The GRADE handbook
Or go directly to one of the chapters:
1. Overview of the GRADE Approach
1.1 Purpose and advantages of the GRADE approach
1.2 Separation of confidence in effect estimates from strength of recommendations
1.3 Special challenges in applying the the GRADE approach
1.4 Modifications to the GRADE approach
2. Framing the health care question
2.1 Defining the patient population and intervention
2.2 Dealing with multiple comparators
2.4 Format of health care questions using the GRADE approach
3. Selecting and rating the importance of outcomes
3.1 Steps for considering the relative importance of outcomes
3.3 Using evidence in rating the importance of outcomes
3.4 Surrogate (substitute) outcomes
5.1 Factors determining the quality of evidence
5.2 Factors that can reduce the quality of the evidence
5.2.1 Study limitations (Risk of Bias)
5.2.2 Inconsistency of results
5.2.2.1 Deciding whether to use estimates from a subgroup analysis
5.2.3 Indirectness of evidence
5.2.4.1 Imprecision in guidelines
5.2.4.2 Imprecision in in systematic reviews
5.2.4.3 Rating down two levels for imprecision
5.3. Factors that can increase the quality of the evidence
5.3.1 Large magnitude of an effect
5.3.3. Effect of plausible residual confounding
5.4 Overall quality of evidence
6. Going from evidence to recommendations
6.1 Recommendations and their strength
6.1.3 Recommendations to use interventions only in research
6.2 Factors determining direction and strength of recommendations
6.2.1 Balance of desirable and undesirable consequences
6.2.1.1 Estimates of the magnitude of the desirable and undesirable effects
6.2.1.2 Best estimates of values and preferences
6.3.2 Confidence in best estimates of magnitude of effects (quality of evidence)
6.3.3 Confidence in values and preferences
6.3.4.1 Differences between costs and other outcomes
6.3.4.3 Resource implications considered
6.3.4.4 Confidence in the estimates of resource use (quality of the evidence about cost)
6.3.4.5 Presentation of resource use
6.3.4.7 Consideration of resource use in recommendations
6.4 Presentation of recommendations
6.4.1 Wording of recommandations
6.4.3 Providing transparent statements about assumed values and preferences
6.5 The Evidence-to-Decision framework
7. The GRADE approach for diagnostic tests and strategies
7.1. Questions about diagnostic tests
7.1.1. Establishing the purpose of a test
7.1.2. Establishing the role of a test
7.1.3. Clear clinical questions
7.2. Gold standard and reference test
7.3. Estimating impact on patients
7.4. Indirect evidence and impact on patient-important outcomes
7.5. Judgment about the quality of the underlying evidence
7.5.2. Factors that determine and can decrease the quality of evidence
7.5.2.2. Indirectness of the evidence
7.5.3. Overall confidence in estimates of effects
8. Criteria for determining whether the GRADE approach was used
9. Glossary of terms and concepts