Grading Strength of Evidence Interactive Quiz Prepared for: The Agency for Healthcare Research and Quality (AHRQ) Training...
<ul><li>Is grading the strength of evidence the same as rating the quality of studies? </li></ul><ul><li>Yes, they are the...
<ul><li>Strength-of-evidence grading specifies required domains. What are they? </li></ul><ul><li>Risk of bias, consistenc...
<ul><li>Which list below reflects the correct grades for strength of evidence?  </li></ul><ul><li>High, moderate, low, ver...
<ul><li>What discretionary domains can be used to reach a strength-of-evidence grade? </li></ul><ul><li>Dose-response asso...
<ul><li>In combining scores for domains into an overall grade for strength of evidence, which of the following approaches ...
<ul><li>In scoring required and additional domains and in arriving at an overall grade for strength of evidence, which of ...
<ul><li>To grade strength of evidence within a comparative effectiveness review, reviewers must: </li></ul><ul><ul><li>Und...
<ul><li>This quiz was prepared by Kathleen N. Lohr, Ph.D., a Distinguished Fellow at RTI International.   </li></ul><ul><l...
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Grading Strength of Evidence Quiz

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  • Grading Strength of Evidence: Interactive Quiz
  • Strength of Evidence Versus Quality Is grading the strength of evidence the same as rating the quality of studies? Incorrect. Individual studies are rated for their internal validity or risk of bias. Grading pertains to entire bodies of evidence about important key questions, outcomes, or comparisons. The quality of individual studies is just one of four required domains in strength-of-evidence grading. Incorrect. Grading pertains to entire bodies of evidence about important key questions, outcomes, or comparisons. Because domains other than the quality (risk of bias) of individual studies must also be used in strength-of-evidence grading, evaluating study quality and strength of evidence at the same time is insufficient. Correct. Strength-of-evidence grading is one of the final steps in the review process. It requires judgments about four key domains. Only one of these is quality (risk of bias) of the individual studies.
  • Required Domains Strength-of-evidence grading specifies required domains. What are they? Correct. The four required domains are risk of bias (i.e., quality ratings for individual studies with respect to a specific outcome), consistency (i.e., degree of similarity in the effect sizes of different studies within an evidence base with respect to a specific outcome), directness (i.e., whether evidence reflects a single, direct link between the interventions of interest and the ultimate health outcome under consideration, or, for comparisons, whether the evidence base has head-to-head studies), and precision (i.e., degree of certainty for estimate of effect with respect to a specific outcome). Incorrect. The four required domains are risk of bias, consistency, directness, and precision. Publication bias is an additional domain that can and should be used only when relevant. Incorrect. The four required domains are risk of bias, consistency (which is the missing required domain in this answer), directness, and precision. Strength of association is an additional domain referring to magnitude of effect that can be used when relevant.
  • Strength-of-Evidence Grades Which list below reflects the correct grades for strength of evidence? Incorrect. Very low is not an option. The four correct options for scores are high, moderate, low, and insufficient. Incorrect. Very high and very low are not used. The four correct options for scores are high, moderate, low, and insufficient. Correct. Strength of evidence can have three “strength” grades relating to the confidence one has that evidence reflects the true effect and that future research might confirm or overturn the results. Insufficient implies either that one has no relevant evidence or that the evidence is so mixed and inadequate that one cannot use any of the other levels.
  • Discretionary Domains What discretionary domains can be used to reach a strength-of-evidence grade? Correct. Any of these four domains can be used when they are relevant and the appropriate data or statistical tests are available. They are used only after the required domains have been scored. Incorrect. The correct other domains are dose-response association, plausible confounders, strength of association, and publication bias. Applicability is not used in grading strength of evidence; it is reported separately. Funding sources are not considered in strength-of-evidence grading. Incorrect. The correct other domains are dose-response association, plausible confounders, strength of association, and publication bias. Number of studies (or articles) by itself is not considered in strength-of-evidence grading. Applicability is not used in strength-of-evidence grading; it is reported separately.
  • Combining Scores for Overall Grade In combining scores for domains into an overall grade for strength of evidence, which of the following approaches can be used? Incorrect. Any of these three approaches can be used. The critical element in selecting any option is careful documentation of the methods. Incorrect. Any of these three approaches can be used. The critical element in selecting any option is careful documentation of the methods. Incorrect. Any of these three approaches can be used. The critical element in selecting any option is careful documentation of the methods. Correct. Any of the three approaches can be used. The critical element in selecting any option is careful documentation of the methods.
  • Consensus Scoring In scoring required and additional domains and in arriving at an overall grade for strength of evidence, which of the following should be done? Incorrect. At least two reviewers with appropriate clinical and methodological expertise should participate. Incorrect. At least two reviewers with appropriate clinical and methodological expertise should participate, but differences should be mediated or adjudicated by a third party. Only the consensus grade should be reported. Correct. At least two reviewers with appropriate clinical and methodological expertise should participate, and differences should be mediated or adjudicated by a third party. Only the consensus grade should be reported.
  • Summary
  • Author This interactive quiz augments the module on grading strength of evidence. It was prepared by Kathleen N. Lohr, Ph.D., a Distinguished Fellow at RTI International, and is based on an update of chapter 11 in version 1.0 of the Methods Guide for Comparative Effectiveness Reviews (updated chapter available at: http://effectivehealthcare. ahrq.gov/ehc/products/60/318/2009_0805_ grading.pdf ).
  • Grading Strength of Evidence Quiz

    1. 1. Grading Strength of Evidence Interactive Quiz Prepared for: The Agency for Healthcare Research and Quality (AHRQ) Training Modules for Systematic Reviews Methods Guide www.ahrq.gov
    2. 2. <ul><li>Is grading the strength of evidence the same as rating the quality of studies? </li></ul><ul><li>Yes, they are the same thing. </li></ul><ul><li>No, but you can grade strength of evidence at the same time that you rate the quality of the individual studies. </li></ul><ul><li>No, you can grade the strength of evidence only after you have rated the quality of individual studies. </li></ul>Strength of Evidence Versus Quality
    3. 3. <ul><li>Strength-of-evidence grading specifies required domains. What are they? </li></ul><ul><li>Risk of bias, consistency, directness, and precision </li></ul><ul><li>Risk of bias, consistency, directness, precision, and publication bias </li></ul><ul><li>Risk of bias, precision, strength of association, and directness </li></ul>Required Domains
    4. 4. <ul><li>Which list below reflects the correct grades for strength of evidence? </li></ul><ul><li>High, moderate, low, very low </li></ul><ul><li>Very high, high, moderate, low, very low </li></ul><ul><li>High, moderate, low, insufficient </li></ul>Strength-of –Evidence Grades
    5. 5. <ul><li>What discretionary domains can be used to reach a strength-of-evidence grade? </li></ul><ul><li>Dose-response association, plausible confounders, strength of association, and publication bias </li></ul><ul><li>Plausible confounders, strength of association, applicability, funding sources, and publication bias </li></ul><ul><li>Numbers of studies or articles, publication bias, and applicability </li></ul>Discretionary Domains
    6. 6. <ul><li>In combining scores for domains into an overall grade for strength of evidence, which of the following approaches can be used? </li></ul><ul><li>Only the GRADE algorithm for weighting domains </li></ul><ul><li>Only the reviewer’s own numerical weighting system </li></ul><ul><li>Only the reviewer’s own qualitative (nonnumerical) approach </li></ul><ul><li>Any of the above </li></ul>Combining Scores for Overall Grade
    7. 7. <ul><li>In scoring required and additional domains and in arriving at an overall grade for strength of evidence, which of the following should be done? </li></ul><ul><li>Use only one senior reviewer to perform these tasks and report this score. </li></ul><ul><li>Use two or more reviewers, resolve differences by consensus or adjudication by a third party, and report all scores. </li></ul><ul><li>Use two or more reviewers, resolve differences by consensus or adjudication by a third party, and report a consensus score. </li></ul>Consensus Scoring
    8. 8. <ul><li>To grade strength of evidence within a comparative effectiveness review, reviewers must: </li></ul><ul><ul><li>Understand the major concepts of strength-of-evidence grading </li></ul></ul><ul><ul><li>Know the difference between rating the quality of individual studies and grading whole bodies of evidence </li></ul></ul><ul><ul><li>Know the four required domains to be assessed and the possible other domains that can be used </li></ul></ul><ul><ul><li>Understand the strength-of-evidence grades and the approaches that can be used to combine domain scores </li></ul></ul>Summary
    9. 9. <ul><li>This quiz was prepared by Kathleen N. Lohr, Ph.D., a Distinguished Fellow at RTI International. </li></ul><ul><li>This module is based on an update of chapter 11 in version 1.0 of the Methods Guide for Comparative Effectiveness Reviews (updated chapter available at: http://effectivehealthcare.ahrq.gov/ehc/products/60/318/2009_0805_ grading.pdf ) . </li></ul>Author

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