Article type
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Abstract
Background: The GRADE process requires that the quality of evidence and strength of recommendation are assessed, and the reasons for downgrading or upgrading the evidence, and for giving strong or weak recommendations are described transparently. Since 2000, we have developed over 4000 evidence summaries containing evidence statements in PICO (Patient, Intervention, Comparison, Outcome) format, and recently we started to include recommendations. The main source for the evidence summaries are Cochrane reviews.
Objectives: To develop standard expressions in the English language for the evidence and recommendations reflecting different grades of quality and strength, and stating reasons for downgrading and upgrading.
Methods: Using the publications of the GRADE Group as a starting point, the EBM Guidelines Editorial Team developed standard wording in a consensus process. A web-based questionnaire was used in 2010 to examine the confidence of professionals in the evidence supporting an intervention when the same evidence statement used different verbs. The 132 respondents from several countries were mainly physicians involved in developing guidelines and systematic reviews.
Results: On a 7-point Likert scale where 1 represented the highest and 7 the lowest confidence in the evidence, different verbs received mean scores as follows: is 2.12, seems 3.65, appears 3.67, may 4.08, might 4.39, might possibly 5.02. Examples of evidence statements and recommendations using standard expressions are shown, and a website is presented that contains all the expressions used in commenting on the evidence and the recommendations.
Conclusions: There is wide variation in professionals' interpretation of different wording, but wording that results in differences in confidence can be found. We selected the following verbs to express the four grades of the quality of evidence: high - is; moderate - appears; low - may; very low - might possibly. Standard expressions can make evidence and recommendations more transparent and easier to interpret by professionals.
Objectives: To develop standard expressions in the English language for the evidence and recommendations reflecting different grades of quality and strength, and stating reasons for downgrading and upgrading.
Methods: Using the publications of the GRADE Group as a starting point, the EBM Guidelines Editorial Team developed standard wording in a consensus process. A web-based questionnaire was used in 2010 to examine the confidence of professionals in the evidence supporting an intervention when the same evidence statement used different verbs. The 132 respondents from several countries were mainly physicians involved in developing guidelines and systematic reviews.
Results: On a 7-point Likert scale where 1 represented the highest and 7 the lowest confidence in the evidence, different verbs received mean scores as follows: is 2.12, seems 3.65, appears 3.67, may 4.08, might 4.39, might possibly 5.02. Examples of evidence statements and recommendations using standard expressions are shown, and a website is presented that contains all the expressions used in commenting on the evidence and the recommendations.
Conclusions: There is wide variation in professionals' interpretation of different wording, but wording that results in differences in confidence can be found. We selected the following verbs to express the four grades of the quality of evidence: high - is; moderate - appears; low - may; very low - might possibly. Standard expressions can make evidence and recommendations more transparent and easier to interpret by professionals.