SANRA Tool for Assessing Narrative Review Articles
                     SANRA: 
Tool for 
Assessing 
Narrative 
Review 
Articles
Introduction
SANRA is a tool for improving the 
quality of narrative articles. The 
tool was developed in 2010 and 
has been revised to make it 
simpler. The tool allows the editor 
to judge the quality of the 
manuscript and the readers to 
identify the relevance. It should be 
incorporated while authoring the 
narrative review articles.
Narrative Review Articles
Narrative reviews form an important 
part of medical literature. In medical 
literature, narrative reviews have 
the largest share of text. There are 
two types of literature reviews, i.e. 
systematic reviews and narrative or 
non-systematic reviews. While 
various guidelines have been 
proposed for systematic reviews, 
there are no standard guidelines for 
non-systematic or narrative 
reviews. 
Advantages of Narrative 
Review Articles
Comprehensiveness: Narrative reviews 
provide more detailed and 
comprehensive information about a 
particular topic. They also include the 
debate and current lack of knowledge.
Avoid duplication: By including several 
primary studies, the narrative reviews 
avoid duplication of studies performed.
Guide future research: As they 
provide information about the lack of 
knowledge in a particular area, they act 
as guiding light for future researches.
New medical intervention: Through 
the analysis of primary studies, they 
sometimes propose a new medical 
intervention.
Assessing Narrative Review 
Articles: SANRA
Although narrative review articles or 
non-systematic reviews play an 
important role in the dissemination 
of medical information, they are 
generally considered as non-
authentic and unreliable. This is 
probably the reason that the non-
systematic reviews are placed lower 
in the hierarchy of evidence-based 
medicine relative to systematic 
reviews.
The main aim of developing SANRA was 
to help the editors to determine the 
quality of narrative reviews, the readers 
to evaluate what quality of review they 
are reading, and to improve the authors 
in writing the narrative review.
The scale was then revised into a 6-
item version. Each item has a score 
from 0 to 2, 0 being the low standard 
while 2 is a high standard score. 1 is 
considered as the intermediate score. 
The maximum score a narrative review 
can achieve can be 12. The 6 items that 
form the part of SANRA are:
1) Important to readers: This item 
determines whether a proper 
justification is given to prove the 
importance of narrative reviews to 
readers. 
2) Aims of the narrative reviews: If 
the aims of the review or questions are 
formulated concretely, scores are given 
to the article.
3) Comprehensive literature search 
description: If the search strategy is 
not provided in the article, a 0 score is 
given. 
4) Referencing: If the key statements 
in the review are included without any 
appropriate references, the score given 
is 0, while for key statements with 
references, score 2 is allotted.
5) Scientific reasoning: Scientific 
reasoning is an important part of the 
narrative review. 
6) Appropriate presentation of 
data: The author should present the 
data completely and in the most 
appropriate manner. 
A field testing was carried out to 
determine the internal consistency, item-
total correlation, feasibility, validity, and 
reliability. All the three developers of 
SANRA rated the 30 manuscripts without 
systematic literature searches. These 
manuscripts were submitted to 
Deutsches Ärzteblatt in 2015. These 
ratings were given blindly and 
independently of each other. The SANRA 
should be incorporated while authoring 
and reviewing the narrative reviews, 
which are widespread in the medical 
literature. 
REFERENCE
Baethge C, Goldbeck-Wood S, Mertens 
S. SANRA-a scale for the quality 
assessment of narrative review 
articles. Res Integr Peer Rev 2019; 4: 5
Bastian H, Glasziou P, Chalmers I. 
Seventy-five trials and eleven 
systematic reviews a day: how will we 
ever keep up? PLoS Med. 
2010;7(9):e1000326.
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