Challenges in developing evidence-based recommendations using the GRADE approach: the case of mental, neurological, and substance use disorders

GRADE is an approach for creating clinical practice guidelines based on an explicit assessment of the evidence base. GRADE is not a system for performing systematic reviews and meta-analyses (it is not a systematic review tool as, for example, the RevMan software of the Cochrane Collaboration at http://www.cc-ims.net/revman). The GRADE approach is suitable for (a) summarizing the evidence extracted from systematic reviews and meta-analyses into "Summary of Findings (SoF) tables"; (b) grading the quality of evidence summarized in SoF tables; and (c) grading the strength of treatment recommendations. GRADE separates the judgment on quality of evidence from strength of recommendations. An application called GRADE Profiler (GRADEpro) has been developed to summarize the evidence and grade its quality. GRADEpro can be freely downloaded at http://www.gradeworkinggroup.org/toolbox/index.htm. Additional information on the GRADE methodology and on the GRADE working group can be found at http://www.gradeworkinggroup.org/index.htm. © 2010 Barbui et al