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1. Introduction
1.1. What is GRADE?
1.2. Limitations of GRADE
1.3. Steps in the process
2. Framing the question
3. Deciding on important outcomes
3.1. General approach
3.2. Perspective of outcomes
3.3. Before and after literature review
3.4. Implications of the classification
3.5. Expert involvement
3.6. Use of surrogates
3.7. Clinical decision threshold and minimally important difference
3.8. Adverse effects
4. Summarizing the evidence
5. Rating the quality of evidence
5.1. Introduction
5.1.1. Four levels of evidence
5.1.2. Overall quality of evidence
5.1.3. GRADE and meta-analysis
5.2. Study limitations, risk of bias
5.2.1. Risk of bias assessment of individual studies should be done using a validated assessment tool
5.2.2. Moving from individual risk of bias to a judgment about rating down for risk of bias across a body of evidence
5.3. Inconsistency
5.3.1. Heterogeneity and inconsistency
5.3.2. Judging heterogeneity and inconsistency
5.3.3. Other considerations
5.4. Indirectness
5.5. Imprecision
5.5.1. Clinical decision threshold and minimally important difference
5.5.1.1. Categorical outcomes
5.5.1.2. Continuous outcomes
5.5.2. Application and examples
5.5.3. Relative versus absolute reductions
5.5.4. Dealing with fragility: Optimal Information Size (OIS)
5.5.5. Low event rates with large sample size: an exception to the need for OIS
5.6. Publication bias
5.7. Reasons to upgrade studies
5.7.1. Large magnitude of effect
5.7.3. Dose-response gradient
6. Recommendations
6.1. Four key factors influence the strength of a recommendation
6.2. Wording of a recommendation
7. GRADE and diagnostic testing
7.4. Critical appraisal of observational studies
ADAPTE (GCP)
ADAPTE: To use or not to use?
The ADAPTE methodology

Related Co-Author content

7. Quality assessment of studies
8. Data extraction
Evidence tables
GRADE evidence profiles