Other factors – upgrading the quality of evidence

GRADE approach to evaluating the quality of evidence: a pathway


This lesson is the eighth 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 discusses the factors that lead to upgrading the quality of evidence. It provides a rule of thumb for upgrading the evidence based on large effects. Evidence can also be upgraded based on dose response relations. Finally, the quality of evidence can be raised if all plausible residual confounding and biases may be working to reduce the demonstrated effect. Examples are provided to illustrate these factors.

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After using this resource, you should be able to...
  • understand how different factors affect the assessment of quality of evidence
  • upgrade the quality of evidence when appropriate

Other factors – upgrading the quality of evidence

Author information: 
Schünemann, Holger; Santesso, Nancy

Prepared by Holger Schünemann 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.