GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations

Schünemann, H., & Santesso, N. (n.d.). Introduction to GRADE. Retrieved from Organization website:

Video available Evaluated/validated


This tool provides a transparent way for creating and presenting evidence syntheses. The framework applies a rating of quality of evidence and a grading of strength of recommendations for systematic reviews and clinical practice guidelines. GRADE rates the quality of a body of evidence.

Steps for Using Method/Tool

The GRADE tool guides users through eight criteria for critically assessing the quality of evidence:

  1. Risk of bias/study limitations
  2. Inconsistency of results
  3. Indirectness of evidence
  4. Imprecision
  5. Reporting bias
  6. Magnitude of effect
  7. Dose-response gradient
  8. Direction of plausible biases


Moberg, J., Oxman, A. D., Rosenbaum, S., Schünemann, H. J., Guyatt, G., Flottorp, S., Glenton, C., Lewin, S., Morelli, A., Rada, G., Alonso-Coello, P., & GRADE Working Group (2018). The GRADE vidence to Decision (EtD) framework for health system and public health decisions. Health Research Policy and Systems, 16(1), 45.


Neumann, I., Brignardello-Petersen, R., Wiercioch, W., Carrasco-Labra, A., Cuello, C., Akl, E., et al. (2016). The GRADE evidence-to-decision framework: a report of its testing and application in 15 international guideline panels. Implementation Science : IS, 11, 93.

These summaries are written by the NCCMT to condense and to provide an overview of the resources listed in the Registry of Methods and Tools and to give suggestions for their use in a public health context. For more information on individual methods and tools included in the review, please consult the authors/developers of the original resources.

We have provided the resources and links as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by McMaster University of any of the products, services or opinions of the external organizations, nor have the external organizations endorsed their resources and links as provided by McMaster University. McMaster University bears no responsibility for the accuracy, legality or content of the external sites.

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