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KMID : 1040120150010010005
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Evidence and Values in Healthcare
2015 Volume.1 No. 1 p.5 ~ p.15
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Recent advances in methodologies of the GRADE approach
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Kim Soo-Young
Choi Mi-Young
Sheen Seung-Soo
Ji Seon-Mi
Park Ji-Jeong
You Ji-Hye
Lyu Da-Hyun
Park Seung-Hee
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Abstract
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The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach provides guidance for rating the quality of evidence and grading the strength of recommendations in health care. GRADE provides a systematic and transparent framework for clarifying questions, determining the outcomes of interest, summarizing the evidence that addresses a question, and moving from the evidence to a recommendation or decision. In 2011, the GRADE approach was summarized in “NECA’s guidance for undertaking systematic reviews and meta-analyses for intervention”. Since then, the GRADE methodologies have been revised and published in the GRADE handbook and articles in the Journal of Clinical Epidemiology . In this review, we report and summarize themain revisions: 1) the limitations of the GRADE approach, 2) the determining the importance of outcomes, 3) the definition of quality of evidence, 4) the meaning of imprecision, 5) deciding whether to use estimates from a subgroup analysis, 6) alarge magnitude of effect, 7) an overall rating of quality of evidence, 8) balance between desirable and undesirable outcomes, 9) a strong recommendation despite low quality of evidence, 10) no recommendation, 11) evidence fordecision frameworks, and 12) a guideline development tool (GDT).
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KEYWORD
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GRADE, Level of evidence, Strength of recommendation, Systematic review, Clinical practice guideline
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