GRADE guidelines: 3. Rating the quality of evidence

Howard Balshem, Mark Helfand, Holger J. Schünemann, Andrew D. Oxman, Regina Kunz, Jan Brozek, Gunn E. Vist, Yngve Falck-Ytter, Joerg Meerpohl, Susan Norris, Gordon H. Guyatt

Research output: Contribution to journalArticle

2411 Scopus citations

Abstract

This article introduces the approach of GRADE to rating quality of evidence. GRADE specifies four categories - high, moderate, low, and very low - that are applied to a body of evidence, not to individual studies. In the context of a systematic review, quality reflects our confidence that the estimates of the effect are correct. In the context of recommendations, quality reflects our confidence that the effect estimates are adequate to support a particular recommendation. Randomized trials begin as high-quality evidence, observational studies as low quality. "Quality" as used in GRADE means more than risk of bias and so may also be compromised by imprecision, inconsistency, indirectness of study results, and publication bias. In addition, several factors can increase our confidence in an estimate of effect. GRADE provides a systematic approach for considering and reporting each of these factors. GRADE separates the process of assessing quality of evidence from the process of making recommendations. Judgments about the strength of a recommendation depend on more than just the quality of evidence.

Original languageEnglish (US)
Pages (from-to)401-406
Number of pages6
JournalJournal of Clinical Epidemiology
Volume64
Issue number4
DOIs
Publication statusPublished - Apr 2011

    Fingerprint

Keywords

  • Body of evidence
  • Imprecision
  • Inconsistency
  • Indirectness
  • Publication bias
  • Quality assessment

ASJC Scopus subject areas

  • Epidemiology

Cite this

Balshem, H., Helfand, M., Schünemann, H. J., Oxman, A. D., Kunz, R., Brozek, J., ... Guyatt, G. H. (2011). GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology, 64(4), 401-406. https://doi.org/10.1016/j.jclinepi.2010.07.015