[EQ] Going from evidence to recommendations

Rating quality of evidence and strength of recommendations:
 
Going from evidence to recommendations

Gordon H Guyatt, professor¹, Andrew D Oxman, researcher², Regina Kunz, associate professor³, Yngve Falck-Ytter, assistant professor⁴, Gunn E Vist, researcher², Alessandro Liberati, associate professor⁵, Holger J Schünemann, associate professor⁶, for the GRADE Working Group

¹ CLARITY Research Group, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada L8N 3Z5, ² Norwegian Knowledge Centre for the Health Services, Oslo, Norway, ³ Basel Institute of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland, ⁴ Division of Gastroenterology, Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA, ⁵ University of Modena and Reggio Emilia and Agenzia Sanitaria Regionale, Bologna, Italy, ⁶ Department of Epidemiology, CLARITY Research Group, Italian National Cancer Institute Regina Elena, Rome, Italy
BMJ 2008;336(7652):1049 -10 May 2008 - doi:10.1136/bmj.39493.646875.AE

Available online at: http://www.bmj.com/cgi/content/full/336/7652/1049

 

The GRADE system classifies recommendations made in guidelines as either strong or weak.
This article explores the meaning of these descriptions and their implications for patients, clinicians, and policy makers

 

“…..This is the third of a series of five articles describing the GRADE approach to developing and presenting recommendations for management of patients. In it, we deal with how GRADE suggests clinicians should interpret the strength of a recommendation.

 

What do we mean by strength of recommendation?

The strength of a recommendation reflects the extent to which we can, across the range of patients for whom the recommendations are intended, be confident that the desirable effects of an intervention outweigh the undesirable effects. Alternatively, in considering two or more possible management strategies, a recommendation’s strength represents our confidence that the net benefit clearly favours one alternative or another.

 

Desirable effects of an intervention include reduction in morbidity and mortality, improvement in quality of life, reduction in the burden of treatment (such as having to take drugs or the inconvenience of having blood tests or going to the doctor’s office for monitoring), and reduced resource expenditures. Undesirable consequences include adverse effects that may have a deleterious impact on morbidity, mortality, or quality of life or increase use of resources….”

 

Related articles:

 

What is "quality of evidence" and why is it important to clinicians?

Gordon H Guyatt, Andrew D Oxman, Regina Kunz, Gunn E Vist, Yngve Falck-Ytter, Holger J Schünemann for the GRADE Working Group
BMJ 2008 336: 995-998. [Extract] [Full Text] [PDF]

GRADE: an emerging consensus on rating quality of evidence and strength of recommendations

Gordon H Guyatt, Andrew D Oxman, Gunn E Vist, Regina Kunz, Yngve Falck-Ytter, Pablo Alonso-Coello, Holger J Schünemann for the GRADE Working Group
BMJ 2008 336: 924-926. [Extract] [Full Text] [PDF]

 

 

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