Gradering av kvaliteten på dokumentasjonen
DOI:
https://doi.org/10.5324/nje.v23i2.1637Abstract
Hva menes med at noe er ”godt dokumentert”? I hvilken grad kan vi stole på forskningsresultater? Den mest brukte metoden for å vurdere kvalitet på dokumentasjon og styrke på anbefalinger er GRADE (Grading of Recommendations Assessment, Development and Evaluation). GRADE brukes i systematiske oversikter og i retningslinjer der man vurderer effekten av og gir anbefalinger om ulike behandlingsalternativer. I GRADE gjøres et klart skille mellom kvaliteten på dokumentasjonen og styrken på anbefalingene. For å vurdere kvaliteten på dokumentasjonen tar GRADE utgangspunkt i en godt utført systematisk oversikt som omfatter den aktuelle problemstillingen. Både randomiserte forsøk og observasjonsstuder kan inngå. GRADE benytter fem kriterier som vurderes for eventuell nedgradering av kvaliteten på dokumentasjonen: studiekvalitet, konsistens mellom studiene, direkthet, presisjon og rapporteringsskjevheter. I tillegg kan observasjonsstudier vurderes for oppgradering ved følgende tre kriterier: sterke assosiasjoner, dose-responseffekter og forvekslingsfaktorer. Alle vurderingene noteres og presenteres sammen med resultatene i oppsummeringstabeller.
Vist GE, Sæterdal I, Vandvik PO, Flottorp SA. Grading the quality of the evidence. Nor J Epidemiol 2013; 23 (2): 151-156.
ENGLISH SUMMARY
What is meant by the claim that something is “well documented”? How much confidence can we have in the results? The most commonly used method to grade the quality of the evidence is GRADE (Grading of Recommendations Assessment, Development and Evaluation). GRADE is used in systematic reviews, where the effects of different treatments or options are being compared, and in guidelines with recommendations about the competing options. GRADE makes a clear distinction between the quality of the evidence and the strength of recommendation. When grading the quality of the evidence with GRADE, the starting point is a well conducted systematic review of research on the question that is being assessed. Both randomized controlled trials and observational studies can be included in the evaluation. GRADE uses five criteria to judge for possible downgrading of the quality of the evidence: risk of bias, consistency, directness, precision and reporting bias. Observational studies may in addition be assessed for possible upgrading of the quality of evidence using the following three criteria: strong association, dose response relationship, and plausible confounding. All the judgments are noted and presented together with the results in tables.
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