The use of GRADE approach in Cochrane reviews of TCM was insufficient: a cross-sectional survey

Qi Wang; Ya Xiao; Taotao Guo; Hongfei Zhu; Jieyun Li; Honghao Lai; Ying Zhang; Fengwen Yang; Yu Liu; Kehu Yang; Yaolong Chen; Jinhui Tian; Guowu Ding; Long Ge

doi:10.1016/j.jclinepi.2021.11.004

The use of GRADE approach in Cochrane reviews of TCM was insufficient: a cross-sectional survey

J Clin Epidemiol. 2022 Feb:142:1-9. doi: 10.1016/j.jclinepi.2021.11.004. Epub 2021 Nov 6.

Authors

Qi Wang¹, Ya Xiao², Taotao Guo², Hongfei Zhu¹, Jieyun Li³, Honghao Lai², Ying Zhang⁴, Fengwen Yang⁵, Yu Liu⁶, Kehu Yang⁷, Yaolong Chen⁸, Jinhui Tian⁹, Guowu Ding¹⁰, Long Ge¹¹

Affiliations

¹ Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Department of Social Science and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.
² Department of Social Science and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.
³ Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
⁴ School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
⁵ Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
⁶ Department of Scientific Research Management, China Academy of Chinese Medical Sciences, Beijing, China; China Center for Evidence Based Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China; Acupuncture Department, Guang' anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
⁷ Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
⁸ Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Chinese GRADE Center, Lanzhou, China.
⁹ Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China. Electronic address: tjh996@163.com.
¹⁰ Department of Social Science and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Electronic address: dinggw@lzu.edu.cn.
¹¹ Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Department of Social Science and Health Management, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China. Electronic address: gelong2009@163.com.

PMID: 34752940
DOI: 10.1016/j.jclinepi.2021.11.004

Abstract

Objective: To conduct a cross-sectional survey on the application status of the Grades of Recommendations Assessment Development and Evaluation (GRADE) in Cochrane systematic reviews (CSRs) of traditional Chinese medicine (TCM).

Study design and setting: We searched CSRs of TCM from the inception to December 2020 in the Cochrane Library database. General characteristics and details of GRADE were extracted.

Results: Among 226 CSRs of TCM, 86 (38.05%) involving 711 outcomes used GRADE to rate the certainty of evidence. Topics mainly focused on genitourinary diseases (17.44%), diseases of the musculoskeletal system or connective tissue (11.63%), and diseases of the nervous system (10.47%). Only 15.89% of the outcomes reported high or moderate certainty of evidence. Acupuncture was the most common intervention. There were no significant differences in evidence certainty between acupuncture and non-acupuncture, between TCM alone and integrated Chinese and western medicine, or between Chinese patent medicines and non-Chinese patent medicines (P > 0.05). Among 1 273 instances of downgrading, 44.62% were due to the risk of bias and 40.14% due to imprecision.

Conclusion: Overall, GRADE approach is not widely used in CSRs of TCM. The certainty of evidence is generally low to very low, mainly because of the serious risk of bias and imprecision.

Keywords: Acupuncture; Certainty of evidence; Cochrane systematic reviews; Cross-sectional study; GRADE; Traditional Chinese medicine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acupuncture Therapy*
Cross-Sectional Studies
GRADE Approach
Humans
Medicine, Chinese Traditional*
Nonprescription Drugs

Substances

Nonprescription Drugs