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[Is there such a thing as 'fitting evidence'?].

Patrick M M Bossuyt1, Marc G H Besselink

  • 1Academisch Medisch Centrum, Afd. Klinische Epidemiologie, Amsterdam, the Netherlands. p.m.bossuyt@amc.uva.nl

Nederlands Tijdschrift Voor Geneeskunde
|April 12, 2013
PubMed
Summary
This summary is machine-generated.

The traditional 'levels of evidence' system for ranking studies is being updated. Modern approaches like GRADE and the new "fitting evidence" system offer more nuanced evaluations of research credibility for evidence-based medicine.

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Area of Science:

  • Clinical research methodology
  • Evidence-based medicine evaluation

Background:

  • The traditional 'levels of evidence' system, originating in the 1980s, ranks studies solely on study design strength.
  • This system is widely used but has limitations in comprehensively assessing evidence quality.
  • Modern evidence-based medicine (EBM) requires evaluating credibility beyond study design, considering effect magnitude and applicability.

Purpose of the Study:

  • To critically evaluate the limitations of the traditional 'levels of evidence' system.
  • To introduce and explain newer systems like GRADE and the Dutch 'fitting evidence' system.
  • To discuss the evolving methodologies for appraising the strength of clinical research evidence.

Main Methods:

  • Review of the historical development and application of 'levels of evidence' systems.
  • Comparison of the traditional system with modern frameworks such as GRADE.
  • Description of the novel 'fitting evidence' system, including its checklist approach for evaluating study validity and feasibility of randomized comparisons.

Main Results:

  • The traditional 'levels of evidence' system is insufficient for comprehensive evidence appraisal in EBM.
  • Modern systems like GRADE differentiate between evidence credibility, effect size, and applicability.
  • The 'fitting evidence' system provides a structured checklist to assess study validity and the appropriateness of randomized trial designs.

Conclusions:

  • Assigning evidence levels based solely on study design is an outdated and inadequate practice in EBM.
  • Newer systems offer a more sophisticated approach to evaluating the strength and relevance of research findings.
  • Further research is needed to integrate these advanced evaluation methods into a cohesive framework for appraising evidence, particularly for healthcare reimbursement decisions.