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The applicability of grading systems for guidelines
Adrian Baker1, Jonathan Potter, Katharine Young
1NHS Plus, Bristol, UK.
Journal of Evaluation in Clinical Practice
|May 28, 2011
Summary
Specialist societies should carefully select evidence grading systems like GRADE, SIGN, and NSF-LTC based on evidence type and appraiser expertise. Training is crucial for accurate grading and recommendation assessment.
Area of Science:
- Health services research
- Clinical guideline development
- Evidence-based practice
Background:
- Specialist societies face challenges selecting appropriate evidence grading systems.
- Key considerations include methodological rigor, applicability, and ease of use.
- This study evaluated the Scottish Intercollegiate Guidelines Network (SIGN), Grading of Recommendations Assessment, Development and Evaluation (GRADE), and National Service Framework for long-term neurological conditions critical appraisal tool (NSF-LTC).
Purpose of the Study:
- To assess specialist societies' concerns regarding evidence grading systems.
- To compare the usability and perceived rigor of SIGN, GRADE, and NSF-LTC.
- To identify factors influencing the selection and application of these systems.
Main Methods:
- Twelve assessors evaluated papers and recommendations from diverse clinical guidelines.
- Assessors used SIGN, GRADE, and NSF-LTC over three months.
- Qualitative questionnaires and thematic analysis were employed to gather feedback.
Main Results:
- All systems presented trade-offs between complexity, rigor, and usability.
- GRADE was perceived as most rigorous but complex; SIGN and NSF-LTC were easier but less rigorous.
- Significant incorrect usage rates were observed for all systems in grading evidence and recommendations, particularly NSF-LTC for evidence and GRADE for recommendations.
Conclusions:
- System selection should align with the nature of evidence and appraiser experience.
- Inadequate training contributed to incorrect system application.
- Recommendations include tailored system selection and comprehensive appraiser training.
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