Grading Strength of EvidenceInteractive Quiz

Prepared for:

The Agency for Healthcare Research and Quality (AHRQ)

Training Modules for Systematic Reviews Methods Guide

www.ahrq.gov

Is grading the strength of evidence the same as rating the quality of studies?

A.Yes, they are the same thing.

B.No, but you can grade strength of evidence at the same time that you rate the quality of the individual studies.

C.No, you can grade the strength of evidence only after you have rated the quality of individual studies.

Strength of Evidence Versus Quality

Strength-of-evidence grading specifies required domains. What are they?

A.Risk of bias, consistency, directness, and precision

B.Risk of bias, consistency, directness, precision, and publication bias

C.Risk of bias, precision, strength of association, and directness

Required Domains

Which list below reflects the correct grades for strength of evidence?

A.High, moderate, low, very low

B.Very high, high, moderate, low, very low

C.High, moderate, low, insufficient

Strength-of –Evidence Grades

What discretionary domains can be used to reach a strength-of-evidence grade?

A.Dose-response association, plausible confounders, strength of association, and publication bias

B.Plausible confounders, strength of association, applicability, funding sources, and publication bias

C.Numbers of studies or articles, publication bias, and applicability

Discretionary Domains

In combining scores for domains into an overall grade for strength of evidence, which of the following approaches can be used?A.Only the GRADE algorithm for weighting domainsB.Only the reviewer’s own numerical weighting systemC.Only the reviewer’s own qualitative (nonnumerical) approachD.Any of the above

Combining Scores for Overall Grade

In scoring required and additional domains and in arriving at an overall grade for strength of evidence, which of the following should be done?A.Use only one senior reviewer to perform these tasks and report this score.

B.Use two or more reviewers, resolve differences by consensus or adjudication by a third party, and report all scores.

C.Use two or more reviewers, resolve differences by consensus or adjudication by a third party, and report a consensus score.

Consensus Scoring

To grade strength of evidence within a comparative effectiveness review, reviewers must: Understand the major concepts of strength-of-

evidence grading Know the difference between rating the quality of

individual studies and grading whole bodies of evidence

Know the four required domains to be assessed and the possible other domains that can be used

Understand the strength-of-evidence grades and the approaches that can be used to combine domain scores

Summary

This quiz was prepared by Kathleen N. Lohr, Ph.D., a Distinguished Fellow at RTI International.

This module is based on an update of chapter 11 in version 1.0 of the Methods Guide for Comparative Effectiveness Reviews (updated chapter available at: http://effectivehealthcare.ahrq.gov/ehc/products/60/318/2009_0805_ grading.pdf ).

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