systematic literature review x narrative review

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Int J Prev Med

How to Write a Systematic Review: A Narrative Review

Ali hasanpour dehkordi.

Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran

Elaheh Mazaheri

1 Health Information Technology Research Center, Student Research Committee, Department of Medical Library and Information Sciences, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

Hanan A. Ibrahim

2 Department of International Relations, College of Law, Bayan University, Erbil, Kurdistan, Iraq

Sahar Dalvand

3 MSc in Biostatistics, Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran

Reza Ghanei Gheshlagh

4 Spiritual Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran

In recent years, published systematic reviews in the world and in Iran have been increasing. These studies are an important resource to answer evidence-based clinical questions and assist health policy-makers and students who want to identify evidence gaps in published research. Systematic review studies, with or without meta-analysis, synthesize all available evidence from studies focused on the same research question. In this study, the steps for a systematic review such as research question design and identification, the search for qualified published studies, the extraction and synthesis of information that pertain to the research question, and interpretation of the results are presented in details. This will be helpful to all interested researchers.

A systematic review, as its name suggests, is a systematic way of collecting, evaluating, integrating, and presenting findings from several studies on a specific question or topic.[ 1 ] A systematic review is a research that, by identifying and combining evidence, is tailored to and answers the research question, based on an assessment of all relevant studies.[ 2 , 3 ] To identify assess and interpret available research, identify effective and ineffective health-care interventions, provide integrated documentation to help decision-making, and identify the gap between studies is one of the most important reasons for conducting systematic review studies.[ 4 ]

In the review studies, the latest scientific information about a particular topic is criticized. In these studies, the terms of review, systematic review, and meta-analysis are used instead. A systematic review is done in one of two methods, quantitative (meta-analysis) and qualitative. In a meta-analysis, the results of two or more studies for the evaluation of say health interventions are combined to measure the effect of treatment, while in the qualitative method, the findings of other studies are combined without using statistical methods.[ 5 ]

Since 1999, various guidelines, including the QUORUM, the MOOSE, the STROBE, the CONSORT, and the QUADAS, have been introduced for reporting meta-analyses. But recently the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement has gained widespread popularity.[ 6 , 7 , 8 , 9 ] The systematic review process based on the PRISMA statement includes four steps of how to formulate research questions, define the eligibility criteria, identify all relevant studies, extract and synthesize data, and deduce and present results (answers to research questions).[ 2 ]

Systematic Review Protocol

Systematic reviews start with a protocol. The protocol is a researcher road map that outlines the goals, methodology, and outcomes of the research. Many journals advise writers to use the PRISMA statement to write the protocol.[ 10 ] The PRISMA checklist includes 27 items related to the content of a systematic review and meta-analysis and includes abstracts, methods, results, discussions, and financial resources.[ 11 ] PRISMA helps writers improve their systematic review and meta-analysis report. Reviewers and editors of medical journals acknowledge that while PRISMA may not be used as a tool to assess the methodological quality, it does help them to publish a better study article [ Figure 1 ].[ 12 ]

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Screening process and articles selection according to the PRISMA guidelines

The main step in designing the protocol is to define the main objectives of the study and provide some background information. Before starting a systematic review, it is important to assess that your study is not a duplicate; therefore, in search of published research, it is necessary to review PREOSPERO and the Cochrane Database of Systematic. Sometimes it is better to search, in four databases, related systematic reviews that have already been published (PubMed, Web of Sciences, Scopus, Cochrane), published systematic review protocols (PubMed, Web of Sciences, Scopus, Cochrane), systematic review protocols that have already been registered but have not been published (PROSPERO, Cochrane), and finally related published articles (PubMed, Web of Sciences, Scopus, Cochrane). The goal is to reduce duplicate research and keep up-to-date systematic reviews.[ 13 ]

Research questions

Writing a research question is the first step in systematic review that summarizes the main goal of the study.[ 14 ] The research question determines which types of studies should be included in the analysis (quantitative, qualitative, methodic mix, review overviews, or other studies). Sometimes a research question may be broken down into several more detailed questions.[ 15 ] The vague questions (such as: is walking helpful?) makes the researcher fail to be well focused on the collected studies or analyze them appropriately.[ 16 ] On the other hand, if the research question is rigid and restrictive (e.g., walking for 43 min and 3 times a week is better than walking for 38 min and 4 times a week?), there may not be enough studies in this area to answer this question and hence the generalizability of the findings to other populations will be reduced.[ 16 , 17 ] A good question in systematic review should include components that are PICOS style which include population (P), intervention (I), comparison (C), outcome (O), and setting (S).[ 18 ] Regarding the purpose of the study, control in clinical trials or pre-poststudies can replace C.[ 19 ]

Search and identify eligible texts

After clarifying the research question and before searching the databases, it is necessary to specify searching methods, articles screening, studies eligibility check, check of the references in eligible studies, data extraction, and data analysis. This helps researchers ensure that potential biases in the selection of potential studies are minimized.[ 14 , 17 ] It should also look at details such as which published and unpublished literature have been searched, how they were searched, by which mechanism they were searched, and what are the inclusion and exclusion criteria.[ 4 ] First, all studies are searched and collected according to predefined keywords; then the title, abstract, and the entire text are screened for relevance by the authors.[ 13 ] By screening articles based on their titles, researchers can quickly decide on whether to retain or remove an article. If more information is needed, the abstracts of the articles will also be reviewed. In the next step, the full text of the articles will be reviewed to identify the relevant articles, and the reason for the removal of excluded articles is reported.[ 20 ] Finally, it is recommended that the process of searching, selecting, and screening articles be reported as a flowchart.[ 21 ] By increasing research, finding up-to-date and relevant information has become more difficult.[ 22 ]

Currently, there is no specific guideline as to which databases should be searched, which database is the best, and how many should be searched; but overall, it is advisable to search broadly. Because no database covers all health topics, it is recommended to use several databases to search.[ 23 ] According to the A MeaSurement Tool to Assess Systematic Reviews scale (AMSTAR) at least two databases should be searched in systematic and meta-analysis, although more comprehensive and accurate results can be obtained by increasing the number of searched databases.[ 24 ] The type of database to be searched depends on the systematic review question. For example, in a clinical trial study, it is recommended that Cochrane, multi-regional clinical trial (mRCTs), and International Clinical Trials Registry Platform be searched.[ 25 ]

For example, MEDLINE, a product of the National Library of Medicine in the United States of America, focuses on peer-reviewed articles in biomedical and health issues, while Embase covers the broad field of pharmacology and summaries of conferences. CINAHL is a great resource for nursing and health research and PsycINFO is a great database for psychology, psychiatry, counseling, addiction, and behavioral problems. Also, national and regional databases can be used to search related articles.[ 26 , 27 ] In addition, the search for conferences and gray literature helps to resolve the file-drawn problem (negative studies that may not be published yet).[ 26 ] If a systematic review is carried out on articles in a particular country or region, the databases in that region or country should also be investigated. For example, Iranian researchers can use national databases such as Scientific Information Database and MagIran. Comprehensive search to identify the maximum number of existing studies leads to a minimization of the selection bias. In the search process, the available databases should be used as much as possible, since many databases are overlapping.[ 17 ] Searching 12 databases (PubMed, Scopus, Web of Science, EMBASE, GHL, VHL, Cochrane, Google Scholar, Clinical trials.gov, mRCTs, POPLINE, and SIGLE) covers all articles published in the field of medicine and health.[ 25 ] Some have suggested that references management software be used to search for more easy identification and removal of duplicate articles from several different databases.[ 20 ] At least one search strategy is presented in the article.[ 21 ]

Quality assessment

The methodological quality assessment of articles is a key step in systematic review that helps identify systemic errors (bias) in results and interpretations. In systematic review studies, unlike other review studies, qualitative assessment or risk of bias is required. There are currently several tools available to review the quality of the articles. The overall score of these tools may not provide sufficient information on the strengths and weaknesses of the studies.[ 28 ] At least two reviewers should independently evaluate the quality of the articles, and if there is any objection, the third author should be asked to examine the article or the two researchers agree on the discussion. Some believe that the study of the quality of studies should be done by removing the name of the journal, title, authors, and institutions in a Blinded fashion.[ 29 ]

There are several ways for quality assessment, such as Sack's quality assessment (1988),[ 30 ] overview quality assessment questionnaire (1991),[ 31 ] CASP (Critical Appraisal Skills Program),[ 32 ] and AMSTAR (2007),[ 33 ] Besides, CASP,[ 34 ] the National Institute for Health and Care Excellence,[ 35 ] and the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information checklists.[ 30 , 36 ] However, it is worth mentioning that there is no single tool for assessing the quality of all types of reviews, but each is more applicable to some types of reviews. Often, the STROBE tool is used to check the quality of articles. It reviews the title and abstract (item 1), introduction (items 2 and 3), implementation method (items 4–12), findings (items 13–17), discussion (Items 18–21), and funding (item 22). Eighteen items are used to review all articles, but four items (6, 12, 14, and 15) apply in certain situations.[ 9 ] The quality of interventional articles is often evaluated by the JADAD tool, which consists of three sections of randomization (2 scores), blinding (2 scores), and patient count (1 scores).[ 29 ]

Data extraction

At this stage, the researchers extract the necessary information in the selected articles. Elamin believes that reviewing the titles and abstracts and data extraction is a key step in the review process, which is often carried out by two of the research team independently, and ultimately, the results are compared.[ 37 ] This step aimed to prevent selection bias and it is recommended that the chance of agreement between the two researchers (Kappa coefficient) be reported at the end.[ 26 ] Although data collection forms may differ in systematic reviews, they all have information such as first author, year of publication, sample size, target community, region, and outcome. The purpose of data synthesis is to collect the findings of eligible studies, evaluate the strengths of the findings of the studies, and summarize the results. In data synthesis, we can use different analysis frameworks such as meta-ethnography, meta-analysis, or thematic synthesis.[ 38 ] Finally, after quality assessment, data analysis is conducted. The first step in this section is to provide a descriptive evaluation of each study and present the findings in a tabular form. Reviewing this table can determine how to combine and analyze various studies.[ 28 ] The data synthesis approach depends on the nature of the research question and the nature of the initial research studies.[ 39 ] After reviewing the bias and the abstract of the data, it is decided that the synthesis is carried out quantitatively or qualitatively. In case of conceptual heterogeneity (systematic differences in the study design, population, and interventions), the generalizability of the findings will be reduced and the study will not be meta-analysis. The meta-analysis study allows the estimation of the effect size, which is reported as the odds ratio, relative risk, hazard ratio, prevalence, correlation, sensitivity, specificity, and incidence with a confidence interval.[ 26 ]

Estimation of the effect size in systematic review and meta-analysis studies varies according to the type of studies entered into the analysis. Unlike the mean, prevalence, or incidence index, in odds ratio, relative risk, and hazard ratio, it is necessary to combine logarithm and logarithmic standard error of these statistics [ Table 1 ].

Effect size in systematic review and meta-analysis

OR=Odds ratio; RR=Relative risk; RCT= Randomized controlled trial; PPV: positive predictive value; NPV: negative predictive value; PLR: positive likelihood ratio; NLR: negative likelihood ratio; DOR: diagnostic odds ratio

Interpreting and presenting results (answers to research questions)

A systematic review ends with the interpretation of results. At this stage, the results of the study are summarized and the conclusions are presented to improve clinical and therapeutic decision-making. A systematic review with or without meta-analysis provides the best evidence available in the hierarchy of evidence-based practice.[ 14 ] Using meta-analysis can provide explicit conclusions. Conceptually, meta-analysis is used to combine the results of two or more studies that are similar to the specific intervention and the similar outcomes. In meta-analysis, instead of the simple average of the results of various studies, the weighted average of studies is reported, meaning studies with larger sample sizes account for more weight. To combine the results of various studies, we can use two models of fixed and random effects. In the fixed-effect model, it is assumed that the parameters studied are constant in all studies, and in the random-effect model, the measured parameter is assumed to be distributed between the studies and each study has measured some of it. This model offers a more conservative estimate.[ 40 ]

Three types of homogeneity tests can be used: (1) forest plot, (2) Cochrane's Q test (Chi-squared), and (3) Higgins I 2 statistics. In the forest plot, more overlap between confidence intervals indicates more homogeneity. In the Q statistic, when the P value is less than 0.1, it indicates heterogeneity exists and a random-effect model should be used.[ 41 ] Various tests such as the I 2 index are used to determine heterogeneity, values between 0 and 100; the values below 25%, between 25% and 50%, and above 75% indicate low, moderate, and high levels of heterogeneity, respectively.[ 26 , 42 ] The results of the meta-analyzing study are presented graphically using the forest plot, which shows the statistical weight of each study with a 95% confidence interval and a standard error of the mean.[ 40 ]

The importance of meta-analyses and systematic reviews in providing evidence useful in making clinical and policy decisions is ever-increasing. Nevertheless, they are prone to publication bias that occurs when positive or significant results are preferred for publication.[ 43 ] Song maintains that studies reporting a certain direction of results or powerful correlations may be more likely to be published than the studies which do not.[ 44 ] In addition, when searching for meta-analyses, gray literature (e.g., dissertations, conference abstracts, or book chapters) and unpublished studies may be missed. Moreover, meta-analyses only based on published studies may exaggerate the estimates of effect sizes; as a result, patients may be exposed to harmful or ineffective treatment methods.[ 44 , 45 ] However, there are some tests that can help in detecting negative expected results that are not included in a review due to publication bias.[ 46 ] In addition, publication bias can be reduced through searching for data that are not published.

Systematic reviews and meta-analyses have certain advantages; some of the most important ones are as follows: examining differences in the findings of different studies, summarizing results from various studies, increased accuracy of estimating effects, increased statistical power, overcoming problems related to small sample sizes, resolving controversies from disagreeing studies, increased generalizability of results, determining the possible need for new studies, overcoming the limitations of narrative reviews, and making new hypotheses for further research.[ 47 , 48 ]

Despite the importance of systematic reviews, the author may face numerous problems in searching, screening, and synthesizing data during this process. A systematic review requires extensive access to databases and journals that can be costly for nonacademic researchers.[ 13 ] Also, in reviewing the inclusion and exclusion criteria, the inevitable mindsets of browsers may be involved and the criteria are interpreted differently from each other.[ 49 ] Lee refers to some disadvantages of these studies, the most significant ones are as follows: a research field cannot be summarized by one number, publication bias, heterogeneity, combining unrelated things, being vulnerable to subjectivity, failing to account for all confounders, comparing variables that are not comparable, just focusing on main effects, and possible inconsistency with results of randomized trials.[ 47 ] Different types of programs are available to perform meta-analysis. Some of the most commonly used statistical programs are general statistical packages, including SAS, SPSS, R, and Stata. Using flexible commands in these programs, meta-analyses can be easily run and the results can be readily plotted out. However, these statistical programs are often expensive. An alternative to using statistical packages is to use programs designed for meta-analysis, including Metawin, RevMan, and Comprehensive Meta-analysis. However, these programs may have limitations, including that they can accept few data formats and do not provide much opportunity to set the graphical display of findings. Another alternative is to use Microsoft Excel. Although it is not a free software, it is usually found in many computers.[ 20 , 50 ]

A systematic review study is a powerful and valuable tool for answering research questions, generating new hypotheses, and identifying areas where there is a lack of tangible knowledge. A systematic review study provides an excellent opportunity for researchers to improve critical assessment and evidence synthesis skills.

Authors' contributions

All authors contributed equally to this work.

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Conflicts of interest.

There are no conflicts of interest.

About Systematic Reviews

The Difference Between Narrative Review and Systematic Review

systematic literature review x narrative review

Automate every stage of your literature review to produce evidence-based research faster and more accurately.

Reviews in scientific research are tools that help synthesize literature on a topic of interest and describe its current state. Different types of reviews are conducted depending on the research question and the scope of the review. A systematic review is one such review that is robust, reproducible, and transparent. It involves collating evidence by using all of the eligible and critically appraised literature available on a certain topic. To know more about how to do a systematic review , you can check out our article at the link. The primary aim of a systematic review is to recommend best practices and inform policy development. Hence, there is a need for high-quality, focused, and precise methods and reporting. For more exploratory research questions, methods such as a scoping review are employed. Be sure you understand the difference between a systematic review and a scoping review , if you don’t, check out the link to learn more.

When the word “review” alone is used to describe a research paper, the first thing that should come to mind is that it is a literature review. Almost every researcher starts off their career with literature reviews. To know the difference between a systematic review and a literature review , read on here. Traditional literature reviews are also sometimes referred to as narrative reviews since they use narrative analysis to synthesize data. In this article, we will explore the differences between a systematic review and a narrative review, in further detail.

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systematic literature review x narrative review

Narrative Review vs Systematic Review

Both systematic and narrative reviews are classified as secondary research studies since they both use existing primary research studies e.g. case studies. Despite this similarity, there are key differences in their methodology and scope. The major differences between them lie in their objectives, methodology, and application areas.

Differences In Objective

The main objective of a systematic review is to formulate a well-defined research question and use qualitative and quantitative methods to analyze all the available evidence attempting to answer the question. In contrast, narrative reviews can address one or more questions with a much broader scope. The efficacy of narrative reviews is irreplaceable in tracking the development of a scientific principle, or a clinical concept. This ability to conduct a wider exploration could be lost in the restrictive framework of a systematic review.

Differences in Methodology

For systematic reviews, there are guidelines provided by the Cochrane Handbook, ROSES, and the PRISMA statement that can help determine the protocol, and methodology to be used. However, for narrative reviews, such standard guidelines do not exist. Although, there are recommendations available.

Systematic reviews comprise an explicit, transparent, and pre-specified methodology. The methodology followed in a systematic review is as follows,

A narrative review on the other hand does not have a strict protocol to be followed. The design of the review depends on its author and the objectives of the review. As yet, there is no consensus on the standard structure of a narrative review. The preferred approach is the IMRAD (Introduction, Methods, Results, and Discussion) [2]. Apart from the author’s preferences, a narrative review structure must respect the journal style and conventions followed in the respective field.

Differences in Application areas

Narrative reviews are aimed at identifying and summarizing what has previously been published. Their general applications include exploring existing debates, the appraisal of previous studies conducted on a certain topic, identifying knowledge gaps, and speculating on the latest interventions available. They are also used to track and report on changes that have occurred in an existing field of research. The main purpose is to deepen the understanding in a certain research area. The results of a systematic review provide the most valid evidence to guide clinical decision-making and inform policy development [1]. They have now become the gold standard in evidence-based medicine [1].

Although both types of reviews come with their own benefits and limitations, researchers should carefully consider the differences between them before making a decision on which review type to use.

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systematic literature review x narrative review

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Difference Between Systematic Review and Narrative Reviews

Watching now: Chapter 1: A Comparison of Systematic and Narrative Literature Reviews Start time: 00:00:00 End time: 00:02:54

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(2020). Difference between systematic review and narrative reviews [Video]. Sage Research Methods. https:// doi. org/10.4135/9781529627206

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A comparison of systematic and narrative literature reviews highlighting their distinct characteristics and goals.

Chapter 1: A Comparison of Systematic and Narrative Literature Reviews

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Systematic reviews versus narrative reviews in clinical anatomy: Methodological approaches in the era of evidence-based anatomy

Two main types of review articles with distinct characteristics and goals are commonly found in the scientific literature: systematic reviews and narrative (also called expert or traditional) reviews. Narrative reviews are publications that describe and discuss the state of science on a specific topic or theme from a theoretical and contextual point of view with little explicit structure for gathering and presenting evidence. Systematic reviews are overviews of the literature undertaken by identifying, critically appraising and synthesizing the results of primary research studies using an explicit methodological approach. With the recent rise of evidence-based anatomy, important questions arise with respect to the utility of narrative reviews in clinical anatomy. The goal of this perspective article is to address the key differences between narrative and systematic reviews in the context of clinical anatomy, to provide guidance on which type of review is most appropriate for a specific issue, and to summarize how the two types of reviews can work in unison to enhance the quality of anatomical research and its delivery to clinicians and anatomists alike. Clin. Anat. 31:364-367, 2018. © 2018 Wiley Periodicals, Inc.

Keywords: clinical anatomy; evidence-based anatomy; literature review; methodology; systematic review.

© 2018 Wiley Periodicals, Inc.

Publication types

Narrative vs systematic vs scoping review: What’s the difference?

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I often get asked what the difference between a narrative review and a systematic review is, or what the difference between a narrative review and a scoping review is. This is also something I wondered about when I was new to the world of research.

Let’s first look at what a systematic review and scoping review are. A systematic review is done to identify research studies published on a certain topic, with the primary aim to recommend best practice on a certain topic and inform policy. This is very useful if there are discrepancies in the way in which a certain practice is performed, but also to recommend new approaches to practice. A scoping review is done to determine the research out there on a certain topic. Scoping reviews do not involve a critical appraisal process like systematic reviews do, but they are also conducted using a rigorous and systematic process. This video elaborates on the difference between systematic and scoping reviews.

A narrative review, also referred to as a traditional review, summarises and presents the available research on a topic. You will commonly see a traditional or narrative review as part of a thesis or dissertation. A narrative review is more biased than systematic and scoping reviews as it relies on the author’s background knowledge on a topic.

Zachary Munn, and his colleagues, all of them systematic review experts, alludes to the difference in a very useful article published in 2018 . Munn et al list the differences between scoping reviews and narrative reviews, but the same goes for the difference between systematic reviews and narrative reviews. Scoping reviews:

1. “Are informed by an a priori protocol;

2. Are systematic and often include exhaustive searching for information;

3. Aim to be transparent and reproducible;

4. Include steps to reduce error and increase reliability (such as the inclusion of multiple reviewers);

5. Ensure data is extracted and presented in a structured way”.

In Table 1 of this article , the difference between the three types of review becomes clear.

How do you know if an article is a narrative review or a systematic review or scoping review? These three look different to one another. In the video below, we look at an example of each.

Now that you know the difference between a narrative review, a scoping and a systematic review, you are ready to decide if a narrative review needs to be done or should it be a systematic or scoping review. If you know that you need to do a systematic review or scoping review, but you are not sure what the difference is, or if you can’t decide what type of systematic review you want to do, or even if you want to figure out the difference between a systematic review and meta-analysis, have a look at the Systematic Reviews playlist on the Research Masterminds YouTube channel to get your questions answered. And while you are at it, subscribe to the Research Masterminds YouTube channel .

One last thing, if you are a (post)graduate student working on a masters or doctoral research project, and you are passionate about life, adamant about completing your studies successfully and ready to get a head-start on your academic career, this opportunity is for you! An awesome membership site - a safe haven offering you coaching, community and content to boost your research experience and productivity. Check it out! https://researchmasterminds.com/academy

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Opinion article, systematic vs. narrative reviews in sport and exercise psychology: is either approach superior to the other.

Introduction

With the explosion of published primary research there has been a parallel increase of secondary literature. Literature reviews substantially reduce the burden of readership, as readers are not only given a shortcut to the most important citations without having to review the wider literature pool on a certain topic but are also given an intelligent synthesis from the perspective of an expert. Although there are many published methodological guidelines (e.g., Grant and Booth, 2009 ; Higgins et al., 2019 ; Snyder, 2019 ) on how to conduct literature reviews, the interdisciplinary nature and broad scope of topics that are covered by the umbrella term of sport psychology calls for a critical discussion of how to adopt methodological guidelines developed in other fields. This paper addresses the increasing opinion ( Mulrow et al., 1988 ; Higgins et al., 2019 ) that systematic reviews are the state of the art and superior to other forms of reviews as they have explicit and reproducible methodology and are assumed to be less biased than other reviews ( Faggion et al., 2017 ).

We have made the experience and heard increasing reports in which editors and reviewers reject articles on the simple grounds of being “not systematic.” It is arguably more difficult and arduous to evaluate narrative reviews compared to systematic reviews given the precise methodological guidelines available for systematic reviews. However, this does not mean that systematic reviews are always the superior form of literature review, particularly in a diverse, interdisciplinary research field like sport and exercise psychology. Similar to Abraham Maslow's 1966 law of instrument (… “ it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail .” p. 15) we will argue that different forms of literature review have different goals, are better suited for different questions or bodies of literature, cannot be ranked hierarchically, should be viewed as complementary, and need to be reviewed and evaluated differently.

Systematic Review

In 1993 the Cochrane collaboration was founded with the goal to enhance healthcare knowledge and to facilitate health-related decision making by providing high-quality information by publishing and updating guidelines of how to synthesize knowledge in the form of systematic reviews ( Higgins et al., 2019 ; Johnson and Hennessy, 2019 ; Alexander, 2020 ). The defining features of systematic reviews is a predetermined structured method to search, screen, select, appraise, and summarize primary research findings to answer a highly specific research question. The recommendation is to use an algorithmic approach by first explicitly stating the narrow research question and the exhaustive literature search methodology with precise predetermined inclusion and exclusion criteria. Usually a large body of articles are initially identified and subsequently whittled down to a lower number before the researcher starts to read the articles. The next step typically entails the creation of tables by extracting data from the primary research articles and mathematically summing the findings. The recommended approach for reporting the findings has been published on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) website ( http://www.prisma-statement.org/ ) which originated from a report by Cynthia Mulrow and coauthors ( Mulrow et al., 1988 ) that identified major pitfalls of published reviews (see AMSTAR for an alternative approach, Shea et al., 2017 ).

Narrative Review

A narrative review can be defined as a scholarly report of a body of literature that includes interpretation and critique ( Baumeister and Leary, 1997 ; MacLure, 2005 ; Grant and Booth, 2009 ; Greenhalgh et al., 2018 ). Although there are different types of narrative reviews that differ in their goals and approaches, it is important to note that none of these approaches is unsystematic, or ad-hoc , or even careless. A common goal of narrative reviews is to provide authoritative argument based on published primary evidence that is convincing to readers. Further goals are to enhance understanding of a topic and theory development (e.g., Dixon-Woods et al., 2006 ). A narrative review may or may not use systematic search methods with fixed inclusion/exclusion criteria. Narrative reviews are also often referred to as integrative ( Torraco, 2005 ; Whittemore and Knafl, 2005 ) or critical review ( Grant and Booth, 2009 ; Saunders and Rojon, 2011 ). There are many labels for different types of narrative reviews which we do not want to discuss in this commentary ( MacLure, 2005 ; Grant and Booth, 2009 ; Greenhalgh et al., 2018 ), however they all share the distinctive goal of advancing understanding and theory development of a certain topic.

Systematic or Narrative Review in Sport and Exercise Psychology?

It clearly depends on the aim of the researcher and the questions attempted to address that determine which type of approach to choose. However, people should not conflate “systematic” with superior quality and “narrative” with inferior quality ( Greenhalgh et al., 2018 ):

This implicit evidence hierarchy (or pyramid) elevates the mechanistic processes of exhaustive search, wide exclusion and mathematical averaging over the thoughtful, in-depth, critically reflective processes of engagement with ideas (p. 3).

We do not consider it sensible to primarily educate students and young scholars in the technical skills of searching, sorting, utilizing inclusion/exclusion criteria, extracting data, and calculating summarizing statistics at the expense of understanding, argumentation, weighing evidence, writing, and formulating convincing narratives. Even though people have great confidence in numbers, which seems to be deeply rooted in human psychology ( Porter, 2020 ), “ numbers or data have no way of speaking for themselves ” ( Silver, 2012 , p. 9). It is very unlikely that we will draw important conclusions and enhance cumulative understanding by simply extracting numbers from primary research without corresponding interpretation and theory, or as stated in the editorial of Psychological Bulletin: “ evidence synthesis that focuses purely on fancy statistical operations is unlikely to ‘tell the story' of a phenomenon ” ( Johnson, 2021 , p. 1).

The medical field has also acknowledged the problems of the mass production of systematic reviews. Prominent scholar Ioannidis (2016) critiqued the massive production of systematic reviews as this can be harmful due to the major prestige these types of publication: “ these instruments often serve mostly as easily produced publishable units or marketing tools ” (p. 485). In sport psychology there seems to be a similar trend, although there is the added difficulty that the methodologies used in these fields are very diverse and therefore cannot be easily be integrated in systematic reviews. While some research in sport psychology is focused on testing interventions (e.g., to improve performance or increasing exercise participation) a vast amount of research is focused on understanding the complex nature of the psychology of sport performance and exercise behavior. As research on the latter does not have an agreed-upon gold standard methodology like double-blind-randomized-controlled-trials, this research often requires narrative literature reviews that are focused on advancing theoretical understanding (e.g., Strauss, 2002 ; Nieuwenhuys and Oudejans, 2012 ). Considering calls for a renewed focus on theory development in psychological science ( Muthukrishna and Henrich, 2019 ; Berkman and Wilson, 2021 ; Eronen and Bringmann, 2021 ) we consider narrative reviews highly important in this endeavor in sport psychology.

A common argument for systematic reviews over narrative reviews is that systematic reviews are less biased due to its dispassionate, instrumental nature that apparently leaves no room for subjectivity. However, this “view from nowhere perspective” is neither realistic nor even desirable as different perspectives and discourse are a prerequisite for scientific progress ( Merton, 1938 ). Moreover, it is even questionable if the systematic review technique is superior in reducing bias given recent demonstrations that data have no way of speaking for themselves ( Silberzahn et al., 2018 ).

Narrative reviews are also not without problems and can be performed badly. Authors might “cherry pick” certain primary research to bolster a certain opinion. However, the quality of a literature review should not be determined or influenced simply by the words “systematic” or “narrative” in the title. Although there are some distinguishing characteristics between the two broad categories “systematic” and “narrative” there are no clear boundaries between these categories and there are many subtypes that share features of both types of review categories. Therefore, it can be sensible to combine the “best of both worlds” by integrating systematic methodology and narrative approaches, which is precisely what characterizes good reviews ( Johnson, 2021 ). Several recent publications ( Johnson and Hennessy, 2019 ; Alexander, 2020 ; Hulland and Houston, 2020 ) have proposed guidelines of improving systematic reviews, especially regarding their role in theory development. However, these guidelines typically pertain to systematic reviews and not to narrative reviews and often implicitly demean narrative reviews by using terminology like “meandering narrative stroll” ( Hulland and Houston, 2020 , p. 352) or “simple narrative description” ( Hulland and Houston, 2020 , p. 353). Hence, the following section summarizes ways of improving narrative reviews and defending their role in the scholarship of sport psychology.

Writing and Evaluating a Narrative Review

This section is not supposed to be a “How to Guide” of writing what we consider to be a good literature review. Instead we propose some guiding questions that might help authors give readers an interpretative overview of a topic with the aim of clearly highlighting the state of knowledge in a field, outlining how this knowledge was obtained, highlighting uncertainty in a field, and thereby pointing to the most important unanswered questions. No matter what type of review an author adopts they need to specify the topic and the goal of the review. Baumeister and Leary (1997) propose five goals of narrative reviews: (1) theory development; (2) theory evaluation; (3) survey the state of knowledge on a particular topic; (4) problem identification; (5) historical account of a particular research topic. Once the goal of a narrative review has been stated the following guiding questions (adapted from Baumeister and Leary, 1997 ; Saunders and Rojon, 2011 ) might be helpful for writing and evaluating the literature review. (1) Are the goals of the literature review explicitly stated and contextualized?; (2) Has the most relevant research on the topic been identified and included?; (3) Has the strength of evidence been addressed? (4) How consistent is the evidence and what factors are associated with variability? (5) Has the included primary research been critically evaluated and reported with a clear structure that is logical to the reader?; (6) Is primary research included that both supports and opposes the main arguments of the author? (7) Are explicit and comprehensible reasons mentioned for excluding primary literature; (8) Is empirical evidence clearly distinguished from personal or expert opinion?; (9) Are the arguments made logically and are they justified with valid evidence?; (10) Does the report point out areas of agreement and disagreement? (11) Are the conclusions straight-forward and logical?; (12) Does the report explicitly identify limitations and future research directions that follow from the review in a logical manner?

The unreflective adoption of the systematic review approach that originated in the field of medicine as the gold standard of literature reviews has received hefty critique ( Greenhalgh, 2012 ; Ioannidis, 2016 ; Greenhalgh et al., 2018 ). The problem of adopting the systematic review approach as gold standard in other fields has been vividly captured in the field of education by a report with the memorable title “Clarity bordering on stupidity:” where's the quality in systematic review? ( MacLure, 2005 ). We do not question the merit of systematic reviews for some questions in the field of sport psychology but consider narrative reviews as equally important complementary approaches. Or stated in the words of Maslow (1966) , just as carpenters need different tools to get different jobs done, (sport)psychological researchers need different tools for summarizing the quickly growing body of primary research. There is no hierarchy in these different approaches and the merit of each of these approaches needs to be evaluated differently. Hence, we neither recommend rejecting literature reviews on the simple grounds that they are “not systematic” nor do we recommend the simple rule of thumb to revise narrative reviews to be transformed to systematic reviews as “ the narrative review is not a poor cousin of the systematic review but a different and potentially complementary form of scholarship ” ( Greenhalgh et al., 2018 , p. 4).

Author Contributions

PF wrote the first draft of the manuscript. NG contributed to this draft and provided critical feedback. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords: secondary literature, PRISMA, Cochrane, literature review, critical review

Citation: Furley P and Goldschmied N (2021) Systematic vs. Narrative Reviews in Sport and Exercise Psychology: Is Either Approach Superior to the Other? Front. Psychol. 12:685082. doi: 10.3389/fpsyg.2021.685082

Received: 24 March 2021; Accepted: 17 June 2021; Published: 09 July 2021.

Copyright © 2021 Furley and Goldschmied. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Philip Furley, p.furley@dshs-koeln.de ; Nadav Goldschmied, ngoldschmied@sandiego.edu

How to Practice Academic Medicine and Publish from Developing Countries? pp 277–281 Cite as

Systematic, Scoping and Narrative Reviews

A Systematic Review is an attempt to distill the essence of a large number of studies in medicine by first asking a research question and then first identifying and later synthesizing carefully chosen studies of a high quality which might provide the answers. A more precise definition is ‘a summary of the medical literature that uses explicit and reproducible methods to systematically search, critically appraise and synthesise the results of multiple primary studies related to each other by using strategies to reduce bias and random errors’ [1].

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1 What Is a Systematic Review?

A Systematic Review is an attempt to distill the essence of a large number of studies in medicine by first asking a research question and then first identifying and later synthesizing carefully chosen studies of a high quality which might provide the answers. A more precise definition is ‘a summary of the medical literature that uses explicit and reproducible methods to systematically search, critically appraise and synthesise the results of multiple primary studies related to each other by using strategies to reduce bias and random errors’ [ 1 ].

In 1979, Archibald Cochrane, a Scottish doctor, proposed: ‘It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials’. Cochrane was one of the founding fathers of evidence-based medicine (Fig. 29.1 ). He highlighted and advocated the importance of critically summarizing the findings of research studies and designated the systematic review as a method of providing such a summary. This ultimately led to the development of the Cochrane Collaboration in 1993 [ 2 ]. The findings of systematic reviews are now widely used for clinical decision-making and have become integral towards the development of sound clinical practice guidelines and recommendations. In fact, they now occupy the summit of the pyramid for the quality of evidence.

Shows the quality of evidence from various types of research papers

2 How Is a Systematic Review Done?

It is done using the following steps:

Step 1 —Defining the research question clearly and formulating criteria for which reports to include.

Searching for and selecting these studies and collecting their data. This will involve a review of all the available databases and citation indexes like the Web of Science, Embase, PubMed and others using different search technologies or even artificial intelligence-based tools. Each study should conform to the PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analyses) guidelines or the standards of the Cochrane Collaboration [ 3 ].

The PRISMA guidelines (Fig. 29.2 ) are steps that depict the flow of information through the different phases of a systematic review. It maps out the number of records identified, included and excluded, and the reasons for exclusions.

PRISMA guidelines

Step 2 —Assess their risk of bias. The review should use an objective and transparent approach for collection and synthesizing the data to minimize bias.

Step 3 —Analyse the data and undertake a meta-analysis. This may involve using complex statistical methods and the more data that is analyzed the more confident we can be of the result.

Step 4 —Write conclusions. Present the results and summarize the findings. Interpret the results, draw conclusions and suggest a message.

3 Why Is a Systematic Review Useful?

Many clinical decisions are guided by published studies but, unfortunately, there are now too many to choose from for a busy clinician. These studies often vary in their design, methodological quality, population involved and the intervention or condition considered. To take a rational clinical decision involves trying to reconcile the results of studies that provide different answers to the same question. Because it is often impractical for readers to track down and read all of the primary studies, systematic review articles are an important source of summarized evidence on a particular topic [ 4 , 5 ].

4 What Are Its Weaknesses?

Most systematic reviews focus on a single question when more than one may be relevant in a particular situation, e.g., the best treatment for variceal bleeding in a developed country may be endoscopic sclerotherapy but not in a person in a developing country who is poor, has good liver function and does not have access to sophisticated medical facilities. In him or her a portosystemic shunt operation and a one-time procedure may be the more appropriate.

Then search strategies are often not provided in detail, the selection of studies may be biased, and only the positive results may reach publication. It also takes about 6 months to complete a single systematic review [ 6 , 7 ].

5 What Is a Meta-Analysis? How Does It Differ from a Systematic Review?

A meta-analysis is a summary of data collected from multiple sources by collating it and helping to frame guidelines. While a systematic review includes the entire process of collecting, reviewing and presenting all available evidence, a meta-analysis only refers to the statistical technique of extracting and combining the data to produce a summary [ 7 , 8 ].

6 What Are Scoping and Narrative Reviews? How Do They Differ from a Systematic Review?

A Scoping review is a preliminary assessment of the potential size and scope of the available research literature. It aims to identify the nature and extent of research evidence (usually including ongoing research) and present an overview of a potentially large and diverse body of literature pertaining to a broad topic. In contrast, a systematic review attempts to collate empirical evidence from a relatively smaller number of studies pertaining to a focused research question.

A Narrative review is the type first-year college students often learn as a general approach. Its purpose is to identify a few studies that describe a problem of interest. Narrative reviews have no predetermined research question or specified search strategy, only a topic of interest. They are not systematic and follow no specified protocol. No standards or protocols guide the review. Although the reviewers will learn about the problem, they will not arrive at a comprehensive understanding of the state of the science related to the problem [ 9 , 10 ]. No strict rules are there for narrative review and can be done using the keywords.

7 Conclusions

A Systemic review gives a comprehensive and complete plan and search approach to study a topic of interest. This reduces the bias by recognizing, assessing and creating all relevant studies on a particular topic.

Systematic reviews can be ambiguous, not helpful, or even harmful when data are incorrectly handled.

A Meta-analysis involves using statistical methods to create the data from several studies into a single quantitative study.

Outcomes from a meta-analysis may help to estimate the effect of treatment or risk factors for disease, or other outcomes.

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Nundy, S., Kakar, A., Bhutta, Z.A. (2022). Systematic, Scoping and Narrative Reviews. In: How to Practice Academic Medicine and Publish from Developing Countries?. Springer, Singapore. https://doi.org/10.1007/978-981-16-5248-6_29

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