Visual transformation for guidelines presentation of the strength of recommendations and the certainty of evidence

Andrea Pokorná,Lucia Kantorová,Miloslav Klugar,Radim Líčeník,Jiří Kantor,Holger J Schünemann,Jitka Klugarová,Abanoub Riad,Ladislav Dušek

doi:10.1016/j.jclinepi.2021.11.009

Abstract

ObjectiveThe objective of this paper is to propose an approach to visual unification of adapted guidelines and transformation of classifications of certainty of evidence (CoE) and strength of recommendations (SoR) into the approach suggested by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group. Study design and SettingWe carried out a literature search in MEDLINE and Epistemonikos, an analysis of selected guidelines, and an iterative discussion to decide on a consistent visual presentation and CoE and SoR depictions. ResultsThe results of the literature search suggested this issue had not been addressed yet. The analysis of the chosen eight guidelines showed significant heterogeneity in the visual presentation of recommendations. Recommendations were often worded similarly to whether or not they were strong or conditional. Many guidelines contained "statements," almost all of which did not fulfill the good practice statement (GPS) criteria. We proposed an approach for transforming recommendations that are being adapted and which use various classification systems for CoE and SoR into GRADE and a consistent visual style. ConclusionGuideline developers should aim for unification in the formulation of recommendations to improve transferability.

Highlights

Organizations dedicated to the development of clinical practice guidelines from around the world have been using a range of systems to rate the certainty of evidence (CoE) and strength of recommendations (SoR), each of which has its own symbols and overall visual form
An analysis of eight pilot guidelines being adapted for use in the Czech context showed high heterogeneity in their visual style, the depictions of CoE and SoR, and the approach to good practice statements
Many organizations build on the GRADE methodology and their clinical practice guidelines are of high quality

Summary

November 2021

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Key findings We suggest a strategy for harmonized expression of the certainty of evidence (CoE) and strength of recommendations (SoR) in adapted guidelines. What should change We emphasize a thorough application of the GRADE methodology, without modification, when developing guidelines

Results

Introduction

Methods

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