Understanding the certainty of evidence from systematic reviews in rehabilitation science: what do clinicians need to know about GRADE?

Abstract

Purpose

Systematic reviews of interventions are published each year evaluating rehabilitation approaches such as exercise, manual therapy, or electrotherapy. Currently, important methodological approaches are available to make systematic reviews more robust and transparent. One of these approaches is the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) system.

Material and methods

A perspective for rehabilitation was conducted aiming to (1) shed light on the meaning and relevance of the GRADE system in systematic reviews with meta-analysis of rehabilitation science, and (2) propose suggestions for helping clinicians improve the interpretation of the GRADE findings.

Results

The meaning and relevance of GRADE in rehabilitation science was discussed. Suggestions were proposed to help clinicians in the interpretation of the GRADE findings. We discussed the use of meta-analyses, meta-regressions, subgroups meta-analyses, and sensitivity analyses to increase the objectivity of the domains of GRADE. Finally, a future agenda was provided.

Conclusion

The use of GRADE is essential for improving the synthesis of evidence that clinicians may often use in rehabilitation practice. However, GRADE is only one hallmark when the findings of systematic reviews are interpreted. The issues of sample size, futile research, pre-registration, switching outcomes, or narrative bias should be also considered.

IMPLICATIONS FOR REHABILITATION

• Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) is helpful in systematic reviews for understanding the certainty of evidence is analyzed.

• GRADE could detect limitation in the certainty of evidence helping clinicians to choose the best therapeutic option for their patients.

• Some domains of GRADE (indirectness and inconsistency) are particularly useful for clinicians who aim to translate the conclusions of a synthesis of evidence into clinical practice.

Keywords:

• GRADE
• meta-analysis
• methods
• rehabilitation
• review

Authors contributions

Javier Martinez-Calderon developed the first draft of this article. Cristina Garcia Muñoz developed the figures. Both authors edited and revised the entire manuscript. Both authors approved the final version of the manuscript.

Disclosure statement

The authors declare that they had not a conflict of interest.

Data availability statement

There are no data in this manuscript.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.