5.2.9 Assessing certainty or confidence in the evidence

Further consideration is required to assess the certainty of the evidence, or confidence in the final synthesized finding being used to make recommendations for clinical practice and policy. For systematic reviews of textual evidence, the GRADE approach⁷ (assessing certainty) or the ConQual approach⁴⁴ (assessing confidence), presented in a ‘Summary of Findings’ table may not be appropriate, especially when the certainty of the evidence is very low to begin with.

It may be more appropriate to consider issuing a recommendation as a Good Practice Statement (GPS), that is clearly articulated as separate to GRADEd recommendations.⁴⁵ The JBI Textual Evidence methodology group is planning to do some ongoing work in this area.