How to GRADE the evidence: Indirectness

GRADE approach to evaluating the quality of evidence: a pathway


This lesson is the fifth in the series of online learning materials designed to help guideline developers and authors of systematic reviews learn how to use the GRADE approach to grade the evidence in systematic reviews, to create Summary of Findings Tables and GRADE Evidence Profiles, and move from evidence to making recommendations.

This lesson deals with indirectness as a criterion for assessing the quality of a body of evidence. It explains what is a direct evidence and how indirectness can be caused by differences in populations or patients, interventions, comparators, and outcomes.

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After using this resource, you should be able to...
  • understand difference between likelihood of and confidence in an effect
  • assess whether the evidence is direct enough that we can be confident in the estimate of effect
  • address indirectness in the presentation of evidence

Assessing indirectness

Author information: 
Sch√ľnemann, Holger; Santesso, Nancy

Prepared by Holger Sch√ľnemann and Nancy Santesso from the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. Funding for the development of this lesson was provided by the Cochrane Collaboration through the grant 'Training and Capacity Building for Summary of Findings Tables' and the World Health Organization.