Abstract
Objectives
The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working
group has developed GRADE evidence profiles (EP) and summary of findings (SoF) tables
to present evidence summaries in systematic reviews, clinical guidelines, and health
technology assessments. Explanatory notes are used to explain choices and judgments
in these summaries, for example, on rating of the quality of evidence.
Study Design and Setting
A systematic survey of the explanations in SoF tables in 132 randomly selected Cochrane
Intervention reviews and in EPs of 10 guidelines. We analyzed the content of 1,291
explanations using a predefined list of criteria.
Results
Most explanations were used to describe or communicate results and to explain downgrading
of the quality of evidence, in particular for risk of bias and imprecision. Addressing
the source of baseline risk (observational data or control group risk) was often missing.
For judgments about downgrading the quality of evidence, the percentage of informative
explanations ranged between 41% (imprecision) and 79% (indirectness).
Conclusion
We found that by and large explanations were informative but detected several areas
for improvement (e.g., source of baseline risk and judgments on imprecision). Guidance
about explanatory footnotes and comments will be provided in the last article in this
series.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical EpidemiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- User testing and stakeholder feedback contributed to the development of understandable and useful summary of findings tables for Cochrane reviews.J Clin Epidemiol. 2010; 63: 607-619
- Summary-of-findings tables in Cochrane reviews improved understanding and rapid retrieval of key information.J Clin Epidemiol. 2010; 63: 620-626
- Assessing and presenting summaries of evidence in Cochrane Reviews.Syst Rev. 2013; 2: 81
- GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables.J Clin Epidemiol. 2011; 64: 383-394
Schunemann H, Oxman A, Higgins J, Vist G, Glasziou P, Guyatt G. Chapter 11: presenting results and ‘summary of findings’ tables. In: Higgins J, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 510 (updated March 2011). The Cochrane Collaboration; 2011. Available at www.cochrane-handbook.org.
- Harmonization of explanations for common judgments about the quality of evidence in summary of findings tables.Cochrane Database Syst Rev. 2013; : 1
- Improving GRADE evidence tables: A randomized trial shows improved understanding of content in Summary-of-Findings Tables with a new format.J Clin Epidemiol. 2016; 74: 7-18
- Evidence-based management of anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed.: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.Chest. 2012; 141 (e152S-84S)
- Pharmacologic therapy for pulmonary arterial hypertension in adults: CHEST guideline and expert panel report.Chest. 2014; 146: 449-475
- Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision.J Allergy Clin Immunol. 2010; 126: 466-476
- An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management.Am J Respir Crit Care Med. 2011; 183: 788-824
- Diagnosis and Rationale for Action against Cow's Milk allergy (DRACMA): a summary report.J Allergy Clin Immunol. 2010; 126 (1119–1128 e12)
- The Use of Bedaquiline in the Treatment of Multidrug-Resistant Tuberculosis: Interim Policy Guidance.World Health Organization Copyright (c) World Health Organization 2013, Geneva2013
- WHO Recommendations for Augmentation of Labour.World Health Organization Coypright (c) World Health Organization 2014, Geneva2014
- WHO Recommendation on Community Mobilization through Facilitated Participatory Learning and Action Cycles with Women's Groups for Maternal and Newborn Health.World Health Organization Copyright (c) World Health Organization 2014, Geneva2014
- Guidelines for the Identification and Management of Substance Use and Substance Use Disorders in Pregnancy.World Health Organization Copyright (c) World Health Organization 2014, Geneva2014
- WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus.Lancet Infect Dis. 2007; 7: 21-31
- The GRADE approach is reproducible in assessing the quality of evidence of quantitative evidence syntheses.J Clin Epidemiol. 2013; 66 (quiz 42 e1–5): 736-742
- Acamprosate for alcohol dependence.Cochrane Database Syst Rev. 2010; : CD004332
- GRADE guidelines: 12. Preparing summary of findings tables-binary outcomes.J Clin Epidemiol. 2013; 66: 158-172
- GRADE guidelines: 4. Rating the quality of evidence–study limitations (risk of bias).J Clin Epidemiol. 2011; 64: 407-415
- GRADE guidelines 6. Rating the quality of evidence –imprecision.J Clin Epidemiol. 2011; 64: 1283-1293
- GRADE guidelines: 7. Rating the quality of evidence –inconsistency.J Clin Epidemiol. 2011; 64: 1294-1302
- GRADE guidelines: 8. Rating the quality of evidence–indirectness.J Clin Epidemiol. 2011; 64: 1303-1310
- GRADE guidelines: 5. Rating the quality of evidence–publication bias.J Clin Epidemiol. 2011; 64: 1277-1282
- GRADE guidelines: 9. Rating up the quality of evidence.J Clin Epidemiol. 2011; 64: 1311-1316
- Non-randomized studies as a source of complementary, sequential or replacement evidence for randomized controlled trials in systematic reviews on the effects of interventions.Res Synth Methods. 2013; 4: 49-62
Article info
Publication history
Published online: January 11, 2016
Accepted:
December 22,
2015
Footnotes
Conflict of interest: The authors of this study declare no financial conflict of interest. However, most of them are members of the GRADE working group and the Cochrane Collaboration.
Funding: This study was supported by the Cochrane Collaboration's Methods Innovation Fund and the McMaster GRADE Center. Neither of these institutions played a role in the planning, conduct, or publishing the study findings except through the authors' affiliation.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
