Table 1

ADA-adapted system for grading reviewed studies.

EVIDENCE GRADE

DEFINITION

STRENGTH RECOMMENDATION

DEFINITION


A

1. Clear evidence from well-conducted, generalizeable, randomized-controlled trials that are adequately powered, including:

1

Substantial benefit to persons at-risk

a. evidence from a multi-center trial

b. evidence from a meta-analysis

2. Supportive evidence from well-conducted, randomized-controlled trials that are adequately powered, including:

a. evidence from a trial at one or more institutions

b. evidence from a meta-analysis


B

3. Supportive evidence from well-conducted cohort studies, including:

2

Moderate benefit to persons at-risk

a. evidence from a prospective cohort study

b. evidence from a prospective registry

c. evidence from a meta-analysis of cohort studies

4. Supportive evidence from well-conducted case-control studies


C

5. Supportive evidence from poorly controlled or uncontrolled studies, including:

3

Uncertain benefit to persons at-risk

a. evidence from randomized clinical trials with one or more major or three or more minor methodological flaws that could confound results

b. evidence from observational studies with high potential for bias

c. evidence from case series or case reports

6. Conflicting results with the weight of the evidence supporting the recommendation

7. Expert consensus or clinical experience without support from research studies


VanWormer et al. International Journal of Behavioral Nutrition and Physical Activity 2008 5:54   doi:10.1186/1479-5868-5-54

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