GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) is a systematic approach used to assess the quality of evidence and make recommendations in healthcare. It is often used in systematic reviews and meta-analyses to help summarise the evidence and make recommendations about clinical practices or health policies. GRADE is produced using GRADE Pro software.
GRADEProGRADE categorizes the quality of evidence into four levels:
High: Further research is unlikely to change the confidence in the estimate of effect.
Moderate: Further research is likely to have an impact on the confidence in the estimate of effect and may change the estimate.
Low: Further research is likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate.
Very Low: Any estimate of effect is very uncertain.
GRADE framework considers the following factors that can increase or decrease the confidence in evidence:
Risk of Bias: The potential for systematic errors in the studies.
Inconsistency: Variations in results across studies.
Indirectness: Differences between the population, intervention or outcomes studied and the context of the decision.
Imprecision: Uncertainty around the results due to small sample sizes or wide confidence intervals.
Publication Bias: The potential for positive results to be more likely to be published than negative ones.