GRADE: um sistema para graduar qualidade de evidência e força da recomendação e as implicações para a prática fisioterapêutica
DOI:
https://doi.org/10.33233/fb.v18i5.1564Abstract
Introdução: O sistema de graduação de qualidade de evidência e força de recomendação, denominado Grading of Recommendations, Assessment, Development and Evaluation (GRADE), tem sido adotado por organizações para o desenvolvimento de diretrizes e por revisores sistemáticos para análise da qualidade da evidência. Esse artigo tem como objetivo descrever os princípios e a abordagem do sistema GRADE. Método: Revisão de literatura utilizando as bases de dados Medline, CINAHL e Web of Science. Resultados: O sistema classifica a qualidade da evidência em alta, moderada, baixa e muito baixa, de acordo com fatores que consideram: a metodologia dos estudos, a consistência e a precisão dos resultados, o direcionamento da evidência e o viés de publicação. A força da recomendação é graduada em forte ou fraca e baseia-se não apenas na qualidade da evidência, mas no equilíbrio entre benefício e malefício da intervenção, valores e preferências do paciente e utilização dos recursos e custos. Os achados apresentados por esse sistema refletem a extensão da confiabilidade de que as estimativas dos efeitos encontradas estão corretas. Conclusão: O entendimento do sistema GRADE facilita a interpretação crítica de revisões sistemáticas e diretrizes que o utilizam e espera-se que haja um aumento da sua incorporação na produção desses estudos na área da fisioterapia.
Palavras-chave: prática clínica baseada em evidências, revisão, guia de prática clínica.
Â
References
GRADE working group. Grading quality of evidence and strength of recommendations. BMJ 2004;19:1490-94.
Atkins D, Eccles M, Flottorp S, Guyatt GH, Henry D, Hill S, et al. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches. The GRADE Working Group. BMC Health Serv Res 2004;4(1):38.
BMJ Publishing Group Ltd. Article requirements. 2006. [citado 2016 Ago 7]. DisponÃvel em URL: http://resources,bmj.com/bmj/autrhors/article-submission/article-requirements.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coelho P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendation. BMJ 2008;336:924-26.
Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schunemann HJ. What is “quality of evidence†and why is it important to clinicians? BMJ 2008;2008;336:995-8.
Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y , Vist GE, Liberati, A et al. Going from evidence to recommendations. BMJ 2008;336:1049-51.
Schunemann HJ, Oxman AD, Brozek J, Glasziou P, Jaeschke R, Vist GE, et al. Grading quality of evidence and strength of recommendation for diagnostic tests and strategies. BMJ 2008;336:1106-10.
Guyatt GH, Oxman AD, Kunz R, Jaeschke R, Helfand M, Liberati A et al. Incorporating considerations of resources use into grading recommendations. BMJ 2008;336:1170-3.
Jaeschke R, Guyatt GH, Dellinger P, Schunemann H, Levy MM, Kunz R et al. Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive. BMJ 2008;337.a744.
Guyatt GH, Oxman AD, Schunemann HJ, Tugwell P, Knottnerus A. GRADE guidelines: a new series of articles in the J Clin Epidemiol. J Clin Epidemiol 2011;64:380-2.
Andrews JC, Schunemann HJ, Oxman AD, Pottie K, Meerpohl JJ, Alonso-Coello P et al. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation’s direction and strength. J Clin Epidemiol 2013;66(7):726-35.
GRADE Working group. [citado 2016 Ago 10]. DisponÃvel em URL: http://www.gradeworkinggroup.org/.
Davoli M, Amato L, Clark N, Farrell M, Hickman M, Hill S et al. The role of Cochrane reviews in informing international guidelines: a case study of using the Grading of Recommendation, Assessment, Development and Evaluation system to develop World Health Organization guidelines for the psychosocially assisted pharmacology treatment of opioid dependence. Addiction 2015;110(6):891-8.
Schünemann H, Brożek J, Guyatt G, Oxman A, eds. GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group, 2013. [citado 2016 Ago 10]. DisponÃvel em: URL: www.guidelinedevelopment.org/handbook.
Harvey LA. GRADE the evidence. J Physiother 2013;59:5.
Austin TM, Richter RR, Sebelski CA. Introduction to the GRADE approach for guideline development: considerations for physical therapist practice. Phys Ther 2014;94:1652-9.
Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011;64:401-6.
Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, et al. GRADE guidelines: 4. Rating the quality of evidence- study limitations (risk of bias). J Clin Epidemiol 2011;64 (4):407-15.
Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al. GRADE guidelines: 7. Rating the quality of evidence –inconsistency. J Clin Epidemiol 2011;64(12):1294-302.
Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coelho P, Rind D. GRADE guidelines: 6. Rating the quality of evidence-imprecision. . J Clin Epidemiol 2011;64(12):1283-93.
Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M et al. GRADE guidelines: 8. Rating the quality of evidence-indirectness. J Clin Epidemiol 2011;64(12):1303-10.
Guyatt GH, Oxman AD, Montori V, Vist G, Kunz R, Brozek J et al. GRADE guidelines: 5. Rating the quality of evidence-publication bias. J Clin Epidemiol 2011;64(12):1277-82.
Guyatt GH, Oxman AD, Sultan S, Glasziou P, Aki EA, Alonso-Coello P. GRADE guidelines: 9. Rating up the quality of evidence. J Clin Epidemiol 2011;64(12):1311-6.
Devereaux PJ, Choi PT, Lacchetti C, Weaver B, Schunemann HJ, Haines T et al. A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. CMAJ 2002;166:1399-406.
Brozek JL, AKl EA, Compalati E, Kreis J, Terracciano L, Fiocchi A et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines Part 3 of 3. The GRADE approach to developing recommendations. Allergy 2011;66:588-95.
Guyatt GH, Oxman AD, Kunz R, Atkins D, Brozek J, Vist G et al. GRADE guidelines: 2 . Framing the question and deciding on important outcomes. J Clin Epidemiol 2013;64 (4):395-40.
Guyatt G, Oxman AD, Sultan S, Brozek J, Glasziou P, Alonso-Coello P. GRADE guidelines 11 – making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. J Clin Epidemiol 2013;66 (2):151-7.
GRADE guidelines: 1. Introduction. GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011;383-94.
Guyatt GH, Oxman AD, Santesso N, Helfand M, Vist G, Kunz R. GRADE guidelines: 12. Preparing Summary of Findings tables-binary outcomes. J Clin Epidemiol 2013;66(2):158-72.
Guyatt GH, Thorlund K, Oxman AD, Walter SD, Patrick D, Furukawa TA et al. GRADE guidelines: 13. Preparing summary of findings tables and evidence profiles-continuous outcomes. J Clin Epidemiol 2013;66(2):173-83.
Kannan P, Claydon LS. Some physiotherapy treatments may relieve menstrual pain in women with primary dysmenorrheal: a systematic review. J Physiother 2014;60:13-21.
Zwerink M, Brusse-Keizer M, van der Valk PD, Zielhuis GA, Monninkhof EM, van der Palen J et al. Self management for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014;19(3): CD002990. doi: 10.1002/14651858.CD002990.pub3.
GRADEpro GDT. [citado 2016 Ago 10]. DisponÃvel em URL: https://gradepro.org.
Andrews J, Guyatt G, Oxman AD, Alderson P, Dahm P, Falck-Ytter Y. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol 2013;66(7):719-25.
Published
Issue
Section
License
Authors are authorized for non-exclusive distribution of the version of the work published in this journal (eg, publishing in an institutional repository or as a book chapter), with acknowledgment of authorship and initial publication in this journal.
