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"directness"

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Rating the Strength of Evidence From the CER

Presentation: Analgesics for Osteoarthritis—An Update
Keywords: comparative effectiveness | strength of evidence | systematic review | methods
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Rating the Strength of Evidence From the Comparative Effectiveness Review

Presentation: Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Peptide Testing for the Evaluation of Musculoskeletal Complaints in Pediatric Populations
Keywords: comparative effectiveness review | strength of evidence | evidence grade | risk of bias | consistency | directness | precision | Quality Assessment of Diagnostic Accuracy Studies | QUADAS
Defining Applicability. Applicability is defined as the extent to which the results observed in published studies are likely to reflect the expected outcomes when an intervention is applied to broader populations under real-world conditions. Similar terms include external validity, generalizability, directness, and relevance.
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Defining Applicability

Presentation: Assessing Applicability
Keywords: applicability | intervention | external validity | relevance | generalizability
Judge Applicability and Strength of Evidence Separately. Applicability is best reported separately from quality or strength of evidence. Internal validity concerns are not altered by changes in perspective, but applicability is. Some evidence hierarchies (GRADE) consider applicability “or directness” when assessing the quality of evidence. For systematic reviews in which multiple perspectives (clinician, patient, policymaker) are considered, applicability should be assessed separately.
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Judge Applicability and Strength of Evidence Separately

Presentation: Assessing Applicability
Keywords: applicability | strength of evidence | internal validity | GRADE
Consider the Contribution of an Individual Study to the Body of Evidence. This slide shows how characteristics of the individual study relate to domains evaluating the strength of the body of evidence. Each characteristic of the individual study is linked by an arrow to a domain for the strength of the body of evidence. The slide shows that the quality or internal validity of a study (i.e., limitations of study design and conduct) is one of several ways in which an individual study can contribute to the body of evidence. When evaluating the strength of the entire body of evidence, the quality of the study and the type of design influence the evaluation of the risk of bias for the entire body of evidence. The direction and magnitude of the results influence considerations of consistency of the body of evidence. The size of the study could result in nonsystematic or random error; it influences considerations of precision of the body of evidence. The relevance of the results to the key questions influences the evaluation of directness of the body of evidence. The relevance of the study sample to the population(s) of interest influences the assessment of applicability or generalizability of the body of evidence.
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Consider the Contribution of an Individual Study to the Body of Evidence

Presentation: Assessing the Quality of Individual Studies
Keywords: internal validity | study design | body of evidence | key questions | applicability | generalizability
This slide includes a table with two columns and three rows. Column 1, row 1: high. Column 2, row 2: High confidence that the evidence reflects the true effect. Further research is very unlikely to change our confidence in the estimate of effect. Column 1, row 2: moderate. Column 2, row 2: Moderate confidence that the evidence reflects the true effect. Further research may change our confidence in the estimate of effect and may change the estimate. Column 1, row 3: low. Column 2, row 3: Low confidence that the evidence reflects the true effect. Further research is likely to change our confidence in the estimate of effect and is likely to change the estimate. Column 1, row 4: insufficient. Column 2, row 4: Evidence is either unavailable or does not permit estimation of an effect. There is a footnote at the bottom that includes the following references: Guyatt GH, et al. BMJ 2008;336:924-6; Owens DK, et al. J Clin Epidemiol 2010;63:513-23; Samson DJ, et al. AHRQ Comparative Effectiveness Review No. 20. Available at: http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=447.
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Rating the Strength of Evidence From the CER: A Modification of the GRADE Methodology

Presentation: Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer
Keywords: evidence rating | comparative effectiveness review
To determine the strength of the evidence resulting from the systematic review, researchers used the methodology of the University of Connecticut/Hartford Hospital Evidence-Based Practice Center for grading, which is based on the GRADE (Grading of Recommendations, Assessment, DEvelopment) system of the Cochrane Collaboration. This system uses four required domains — risk of bias, consistency, directness, and precision — for assessments. All assessments were made by two investigators who resolved disagreements through discussion. The strength of evidence pertaining to each key question was classified into three broad categories or grades: 1. High means that there are consistent results from good quality clinical trials. Further research is very unlikely to change the conclusions. 2. Moderate means that findings are supported, but further research could change the conclusions. 3. Low means that there are very few clinical trials, or existing trials are flawed.
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Rating the Strength of Evidence From the CER: A Modification of the GRADE Methodology

Presentation: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function
Keywords: effective health care | GRADE | strength of evidence | comparative effectiveness
Four Domains Used To Assess Relevant Studies The following four major domains were examined: risk of bias (low, medium, high), consistency (no inconsistency, inconsistency present, unknown, or not applicable), directness (direct, indirect), and precision (precise, imprecise). Each key outcome on each comparison of interest was given an overall evidence grade based on the ratings for the individual domains.
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Four Domains Used To Assess Relevant Studies

Presentation: Comparative Effectiveness of In-Hospital Use of Recombinant Factor VIIa for Off-Label Indications vs. Usual Care
Keywords: comparative effectiveness | recombinant factor VIIa | off-label | risk of bias | consistency | directness | precision
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Rating the Strength of Evidence From the CER

Presentation: Comparative Effectiveness of Management Strategies for Adults With Gastroesophageal Reflux Disease: An Update
Keywords: comparative effectiveness | strength of evidence | systematic review | methods
Four Domains Used To Assess Relevant Studies The following four major domains were examined: risk of bias (low, medium, high), consistency (no inconsistency, inconsistency present, unknown, or not applicable), directness (direct, indirect), and precision (precise, imprecise). Four of the outcomes (health-related quality of life, shoulder function, cuff integrity and time to return to work) for each comparison of interest were given an overall evidence grade based on the ratings for the individual domains.
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Four Domains Used To Assess Relevant Studies

Presentation: Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears
Keywords: comparative effectiveness | nonoperative | operative | rotator cuff tear
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Strength of Evidence Ratings

Presentation: Comparative Effectiveness of Therapies for Children With Autism Spectrum Disorders
Keywords: comparative effectiveness review | CER | strength of evidence
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Strength of Evidence Ratings

Presentation: Comparisons of Medical, Laser, and Incisional Surgical Treatments for Open-Angle Glaucoma in Adults
Keywords: systematic review | strength of evidence | grading | risk of bias | consistency | directness | precision
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