Background

GRADE (Grading of Recommendations, Assessment, Development and Evaluation) is used by over 100 international organisations such as WHO, Cochrane, American Society of Haematology and others to produce rigorous and transparent clinical practice guidelines and other healthcare recommendations.

GRADE is a standardised and transparent approach to assessing the certainty of evidence and the strength of healthcare recommendations. The approach provides a manageable system that integrates all important aspects. The GRADE approach was developed by the multidisciplinary GRADE working group. More information on GRADE can be found at: http://de.gradeworkinggroup.org

Aim

To lead course participants through the complete process of guideline development with GRADE using a concrete example: starting with the selection of a relevant PICCO question and ending with the formulation of a recommendation. The GRADEpro GDT software is used for this purpose. The thematic focus is on assessing the certainty of the underlying evidence as well as the strength of the recommendation. In lectures, we introduce GRADE and explain its use with examples.  

Learning outcomes

In this course participants will be enabled to:

• Understand the basic principles of the GRADE approach and be able to comprehend the individual steps in the assessment of the evidence and their impact on the strength of the recommendation

• Be able to create an evidence profile for a therapeutic intervention based on a systematic review

• Have a basic understanding of the GRADE Software

Teaching strategies

The workshop will consist of a mixture of presentations and exercises in small groups.

Course content/timetable

Day 1

10:15 - 10:30 Welcome & introduction of presenters

10:30 -11:15 Presentation: Evidence-based healthcare

11:15 -11:30 Break

11:30 -12:15 Presentation: What is GRADE? An overview

12:15 -12:30 Break

12:45 -13:00 Practical exercise: Set PICO and outcomes

Day 2

10:15 -10:45 Recap & questions on previous presentations & exercise

10:45 -11:45 Presentation: Certainty of evidence - downgrade

11:45 -12:00 Break

12:00 -12:45 Presentation: Certainty of evidence - upgrading and Summary of Findings tables

12:45 -13:00 Break

13:00 - 13:30 Presentation: Introduction to GRADEpro GDT (GRADE software)

Day 3

10:15 - 10:45 Recap & questions on previous presentations & exercise

10:45 - 12:00 Exercise: Assessing the certainty of evidence (Methodological limitations)

12:00 - 12:15 Break

12:15 - 13:30 Exercise: Assessing the certainty of evidence (Inconsistency)

Day 4

10:15 - 10:45 Recap & questions on previous presentations & exercise

10:45 - 12:00 Exercise: Assessing the certainty of evidence (Indirectness)

12:00 - 12:15 Break

12:15 - 13:30 Exercise: Assessing the certainty of evidence (Imprecision)

Day 5

10:15 - 11:00 Presentation: Formulation of recommendations

11:00 - 11:15 Break

11:15 - 12:15 Exercise: Developing and formulating recommendations (Evidence to decision)

12:15 - 12:30 Break

12:30 - 13:30 Discussion of the results and conclusion

Facilitators

Inrgrid Töws (Institute for Evidence in Medicine, University Medical Centre, Freiburg, Germany)

Dr Nuala Livingstone (Cochrane)

Dr Chris Noone (NUI Galway)

Dr Heiki Raatz (Institute for Evidence in Medicine, University Medical Centre, Freiburg, Germany) 

Dr Blin Nagavci (Institute for Evidence in Medicine, University Medical Centre, Freiburg, Germany)