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Outcomes in systematic reviews of complex interventions never reached "high" GRADE ratings when compared with those

Ani Movsisyan1, G J Melendez-Torres1, Paul Montgomery1

  • 1Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford OX1 2ER, UK.

Journal of Clinical Epidemiology
|April 4, 2016
PubMed

Insights

The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach may not fully capture the evidence quality for complex interventions. Complex intervention reviews showed more very low-quality evidence ratings compared to simple ones.

Area of Science:

  • Health Research Methodology
  • Evidence Synthesis
  • Intervention Science

Background:

  • The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) is widely used to assess evidence quality.
  • Complex interventions present unique challenges in systematic reviews due to their multifaceted nature.
  • Understanding GRADE's applicability to complex interventions is crucial for accurate evidence appraisal.

Purpose of the Study:

  • To evaluate the application of the GRADE approach in systematic reviews of complex interventions.
  • To compare the quality of evidence ratings between complex and simple intervention reviews.
  • To identify patterns in GRADE ratings specific to complex intervention reviews.

Main Methods:

  • Systematic review of 40 Cochrane reviews (2013-2014) from three Cochrane Review Groups.
  • Classification of reviews into 'complex' (n=24) and 'simple' (n=16) based on PICOTS framework dimensions.
  • Analysis of GRADE ratings, focusing on reasons for downgrading evidence quality.

Main Results:

  • Complex intervention reviews had a higher proportion of 'very low' quality evidence ratings (37.5%) compared to simple reviews (9.1%) for primary benefit outcomes.
  • Complex intervention reviews were more frequently downgraded for inconsistency, performance bias, and study design.
  • No 'high' GRADE ratings were assigned to outcomes in complex intervention reviews.

Conclusions:

  • The GRADE assessment may not adequately describe the evidence base for complex interventions.
  • Current GRADE application may underestimate the evidence quality of complex interventions.
  • Further refinement of GRADE or alternative methods may be needed for complex intervention reviews.
Abstract

Keywords:
Complex interventionsGRADEQuality of evidenceSummary of findings tablesSystematic reviewsThe Cochrane Collaboration

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