Users' Guides to the Medical Literature: IX. A Method for Grading Health Care Recommendations
Abstract
THE ULTIMATE PURPOSE of applied health research is to improve health care. Summarizing the literature to adduce recommendations for clinical practice is an important part of the process. Recently, the health sciences community has reduced the bias and imprecision of traditional literature summaries and their associated recommendations through the development of rigorous criteria for both literature overviews1-3and practice guidelines.4,5Even when recommendations come from such rigorous approaches, however, it is important to differentiate between those based on weak vs strong evidence. Recommendations based on inadequate evidence often require reversal when sufficient data become available,6while timely implementation of recommendations based on strong evidence can save lives.6In this article, we suggest an approach to classifying strength of recommendations. We direct our discussion primarily at clinicians who make treatment recommendations that they hope their colleagues will follow. However, we believe that any clinician who attends to
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Systematic reviews of systematic reviews and meta-analyses are at the pinnacle of contemporary hierarchies of health evidence.
“At the pinnacle of contemporary hierarchies are systematic reviews of systematic reviews and the gold standard, systematic reviews of meta-analyses.25”
From Effectiveness of wearable activity trackers to increase physical activity and improve health: a systematic review of systematic reviews and meta-analyses. (2022) · cites this paper as [24]
Cites
Wasserman, S. S., Hedges, L. V., & Olkin, I. (1988) · Journal of Educational Statistics · doi:10.2307/1164953 · Cited by 10,347 · see citing works
Measurement of health state utilities for economic appraisal
Torrance, G. W. (1986) · Journal of Health Economics · doi:10.1016/0167-6296(86)90020-2 · Cited by 2,213 · see citing works
An Assessment of Clinically Useful Measures of the Consequences of Treatment
Laupacis, A., Sackett, D. L., & Roberts, R. S. (1988) · New England Journal of Medicine · doi:10.1056/nejm198806303182605 · Cited by 1,681 · see citing works
Antman, E. M. (1992) · JAMA · doi:10.1001/jama.268.2.240 · Cited by 1,535 · see citing works
Rules of Evidence and Clinical Recommendations on the Use of Antithrombotic Agents
Sackett, D. L. (1989) · CHEST Journal · doi:10.1378/chest.95.2_supplement.2s · Cited by 1,369 · see citing works
Statistics with Confidence: Confidence Intervals and Statistical Guidelines.
JOLLIFFE, F. R., Gardner, M. J., & Altman, D. G. (1990) · Journal of the Royal Statistical Society Series A (Statistics in Society) · doi:10.2307/2982808 · Cited by 1,319 · see citing works
Meta-Analysis in Clinical Research
L'ABBÉ, K. A., DETSKY, A. S., & O'ROURKE, K. (1987) · Annals of Internal Medicine · doi:10.7326/0003-4819-107-2-224 · Cited by 1,267 · see citing works
Meta-Analyses of Randomized Controlled Trials
Sacks, H. S., Berrier, J., Reitman, D., Ancona-Berk, V. A., & Chalmers, T. C. (1987) · New England Journal of Medicine · doi:10.1056/nejm198702193160806 · Cited by 1,253 · see citing works
Yusuf, S. (1991) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1991.03470010097038 · Cited by 1,014 · see citing works
Risk Factors for Gastrointestinal Bleeding in Critically Ill Patients
Cook, D. J., Fuller, H. D., Guyatt, G. H., Marshall, J. C., Leasa, D., Hall, R., Winton, T. L., Rutledge, F., Todd, T., Roy, P., et al. (1994) · New England Journal of Medicine · doi:10.1056/nejm199402103300601 · Cited by 1,010 · see citing works
Self-citationA consumer's guide to subgroup analyses
Oxman, A. D., & Guyatt, G. H. (1992) · Annals of Internal Medicine · doi:10.7326/0003-4819-116-1-78 · Cited by 914 · see citing works
Self-citationBias in treatment assignment in controlled clinical trials
Chalmers, T. C., Celano, P., Sacks, H. S., & Smith, H. (1983) · New England Journal of Medicine · doi:10.1056/nejm198312013092204 · Cited by 864 · see citing works
Users' Guides to the Medical Literature
Oxman, A. D. (1994) · JAMA · doi:10.1001/jama.1994.03520170077040 · Cited by 813 · see citing works
Users' Guides to the Medical Literature
Guyatt, G. H. (1994) · JAMA · doi:10.1001/jama.1994.03510250075039 · Cited by 693 · see citing works
Self-citationOxman, A. D. (1993) · JAMA · doi:10.1001/jama.270.17.2093 · Cited by 656 · see citing works
Stress Ulcer Prophylaxis in Critically III Patients
Cook, D. J. (1996) · JAMA · doi:10.1001/jama.1996.03530280060038 · Cited by 603 · see citing works
Guyatt, G. H. (1994) · JAMA · doi:10.1001/jama.271.1.59 · Cited by 581 · see citing works
Self-citationThe Periodic Health Examination
Frappier-Davignon, L. (1934) · New England Journal of Medicine · doi:10.1056/nejm193401252100413 · Cited by 488 · see citing works
Risk Factors for Gastrointestinal Bleeding in Critically Ill Patients
COOK, D. J., Fuller, H. D., Marshall, J. C., Leasa, D. J., Hall, R., Winton, T. L., Rutledge, F. S., TODD, T. J. R., Roy, P., Lacroix, J., et al. (1994) · Survey of Anesthesiology · doi:10.1097/00132586-199412000-00065 · Cited by 469 · see citing works
Users' Guides to the Medical Literature
Hayward, R. S. (1995) · JAMA · doi:10.1001/jama.1995.03530070068032 · Cited by 392 · see citing works
Users' Guides to the Medical Literature
Wilson, M. C. (1995) · JAMA · doi:10.1001/jama.274.20.1630 · Cited by 276 · see citing works
Clinically useful measures of effect in binary analyses of randomized trials
Sinclair, J. C., & Bracken, M. B. (1994) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(94)90191-0 · Cited by 271 · see citing works
Management of raised blood pressure in New Zealand: a discussion document.
Jackson, R., Barham, P., Bills, J., Birch, T. B., McLennan, L., MacMahon, S. W., & Tj, M. (1993) · BMJ · doi:10.1136/bmj.307.6896.107 · Cited by 262 · see citing works
Woolf, S. H. (1990) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(90)90073-x · Cited by 259 · see citing works
Users' Guides to the Medical Literature
Wilson, M. C. (1995) · JAMA · doi:10.1001/jama.1995.03530200066040 · Cited by 228 · see citing works
Who benefits from medical interventions?
Smith, G. D., & Egger, M. (1994) · BMJ · doi:10.1136/bmj.308.6921.72 · Cited by 128 · see citing works
Basic statistics for clinicians: 2. Interpreting study results: confidence intervals.
Guyatt, G. H., Jaeschke, R., Heddle, N. M., Cook, D., Shannon, H. S., & Walter, S. D. (1995) · Europe PMC (PubMed Central) · Cited by 118 · see citing works
Self-citationBasic statistics for clinicians: 3. Assessing the effects of treatment: measures of association.
Jaeschke, R., Guyatt, G. H., Shannon, H. S., Walter, S. D., Cook, D., & Heddle, N. M. (1995) · Europe PMC (PubMed Central) · Cited by 111 · see citing works
Self-citationSensitivity and Specificity of Clinical Trials
Sacks, H. S. (1983) · Archives of Internal Medicine · doi:10.1001/archinte.1983.00350040143020 · Cited by 87 · see citing works
Risk factors for gastrointestinal bleeding in critically ill patients
Cook, D. J., Fuller, H. D., Guyatt, G. H., Marshall, J. C., Leasa, D. J., Hall, R., Winton, T., Rutledge, F. S., Todd, T. R. J., Roy, P., et al. (1994) · Gastroenterology Nursing · doi:10.1097/00001610-199409000-00015 · Cited by 81 · see citing works
Self-citationAlternative Perspectives on the Biased Foundations of Medical Technology Assessment
Diamond, G. A., & Denton, T. A. (1993) · Annals of Internal Medicine · doi:10.7326/0003-4819-118-6-199303150-00010 · Cited by 70 · see citing works
Vial, T., Goubier, C., Bergeret, A., Cabrera, F., Evreux, J. C., & Descotes, J. (1991) · Drug Safety · doi:10.2165/00002018-199106020-00002 · Cited by 66 · see citing works
Screening for Adolescent Idiopathic Scoliosis
Sox, H. C. (1993) · JAMA · doi:10.1001/jama.1993.03500200081038 · Cited by 57 · see citing works
Large trials with simple protocols: Indications and contraindications
Lubsen, J. C., & Tijssen, J. G. P. (1989) · Controlled Clinical Trials · doi:10.1016/0197-2456(89)90054-8 · Cited by 43 · see citing works
Statistical Guidelines for Contributors to Medical Journals
Altman, D. G., Gore, S. M., Gardner, M. J., & Pocock, S. (1992) · Annals of Clinical Biochemistry International Journal of Laboratory Medicine · doi:10.1177/000456329202900101 · Cited by 29 · see citing works
Turmoil in Medical Education: Peking, Paris, and Points West
H., E. J. (1969) · Annals of Internal Medicine · doi:10.7326/0003-4819-70-1-225 · Cited by 24 · see citing works
Dobbs, J., Muir, J. G., & Smith, R. (1986) · PubMed · Cited by 10 · see citing works
Late-Stage African Trypanosomiasis and Eflornithine
Bari, C. D., Pastore, G., Roscigno, G., Schechter, P. J., & Sjoerdsma, A. (1986) · Annals of Internal Medicine · doi:10.7326/0003-4819-105-5-803_3 · Cited by 10 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Grading quality of evidence and strength of recommendations
(2004) · BMJ · doi:10.1136/bmj.328.7454.1490 · Cited by 8,477 · see citing works
Self-citationMoher, D., Cook, D. J., Eastwood, S., Olkin, I., Rennie, D., & Stroup, D. F. (1999) · The Lancet · doi:10.1016/s0140-6736(99)04149-5 · Cited by 4,826 · see citing works
Allergic Rhinitis and Its Impact on Asthma
Bousquet, J., van Cauwenberge, P., & Khaltaev, N. (2001) · Journal of Allergy and Clinical Immunology · doi:10.1067/mai.2001.118891 · Cited by 3,588 · see citing works
Randomized, Controlled Trials, Observational Studies, and the Hierarchy of Research Designs
Concato, J., Shah, N., & Horwitz, R. I. (2000) · New England Journal of Medicine · doi:10.1056/nejm200006223422507 · Cited by 3,563 · see citing works
Zhang, W., Moskowitz, R. W., Nuki, G., Abramson, S., Altman, R. D., Arden, N., Bierma-Zeinstra, S., Brandt, K. D., Croft, P., Doherty, M., et al. (2008) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2007.12.013 · Cited by 2,796 · see citing works
Moher, D., Schulz, K. F., & Altman, D. G. (2001) · BMC Medical Research Methodology · doi:10.1186/1471-2288-1-2 · Cited by 2,755 · see citing works
Systematic Reviews: Synthesis of Best Evidence for Clinical Decisions
Cook, D. J., Mulrow, C. D., & Haynes, R. B. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-126-5-199703010-00006 · Cited by 2,184 · see citing works
Bonevski, B., Randell, M., Paul, C. L., Chapman, K. L., Twyman, L., Bryant, J., Brozek, I., & Hughes, C. (2014) · BMC Medical Research Methodology · doi:10.1186/1471-2288-14-42 · Cited by 1,495 · see citing works
BTS guidelines for the management of community acquired pneumonia in adults: update 2009
Lim, W. S., Baudouin, S., George, R. C., Hill, A. T., Jamieson, C., Jeune, I. L., Macfarlane, J. T., Read, R. C., Roberts, H. J., Levy, M. L., et al. (2009) · Thorax · doi:10.1136/thx.2009.121434 · Cited by 1,417 · see citing works
Atkins, D., Eccles, M., Flottorp, S., Guyatt, G. H., Henry, D., Hill, S., Liberati, A., O'Connell, D., Oxman, A. D., Phillips, B., et al. (2004) · BMC Health Services Research · doi:10.1186/1472-6963-4-38 · Cited by 1,235 · see citing works
Self-citationLévesque, L. E., Hanley, J. A., Kezouh, A., & Suissa, S. (2010) · BMJ · doi:10.1136/bmj.b5087 · Cited by 1,199 · see citing works
Hill, I. D., Dirks, M., Liptak, G. S., Colletti, R. B., Fasano, A., Guandalini, S., Hoffenberg, E. J., Horváth, K., Murray, J. A., Pivor, M., et al. (2004) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/00005176-200501000-00001 · Cited by 1,187 · see citing works
Delitto, A., George, S. Z., Dillen, L. V., Whitman, J. M., Sowa, G., Shekelle, P., Denninger, T. R., & Godges, J. J. (2012) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2012.42.4.a1 · Cited by 1,166 · see citing works
International Clinical Recommendations on Scar Management
Mustoe, T. A., Cooter, R. D., Gold, M. H., Hobbs, R. F., Ramelet, A.-A., Shakespeare, P. G., Stella, M., Téot, L., Wood, F. M., & Ziegler, U. E. (2002) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-200208000-00031 · Cited by 1,081 · see citing works
Evaluation of networks of randomized trials
Salanti, G., Higgins, J. P., Ades, A., & Ioannidis, J. P. (2008) · Statistical Methods in Medical Research · doi:10.1177/0962280207080643 · Cited by 1,078 · see citing works
Progress in evidence-based medicine: a quarter century on
Djulbegovic, B., & Guyatt, G. H. (2017) · The Lancet · doi:10.1016/s0140-6736(16)31592-6 · Cited by 1,022 · see citing works
Self-citationHierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions
Evans, D. (2003) · Journal of Clinical Nursing · doi:10.1046/j.1365-2702.2003.00662.x · Cited by 993 · see citing works
Registries for Evaluating Patient Outcomes: A User’s Guide
(2020) · doi:10.23970/ahrqepcregistries4 · Cited by 968 · see citing works
Network meta-analysis: an introduction for clinicians
Rouse, B., Chaimani, A., & Li, T. (2017) · Internal and Emergency Medicine · doi:10.1007/s11739-016-1583-7 · Cited by 875 · see citing works
Users' Guides to the Medical Literature
Guyatt, G. H., Haynes, R. B., Jaeschke, R. Z., Cook, D. J., Green, L. A., Naylor, C. D., Wilson, M. C., Richardson, W. S., & for the Evidence-Based Medicine Working Group (2000) · JAMA · doi:10.1001/jama.284.10.1290 · Cited by 741 · see citing works
Self-citationGarrison, L. P., Neumann, P. J., Erickson, P., Marshall, D. A., & Mullins, C. D. (2007) · Value in Health · doi:10.1111/j.1524-4733.2007.00186.x · Cited by 694 · see citing works
Meta‐Analysis in Medical Research
Haidich, A. (2005) · Wiley eBooks · doi:10.1002/9780470994894 · Cited by 691 · see citing works
Photoaging: mechanisms and repair
Rabe, J. H., Mamelak, A. J., McElgunn, P. J. S., Morison, W. L., & Sauder, D. N. (2006) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2005.05.010 · Cited by 610 · see citing works
Deer, T. R., Mekhail, N. A., Provenzano, D. A., Pope, J. E., Krames, E. S., Leong, M. S., Levy, R. M., Abejón, D., Buchser, E., Burton, A., et al. (2014) · Neuromodulation Technology at the Neural Interface · doi:10.1111/ner.12208 · Cited by 606 · see citing works
The Iowa Model of Evidence-Based Practice to Promote Quality Care
Titler, M. G., Kleiber, C., Steelman, V. J., Rakel, B. A., Budreau, G., Everett, L. Q., Buckwalter, K. C., Tripp-Reimer, T., & Goode, C. J. (2001) · Critical Care Nursing Clinics of North America · doi:10.1016/s0899-5885(18)30017-0 · Cited by 586 · see citing works
Ferguson, T., Olds, T., Curtis, R., Blake, H., Crozier, A. J., Dankiw, K., Dumuid, D., Kasai, D., O'Connor, E., Virgara, R., et al. (2022) · The Lancet Digital Health · doi:10.1016/s2589-7500(22)00111-x · Cited by 560 · see citing works
Leichsenring, F., Rabung, S., & Leibing, E. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.12.1208 · Cited by 513 · see citing works
Hemmann, S., Graf, J., Roderfeld, M., & Roeb, E. (2007) · Journal of Hepatology · doi:10.1016/j.jhep.2007.02.003 · Cited by 509 · see citing works
BTS Guidelines for the Management of Community Acquired Pneumonia in Adults
British Thoracic Society Standards of Care Committee in collaboration with and endorsed by the Royal College of Physicians of London, Royal College of General Practitioners, British Geriatrics Society, British Lung Foundation, British Infection Society, & B (2001) · Thorax · doi:10.1136/thx.56.suppl_4.iv1 · Cited by 506 · see citing works
Price, M. J., Ades, A., Soldan, K., Welton, N. J., Macleod, J., Simms, I., DeAngelis, D., Turner, K. M., & Horner, P. J. (2016) · Health Technology Assessment · doi:10.3310/hta20220 · Cited by 494 · see citing works
Shoulder Pain and Mobility Deficits: Adhesive Capsulitis
Kelley, M. J., Shaffer, M. A., Kuhn, J. E. “., Michener, L. A., Seitz, A. L., Uhl, T. L., Godges, J. J., & McClure, P. W. (2013) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2013.0302 · Cited by 485 · see citing works
New directions in evidence-based policy research: a critical analysis of the literature
Oliver, K. A., Lorenc, T., & Innvær, S. (2014) · Health Research Policy and Systems · doi:10.1186/1478-4505-12-34 · Cited by 476 · see citing works
Psychological factors affecting the outcome of total hip and knee arthroplasty: a systematic review
Vissers, M. M., Bussmann, J. B., Verhaar, J. A. N., Busschbach, J. J. V., Bierma-Zeinstra, S. M. A., & Reijman, M. (2012) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2011.07.003 · Cited by 473 · see citing works
de Sèze, M., Ruffion, A., Denys, P., Joseph, P., Perrouin-Verbe, B., & International Francophone Neuro-Urological expert study group (GENULF) (2007) · Multiple Sclerosis Journal · doi:10.1177/1352458506075651 · Cited by 457 · see citing works
Manchikanti, L. (2008) · Pain Physician · doi:10.36076/ppj.2008/11/s5 · Cited by 430 · see citing works
QUOROM Group, Moher, D., Cook, D. J., Eastwood, S., Olkin, I., Rennie, D., & Stroup, D. F. (2000) · British journal of surgery · doi:10.1046/j.1365-2168.2000.01610.x · Cited by 418 · see citing works
Understanding Nutritional Epidemiology and Its Role in Policy
Satija, A., Yu, E., Willett, W. C., & Hu, F. B. (2015) · Advances in Nutrition · doi:10.3945/an.114.007492 · Cited by 414 · see citing works
Ettinger, B. B., Harris, S. T., Kendler, D. L., Kessel, B., McClung, M. R., Gorodeski, G. I., Rothert, M. L., Henderson, V. W., Richardson, M. K., Freedman, R. R., et al. (2006) · Cited by 403 · see citing works
Tanamas, S. K., Hanna, F. S., Cicuttini, F., Wluka, A. E., Berry, P., & Urquhart, D. M. (2009) · Arthritis Care & Research · doi:10.1002/art.24336 · Cited by 394 · see citing works
A systematic review of the content of critical appraisal tools
Katrak, P., Bialocerkowski, A. E., Massy‐Westropp, N., Kumar, S., & Grimmer, K. A. (2004) · BMC Medical Research Methodology · doi:10.1186/1471-2288-4-22 · Cited by 389 · see citing works
Management of osteoporosis in postmenopausal women
(2010) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e3181c617e6 · Cited by 382 · see citing works
How to use the evidence: assessment and application of scientific evidence
Glasziou, P., Irwig, L., Bain, C., & Colditz, G. A. (2000) · Cited by 378 · see citing works
‘Is it worth doing?’ Measuring the impact of patient and public involvement in research
Staley, K. (2015) · Research Involvement and Engagement · doi:10.1186/s40900-015-0008-5 · Cited by 363 · see citing works
Clinical Practice Guideline: Early Detection of Developmental Dysplasia of the Hip
Committee on Quality Improvement, S. O. D. D. O. T. H. (2000) · PEDIATRICS · doi:10.1542/peds.105.4.896 · Cited by 363 · see citing works
Systematic Review on the Management of Chronic Constipation in North America
Brandt, L. J., Prather, C. M., Quigley, E. M. M., Schiller, L. R., Schoenfeld, P., & Talley, N. J. (2005) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2005.50613_2.x · Cited by 342 · see citing works
Nielsen, K. M., & Miraglia, M. (2016) · Human Relations · doi:10.1177/0018726716670226 · Cited by 335 · see citing works
McPoil, T. G., Martin, R. L., Cornwall, M. W., Wukich, D. K., Irrgang, J. J., & Godges, J. J. (2008) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2008.0302 · Cited by 320 · see citing works
Influence of obesity on the development of osteoarthritis of the hip: a systematic review
Lievense, A. M. (2002) · British journal of rheumatology · doi:10.1093/rheumatology/41.10.1155 · Cited by 307 · see citing works
Nikolakopoulou, A., White, I. R., & Salanti, G. (2020) · Chapman & Hall/CRC eBooks · doi:10.1201/9781315119403-10 · Cited by 307 · see citing works
Screening for Thyroid Disease: An Update
Helfand, M., & Redfern, C. C. (1998) · Annals of Internal Medicine · doi:10.7326/0003-4819-129-2-199807150-00020 · Cited by 304 · see citing works
Trustworthy Online Controlled Experiments: A Practical Guide to A/B Testing
Kohavi, R., Tang, D., & Xu, Y. (2020) · doi:10.1017/9781108653985 · Cited by 297 · see citing works
An overview of meta-analysis for clinicians
Lee, Y. H. (2017) · The Korean Journal of Internal Medicine · doi:10.3904/kjim.2016.195 · Cited by 294 · see citing works
Sedentary lifestyle as a risk factor for low back pain: a systematic review
Chen, S.-M., Liu, M., Cook, J. L., Bass, S. L., & Lo, S. K. (2009) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-009-0410-0 · Cited by 282 · see citing works
Users' Guides to the Medical Literature
Wilson, M. C. (1995) · JAMA · doi:10.1001/jama.274.20.1630 · Cited by 276 · see citing works
Evidence-Based Policymaking: A Critique
Greenhalgh, T., & Russell, J. (2009) · Perspectives in biology and medicine · doi:10.1353/pbm.0.0085 · Cited by 275 · see citing works
Clinical Recommendations Using Levels of Evidence for Antithrombotic Agents
Cook, D. J., Guyatt, G. H., Laupacis, A., Sackett, D. L., & Goldberg, R. J. (1995) · CHEST Journal · doi:10.1378/chest.108.4_supplement.227s · Cited by 275 · see citing works
Self-citationHow to read a paper : getting your bearings (deciding what the paper is about)
Greenhalgh, T. (1997) · BMJ · doi:10.1136/bmj.315.7102.243 · Cited by 272 · see citing works
Zundert, J. H. M. V., Patijn, J., Kessels, A. G. H., Lamé, I. E., van Suijlekom, H., & van Kleef, M. (2006) · Pain · doi:10.1016/j.pain.2006.09.002 · Cited by 269 · see citing works
Taylor, R. S., Buyten, J. V., & Buchser, E. (2005) · European Journal of Pain · doi:10.1016/j.ejpain.2005.02.004 · Cited by 269 · see citing works
Ankle Stability and Movement Coordination Impairments: Ankle Ligament Sprains
Martin, R. L., Davenport, T. E., Paulseth, S. G., Wukich, D. K., & Godges, J. J. (2013) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2013.0305 · Cited by 268 · see citing works
Mother–To–Infant Transmission of Hepatitis C Virus
Yeung, L., King, S., & Roberts, E. A. (2001) · Hepatology · doi:10.1053/jhep.2001.25885 · Cited by 264 · see citing works
Six ‘biases’ against patients and carers in evidence-based medicine
Greenhalgh, T., Snow, R., Ryan, S., Rees, S., & Salisbury, H. (2015) · BMC Medicine · doi:10.1186/s12916-015-0437-x · Cited by 259 · see citing works
Ellis, P. M. (2000) · Annals of Oncology · doi:10.1023/a:1008342222205 · Cited by 258 · see citing works
Persistent pain and uncomfortable sensations in persons with multiple sclerosis
Hadjimichael, O. C., Kerns, R. D., Rizzo, M., Cutter, G., & Vollmer, T. L. (2006) · Pain · doi:10.1016/j.pain.2006.07.015 · Cited by 253 · see citing works
Users' Guides to the Medical Literature
Dans, A. L., Dans, L. F., Guyatt, G. H., Richardson, S., & for the Evidence-Based Medicine Working Group (1998) · JAMA · doi:10.1001/jama.279.7.545 · Cited by 250 · see citing works
Self-citationThe GRADE system for rating clinical guidelines
Kavanagh, B. P. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000094 · Cited by 246 · see citing works
“Systems for Grading Evidence and Issuing Guidelines Based on the Evidence Atkins and colleagues compared the following six systems [6]: N The American College of Chest Physicians Evidence-Based Guidelines (http:// www.chestnet.org/education/hsp/guidelinesProducts.php) N Australian National Health and Medical Research…”
MethodKatkade, V., Sanders, K. N., & Zou, K. H. (2018) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s160029 · Cited by 240 · see citing works
The Vermont Oxford Network: Evidence-Based Quality Improvement for Neonatology
Horbar, J. D. (1999) · PEDIATRICS · doi:10.1542/peds.103.se1.350 · Cited by 237 · see citing works
Moher, D., Cook, D. J., Eastwood, S., Olkin, I., Rennie, D., & Stroup, D. F. (2000) · Oncology Research and Treatment · doi:10.1159/000055014 · Cited by 235 · see citing works
Appraisal Tools for Clinical Practice Guidelines: A Systematic Review
Siering, U., Eikermann, M., Hausner, E., Hoffmann-Eßer, W., & Neugebauer, E. A. M. (2013) · PLoS ONE · doi:10.1371/journal.pone.0082915 · Cited by 233 · see citing works
Users' Guides to the Medical Literature
McAlister, F. A., Straus, S. E., Guyatt, G. H., Haynes, R. B., & for the Evidence-Based Medicine Working Group (2000) · JAMA · doi:10.1001/jama.283.21.2829 · Cited by 228 · see citing works
Self-citationDeeks, J. J., Bracken, M. B., Sinclair, J. C., Davies, H. T. O., Tavakoli, M., & Crombie, I. K. (1998) · BMJ · doi:10.1136/bmj.317.7166.1155a · Cited by 225 · see citing works
Epistemologic Inquiries in Evidence-Based Medicine
Djulbegović, B., Guyatt, G. H., & Ashcroft, R. E. (2009) · Cancer Control · doi:10.1177/107327480901600208 · Cited by 218 · see citing works
Self-citationTranslating Research into Practice
Titler, M. G., & Everett, L. Q. (2001) · Critical Care Nursing Clinics of North America · doi:10.1016/s0899-5885(18)30026-1 · Cited by 218 · see citing works
Are psychodynamic and psychoanalytic therapies effective? A review of empirical data
Leichsenring, F. (2005) · The International journal of psycho-analysis · doi:10.1516/rfee-lkpn-b7tf-kpdu · Cited by 227 · see citing works
Moher, D., Cook, D. J., Eastwood, S., Olkin, I., Rennie, D., & Stroup, D. F. (2000) · Revista Española de Salud Pública · doi:10.1590/s1135-57272000000200002 · Cited by 213 · see citing works
Evidence of Benefit of Telerehabitation After Orthopedic Surgery: A Systematic Review
Pastora‐Bernal, J., Martín‐Valero, R., Barón-López, F. J., & Estebanez-Pérez, M. J. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.6836 · Cited by 207 · see citing works
A review of journal clubs in postgraduate medical education
Alguire, P. C. (1998) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.1998.00102.x · Cited by 206 · see citing works
Quality Improvement Methods in Clinical Medicine
Plsek, P. E. (1999) · PEDIATRICS · doi:10.1542/peds.103.se1.203 · Cited by 202 · see citing works
Grades of Recommendation for Antithrombotic Agents
Guyatt, G. H., Cook, D. J., Sackett, D. L., Eckman, M. H., & Pauker, S. G. (1998) · CHEST Journal · doi:10.1378/chest.114.5_supplement.441s · Cited by 199 · see citing works
Self-citationEvidence-based nursing: What it is and what it isn't
Ingersoll, G. L. (2000) · Nursing Outlook · doi:10.1067/mno.2000.107690 · Cited by 199 · see citing works
Hayward, R. A., Kent, D. M., Vijan, S. S., & Hofer, T. P. (2006) · BMC Medical Research Methodology · doi:10.1186/1471-2288-6-18 · Cited by 196 · see citing works
Wood, F. M., Kolybaba, M. L., & Allen, P. (2006) · Burns · doi:10.1016/j.burns.2006.01.008 · Cited by 191 · see citing works
Manchikanti, L. (2009) · Pain Physician · doi:10.36076/ppj.2009/12/35 · Cited by 186 · see citing works
Rating the strength of scientific evidence: relevance for quality improvement programs
Lohr, K. N. (2004) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzh005 · Cited by 186 · see citing works
Deliberate self harm in Sri Lanka: an overlooked tragedy in the developing world
Eddleston, M., Sheriff, M. H. R., & Hawton, K. (1998) · BMJ · doi:10.1136/bmj.317.7151.133 · Cited by 185 · see citing works
Management of osteoporosis in postmenopausal women
(2006) · Menopause The Journal of The North American Menopause Society · doi:10.1097/01.gme.0000222475.93345.b3 · Cited by 184 · see citing works
Should Calcaneal Fractures Be Treated Surgically?
Randle, J. A., Kreder, H. J., Stephen, D. J. G., Williams, J., Jaglal, S. B., & Hu, R. W. (2000) · Clinical Orthopaedics and Related Research · doi:10.1097/00003086-200008000-00029 · Cited by 183 · see citing works
Randomized controlled versus naturalistic studies: A new research agenda
Leichsenring, F. (2004) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.68.2.137.35952 · Cited by 183 · see citing works
Determination of the clinical importance of study results
Man‐Son‐Hing, M., Laupacis, A., O’Rourke, K., Molnar, F., Mahon, J., Chan, K. B. Y., & Wells, G. A. (2002) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2002.11111.x · Cited by 182 · see citing works
Users' Guides to the Medical Literature XVI. How to Use a Treatment Recommendation
Guyatt, G. H. (1999) · JAMA · doi:10.1001/jama.281.19.1836 · Cited by 182 · see citing works
Self-citationUnderhill, K., Montgomery, P., & Operario, D. (2007) · BMJ · doi:10.1136/bmj.39245.446586.be · Cited by 176 · see citing works
Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions
Logerstedt, D. S., Snyder‐Mackler, L., Ritter, R. C., Axe, M. J., & Godges, J. J. (2010) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2010.0304 · Cited by 173 · see citing works
Systematic reviews: gatekeepers of nursing knowledge
Evans, D. J., & Pearson, A. (2001) · Journal of Clinical Nursing · doi:10.1046/j.1365-2702.2001.00517.x · Cited by 168 · see citing works
Risk factors of recurrent hamstring injuries: a systematic review
de Visser, H. M., Reijman, M., Heijboer, M. P., & Bos, P. K. (2011) · British Journal of Sports Medicine · doi:10.1136/bjsports-2011-090317 · Cited by 168 · see citing works
Diagnostic Accuracy of Various Imaging Modalities for Suspected Lower Extremity Stress Fractures
Wright, A. A., Hegedus, E. J., Lenchik, L., Kuhn, K. J., Santiago, L., & Smoliga, J. M. (2015) · The American Journal of Sports Medicine · doi:10.1177/0363546515574066 · Cited by 166 · see citing works
Quality assessment of observational studies is not commonplace in systematic reviews
Mallen, C. D., Peat, G., & Croft, P. R. (2006) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2005.12.010 · Cited by 164 · see citing works
EWMA Document: Antimicrobials and Non-healing Wounds: Evidence, controversies and suggestions
Gottrup, F., Apelqvist, J., Bjarnsholt, T., Cooper, R., Moore, Z. E. H., Peters, E. J. G., & Probst, S. (2013) · Journal of Wound Care · doi:10.12968/jowc.2013.22.sup5.s1 · Cited by 163 · see citing works
Koester, M. C., Dunn, W. R., Kuhn, J. E. “., & Spindler, K. P. (2007) · Journal of the American Academy of Orthopaedic Surgeons · doi:10.5435/00124635-200701000-00002 · Cited by 158 · see citing works
- Authors
- Guyatt, G. H.
- Corresponding author
- Guyatt, Gordon H.
- ORCID
- Guyatt, Gordon H.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 1995-12-13
- Volume
- 274
- Issue
- 22
- Pages
- 1800
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2168226052
- Cited by
- 846
- References
- 39
- Citations by year
- 2026: 16 · 2025: 16 · 2024: 15 · 2023: 24 · 2022: 21 · 2021: 18 · 2020: 57 · 2019: 31 · 2018: 24 · 2017: 27 · 2016: 23 · 2015: 35 · 2014: 30 · 2013: 33 · 2012: 23
- FWCI
- 28.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- strength of recommendation, evidence-based medicine, clinical guidelines, guideline implementation, classification of evidence, clinical decision-making
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review