The development methods of official GRADE articles and requirements for claiming the use of GRADE – A statement by the GRADE guidance group

Abstract

One of the aims of the GRADE Working Group has been to develop a single system that would reduce confusion arising from a legion of multiple conflicting systems for grading evidence and recommendations and serve as unifying lingua franca. Although GRADE has been widely endorsed, the way it is being used is not infrequently inconsistent with GRADE guidance and some groups have modified the approach. Based on the suggested criteria for claiming the use and application of GRADE that are available on the GWG website since 2008, we propose seven items that should be met in order to appropriately claim that the GRADE approach was used. These requirements apply to, either assessing certainty of evidence (e.g., in systematic reviews or health technology assessments) and developing recommendations (e.g., in guidelines) or making health care decisions (e.g., coverage, public health or health systems). They include how the certainty of a body of evidence is defined, assessed for each critical outcome using the GRADE domains, and presented. Furthermore, they suggest that explicit criteria (both health related and contextual) and evidence as described in the Evidence to Decision (EtD) frameworks should form the basis for recommendations or decisions and explicit judgements should be made for each criterion that is chosen for the EtD process. A recommendation should have one of two strengths (strong or conditional, also called weak) and one of two directions (for or against). Given these suggested minimal requirements in this article, we also provide a detailed description of the GRADE Working Group’s current methods and processes for developing official GRADE guidance and concepts, as well as by whom and how they are authored.