Application of Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to the guideline development for clinical practice with acupuncture and moxibustion

Abstract

Grading of Recommendations Assessment, Development, and Evaluation (GRADE) offers a worldwide approach to guideline development for clinical practice. For the clinical practice of acupuncture therapy, 18 evidence-based guidelines have been developed in China using GRADE. In this study, we review the advantages and limitations of the GRADE approach in the guideline development for acupuncture and moxibustion and propose some solutions to these limitations. Scientific advantages of rating the quality of evidence, outcome-centric direction, overall progression to develop recommendations, and strength of recommendations providing specific clinical guidance are the advantages of GRADE. The limitations of GRADE in the development of guidelines for acupuncture and moxibustion include rating the quality of evidence for ancient literature and literature on famous traditional Chinese medicine experts' experiences and specific guidelines for formulating recommendations from evidence. In the guideline development for clinical practice with acupuncture and moxibustion, we suggest that a specific method should be explored based on the GRADE approach and the characteristics of acupuncture therapy.

Dexmedetomidine as an adjuvant for single spinal anesthesia in patients undergoing cesarean section: a system review and meta-analysis

“…The quality of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) 17 for the outcomes based on the following criteria: study design, risk of bias (for the included study), rating inconsistency in results (for the heterogeneity, I 2 ≥50% without satisfactory explanation was considered suspect), rating indirectness of evidence (for the data converted from figures or different scales), and others. Each outcome was evaluated as high, moderate, low, or very low levels.…”

GRADE Methods in traditional medicine

“…The GRADE methods were also recommended for development of clinical guidelines on acupuncture and moxibustion. 13 Eighteen evidence-based guidelines on acupuncture used GRADE methods in their development in China, and the guideline developers summarized advantages and limitations of the GRADE approach in the guideline development. 13 The advantages were rating the quality of evidence, outcome-centric direction, and transparent process of recommendation development.…”

“… 13 Eighteen evidence-based guidelines on acupuncture used GRADE methods in their development in China, and the guideline developers summarized advantages and limitations of the GRADE approach in the guideline development. 13 The advantages were rating the quality of evidence, outcome-centric direction, and transparent process of recommendation development. However, they also addressed some limitations of the GRADE approach in acupuncture guidelines such as lack of evidence grading for ancient literature and literature on prestigious Chinese medicine experts’ experience, and specific guidance concerning the characteristics of acupuncture therapy for formulating recommendations.…”

“…However, they also addressed some limitations of the GRADE approach in acupuncture guidelines such as lack of evidence grading for ancient literature and literature on prestigious Chinese medicine experts’ experience, and specific guidance concerning the characteristics of acupuncture therapy for formulating recommendations. 13 Thus, the authors suggest that a specific method should be explored based on the GRADE approach and the characteristics of acupuncture therapy in the guideline development for clinical practice with acupuncture and moxibustion.…”