Resources

These resources are available to help guideline developers and authors of systematic reviews learn how to use the GRADE approach to grade the evidence in systematic reviews, to create Summary of Findings Tables and GRADE Evidence Profiles, and move from evidence to making recommendations.

Cochrane Handbook for Systematic Reviews of Interventions

Chapter 11

Schünemann HJ, Oxman AD, Higgins JP, Vist GE, Glasziou P, Guyatt GH, on behalf of the Cochrane Applicability and Recommendations Methods Group and the Cochrane Statistical Methods Group: Chapter 11: Presenting results and ‘summary of findings’ tables. In Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. Edited by Higgins JPT, Green S. The Cochrane Collaboration; 2011. Available from http://cochrane-handbook.org 

Chapter 12

Schünemann HJ, Oxman AD, Vist GE, Higgins JP, Deeks JJ, Glasziou P, Guyatt GH: Chaper 12: Interpreting results and drawing conclusions. In Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. Edited by Higgins JPT, Green S. The Cochrane Collaboration; 2011. Available from http://cochrane-handbook.org

GRADE Handbook. The GRADE Handbook is available at http://www.guidelinedevelopment.org/handbook/

Incorporating GRADE in Cochrane Reviews: Feedback from the CEU screening programme.

Assessing the quality of the evidence is an integral part of undertaking a Cochrane Review. GRADE is an established method to help authors rate the quality of evidence and to communicate the key results of systematic reviews to users. Since the start of the CEU review screening programme in September 2013 we have been able to see how GRADE is used to assess and communicate the quality of a body of evidence. We also recognise some important challenges Cochrane Review authors and editorial groups have encountered with implementing GRADE. As a result of this experience we are sharing our thoughts on some of the reviews which highlight four key aspects of bringing GRADE methods and ratings into the text of Cochrane Reviews: 1. Describing methods for assessing the quality of the evidence under the ‘Data collection & analysis’ section of protocols and full reviews. 2. Explaining decisions about the quality of the evidence in reporting of results. 3. Incorporating information about the quality of evidence in the Discussion. 4. Drawing on quality of evidence ratings when summarising and interpreting the results e.g. abstracts, plain language summaries and implications for practice sections (read more).

GRADEpro GDT (Guideline Development Tool) is the tool used to create Summary of Findings Tables for Cochrane systematic reviews. You can access the online version and download the App for offline use at www.gradepro.org

Find other resources for GRADEpro GDT and Rev Man on the Cochrane website.

PUBLICATIONS

Guidance specific to GRADE and Summary of Findings Tables in systematic reviews

  • Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, deBeer H, Jaeschke R, Rind D, Meerpohl J, Dahm P, Schunemann HJ. GRADE guidelines: 1. Introduction- GRADE evidence profiles and summary of findings tables. PDF
  • Guyatt GH, Oxman AD, Santesso N, Helfand M, Vist G, Kunz R, Brozek J, Norris S, Meerpohl J, Djulbegovic B, Alonso-Coello P, Post PN, Busse JW, Glasziou P, Christensen R, Schünemann HJ: GRADE guidelines: 12. Preparing summary of findings tables-binary outcomesPDF
  • Guyatt GH, Thorlund K, Oxman AD, Walter SD, Patrick D, Furukawa TA, Johnston BC, Karanicolas P, Akl EA, Vist G, Kunz R, Brozek J, Kupper LL, Martin SL, Meerpohl JJ, Alonso-Coello P, Christensen R, Schunemann HJ. GRADE guidelines: 13. Preparing Summary of Findings tables and evidence profiles—continuous outcomesPDF
  • Mustafa RA, Wiercioch W, Santesso N, Cheung A, Prediger B, Baldeh T, Carrasco-Labra A, Brignardello-Petersen R, Neumann I, Bossuyt P, Garg AX, Lelgemann M, Bühler D, Brozek J, Schünemann HJ. Decision-Making about Healthcare Related Tests and Diagnostic Strategies: User Testing of GRADE Evidence Tables . PLOS One. 2015 Oct 16;10(10) Pubmed central link

GRADE: Introductory articles

  • GRADE guidelines: A new series of articles in the Journal of Clinical Epidemiology. PDF
  • Framing the question and deciding on important outcomes. PDF 
  • Getting to grips with GRADE—perspective from a low-income setting. PDF
  • Challenges in guideline methodology. PDF

Guidance on how to rate the quality of evidence

  • Rating the quality of evidence- introduction (interventions). PDF 
  • Rating the quality of evidence for test accuracy and other test use (link)
  • Rating the quality of evidence: study limitations (risk of bias). PDF 
  • Strength of evidence and handling uncertainty: practical considerations and general observations. PDF
  • Rating the quality of evidence: publication biasPDF  
  • Rating the quality of evidence: imprecisionPDF 
  • Rating the quality of evidence: inconsistencyPDF 
  • Rating the quality of evidence: indirectnessPDF
  • Rating up the quality of evidence. PDF
  • GRADE guidelines—an introduction to the 10th–13th articles in the series. PDF
  • Considering resource use and rating the quality of economic evidence. PDF 
  • Diagnostic Summary of Findings Tables (Pubmed Central Link)

Summarizing the evidence

  • Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. PDF 
  • Preparing Summary of Findings tables for binary outcomes. PDF
  • Preparing Summary of Findings tables for continuous outcomes. PDF

Making recommendations

  • Going from evidence to recommendations: the significance and presentation of recommendations. PDF
  • Going from evidence to recommendations: determinants of a recommendation’s direction and strength. PDF

Our Reviews

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