Judging the quality of evidence in reviews of prognostic factor research: Adapting the GRADE framework

被引：348
作者：
Huguet A. [1 ]
Hayden J.A. [2 ]
Stinson J. [3 ]
McGrath P.J. [1 ,4 ,5 ,6 ]
Chambers C.T. [1 ,4 ]
Tougas M.E. [1 ]
Wozney L. [1 ]
机构：
[1] IWK Health Centre, Centre for Pediatric Pain Research, 5850/5980 University Avenue, PO Box 9700, Halifax, B3K 6R8, NS
[2] Dalhousie University, Department of Community Health and Epidemiology, 5790 University Avenue, Halifax, B3H 1V7, NS
[3] University of Toronto, Hospital for Sick Children, Lawrence S Bloomberg Faculty of Nursing, 555 University Avenue, Toronto, M5G 1X8, ON
[4] Dalhousie University, Department of Psychology and Neuroscience, PO Box 15000, Halifax, B3H 4R2, NS
[5] Dalhousie University, Department of Psychiatry, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, B3H 2E2, NS
[6] Centre for Clinical Research Building, Capital District Health Authority, Research and Innovation, 117-5790 University Avenue, Halifax, B3H 1V7, NS
来源：
Systematic Reviews | / 2卷 / 1期
基金：
加拿大健康研究院;
关键词：
GRADE; Prognosis; Quality of evidence;
D O I：
10.1186/2046-4053-2-71
中图分类号：
学科分类号：
摘要：
Background: Prognosis research aims to identify factors associated with the course of health conditions. It is often challenging to judge the overall quality of research evidence in systematic reviews about prognosis due to the nature of the primary studies. Standards aimed at improving the quality of primary studies on the prognosis of health conditions have been created, but these standards are often not adequately followed causing confusion about how to judge the evidence. Methods: This article presents a proposed adaptation of Grading of Recommendations Assessment, Development and Evaluation (GRADE), which was developed to rate the quality of evidence in intervention research, to judge the quality of prognostic evidence. Results: We propose modifications to the GRADE framework for use in prognosis research along with illustrative examples from an ongoing systematic review in the pediatric pain literature. We propose six factors that can decrease the quality of evidence (phase of investigation, study limitations, inconsistency, indirectness, imprecision, publication bias) and two factors that can increase it (moderate or large effect size, exposure-response gradient). Conclusions: We describe criteria for evaluating the potential impact of each of these factors on the quality of evidence when conducting a review including a narrative synthesis or a meta-analysis. These recommendations require further investigation and testing. © 2013 Huguet et al.; licensee BioMed Central Ltd.
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