Systems for grading the quality of evidence and the strength of recommendations II: pilot study of a new system.
Systems for grading the quality of evidence and the strength of recommendations II: pilot study of a new system.
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评分证据质量和建议力量的系统II：新系统的试点研究。
DOI：
10.1186/1472-6963-5-25
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发表时间：
2005-03-23
影响因子：
2.8
通讯作者：
Williams, John W Jr
中科院分区：
文献类型：
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作者：
Atkins, David;Briss, Peter A;Eccles, Martin;Flottorp, Signe;Guyatt, Gordon H;Harbour, Robin T;Hill, Suzanne;Jaeschke, Roman;Liberati, Alessandro;Magrini, Nicola;Mason, James;O'Connell, Dianne;Oxman, Andrew D;Phillips, Bob;Schunemann, Holger;Edejer, Tessa Tan-Torres;Vist, Gunn E;Williams, John W Jr
不同组织使用的对证据质量和建议强度进行评级的系统各不相同。他们有不同的优点和缺点。 GRADE 工作组开发了一种方法来解决这些系统的主要缺点。本研究的目的是试点测试并进一步开发 GRADE 方法来对证据和建议进行分级。 GRADE 证据概况由两个表组成：质量评估和结果摘要。该试点研究使用了十二个证据概况。每个证据概况都是根据系统评价中提供的信息制定的。 17 人接受了指示，并对 12 种证据概况中每一种的证据水平和推荐强度进行了独立评分。对于每个示例的判断，都会在小组中收集、总结和讨论，目的是改进所提出的评分系统。 Kappas 被计算为十二个证据概况中每个结果的证据质量的机会校正一致性的衡量标准。十七名评委还被问及该方法的难易程度和敏感性。所有的判断都被记录下来并讨论了分歧。对于与十二个问题中的每一个问题相关的结果的证据质量，存在不同程度的一致性（超出偶然性的一致性的 kappa 系数范围为 0 到 0.82）。然而，对于每个结果的相对重要性，人们达成了相当一致的看法。对于利益与危害的平衡以及建议的共识很差。大多数分歧很容易通过讨论得到解决。总的来说，我们发现 GRADE 方法清晰、易于理解且合理。对方法进行了一些修改，并一致认为证据概况中需要更多信息。对证据和建议的判断是复杂的。一些主观性，尤其是关于建议的主观性，是不可避免的。我们相信，我们指导这些复杂判断的系统适当地平衡了简单性的需要与对所有重要问题进行全面和透明考虑的需要。
Systems that are used by different organisations to grade the quality of evidence and the strength of recommendations vary. They have different strengths and weaknesses. The GRADE Working Group has developed an approach that addresses key shortcomings in these systems. The aim of this study was to pilot test and further develop the GRADE approach to grading evidence and recommendations. A GRADE evidence profile consists of two tables: a quality assessment and a summary of findings. Twelve evidence profiles were used in this pilot study. Each evidence profile was made based on information available in a systematic review. Seventeen people were given instructions and independently graded the level of evidence and strength of recommendation for each of the 12 evidence profiles. For each example judgements were collected, summarised and discussed in the group with the aim of improving the proposed grading system. Kappas were calculated as a measure of chance-corrected agreement for the quality of evidence for each outcome for each of the twelve evidence profiles. The seventeen judges were also asked about the ease of understanding and the sensibility of the approach. All of the judgements were recorded and disagreements discussed. There was a varied amount of agreement on the quality of evidence for the outcomes relating to each of the twelve questions (kappa coefficients for agreement beyond chance ranged from 0 to 0.82). However, there was fair agreement about the relative importance of each outcome. There was poor agreement about the balance of benefits and harms and recommendations. Most of the disagreements were easily resolved through discussion. In general we found the GRADE approach to be clear, understandable and sensible. Some modifications were made in the approach and it was agreed that more information was needed in the evidence profiles. Judgements about evidence and recommendations are complex. Some subjectivity, especially regarding recommendations, is unavoidable. We believe our system for guiding these complex judgements appropriately balances the need for simplicity with the need for full and transparent consideration of all important issues.