GRADE approach to evaluating the quality of evidence

This is the Link for the course.

This is the link for their official website.

The basic principles behind the GRADE approach

GRADE ensure systematic approach and transparency.

Quality of evidence

Reflects the extent to which we are confident that the point estimate of effect is correct. How confident we are in the results?


Grade the quality of evidence

  • High
  • Moderate
  • Low
  • Very Low

RCTs starts as high quality.

Observational studies start as low quality.


Factor that can lower the quality of evidence

  1. limitations of detailed design and execution of studies (risk of bias)
  2. Inconsistency (or heterogeneity)
  3. Indirectness (PICO and applicability)
  4. Imprecision (number of events and confidence intervals)
  5. Publication bias


The Summary of Findings tables


Footnotes are very important for the summary of findings table. They provide clarification, judgments and transparency.

GRADEpro software to create tables


Choosing comparisons and outcomes for the SoF table

Which comparison and which outcomes are we choosing?

  • most important comparison
  • most important population

Challenging to choose one comparison or one intervention if there are multiple.

use this table for T1D and the casp for all the adults with polypharmacy?


Provide up to 3 different risks per outcome.

Include up to 7 outcomes, which are the primary outcomes. The outcomes that are important driven not evidence driven; thus is it is important to decision making then include it no matter if there are any data provided.


Risk of bias assessments

Limitations in study design and execution may produce misleading or bias results.

Is evaluated per study and across the studies.

Is selective reporting likely?

  • No, no serious limitations
  • Yes, serious limitations
  • Yes, very serious limitations



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