Strength of Recommendation Taxonomy (SORT): A Patient-Centered Approach to Grading Evidence in the Medical Literature

Ebell, Mark H.; Siwek, Jay; Weiss, Barry D.; Woolf, Steven H.; Susman, Jeffrey; Ewigman, Bernard; Bowman, Marjorie A.

doi:10.3122/jabfm.17.1.59

Cited by 1,027 publications

(977 citation statements)

References 18 publications

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“…[2][3][4] The available evidence was evaluated using a unified system called the Strength of Recommendation Taxonomy (SORT), which was developed by editors of the US family medicine and primary care journals (ie, American Family Physician, Family Medicine, Journal of Family Practice, and BMJ USA). 5 Evidence was graded using a 3-point scale based on the quality of study methodology (eg, randomized controlled trial [RCT ], case-control, prospective/retrospective cohort, case series, etc) and the overall focus of the study (ie, diagnosis, treatment/prevention/screening, or prognosis) as follows: I. Good-quality patient-oriented evidence (ie, evidence measuring outcomes that matter to patients: morbidity, mortality, symptom improvement, cost reduction, and quality of life Clinical recommendations were developed on the basis of the best available evidence tabled in the guideline. These are ranked as follows: A.…”

Section: Methodsmentioning

confidence: 99%

Guidelines of care for the management of basal cell carcinoma

Baum¹,

Bordeaux²,

Brown³

et al. 2018

Journal of the American Academy of Dermatology

326

219

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Basal cell carcinoma (BCC) is the most common form of human cancer, with a continually increasing annual incidence in the United States. When diagnosed early, the majority of BCCs are readily treated with office-based therapy, which is highly curative. In these evidence-based guidelines of care, we provide recommendations for the management of patients with BCC, as well as an in-depth review of the best available literature in support of these recommendations. We discuss biopsy techniques for a clinically suspicious lesion and offer recommendations for the histopathologic interpretation of BCC. In the absence of a formal staging system, the best available stratification based on risk for recurrence is reviewed. With regard to treatment, we provide recommendations on treatment modalities along a broad therapeutic spectrum, ranging from topical agents and superficially destructive modalities to surgical techniques and systemic therapy. Finally, we review the available literature and provide recommendations on prevention and the most appropriate follow-up for patients in whom BCC has been diagnosed. ( J Am Acad Dermatol

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Section: Methodsmentioning

confidence: 99%

Guidelines of care for the management of basal cell carcinoma

Baum¹,

Bordeaux²,

Brown³

et al. 2018

Journal of the American Academy of Dermatology

326

219

View full text Add to dashboard Cite

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“…The strength of recommendation for the Strength-of-Recommendation Taxonomy considers a grade of A as consistent, good-quality patient-oriented evidence; B as inconsistent or limited-quality patient-oriented evidence; and C as consensus evidence, disease-oriented evidence, and so forth. 24 …”

Section: Level Of Evidencementioning

confidence: 99%

“…24 Each of the individual included studies was deemed as level 1, 2, or 3 evidence. Level 1 evidence was considered good-quality (DBQI score of ≥60%) patient-oriented evidence; level 2 evidence was considered limited-quality (DBQI score of <60%) patient-oriented evidence; and level 3 was considered other evidence.…”

Section: Level Of Evidencementioning

confidence: 99%

“…Level 1 evidence was considered good-quality (DBQI score of ≥60%) patient-oriented evidence; level 2 evidence was considered limited-quality (DBQI score of <60%) patient-oriented evidence; and level 3 was considered other evidence. 24 To assess the collective body of evidence, the Strength-of-Recommendation Taxonomy assigns a strength of recommendation. The strength of recommendation for the Strength-of-Recommendation Taxonomy considers a grade of A as consistent, good-quality patient-oriented evidence; B as inconsistent or limited-quality patient-oriented evidence; and C as consensus evidence, disease-oriented evidence, and so forth.…”

Section: Level Of Evidencementioning

confidence: 99%

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Examination of Response Shift After Rehabilitation for Orthopedic Conditions: A Systematic Review

Powden¹,

Hoch²,

Hoch³

2018

Journal of Sport Rehabilitation

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Context: There is an increased emphasis on the need to capture and incorporate self-reported function to make clinical decisions when providing patient-centered care. Response shift (RS), or a change in an individual's self-evaluation of a construct, may affect the accurate assessment of change in self-reported function throughout the course of rehabilitation. A systematic review of this phenomenon may provide valuable information regarding the accuracy of self-reported function. Objectives: To systematically locate and synthesize the existing evidence regarding RS during care for various orthopedic conditions. Evidence Acquisition: Electronic databases (PubMed, MEDLINE, CINAHL, SPORTDiscus, and Psychology & Behavioral Sciences Collection) were searched from inception to November 2016. Two investigators independently assessed methodological quality using the modified Downs and Black Quality Index. The quality of evidence was assessed using the Strength-of-Recommendation Taxonomy. The magnitude of RS was examined through effect sizes. Evidence Synthesis: Nine studies were included (7 high quality and 2 low quality) with a median Downs and Black Quality Index score of 81.25% (range = 56.25%-93.75%). Overall, the studies demonstrated weak to strong effect sizes (range = −1.58-0.33), indicating the potential for RS. Of the 36 point estimates calculated, 22 (61.11%), 2 (5.56%), and 12 (33.33%) were associated with weak, moderate negative, and strong negative effect sizes, respectively. Conclusions: There is grade B evidence that a weak RS, in which individuals initially underestimate their disability, may occur in people undergoing rehabilitation for an orthopedic condition. It is important for clinicians to be aware of the potential shift in their patients' internal standards, as it can affect the evaluation of health-related quality of life changes during the care of orthopedic conditions. A shift in the internal standards of the patient can lead to subsequent misclassification of health-related quality of life changes that can adversely affect clinical decision making.

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“…37 The taxonomy consists of A, B, and C ratings. Grade A represents consistent, good-quality, patient-oriented evidence.…”

Section: Strength Of Recommendationmentioning

confidence: 99%

Health-Related Quality of Life in Athletes: A Systematic Review With Meta-Analysis

Houston

Hoch

2016

Journal of Athletic Training

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Context: Assessment of health-related quality of life (HRQOL) after injury is important. Differences in HRQOL between nonathletes and athletes and between injured and uninjured athletes have been demonstrated; however, the evidence has not been synthesized.Objective: To answer the following questions: (1) Does HRQOL differ among adolescent and collegiate athletes and nonathletes? (2) Does HRQOL differ between injured adolescent and collegiate athletes or between athletes with a history of injury and uninjured athletes or those without a history of injury?Data Sources: We systematically searched CINAHL, MED-LINE, SPORTDiscus, and PubMed. A hand search of references was also conducted.Study Selection: Studies were included if they used generic instruments to compare HRQOL outcomes between athletes and nonathletes and between uninjured and injured athletes. Studies were excluded if they did not use a generic instrument, pertained to instrument development, or included retired athletes or athletes with a chronic disease.Data Extraction:We assessed study quality using the modified Downs and Black Index Tool. Bias-corrected Hedges g effect sizes and 95% confidence intervals (CIs) were calculated.The Strength of Recommendation Taxonomy (SORT) was used to determine the overall strength of the recommendation. A random-effects meta-analysis was performed for all studies using the composite or total score.Data Synthesis: Eight studies with modified Downs and Black scores ranging from 70.6% to 88.4% were included. For question 1, the overall random-effects meta-analysis was weak (effect size ¼ 0.27, 95% confidence interval ¼ 0.14, 0.40; P , .001). For question 2, the overall random-effects meta-analysis was moderate (effect size ¼ 0.68, 95% confidence interval ¼ 0.42, 0.95; P , .001).Conclusions: Grade A evidence indicates that athletes reported better HRQOL than nonathletes and that uninjured athletes reported better HRQOL than injured athletes. However, the overall effect for question 1 was weak, suggesting that the differences between athletes and nonathletes may not be clinically meaningful. Clinicians should monitor HRQOL after injury to ensure that all dimensions of health are appropriately treated.Key Words: patient-centered care, patient outcomes, athletic injuries Key PointsHealth-related quality of life (HRQOL) assessed via generic instruments was better in athletes than in nonathletes, but the differences were small and may not be clinically meaningful. Athletes without a history of injury reported better HRQOL on generic instruments than did injured athletes. To ensure that all health dimensions are being properly assessed and treated, clinicians should monitor patients' HRQOL throughout treatment and perhaps after return to play. Given these differences on generic instruments, it will be prudent to investigate the use of region-specific and dimension-specific instruments in assessing HRQOL. P articipation in interscholastic and intercollegiate athletics has increased roughly 34% since 1980 and 15% over the past...

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Strength of Recommendation Taxonomy (SORT): A Patient-Centered Approach to Grading Evidence in the Medical Literature

Cited by 1,027 publications

References 18 publications

Guidelines of care for the management of basal cell carcinoma

Guidelines of care for the management of basal cell carcinoma

Examination of Response Shift After Rehabilitation for Orthopedic Conditions: A Systematic Review

Health-Related Quality of Life in Athletes: A Systematic Review With Meta-Analysis

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