Grading the strength of a body of evidence when assessing health care interventions: an EPC update

Berkman, Nancy D; Lohr, Kathleen N; Ansari, Mohammed; Balk, Ethan M; Kane, Robert L; McDonagh, Marian; Morton, Sally C.; Viswanathan, Meera; Bass, Eric B.; Butler, Mary; Gartlehner, Gerald; Hartling, Lisa; McPheeters, Melissa L; Morgan, Laura C; Reston, James; Sista, Priyanka; Whitlock, Evelyn P; Chang, Stephanie

doi:10.1016/j.jclinepi.2014.11.023

Cited by 229 publications

(230 citation statements)

References 51 publications

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“…First, no strong empirical evidence supports one approach over another; this gap leads to a proliferation of approaches based on the practices of different academic disciplines and the needs of different clinical topics. Second, in the absence of clear guidance on related components of systematic reviews (such as selection of evidence, 22 assessment of applicability, 23 or grading the strength of evidence 18,[24][25][26][27][28][29][30][31][32] ), some review groups continue to use practices that have served well in the past.…”

Section: Constructs To Include and Exclude From Risk-of-bias Assessmentmentioning

confidence: 99%

“…24 Both GRADE 33 and AHRQ guidance on evaluating the strength of evidence 24 separate the evaluation of precision from that of the summary of risk of bias for a body of evidence (study limitations). Systematic reviews now routinely evaluate precision (through consideration of the optimal information size or required information size and confidence intervals around a summary effect size from pooled estimates) when grading the strength of the body of evidence.…”

Section: Precisionmentioning

confidence: 99%

“…Systematic reviews now routinely evaluate precision (through consideration of the optimal information size or required information size and confidence intervals around a summary effect size from pooled estimates) when grading the strength of the body of evidence. 24 Thus, the inclusion of precision as a construct under risk of bias would constitute double-counting limitations to the evidence from a single source. We recommend that AHRQ reviews exclude considerations of power and precision of the effect estimate when assessing the risk of bias.…”

Section: Precisionmentioning

confidence: 99%

“…34 Both GRADE 33 and AHRQ guidance on evaluating the strength of evidence 24 exclude considerations of applicability in risk-of-bias assessments of individual studies. We note, however, that some study features may be relevant to both risk of bias and applicability.…”

Section: Applicabilitymentioning

confidence: 99%

See 3 more Smart Citations

Assessing the Risk of Bias of Individual Studies in Systematic Reviews of Health Care Interventions

Viswanathan

Ansari

Berkman

et al. 2017

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The information in this report is intended to help health care decisionmakers-patients and clinicians, health system leaders, and policy makers, among others-make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies may not be stated or implied. Persons using assistive technology may not be able to fully access information in this report. For assistance, contact epc@ahrq.hhs.gov. PrefaceThe Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public-and private-sector organizations in their efforts to improve the quality of health care in the United States. The reports and assessments provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies and strategies. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments.Strong methodological approaches to systematic review improve the transparency, consistency, and scientific rigor of these reports. Through a collaborative effort of the Effective Health Care (EHC) Program, the Agency for Healthcare Research and Quality (AHRQ), the EHC Program Scientific Resource Center, and the AHRQ Evidence-based Practice Centers have developed a Methods Guide for Comparative Effectiveness Reviews. This Guide presents issues key to the development of Systematic Reviews and describes recommended approaches for addressing difficult, frequently encountered methodological issues.The Methods Guide for Comparative Effectiveness Reviews is a living document, and will be updated as further empiric evidence develops and our understanding of better methods improves.If you have comments on this Methods Guide paper, they may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research a...

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Section: Constructs To Include and Exclude From Risk-of-bias Assessmentmentioning

confidence: 99%

Section: Precisionmentioning

confidence: 99%

Section: Precisionmentioning

confidence: 99%

Section: Applicabilitymentioning

confidence: 99%

See 2 more Smart Citations

Assessing the Risk of Bias of Individual Studies in Systematic Reviews of Health Care Interventions

Viswanathan

Ansari

Berkman

et al. 2017

Self Cite

394

401

View full text Add to dashboard Cite

show abstract

“…Thus, they need to clarify anything that has been omitted from the reporting for any reason-avoiding publication and outcome reporting biases is critical for audiences to have confidence in the research and the ensuing reporting of that research. [120][121][122][123] This is especially important in specific cases: (1) when the results do not support the main hypotheses of the study, (2) when some results are discordant with the main findings, or (3) when some results are statistically significant and others are not at different measurement points.…”

Section: Basic Elements Of Reporting Researchmentioning

confidence: 99%