Conclusion Grading Table
Strength of Evidence
Elements
Quality
 Scientific rigor/validity question
 Considers design
and execution
Consistency
Of findings across studies
Quantity
 Number of studies
 Number of subjects
in studies
Clinical impact
 Importance of
studied outcomes
 Magnitude of effect
Generalizability
To population of interest
Grades
I II III IV V
Good/Strong Fair Limited/Weak Expert Opinion Only Grade Not
Assignable
Studies of strong design for Studies of strong design Studies of weak design No studies available No evidence that
for question with minor for answering the Conclusion based on pertains to
Free from design flaws, methodological question usual practice, expert question being
bias and execution concerns, OR OR consensus, clinical addressed
problems Only studies of weaker Inconclusive findings due experience, opinion,
study design for question to design flaws, bias or or extrapolation from
execution problems basic research
Findings generally Inconsistency among Unexplained Conclusion supported NA
consistent in direction and results of studies with inconsistency among solely by statements
size of effect or degree of strong design, OR results from different of informed nutrition
association, and statistical Consistency with minor studies OR single study or medical
significance with minor exceptions across unconfirmed by other commentators
exceptions at most studies of weaker design studies
One to several good Several studies by Limited number of Unsubstantiated Relevant studies
quality studies independent studies by published have not been
investigators research studies done
Large number of Low number of subjects
subjects studied Doubts about adequacy studied and/or
of sample size to avoid inadequate sample size
Studies with negative
Type I and Type II error within studies
results have sufficiently
large sample size for
adequate statistical power
Studied outcome relates Studied outcome is an Objective data Indicates area for
directly to the question intermediate outcome or unavailable future research
Some doubt about the
surrogate for the true
Size of effect is clinically statistical or clinical
outcome of interest
meaningful significance of the effect
OR
Significant (statistical) Size of effect is small or
difference is large lacks statistical and/or
clinical significance
Studied population, Minor doubts about Serious doubts about Generalizability NA
intervention and outcomes generalizability generalizability due to limited to scope of
are free from serious narrow or different study experience
doubts about population, intervention
generalizability or outcomes studied