Stage 5: Assessing Quality: Step 3: Assessing the Confidence in Cumulative Evidence

Assessing the Cumulative Evidence

In addition to examining the quality of each individual study, the quality of the cumulative evidence of a review should be assessed.

You can use a framework, such as GRADE (quantitative data) or GRADE-CERQual (qualitative data), to rate the quality of the cumulative evidence and determine what evidence-based recommendations can be made following quality assessment.

For information and training on GRADE or GRADE-CERQual, refer to the Additional Resource section below.

Additional Resources

• GRADE Resources (from Cochrane; Handbook, software, introduction to using GRADE, common errors in GRADE)
• GRADE-CERQual: An introduction for qualitative evidence synthesis [Cochrane webinar)
• GRADE-CERQual: Applying GRADE-CERQual to qualitative evidence synthesis findings–paper 6: how to assess relevance of the data. Noyes, J., Booth, A., Lewin, S., Carlsen, B., Glenton, C., Colvin, C. J., ... & Tunςalp, Ö. (2018). Implementation Science, 13(1), 4.

GRADE provides guidance for rating the quality of evidence and the strength of recommendations in health care. A series of articles describing the GRADE approach were published in the Journal of Clinical Epidemiology (2011, Vol 64, Issue 4).

• GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables
• GRADE guidelines: 2. Framing the question and deciding on important outcomes
• GRADE guidelines: 3. Rating the quality of evidence
• GRADE guidelines: 4. Rating the quality of evidence—study limitations (risk of bias)
• GRADE guidelines: 5. Rating the quality of evidence—publication bias
• GRADE guidelines 6. Rating the quality of evidence—imprecision
• GRADE guidelines: 7. Rating the quality of evidence—inconsistency
• GRADE guidelines: 8. Rating the quality of evidence—indirectness