GRADE guidelines: 8. Rating the quality of evidence-indirectness
Por:
Guyatt, GH, Oxman, AD, Kunz, R, Woodcock, J, Brozek, J, Helfand, M, Alonso-Coello, P, Falck-Ytter, Y, Jaeschke, R, Vist, G, Akl, EA, Post, PN, Norris, S, Meerpohl, J, Shukla, VK, Nasser, M, Schunemann, HJ
Publicada:
1 dic 2011
Resumen:
Direct evidence comes from research that directly compares the interventions in which we are interested when applied to the populations in which we are interested and measures outcomes important to patients. Evidence can be indirect in one of four ways. First, patients may differ from those of interest (the term applicability is often used for this form of indirectness). Secondly, the intervention tested may differ from the intervention of interest. Decisions regarding indirectness of patients and interventions depend on an understanding of whether biological or social factors are sufficiently different that one might expect substantial differences in the magnitude of effect.
Thirdly, outcomes may differ from those of primary interest-for instance, surrogate outcomes that are not themselves important, but measured in the presumption that changes in the surrogate reflect changes in an outcome important to patients.
A fourth type of indirectness, conceptually different from the first three, occurs when clinicians must choose between interventions that have not been tested in head-to-head comparisons. Making comparisons between treatments under these circumstances requires specific statistical methods and will be rated down in quality one or two levels depending on the extent of differences between the patient populations, co-interventions, measurements of the outcome, and the methods of the trials of the candidate interventions. (C) 2011 Elsevier Inc. All rights reserved.
Filiaciones:
Guyatt, GH:
McMaster Univ, Dept Clin Epidemiol & Biostat, CLARITY Res Grp, W Hamilton, ON L8N 3Z5, Canada
McMaster Univ, Dept Med, W Hamilton, ON L8N 3Z5, Canada
Oxman, AD:
Norwegian Knowledge Ctr Hlth Serv, N-0130 Oslo, Norway
Kunz, R:
Univ Basel Hosp, Acad Swiss Insurance Med, CH-4031 Basel, Switzerland
Univ Basel Hosp, Basel Inst Clin Epidemiol, CH-4031 Basel, Switzerland
Woodcock, J:
London Sch Hyg & Trop Med, London WC1, England
Helfand, M:
Oregon Hlth & Sci Univ, Portland VA Med Ctr, Oregon Evidence Based Practice Ctr, Portland, OR 97201 USA
Alonso-Coello, P:
Univ Autonoma Barcelona, Iberoamer Cochrane Ctr, Serv Epidemiol Clin & Salud Publ, Barcelona 08041, Spain
Univ Autonoma Barcelona, Hosp St Pau, CIBERESP, Barcelona 08041, Spain
Falck-Ytter, Y:
Case Western Reserve Univ, Case & VA Med Ctr, Div Gastroenterol, Cleveland, OH 44106 USA
Univ Oxford, Oxford, England
Jaeschke, R:
McMaster Univ, Dept Med, W Hamilton, ON L8N 3Z5, Canada
Vist, G:
Norwegian Knowledge Ctr Hlth Serv, N-0130 Oslo, Norway
Akl, EA:
SUNY Buffalo, Dept Med, Buffalo, NY 14260 USA
Post, PN:
Dutch Inst Healthcare Improvement CBO, Utrecht, Netherlands
Norris, S:
Oregon Hlth & Sci Univ, Dept Med Informat & Clin Epidemiol, Portland, OR 97239 USA
Meerpohl, J:
Univ Med Ctr Freiburg, Inst Med Biometry & Med Informat, German Cochrane Ctr, D-79104 Freiburg, Germany
Univ Med Ctr Freiburg, Dept Pediat & Adolescent Med, Div Pediat Hematol & Oncol, D-79106 Freiburg, Germany
Shukla, VK:
CADTH, Ottawa, ON K1S 5S8, Canada
Nasser, M:
Inst Qual & Efficiency Hlth Care IQWiG, Dept Hlth Informat, Cologne, Germany
Schunemann, HJ:
McMaster Univ, Dept Med, W Hamilton, ON L8N 3Z5, Canada
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