Article type
Year
Abstract
Background: When generating guidelines, quality of evidence is frequently reported in tabulated form capturing several domains, e.g. study design, risk of bias, and heterogeneity. Increasingly this is done using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. A more user-friendly format is needed. One example is a graphic display plotting the several domains used in evidence grading on equiangular spokes starting from the same point, the data length of each spoke proportional to the magnitude of the quality, which succinctly captures tabulated information.
Objectives: To allow easy identification of deficiencies, outliers and similarities in evidence quality for individual and multiple comparisons and outcomes, paving the way for their routine use alongside tabulated information.
Methods: We tabulated findings separately for tocolytic agents compared to placebo and those compared to beta agonists. For each comparison and outcome pair evidence was initially graded by the study design. We assigned all evidence a 'highá level of quality if it was based on randomised controlled trials. If any of the reasons below applied to the body of evidence for each comparison-outcome pair, the quality level was downgraded by one level (if the reason was classified as serious) or by two levels (if the reason was classified as very serious): bias, inconsistency, indirectness, imprecision.
Results: Figures 1 and 2 provide a visually striking display of the strengths and weaknesses of the evidence across the spectrum of comparisons and outcomes which, when tabulated, is dry, cumbersome to read, and difficult to assimilate.
Conclusions: There is considerable opportunity for confusion when moving from evidence syntheses to recommendations. The graphic approach we have developed can make the job of evidence assimilation for decision-making easier. When guideline statements are accompanied by these plots, this approach also has the potential for improving the credibility of the recommendations made as the strength of the evidence is more clearly displayed.
Objectives: To allow easy identification of deficiencies, outliers and similarities in evidence quality for individual and multiple comparisons and outcomes, paving the way for their routine use alongside tabulated information.
Methods: We tabulated findings separately for tocolytic agents compared to placebo and those compared to beta agonists. For each comparison and outcome pair evidence was initially graded by the study design. We assigned all evidence a 'highá level of quality if it was based on randomised controlled trials. If any of the reasons below applied to the body of evidence for each comparison-outcome pair, the quality level was downgraded by one level (if the reason was classified as serious) or by two levels (if the reason was classified as very serious): bias, inconsistency, indirectness, imprecision.
Results: Figures 1 and 2 provide a visually striking display of the strengths and weaknesses of the evidence across the spectrum of comparisons and outcomes which, when tabulated, is dry, cumbersome to read, and difficult to assimilate.
Conclusions: There is considerable opportunity for confusion when moving from evidence syntheses to recommendations. The graphic approach we have developed can make the job of evidence assimilation for decision-making easier. When guideline statements are accompanied by these plots, this approach also has the potential for improving the credibility of the recommendations made as the strength of the evidence is more clearly displayed.
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