GRADE guidelines: 9. Rating up the quality of evidence

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Guyatt, G. H., Oxman, A. D., Sultan, S., Glasziou, P. P., et al. (2011). GRADE guidelines: 9. Rating up the quality of evidence. Journal of clinical epidemiology, 64 (12), 1311-1316.

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2011 HERDC submission. FoR code: 111700

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The most common reason for rating up the quality of evidence is a large effect. GRADE suggests considering rating up quality of evidence one level when methodologically rigorous observational studies show at least a two-fold reduction or increase in risk, and rating up two levels for at least a five-fold reduction or increase in risk. Systematic review authors and guideline developers may also consider rating up quality of evidence when a dose-response gradient is present, and when all plausible confounders or biases would decrease an apparent treatment effect, or would create a spurious effect when results suggest no effect. Other considerations include the rapidity of the response, the underlying trajectory of the condition, and indirect evidence.

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