This article is the first of a series providing guidance for use of the Grading of
Recommendations Assessment, Development, and Evaluation (GRADE) system of rating quality
of evidence and grading strength of recommendations in systematic reviews, health
technology assessments (HTAs), and clinical practice guidelines addressing alternative
management options. The GRADE process begins with asking an explicit question, including
specification of all important outcomes. After the evidence is collected and summarized,
GRADE provides explicit criteria for rating the quality of evidence that include study
design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect.
Recommendations are characterized as strong or weak (alternative terms conditional
or discretionary) according to the quality of the supporting evidence and the balance
between desirable and undesirable consequences of the alternative management options.
GRADE suggests summarizing evidence in succinct, transparent, and informative summary
of findings tables that show the quality of evidence and the magnitude of relative
and absolute effects for each important outcome and/or as evidence profiles that provide,
in addition, detailed information about the reason for the quality of evidence rating.
Subsequent articles in this series will address GRADE's approach to formulating questions,
assessing quality of evidence, and developing recommendations.
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