Hierarchy of evidence and appraisal of limitations (HEAL) grading system |
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| Institution: | 1. Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden;2. DM-STAT, One Salem Street Suite 300, Malden, MA 02148 USA;3. Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215 USA;4. Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA;1. University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, Asheville, NC 28804, United States;2. Georgia Southern University, Jiann-Ping Hsu College of Public Health, Department of Community Health Behavior & Education, Statesboro, GA 30460, United States;3. University of South Florida, Department of Educational Measurement and Research, Tampa, FL 33620, United States;1. Canada Research Chair in Evaluation and Health System Improvement, Department of Community Health Sciences, Charles-LeMoyne Hospital Research Centre, Université de Sherbrooke, Sherbrooke, Quebec, Canada;2. Estrie Regional Public Health Departement, Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada;3. Centre intégré de santé et de services sociaux de l''Estrie-Centre hospitalier universitaire de Sherbrooke
-Installation Centre de réadaptation en Dépendance, Canada;4. Charles-LeMoyne Hospital Research Centre, Université de Sherbrooke, Sherbrooke, Quebec, Canada;5. Psychoeducation, Université de Sherbrooke, Sherbrooke, Quebec, Canada;6. Clinical Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada;1. Department of Educational Research, Lancaster University, Bailrigg, Lancaster LA1 4YW, United Kingdom;2. Family and Community Social Services Program, University of Guelph-Humber, 207 Humber College Blvd., Toronto, ON, M9W 5L7, Canada;1. Oregon State University, 118B Milam Hall, Corvallis, OR 97331, United States;2. California State University, Los Angeles, Los Angeles, CA, United States;3. University of Arizona, Tucson, AZ, United States;4. University of Maryland, College Park, Columbia, MD, United States;5. Yale University, CT, United States |
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| Abstract: | Despite more than 30 years of effort that has been dedicated to the improvement of grading systems for evaluating the quality of research study designs considerable shortcomings continue. These shortcomings include the failure to define key terms, provide a comprehensive list of design flaws, demonstrate the reliability of such grading systems, properly value non-randomized controlled trials, and develop theoretically-derived systems for penalizing and promoting the evidence generated by a study. Consequently, in light of the importance of grading guidelines in evidence-based medicine, steps must be taken to remedy these deficiencies. This article presents two methods – a grading system and a measure of methodological bias – for evaluating the quality of evidence produced by an efficacy study. |
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