Rating certainty when the target threshold is the null and the point estimate is close to the null
When one initially targets the null effect and the point estimate falls close to the null, two challenges exist in rating certainty of evidence. First, when the point estimate is near the null and the data, therefore, suggests little or no effect, rating certainty in a benefit or harm is misleading. Second, since in general the narrower the confidence interval (CI) the more precise the estimate, if the CI is narrow, rating down for imprecision due simply to crossing the null is inappropriate. This paper addresses these issues and provides a solution: to revise the target of certainty rating from a non-zero effect to a little or no effect. This solution requires estimating a range in which the minimal important difference (MID) for benefit and an MID for harm might lie, and thus establishing a range that represents little or no effect. If GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) users are confident that the point estimate represents an effect less than the smallest plausible MID, they will revise their target and rate certainty to a little or no effect. If the entire CI falls within the range of little or no effect, they will not rate down for imprecision. Otherwise (if the CI includes an important effect), they will rate down. Using the solution provided in this paper GRADE users can make an optimal choice of the target of certainty rating.
Authors
- Bradley C. Johnston (ORCID: https://orcid.org/0000-0001-8872-8626)
- Philipp Dahm (ORCID: https://orcid.org/0000-0003-2819-2553)
- Romina Brignardello‐Petersen (ORCID: https://orcid.org/0000-0002-6010-9900)
- Nancy Santesso (ORCID: https://orcid.org/0000-0003-0550-4585)
- Linan Zeng (ORCID: https://orcid.org/0009-0009-5081-3353)
- Ariel Izcovich (ORCID: https://orcid.org/0000-0001-9053-4396)
- Gordon Guyatt (ORCID: https://orcid.org/0000-0003-2352-5718)
- Monica Hultcrantz (ORCID: https://orcid.org/0000-0002-5140-4289)
- Alfonso Iorio (ORCID: https://orcid.org/0000-0002-3331-8766)
- Hans de Beer
- Mohammad Hassan Murad (ORCID: https://orcid.org/0000-0001-5502-5975)
- Martín Ragusa (ORCID: https://orcid.org/0000-0002-3182-8041)
- Reem A. Mustafa (ORCID: https://orcid.org/0000-0002-2091-0875)
- David Tovey (ORCID: https://orcid.org/0000-0002-8889-9246)
- Lingli Zhang (ORCID: https://orcid.org/0000-0001-7339-2197)
Institutions
- Universidad del Salvador (AR)
- Mayo Clinic (US)
- Sichuan University (CN)
- West China Medical Center of Sichuan University (CN)
- Karolinska Institutet (SE)
- West China Second University Hospital of Sichuan University (CN)
- Hospital Fernández (AR)
- Art Innovation (Netherlands) (NL)
- Minneapolis VA Health Care System (US)
- University of Kansas Medical Center (US)
- Impact (CA)
- Texas A&M University (US)
- McMaster University (CA)
Publication Details
- Journal
- BMJ evidence-based medicine
- Published
- 2025-03-05
- DOI
- https://doi.org/10.1136/bmjebm-2024-113077
- Citations
- 4
- Primary Topic
- Meta-analysis and systematic reviews
- Type
- article
- Field-Weighted Citation Impact
- 5.59
Funders
- National Natural Science Foundation of China