#MARCH NETWORKS EVIDENCE REVIEWER GUIDE SOFTWARE#

Uncertainty associated with reviews of poor quality studies, with poorly framed questions or employing poor methodology is often underestimated. The widespread acceptance of evidence-based health care means that systematic reviews are widely viewed as gold standard evidence. Many aspects of GRADE are consensus based due to limitations in the current evidence base and the approach continues to be modified and updated in the light of new evidence from methods research. These criticisms partly reflect limitations in current knowledge. Specific criticisms include failure to adequately account for dependencies across domains, and lack of nuanced judgements when combining multiple sources of bias to produce an overall judgement on the strength of evidence. Another desirable feature of the approach is the ability to make complex, nuanced judgements using a common framework that is not based solely on review process or the type of evidence included in the synthesis. Proposing key specific factors that may lead to downgrading the quality of evidence (and the need to state reasons for each downgrade) provides a clear rationale for such judgements.

This then leads to a rating on the quality of evidence for each outcome of high, moderate, low or very low where high indicates that any future research is likely to be confirmatory.Р”Р„ key advantage of GRADE is that it leads to transparent judgments on the quality of evidence. Non-randomised studies begin at low quality evidence but their rating can be upgraded (provided no other limitations have been identified in the five domains) for three primary reasons: large magnitude of effect, evidence of a dose-response effect, all plausible confounding taken into account. According to the GRADE approach, evidence based on randomised controlled trials is considered high quality (reliable), but can be downgraded across five domains: risk of bias, inconsistency, indirectness, imprecision, publication bias.

#MARCH NETWORKS EVIDENCE REVIEWER GUIDE SOFTWARE#

The GRADE approach is described in online support for software and in a BMJ series of papers in 2008, with updated guidance available in a Journal of Clinical Epidemiology series beginning in 2011. GRADE has been adopted by organisations such as the World Health Organization, Cochrane Collaboration, Agency for Healthcare Research and Quality, and National Institute for Health and Clinical Excellence. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach is the most widespread method for rating the quality of evidence in healthcare. This requires evaluation of biases across studies, as well as biases detected during the process of evidence synthesis.

Easily applicable tools focus on the process and robustness of research synthesis but their practical utility is limited as they do not provide direct information on the quality of evidence underpinning decisions. Researchers have developed a range of tools for considering the validity of conclusions from research synthesis. The reliability of the evidence underpinning decisions is important particularly where high and low quality evidence result in different conclusions regarding effectiveness. The fundamental objective of evidence-based health care is to enable clinicians or policy makers to make informed decisions regarding the development or delivery of effective health interventions.

March networks evidence reviewer guide