Rating System For The Hierarchy Of Evidence Melnyk ((HOT))
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Recommendations are graded according to the strength of the supporting evidence and the desirable and undesirable consequences of the recommended action and inaction. The GRADE approach is often used to grade the quality of the evidence and the strength of recommendations rather than merely to identify the evidence or recommendations that are included in the guideline. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system is now being used at national, regional, and international levels. The Royal Dutch Society for Physical Therapy recently developed a set of GRADE criteria for rating the quality of evidence and the strength of recommendations to describe the quality and strength of the evidence base for physical therapy intervention recommendations. The GRADE group is also expanding the GRADE criteria to guide the development and rating of physical therapy practice guidelines. The GRADE group is making its criteria available on the website www.gradeworkinggroup.org .
GRADE, as well as its predecessor, the Scottish Intercollegiate Guidelines Network (SIGN) system, has a similar hierarchy of evidence, but in GRADE, quality of evidence and strength of recommendations can vary in a systematic way according to the balance between desirable and undesirable consequences of the intervention or test under consideration, that is, the net benefit. For example, the evidence that sun exposure prevents certain types of skin cancer would be of the highest quality, whereas one on which only the potential harm of excessive sun exposure is evaluated would be of the lowest quality.
The American Academy of Pediatrics (AAP) has developed a set of general principles that inform the process by which research is to be conducted and evidence generated. Research methods follow accepted scientific principles and are conducted in a manner that is free of bias. Research is carried out in a manner that is fair and consistent with the ethical principles of health care.
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