The Grading of Recommendations Assessment, Development and Evaluation approach provides a clear interpretation of the quality of evidence for key stakeholders
In 2004, a group of international experts in methodology and practice guidelines first published the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach1 to assess the quality of evidence supporting medical interventions and develop recommendations. Since then, the group has published a six-part series for clinicians using GRADE guidelines,2 and a series of articles supporting systematic review authors and guideline groups using GRADE in their work.3
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- 1. Atkins D, Best D, Briss PA, et al; GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ 2004; 328: 1490.
- 2. Guyatt GH, Oxman AD, Vist GE, et al; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924-926.
- 3. Guyatt G, Oxman AD, Akl EA, et al; GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011; 64: 383-394.
- 4. Andrews JC, Schünemann HJ, Oxman AD, et al; GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation’s direction and strength. J Clin Epidemiol 2013; 66: 726-735.
- 5. Balshem H, Helfand M, Schünemann HJ, et al; GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011; 64: 401-406.
- 6. Guyatt GH, Oxman AD, Vist G, et al; GRADE guidelines: 4. Rating the quality of evidence — study limitations (risk of bias). J Clin Epidemiol 2011; 64: 407-415.
- 7. Guyatt GH, Oxman AD, Kunz R, et al; GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol 2011; 64: 395-400.
- 8. Guyatt GH, Oxman AD, Kunz R, et al; GRADE guidelines 6. Rating the quality of evidence — imprecision. J Clin Epidemiol 2011; 64: 1283-1293.
- 9. Guyatt GH, Oxman AD, Kunz R, et al; GRADE Working Group. GRADE guidelines: 8. Rating the quality of evidence — indirectness. J Clin Epidemiol 2011; 64: 1303-1310.
- 10. Guyatt GH, Oxman AD, Sultan S, et al; GRADE Working Group. GRADE guidelines: 9. Rating up the quality of evidence. J Clin Epidemiol 2011; 64: 1311-1316.
- 11. Alonso-Coello P, Schünemann HJ, Moberg J, et al; GRADE Working Group. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ 2016; 353: i2016.
- 12. Mustafa RA, Santesso N, Brozek J, et al. The GRADE approach is reproducible in assessing the quality of evidence of quantitative evidence syntheses. J Clin Epidemiol 2013; 66: 736-742; quiz 42 e1-5.
- 13. Brozek JL, Akl EA, Alonso-Coello P, et al; GRADE Working Group. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy 2009; 64: 669-677.
- 14. Iorio A, Spencer FA, Falavigna M, et al. Use of GRADE for assessment of evidence about prognosis: rating confidence in estimates of event rates in broad categories of patients. BMJ 2015; 350: h870.
- 15. Lewin S, Glenton C, Munthe-Kaas H, et al. Using qualitative evidence in decision making for health and social interventions: an approach to assess confidence in findings from qualitative evidence syntheses (GRADE-CERQual). PLoS Med 2015; 12: e1001895.
- 16. Brignardello-Petersen R, Bonner A, Alexander PE, et al. Advances in the GRADE approach to rate the certainty in estimates from a network meta-analysis. J Clin Epidemiol 2018; 93: 36-44.
- 17. O’Mara-Eves A, Thomas J, McNaught J, et al. Using text mining for study identification in systematic reviews: a systematic review of current approaches. Syst Rev 2015; 4: 5.
Waleed Alhazzani and Gordon Guyatt are owners of MetaClinician. Gordon Guyatt is a consultant for UpToDate.