Core GRADE 5: rating certainty of evidence—assessing indirectness

This fifth article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to systematic reviews, clinical practice guidelines, and health technology assessments and addresses issues of indirect evidence. Guideline developers and health technology assessment practitioners must carefully specify the population, intervention, comparison, and outcome (PICO)—their target PICO—and consider the extent to which the best available evidence matches their target. When target and study PICOs differ substantially, studies provide indirect evidence and Core GRADE users may rate down the certainty of evidence as a result of this indirectness. Whether examining studies from a search for direct evidence or a deliberate search for indirect evidence, for each substantial difference between target and study PICO Core GRADE users must judge the likelihood that magnitude of effects will differ substantially. The greater the likelihood of substantial differences the more advisable rating down for indirectness.

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Publication Details

Journal
BMJ
Published
2025-05-20
DOI
https://doi.org/10.1136/bmj-2024-083865
Citations
12
Primary Topic
Delphi Technique in Research
Type
article
Field-Weighted Citation Impact
50.42
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article

Core GRADE 5: rating certainty of evidence—assessing indirectness

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BMJ
Delphi Technique in Research
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Core GRADE 5: rating certainty of evidence—assessing indirectness

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article en
12 citations

Abstract

This fifth article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to systematic reviews, clinical practice guidelines, and health technology assessments and addresses issues of indirect evidence. Guideline developers and health technology assessment practitioners must carefully specify the population, intervention, comparison, and outcome (PICO)—their target PICO—and consider the extent to which the best available evidence matches their target. When target and study PICOs differ substantially, studies provide indirect evidence and Core GRADE users may rate down the certainty of evidence as a result of this indirectness. Whether examining studies from a search for direct evidence or a deliberate search for indirect evidence, for each substantial difference between target and study PICO Core GRADE users must judge the likelihood that magnitude of effects will differ substantially. The greater the likelihood of substantial differences the more advisable rating down for indirectness.

BMJVol. 389
Mayo Clinic (US), University of Liverpool (GB), Medical University of South Carolina (US), Nanyang Technological University (SG), University of Oslo (NO), University of Basel (CH), Liverpool School of Tropical Medicine (GB), Sichuan University (CN), West China Medical Center of Sichuan University (CN), Translational Health Science and Technology Institute (IN), University Hospital of Basel (CH), Population Health Research Institute (CA), Karolinska Institutet (SE), New India Foundation (IN), West China Second University Hospital of Sichuan University (CN), University Hospital of Geneva (CH), Manipal University College Malaysia (MY), Institute of Liver and Biliary Sciences (IN), Mayo Clinic in Arizona (US), University of Kansas Medical Center (US), Stockholm Health Care Services (SE), Mayo Clinic in Florida (US), Impact (CA), Child Guidance Center (US), All India Institute of Medical Sciences (IN), University of Plymouth (GB), Stanford University (US), McMaster University (CA)
Reduced inequalities
Openalex Percentile: Top 0%
Delphi Technique in Research
50.42
DOIOpen Access PDFOpenAlex
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