What Is the GRADE Framework?
Looking for the full method? Read the detailed guide: How to Use GRADE to Assess Certainty of Evidence.
GRADE (Grading of Recommendations Assessment, Development and Evaluation) is a framework for rating the certainty of evidence for each outcome and for moving from evidence to recommendations. Certainty is rated high, moderate, low or very low.
Example
Invented for teaching: Randomised trials start at high certainty, and ratings may be lowered for risk of bias, inconsistency, indirectness, imprecision or publication bias. Observational evidence can be raised for large effects or dose-response gradients.
Common misunderstanding
GRADE does not rate the quality of a study overall; it rates certainty in an effect estimate for a specific outcome. It is also not a mechanical score, so judgements should be explained.
Learn more
See How to Use GRADE to Assess Certainty of Evidence.
References and further reading
- Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924-926. doi:10.1136/bmj.39489.470347.AD
- Higgins JPT, Thomas J, Chandler J, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions. Cochrane. Link
Related reading
This page is general educational information about research methods. It is not medical, legal or regulatory advice; follow your institution's ethics board and your target journal's instructions.