The certainty of the evidence for interventions is the certainty or confidence that the true effect is within a particular range or relative to a threshold. In the new pyramid of evidence, systematic reviews represent the magnifying glass through which this certainty is evaluated. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach arises in response to the existence of multiple evidence classification systems, and it offers a transparent and structured process to develop and present summaries of evidence considering its certainty and, in a second step, the strength of the recommendations that they inform. The GRADE process begins with an explicit question that includes all important and critical outcomes explicitly. The main domains used to assess the certainty of the evidence are risk of bias, inconsistency, indirectness of evidence, imprecision, and publication bias. The factors that can increase the certainty of the evidence are dose-response gradient, large magnitude of an effect, and effect of plausible residual confounding. Finally, the Summary of Findings tables summarize the process in a simplified way and with controlled language. This narrative review’s purpose is to address the GRADE approach’s theoretical and practical underlying concepts in a simplified way and with practical examples.

The Orton-Gillingham ® and TouchMath ® systems of instruction were implemented to improve language and mathematics skill development for 6-and 7-year-olds in a 1st-grade classroom. After 2 years of intervention, the participants were found to be no longer in need of special education services. All the participants showed marked improvement in reading scores on the Wide Range Achievement Test-III. The students who were considered to be at risk for reading and mathematics difficulties at the beginning of their 1st-grade year were no longer in need of special education services at the end of their 2nd-grade year.Practitioners, researchers, administrators, parents, and policymakers have been concerned about the reading and mathematics skill development of students in schools all over the world for more than a century. Teachers often cite reading difficulties as the main reason for referring students to special education services. Failure to learn to read in the first grade can have serious and long-term consequences on an individual's literacy development (see Stein

The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology provides a framework for assessing the certainty of the evidence and making recommendations. The Evidence to Decision Framework (EtD) is a transparent and structured system for formulating health recommendations. Once the problem is identified and the certainty of the evidence is assessed, EtD provides several criteria for formulating a recommendation. These criteria include the trade-off between benefits and harms, patients’ values and preferences, acceptability, feasibility, resource use, and impact on equity. The resulting recommendations may differ in strength (strong or weak) and direction (for or against). The process is transparent, allowing other users to adjust the framework of recommendations by modifying the criteria to fit the desired context through an adaptation-adoption process. Given the extensive information available on EtD and the GRADE methodology in general, this narrative review seeks to explain the main concepts involved in decision-making in health by using simplified and friendly descriptions, accompanied by practical examples, thus facilitating its understanding by inexperienced readers.

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