What is the level of Narrative Reviews on the evidence pyramid?

Narrative reviews represent a foundational level of evidence on the evidence pyramid due to several key characteristics. They primarily synthesize existing literature and share insights without a rigorous systematic approach. These reviews do not follow a standardized protocol to search, select, and analyze studies, which can lead to bias in how information is interpreted and presented.

In contrast to systematic reviews or meta-analyses, which provide a structured methodology to evaluate and synthesize research findings, narrative reviews are more subjective. They often reflect the author's perspective rather than an objective aggregation of all relevant evidence. This makes narrative reviews less reliable for informing clinical practices or guidelines compared to higher levels of the evidence pyramid, which prioritize rigorously defined methodologies to ensure accuracy and comprehensiveness.

Consequently, narrative reviews hold a position at the bottom of the evidence pyramid, indicating that they should be interpreted cautiously and supplemented with more robust sources of evidence whenever possible.