A Critical Appraisal of Standard Guidelines for Grading Levels of Evidence

P. Cristian Gugiu · Mihaiela Ristei Gugiu

40 citations0/0 files storedEvaluation & the Health Professions

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Meta-analysis and systematic reviews Health Sciences Research and Education Clinical practice guidelines implementation

Abstract

Over the past 30 years, a general consensus has emerged within the medical community regarding the essential role served by grading guidelines in evaluating the quality of evidence produced by a medical research study. Specifically, consensus exists regarding the hierarchy of evidence, where randomized controlled trials (RCTs) are considered the ''gold standard'' followed by nonrandomized controlled trials (non-RCTs) and uncontrolled trials. As guidelines have become more sophisticated, processes have been developed for downgrading poorly conducted studies and upgrading strong studies. Lists of threats to internal validity have been disseminated, thereby assisting reviewers in grading studies. However, despite these many accomplishments, considerable issues remain unresolved with respect to how to evaluate the strength of evidence produced by flawed RCTs versus well-conducted non-RCTs. The purpose of this article is to evaluate existing evidence-based grading guidelines and to offer suggestions for how such guidelines may be improved.

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1986Introduction to Classical and Modern Test Theory 2008Chapter 8: Assessing risk of bias in included studies 2000Randomized, Controlled Trials, Observational Studies, and the Hierarchy of Research Designs 2008Assessing Risk of Bias in Included Studies 2003Evaluating non-randomised intervention studies 2008Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study 1999The Hazards of Scoring the Quality of Clinical Trials for Meta-analysis 2004The Sage encyclopedia of social science research methods

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2013Defiance and Motivational Postures 2016A Critical Review of Grading Systems: Implications for Public Health Policy 2012An Application of a New Evidence Grading System to Research on the Chronic Care Model 2014Hierarchy of evidence and appraisal of limitations (HEAL) grading system

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