A critical review to grading systems and recommendations of traditional Chinese medicine guidelines

Health and Quality of Life Outcomes
Juan LiYingdong Li

Abstract

To investigate how many traditional Chinese medicine (TCM) guidelines adopted a grading system and the differences among them, and the distribution of level of evidence used to support TCM recommendations. A comprehensive search of relevant guideline webpages and literature databases were undertaken from inception to August 2018 to identify guidelines including TCM interventions. Two independent reviewers extracted the information about grading systems and recommendations. One hundred forty-two TCM guidelines were included, among which, 68 (47.9%) adopted a total of eight grading systems. The definitions, letters, and codes among these systems varied significantly. A total of 1284 recommendations were extracted from included TCM guidelines. More than 60% recommendations were based on a low and very low level of evidence (level C:33.4% and level D: 30.2%). Only 7.8% recommendations were rated as strong recommendation (grade I), while 76.2% recommendations were rated as conditional recommendation (grade II). Various grading systems were used in TCM guidelines, which might confuse guideline users. The low proportion of high level of evidence in TCM recommendations might downgrade the confidence to TCM interventions.

References

Jul 12, 1997·BMJ : British Medical Journal·T Hesketh, W X Zhu
Jun 19, 2004·BMJ : British Medical Journal·David AtkinsUNKNOWN GRADE Working Group
Apr 26, 2008·BMJ : British Medical Journal·Gordon H GuyattUNKNOWN GRADE Working Group
Feb 27, 2009·JAMA : the Journal of the American Medical Association·Pierluigi TricociSidney C Smith
Dec 15, 2010·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Thejaswi K Poonacha, Ronald S Go
Jan 12, 2011·Archives of Internal Medicine·Dong Heun Lee, Ole Vielemeyer
May 21, 2011·Archives of Disease in Childhood·Carlos A Cuello GarcíaGiordano Pérez Gaxiola
Mar 27, 2013·Pediatrics·Andre IsaacJoan L Robinson
Apr 11, 2013·Journal of Clinical Epidemiology·Jeffrey C AndrewsGordon Guyatt
Jan 19, 2016·Journal of Clinical Epidemiology·Liang YaoKehu Yang
Mar 22, 2016·Journal of Evidence-based Medicine·Wei DengYaolong Chen
Feb 14, 2018·BMJ : British Medical Journal·Yaolong ChenSusan L Norris

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Software Mentioned

SPSS
Oxford
GRADE
SIGN
NCCN
VIP
NEEBGDP
GARDE

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