Visual transformation for guidelines presentation of the strength of recommendations and the certainty of evidence

Our original methodology in the approach of making recommendations has been accepted for publication in one of the top-ranking epidemiology periodicals in the world – in (the first-decile) Journal of Clinical Epidemiology. Read the pre-proof article: https://doi.org/10.1016/j.jclinepi.2021.11.009.
 
This excellent paper proposes a visual unification of adapted guidelines into one unified tabular form and the transformation of different certainty of evidence ( CoE) and strength of recommendations (SoR) classes into GRADE symbols. It is hoped that such transformation may make the guidelines easier for interpretation by target users, students in their professional education, and the lay population, foster their implementation, as well as reduce research waste in guideline development. The objective is also not to make shortcuts to GRADE.
 
We are using this methodology not only in the national project of CPG but also in the international RecMap project - recommendations to COVID-19.
 
 
 

Authors

Miloslav Klugar1,2,3 Lucia Kantorová1,2 Andrea Pokorná1,2,3,4 Radim Líčeník1,2 Ladislav Dušek1,3 Holger J Schünemann5 Abanoub Riad1  Jiří Kantor6,7 Jitka Klugarová1,2,3

1 The Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic

2 Czech Health Research Council, Prague, Czech Republic

3 Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic

4 Department of Nursing and Midwifery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
5 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton (ON), Canada

6 The Palacky University Evidence-Based Education working team: Mentee Centre, Faculty of Education, Olomouc, Czech Republic

7 Institute of Special Education Studies, Faculty of Education, Olomouc, Czech Republic

 

Corresponding author:

PhDr. Miloslav Klugar, Ph.D., klugar@med.muni.cz

The Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 3, 625 00 Brno, Czech Republic.

 

Abstract

Objective The objective of this paper is to propose an approach to visual unification of adapted guidelines and transformation of classifications of certainty of evidence (CoE) and strength of recommendations (SoR) into the approach suggested by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group.

Study design and Setting We carried out a literature search in MEDLINE and Epistemonikos, an analysis of selected guidelines, and an iterative discussion to decide on a consistent visual presentation and CoE and SoR depictions.

Results The results of the literature search suggested this issue had not been addressed yet. The analysis of the chosen eight guidelines showed significant heterogeneity in the visual presentation of recommendations. Recommendations were often worded similarly to whether or not they were strong or conditional. Many guidelines contained "statements", almost all of which did not fulfill the good practice statement (GPS) criteria. We proposed an approach for transforming recommendations that are being adapted and which use various classification systems for CoE and SoR into GRADE and a consistent visual style.

Conclusion Guideline developers should aim for unification in the formulation of recommendations to improve transferability.

Keywords: GRADE; clinical practice guidelines; certainty of evidence; strength of recommendations; visual style; good practice statements.