in cultural awareness and promotion and people are required to focus on the cultural goals that are necessary for their better working approach. Music therapy is a widely used way of treatment in every culture, and people seem satisfied with this kind of treatment.

Hypothesis 1:

There is a positive relationship between music therapy and sustainable psychological well-being.

Health awareness is considered the fundamental way to improve the health status of the people. The people who are highly motivated to get health information, are seeking appropriate health opportunities in their life, and on the other hand, those who are not working to get better health facilities, are less motivated to get awareness [ 24 ]. The role of health awareness in the lives of people is critical because it can motivate them to get better treatment and work fairly. The relatable health information to the people and their cultural awareness can motivate them to get treatment for psychological well-being. People in every society have different sets of beliefs and opinions, and they are required to be motivated to a better standard of health and awareness [ 22 ]. The critical role of health awareness is necessary to improve the health standard of people, and people are required to have appropriate motivation to improve their psychological well-being. The role of music therapy is considered appropriate to improve human health, and people are required to get music therapy when they are not feeling well [ 10 ]. Almost, all people belonging to every set of age have a different set of opinions about their treatment. However, the better method to get emotional treatment is music therapy. By getting the entertainment of music, people can get into the catharsis that is necessary for their emotional improvement. The behavior of people for better achievement in health is possible when they have access to health awareness and better health standards [ 26 ]. The relatable health facilities are appropriately improved for the people when they are seeking any information. The awareness of the living standard of people is possible when they are highly motivated to get appropriate health standards. Reasonable health facilities are required for people to get better health opportunities, but music therapy should be used for both males and females to improve their health standards [ 8 ]. The way to improve public health can be a possible way to improve the standard of health in the right direction. People who are motivated to perform well, seek information that is appropriate to their better health standard. Reasonable working opportunities are required for people to get better health facilities when they are introduced to music therapy [ 19 ]. The influence of music therapy on public health is improved over time, and the awareness of the health facilities advanced people’s behavior for health awareness.

Hypothesis 2:

There is a positive moderating role of health awareness between music therapy and sustainable psychological well-being.

Maintaining health is a factor that is directly linked with people improving their work. Those individuals who are motivated to improve their health standards, are seeking relatable health awareness [ 18 ]. The advancement in health behavior can facilitate people to improve their health standards critically. Access to health is a significant factor that is improving public health facilities. Music therapy is considered one of the appropriate ways to promote public health. However, the people who are not motivated to get health facilities appropriately, are required to have health facilities in a significant way [ 9 ]. The relatable health facilities are appropriate for the public to improve their health standard accordingly. Awareness of health facilities can be a significant factor to improve the health behavior of the public. However, fewer people are motivated to get better health facilities, particularly music therapy in modern times. The awareness related to health facilities can promote the living standard of the public. In the meanwhile, those individuals who are less motivated to improve their health, are required to work appropriately for it [ 31 ]. Reasonable health facilities are appropriate for people, but they should have proper consciousness regarding their understanding and health facilities. The awareness to people of better health facilities can provide them with a way forward to improve their health reasonably. Furthermore, those people who have a systematic approach to improving their health, and they have rights plans for it, the health of these people is improved appropriately [ 33 ]. However, less focus on health improvement results in bad health conditions. Many people are highly motivated to improve the standard of their health, and they are required to improve their understanding and get treatment in new ways. The process of music therapy is simple in that people are motivated to improve the standard of their health with an effective approach. Access to public health can be a problem for people when they are motivated to improve their health standards [ 15 ]. Relatable health facilities are required for each disease, and for emotional disorders, therapy with music is highly recommended for the people. The advancement of modern treatment facilities is necessary for people to improve the standard of their health with effective performance and relatable opportunities. Music therapy is useful for people who are facing mental disorders or who are emotionally discouraged.

Hypothesis 3:

There is a positive moderating role of strategic health management between music therapy and sustainable psychological well-being.

The theoretical framework for this research is presented in Fig.  1 .

Theoretical model

Methodology

Questionnaire and pilot testing.

In the current research, the questionnaire was developed by the experts to measure the relationship between numerous variables and test the hypotheses as a matter of results. In such way, in view of past understandable literature, the arrangement of the questionnaire was developed furthermore with the help of the associated concerns. However, the experts had to get on table, and share their viewpoints on different theories. The questionnaire was developed ourself.

This is confirmatory research in which the relationship between different variables is tested with empirical data. In this way, the research is based on the primary data directly collected from the respondents. Since, this study is discussing music therapy for Chinese people in general; therefore, this research population is based on the Chinese community in Mainland China. The study has considered the sample size as 342 because according to Morgan’s Table when the population of any research is more than 1,00,000, then the data collection from 384 respondents would be appropriate for research findings. There was no inclusion and exclusion criteria for the respondents because the population was selected generally. However, the study has considered a Likert scale questionnaire for data collection because this kind of questionnaire is widely used when the behavior and perceptions of the people are required to be measured. Furthermore, this research has considered the reflective questionnaire that can be measured easily by the data collected on the Likert scale questionnaire. The scale items for this research are taken from the findings of existing studies in the literature. Before considering the scale items from these studies, the reliability and validity of the scale items were also tested. In this way, this research has tested the findings of composite reliability > 0.70 and Cronbach alpha > 0.70 for significant findings. The scale items for music therapy are adapted from the study [ 37 ], and it was determined that the scale items have validity and reliability. In the same way, the scale items for sustainable psychological well-being are adapted from the study [ 14 ], and it was determined that the scale items have validity and reliability. Furthermore, the scale items for strategic health management are adapted from the study [ 38 ], and it was determined that the scale items have validity and reliability. Finally, the scale items for health awareness are adapted from the study [ 16 ], and it was determined that the scale items have validity and reliability. According to scholars, when coefficient of reliability such as Cronbach’s alpha is above 0.70 for scale items, the researchers can use same scale in future research. Hence, the reliability of all scales were established based on the findings of source studies. The developed questionnaire is reported in Appendix 1 .

Data collection procedure

The face validity of the scale items was also confirmed by the expert researchers, and it was ensured that the items have appropriate validity. The research used a cross-sectional method of data collection because the scale items were reflective in nature, and many social sciences studies also used a cross-sectional method for data collection and analysis. The duration of data collection was two months because of response rate. However, the respondents were first informed about the purpose of study before the collection of data. Furthermore, the questionnaires were distributed to 500 respondents, and 401 responses were collected back. The respondents were targeted randomly to collect the data. Out of 401, 384 responses were selected back for the final findings of this research. The study has determined the findings with Smart PLS 3.0, and it has utilized the findings of measurement model assessment including convergent validity and discriminant validity, and the findings of structural model assessment including the path findings. These findings are significantly considered for the final empirical evidence of this research support.

Data analysis and findings

The collected data for this research is used to determine the missing values, skewness, and kurtosis. The findings of data normality are used to determine whether the data is useful or not. This research has considered the normality data test with skewness and kurtosis findings. The skewness values and the values of kurtosis for any research data are acceptable when lay between − 1 and + 1 [ 29 ]. The collected data for this research highlighted that the findings of this research have appropriate skewness and kurtosis values because no values were less than − 1 and more than + 1. In this way, the findings highlight that the study has the normality of data distribution. Furthermore, the analyzed data also showed the missing values, and there were no missing values in the data. Hence, the collected data for this research is appropriate and can be used for further tests. The findings are shown in Table  1 .

This research also tested the findings of convergent validity to determine the reliability and validity of research data. The findings of Cronbach alpha, composite reliability, and average variance extracted are checked for it. The composite reliability is tested to determine the reliability of data, the Cronbach alpha is used to test the validity of data, and the average variance extracted is used to test the variance between research data. The significant Cronbach alpha is achieved when the values are more than 0.70 [ 32 ], the significant composite reliability is achieved when the findings are more than 0.70 [ 28 ], and the significant average variance extracted is achieved when the values are more than 0.50 [ 2 ]. The results of these three reported that the study has significant composite reliability > 0.70, significant Cronbach alpha > 0.50, and significant average variance extracted > 0.50. However, the findings of factor loadings were also tested, and the significant factor loadings are achieved when the values are more than 0.60. The analyzed values show that the factor loadings for each item were more than 0.60, and this research has reliable items for data collection. The results are shown in Table  2 ; Fig.  2 .

Convergent validity

The findings of discriminant validity are also tested to determine discrimination between the research data [ 13 ]. This research has used two methods for the determination of discriminant validity. The findings are tested with Heteritrait-Monotrait (HTMT) method earlier. This method is used by the data analysis technique of the social science studies. However, the findings of HTMT < 0.90 are significantly acceptable [ 11 ]. The reported data in Table  3 ; Fig.  3 showed that the appropriate HTMT is achieved by the research findings.

However, the findings of cross-loadings are also used to determine the discriminant validity. This method is used to test the discriminant validity between the research data at the individual item level. The findings of discriminant validity with cross-loadings are significant when the values of items representing one variable are greater than the values of items that are correlated with it [ 4 ]. The output data of the cross-loadings displayed in Fig.  4 ; Table  4 highlighted that this research has appropriately considered discriminant validity. Thus, the data for this research has appropriate discriminant validity and can be used significantly in future studies.

Cross-loadings

Finally, the findings of the hypotheses were also tested, and this research has used structural equation modeling for path findings. The t-values were determined for the determination of the hypotheses’ status. The hypotheses of this research are directional, and the t > 1.64 is appropriate for significant hypotheses [ 27 ]. The analyzed data with the structural model reported that the first relationship of this research is significantly accepted, and there is a positive influence of music therapy on sustainable psychological well-being. The findings of the second hypothesis are also supported by the empirical data, and the study highlighted that there is a significant and positive moderating role of health awareness between music therapy and sustainable psychological well-being. This relationship is positive and strengthens the relationship between music therapy and sustainable psychological well-being, as shown in Fig.  5 . Finally, the findings of the third hypothesis are also supported by the empirical data, and the study emphasized that there is a significant and positive moderating role of strategic health management between music therapy and sustainable psychological well-being. This relationship is positive and strengthens the relationship between music therapy and sustainable psychological well-being, as shown in Fig.  6 . The results of structural equation modeling are highlighted in Fig.  7 ; Table  5 .

Moderation of health awareness

• Strategic health management

Path findings

The findings of this research are taken with measurement model assessment and structural model assessment. After the determination of data reliability, future tests are performed. The structural equation modeling approach is used to determine the findings of this research. The collected data significantly highlighted that the sustainable psychological well-being of the Chinese people is positively influenced by music therapy. Indeed, this relationship is newly developed in the literature, but the findings are in line with the conclusions of the existing studies in the literature. According to [ 10 ], music is regarded as the spirit’s nourishment since it evokes emotions that are relatable to people’s lifestyles and inspires them to interact with others more positively. The arts and entertainment may evoke negative emotions and other times good ones. People differ in nature, and each has a unique set of perceptions that they use to perceive things. According to [ 26 ], each culture has its distinct musical style and the individuals who make up that culture have their distinct mentalities and cultures. Music makes it feasible for people to access information about culture. A common language can indeed provide newcomers to any culture with essential knowledge. According to [ 15 ], one of the most important methods for enhancing human behavior and feelings is music therapy. While human behavior changes, it has a beneficial and important effect on the way people feel. Human behavior and psychology have advanced, which helps people function well in a variety of circumstances. People who struggle with their psychological well-being can experience a variety of cases, and they must work to improve their behavior and academic performance. According to [ 8 ], people’s improved psychological development can be aided by knowing about cultural environments and musical traditions. Human emotions and behavior are intertwined, and cultural associations help people enhance their overall well-being. Individual living standards are rising concerning their cultural affiliation thanks to the availability of cultural awareness and knowledge. Nearly every culture uses the use of music to promote the better development of feelings among individuals. According to [ 7 ], the application of music supports modern therapeutic methods, and patients can relate to the material studied as a result of this therapy. The public’s cultural awareness can be promoted by the knowledge that is relevant to them, and they can develop more effective strategies for practicing sustainability behavior. According to [ 9 ], music plays a crucial function in promoting understanding of cultures, and people must concentrate on the cultural objectives that are essential for their improved working methods. Every culture uses music therapy as a therapeutic method frequently, and people appear to enjoy it. According to [ 12 ], it is impossible to ignore how closely culture and music are related, and history has shown that each civilization has its distinctive musical repertoire and style of performance. It is feasible for people to learn more about their cultural values through performing musical pieces and cultural knowledge of music therapy. Hence, the role of music therapy should be considered practically to improve the psychological well-being of the public. It is important to advance the psychological well-being of the public which is helpful to improve. Therefore, the study rightly recommended the use of music therapy for improving psychological well-being of public.

Furthermore, this research has significantly reported that the empirical evidence supports that the moderating role of health awareness is significantly accepted between music therapy and sustainable psychological well-being. This relationship based on moderating effect is new in the literature on psychological well-being. However, the findings of this relationship are supported by the existing literature developed by the previous studies. According to [ 33 ], the primary means of enhancing people’s health status is thought to be raising their level of awareness of their health. On the contrary, people who have no opportunity to get superior medical care are less driven to get understanding. Individuals who are highly inspired to acquire health knowledge are looking for suitable healthcare possibilities throughout their lives. According to [ 36 ], the daily lives of individuals depend heavily on health knowledge since it can inspire them to receive better care and treat others decently. People may be encouraged to seek therapy for mental well-being if their medical data is relevant to them and they are aware of cultural differences. Individuals can enter the healing process that is required for psychological development by listening to interesting music. According to [ 17 ], whenever individuals have accessibility to improved health standards and health understanding, they are more likely to act in ways that will improve their health outcomes. When people are looking for information, the relevant healthcare facilities are upgraded appropriately. People can become conscious of their living standards when they are very motivated to achieve the right level of health. According to [ 22 ], while sufficient medical services are necessary for people to have better health opportunities, both men and women should use therapy in music to raise their standard of health. When someone is ill, they must take lessons in music therapy because music therapy is thought to be a useful tool for enhancing human health. According to [ 5 ], regardless of age, has a different set of thoughts about how they should be treated. However, music therapy is a more effective way to treat emotional issues. A potential strategy for raising the standard of health in the right direction is to enhance the health of the population. Individuals who are driven to succeed look to find knowledge that is compatible with their higher standard of health. According to [ 35 ], when people are introduced to music therapy, reasonable employment opportunities are necessary for them to have access to better healthcare. Each member of society holds a unique set of beliefs and perspectives, and it is necessary to inspire them to strive for a higher level of knowledge and health. Individuals must have the proper incentive to improve their mental happiness, and health knowledge plays a crucial part in raising people’s health standards. According to [ 23 ], the impact of music therapy on the general public has grown throughout time, and the public’s understanding of health resources has advanced their behavior in terms of health consciousness. The role of health awareness is reliable for the improvement in health standards of the public. Hence, the practitioners are motivated to use the music theory for psychological well-being of the public by ensuring the health awareness in public. The health awareness can provide better and reliable opportunities for the public to improve their standards of health.

Lastly, this research has significantly reported that the empirical evidence supports that the moderating role of strategic health management is significantly accepted between music therapy and sustainable psychological well-being. No doubt, this relationship based on moderating effect is new in the literature on psychological well-being. Nevertheless, the findings of this relationship are supported by the existing literature developed by the previous studies. According to [ 21 ], the component that is directly related to people’s ability to work better is the maintenance of their health. People who are motivated to raise their standard of health are looking for relatable health information. The development of healthy behaviors can help people significantly raise their level of health. The public’s medical facilities are being improved in large part due to increased access to healthcare. One of the relevant strategies for promoting public health is thought to be music therapy. According to [ 24 ], those who lack the necessary motivation to obtain medical treatment must be forced to do so in a significant manner. The required health facilities are available for the general public to raise their current level of health. Consumers can go forward to enhance their health practically by being more aware of improved medical resources. According to [ 31 ], the physical well-being of these individuals has enhanced appropriately if they have an organized method to doing so and the proper plans in place. However, failing to prioritize health improvement leads to poor health. Many people have a strong desire to raise their quality of health, but they must also learn more and receive care through novel methods. People who have the urge to better their health can do so through the straightforward process of therapeutic music listening. People’s knowledge about medical care can raise their level of living. According to [ 30 ], those people who are less driven to enhance their health must work appropriately for it in the interim. Individuals ought to possess proper awareness of their comprehension and medical facilities to benefit from reasonable healthcare resources. When someone is determined to raise their quality of health, getting access to healthcare services can be a challenge. According to [ 39 ], especially for each ailment, appropriate medical facilities are needed, and for persons with emotional disorders, music therapy is strongly advised. Health-related behavior can be significantly improved by raising awareness about medical resources. Nevertheless, fewer people today have the desire to access better healthcare, especially when it comes to the area of music therapy. For individuals to maintain their level of health with successful outcomes and relevant chances, cutting-edge medical services must advance. According to [ 18 ], people with mental illnesses or those who are emotionally depressed can benefit from learning about music therapy. Practically, this study also recommended that the health management should be in a strategic way by the people. It is important because strategic health management provides a way forward to the public for improving their psychological well-being. Hence, the findings of this research are critically important for advancement in health standards.

To sum up, the current study has some theoretical and practical implications to advance the literature and practice for sustainable psychological well-being respectively in post-covid 19 era. In clinical practice in post pandemic period, music therapy can be effectively used to improve the psychological well-being of individuals with sustainability. The information related to health awareness and practice for strategic health management is also necessary for the clinical patients to improve their psychological well-being. To conclude, the study asserted the importance of music therapy for improvement in psychological well-being of the Chinese community in post covid-19 era. The study recommends that the psychological well-being of the people was disturbed in post-covid-19 era which needs appropriate improvement for their better social life. The clinical practitioners are required to work in this direction to improve the level of their learning and performance.

Theoretical and practical implications

This research has developed a newly considered relationship based on theoretical underpinning. However, the empirical results supported the theoretically developed relationship of this research after post-covid era. The research advanced the literature of post covid-19 era on psychological well-being and reported that there is a significant and positive impact of music therapy on the sustainable psychological well-being of students. This relationship has introduced a new factor that is influencing sustainable psychological well-being. Furthermore, this study has contributed two moderating variables between the relationship between music therapy and sustainable psychological well-being, and the literature on psychological well-being is advanced by this research. The study has reported that health awareness is a significant moderator between music therapy and sustainable psychological well-being. This newly developed relationship also advanced the knowledge of psychological well-being with a significant moderating influence. Finally, the study has reported that strategic health management is a significant moderator between music therapy and sustainable psychological well-being. This newly developed relationship also advanced the knowledge of psychological well-being with a significant moderating influence. These findings also advanced the therapy of Psychodynamics as it is significantly accepted in the relationship between music therapy and sustainable psychological well-being. This research has novel findings as it has comprehensively introduced that the relationship between music therapy and psychological well-being can be strong when there is moderating influence of health awareness and strategic health management.

This research also has practical implications based on its significant findings. The study reported that music therapy should be considered the appropriate method to improve the psychological well-being of people. Indeed, people should go for music therapy when they are not appropriately treated for their emotional disorders or mental problems. Emotional health issues are critical, and these issues can damage the public who has a negative emotional state. However, the concerns for emotions are required to be improved with better psychological advancement. The required psychological improvement with music therapy can improve the health awareness and attitude of the public. The clinical treatment should add music therapy as a significant method of emotional treatment for those who are not in good mental health. This study also demonstrated that health awareness is necessary for people to get music therapy. The people have emotions and sentiments, but they can get better and more effective ways of health awareness when the government is creating awareness of health. The healthcare departments are required to promote health awareness in a critical way that should be acceptable for the public to improve their critical performance. However, strategic health management is also required to improve the health awareness of people which can be a significant factor in the advancement of health facilities for the public. The critical role of health awareness programs is to improve the health standard of the public with the newly introduced treatment of music therapy. The mental health of people can be improved significantly with music therapy. The clinical practitioners for psychological well-being can work on these practice-based recommendations to use music therapy for advancement in psychological well-being of the community. The role of music theory and health awareness is considered as critical in this research for advancement in psychological well-being of the community.

Future directions

No doubt, the findings of the study reported that there is a significant and positive influence of music therapy on the sustainable psychological well-being of the Chinese community. On the other hand, this study also concluded that there is a significant and positive moderating role of health awareness and strategic health management between music therapy and sustainable psychological well-being. The findings of this research are new and novel in the literature on psychological well-being. This research has some theoretical and practical implications to advance the literature and practice for sustainable psychological well-being respectively. Similar to the other studies, this research also has some limitations that are required to be addressed by future studies. This research has limitations as it has collected data from the Chinese population only, and the findings of this research can’t be generalized because data collection from backward countries may not support these results as people don’t have access to music therapy. Therefore, scholars are required to collect data from the population of another country to provide significant findings in the literature. Moreover, this research has collected data with a cross-sectional approach which is its limitation. In this way, the scholars are motivated to use the longitudinal data in future studies to understand the consequences of music therapy as well in post covid-19 era. Hence, it would be a significant addition to the body of knowledge.

Data availability

All the data within the manuscript.

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Liu, Y. Psychological wellbeing with music therapy: the moderating role of health awareness, and strategic health management in post Covid-19 era. BMC Psychol 12 , 355 (2024). https://doi.org/10.1186/s40359-024-01845-z

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