Abstract
BackgroundThe grading of recommendation, assessment, development and evaluation (GRADE) approach is widely implemented in health technology assessment and guideline development organisations throughout the world. GRADE provides a transparent approach to reaching judgements about the quality of evidence on the effects of a health care intervention, but is complex and therefore challenging to apply in a consistent manner.MethodsWe developed a checklist to guide the researcher to extract the data required to make a GRADE assessment. We applied the checklist to 29 meta-analyses of randomised controlled trials on the effectiveness of health care interventions. Two reviewers used the checklist for each paper and used these data to rate the quality of evidence for a particular outcome.ResultsFor most (70%) checklist items, there was good agreement between reviewers. The main problems were for items relating to indirectness where considerable judgement is required.ConclusionsThere was consistent agreement between reviewers on most items in the checklist. The use of this checklist may be an aid to improving the consistency and reproducibility of GRADE assessments, particularly for inexperienced users or in rapid reviews without the resources to conduct assessments by two researchers independently.
Highlights
The grading of recommendation, assessment, development and evaluation (GRADE) approach is widely implemented in health technology assessment and guideline development organisations throughout the world
We developed a checklist for evaluating meta-analyses of Randomised controlled trial (RCT) for the purpose of informing a GRADE assessment
In conclusion, experienced systematic reviewers but with little or no experience of conducting GRADE assessments appear to be able to answer our checklist of questions in a broadly consistent and reproducible manner when assessing the quality of evidence for meta-analyses of RCTs
Summary
The grading of recommendation, assessment, development and evaluation (GRADE) approach is widely implemented in health technology assessment and guideline development organisations throughout the world. The grading of recommendation, assessment, development and evaluation (GRADE) approach provides guidance on rating the quality of research evidence in health care [1]. This approach has been widely implemented by organisations such as the World Health Organization, Cochrane Collaboration, Agency for Healthcare Research and Quality (USA) and National Institute of Health and Care Excellence (UK). The GRADE approach is comprehensively described in an online manual (freely available for download with the GRADEpro software at http://tech.cochrane.org/revman/gradepro). This is summarised in a series of papers of a dose-response effect and all plausible confounding taken into account. For the purposes of this paper, we will focus on the application of GRADE to meta-analyses of RCTs
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