Conceptualizing the evidence pyramid for use in clinical practice: a narrative literature review

OBJECTIVE: To explore contemporary iterations of the evidence pyramid as applied in evidence-based practice. METHODS: We searched for articles published in PubMed, Web of Science, and Scopus databases between 2016 and 2024 that assessed the evidence pyramid and its application in clinical practice. Title/abstract and full-text screening were conducted by one reviewer to determine eligibility, followed by data extraction and analysis to summarize themes. RESULTS: Of 83 full-text articles identified, 28 were included. Extracted information centred on three common themes: (1) use of the evidence pyramid as a guide, not a rigid tool; 2) importance of the clinical question; and (3) necessity of clinical expertise to integrate research findings into clinical decision-making. CONCLUSION: Preliminary findings of our review suggest that, when applying the evidence pyramid in practice, clinicians should consider context (i.e., the clinical question, best available evidence, patient preferences, and clinical circumstances), to optimize clinical decision-making and patient outcomes. AUTHOR’S NOTE: This paper is one of seven in a series exploring contemporary perspectives on the application of the evidence-based framework in chiropractic care. The Evidence Based Chiropractic Care (EBCC) initiative aims to support chiropractors in their delivery of optimal patient-centred care. We encourage readers to review all papers in the series.