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Using systematic reviews in guideline development: the GRADE approach.

Yuan Zhang1, Elie A Akl1,2, Holger J Schünemann1,3

  • 1Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada.

Research Synthesis Methods
|July 15, 2018
PubMed
Summary
This summary is machine-generated.

The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach provides a standardized method for assessing evidence certainty in systematic reviews. This ensures trustworthy guidelines by evaluating factors like bias, imprecision, and effect magnitude.

Keywords:
GRADE assessmentcertainty of the evidenceevidence tablesguidelinequality of evidence

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Area of Science:

  • Evidence-based medicine
  • Health technology assessment
  • Clinical guideline development

Background:

  • Systematic reviews are foundational for creating reliable clinical guidelines.
  • The Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group developed a widely adopted approach.
  • Over 100 organizations, including WHO and Cochrane, utilize the GRADE methodology.

Purpose of the Study:

  • To outline the GRADE approach for assessing the certainty of evidence in systematic reviews.
  • To detail the factors considered in GRADE assessments for various types of evidence.
  • To introduce the GRADEpro software and Evidence to Decision frameworks for guideline development.

Main Methods:

  • GRADE provides operational definitions and instructions for rating evidence certainty (high, moderate, low, very low).
  • Assessments include risk of bias, imprecision, inconsistency, indirectness, and publication bias.
  • Factors like effect magnitude, dose-response, and confounding are also evaluated.

Main Results:

  • GRADE enables systematic evaluation of evidence across interventions, prognoses, values, test accuracy, and resource use.
  • GRADE evidence summary tables present statistical information and certainty assessments.
  • The GRADEpro software facilitates the creation of these summary tables.

Conclusions:

  • The GRADE approach offers a structured framework for evaluating evidence quality in systematic reviews.
  • GRADE evidence summary tables and Evidence to Decision frameworks support informed guideline creation.
  • This methodology enhances the transparency and reliability of health recommendations.