Abstract
BackgroundWhen generating guidelines, quality of the evidence is tabulated to capture its several domains, often using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We developed a graphic display to capture deficiencies, outliers and similarities across comparisons contained in GRADE tables.MethodsBased on a systematic literature review capturing the effects of 32 different therapeutic comparisons on dysmenorrhoea, we synthesised evidence quality in tables and graphs. We evaluated time taken to accurately assess evident quality and preference for tables vs graphs.ResultsThe plots provided visually striking displays of strengths and weaknesses of the evidence across the spectrum of comparisons on a single page. Equivalent tabulated information spread over 4 pages. Participants preferred and interpreted graphs quicker and more accurately than tables.ConclusionsThe graphic approach we developed makes interpreting evidence easier. Large tables are dry and cumbersome to read and assimilate. When guideline statements are accompanied by these plots, they have the scope for improving the credibility of the recommendations made, as the strength of the evidence used can be clearly seen. Further empirical research will establish the place for graphic displays.
Highlights
When generating guidelines, quality of the evidence is tabulated to capture its several domains, often using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach
Harms alerts from relevant organizations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA) were searched
Discussion the GRADE quality assessment tool is not used universally, it has been utilised by some large guideline producing bodies including WHO (World Health Organization) and NICE (National Institute for Clinical Excellence)
Summary
Quality of the evidence is tabulated to capture its several domains, often using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. The quality parameters (criteria, factors or domains) have to be included for each outcome and comparison separately, making the tables bulky and difficult to use [3, 20]. These could be presented as graphic displays compressing a large amount of data into concise, easy to interpret figures [12]. This article explores how addition of graphic displays of evidence quality assessment to GRADE may help readers, providing the findings of a user evaluation
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