T.M. Austin, PT, PhD, ATC, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, 3437 Caroline St, Room 1026, St Louis, MO 63104 (USA).
R.R. Richter, PT, PhD, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University.
Phys Ther. 2014 Nov;94(11):1652-9. doi: 10.2522/ptj.20130627. Epub 2014 Jul 17.
Practice guidelines (guidelines) have an increasing role in health care delivery and are being published more frequently. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is an approach for guideline development. The GRADE approach has been adopted by multiple national and international organizations producing guidelines related to physical therapist care.
The purpose of this article is to introduce physical therapists to the GRADE approach for guideline development.
GRADE provides a consistent approach for guideline development and transparency in the communication of how the guidelines were developed and how the recommendations were reached, leading to informed choices by patients, clinicians, and policy makers in health care. GRADE leads to a clear distinction between the strength of the evidence and the recommendation. Both the direction (for or against) and the strength (weak or strong) of the recommendation are considered. For determining the strength of the recommendation, GRADE takes into account the quality of evidence, the balance of benefit and harm, uncertainty about or variability in patients' values and preferences, and uncertainty about whether the intervention is a wise use of resources.
The GRADE approach has been used primarily with interventions and clinical questions and less often with questions related to diagnosis and prognosis.
The frequency of publication of guidelines is increasing. To make informed choices in the health care system, physical therapists should understand how guidelines are developed. The GRADE approach has been adopted by national and international organizations that produce guidelines relevant to physical therapist practice. Understanding the GRADE approach will enable physical therapists to make informed clinical choices.
实践指南（guidelines）在医疗保健服务中发挥着越来越重要的作用，并且发布的频率也越来越高。推荐评估、制定与评估分级（Grading of Recommendations Assessment, Development and Evaluation，GRADE）是一种制定指南的方法。多个国家和国际组织在制定与物理治疗师护理相关的指南时都采用了 GRADE 方法。
本文旨在向物理治疗师介绍用于指南制定的 GRADE 方法。
GRADE 为指南制定提供了一致的方法，并在指南制定过程和建议达成方式的透明度方面进行了沟通，使患者、临床医生和决策者能够在医疗保健中做出明智的选择。GRADE 明确区分了证据的强度和建议。同时考虑了建议的方向（支持或反对）和强度（弱或强）。在确定推荐强度时，GRADE 考虑了证据质量、利益与危害的平衡、患者价值观和偏好的不确定性或可变性，以及干预措施是否明智利用资源的不确定性。
GRADE 方法主要用于干预措施和临床问题，较少用于与诊断和预后相关的问题。
指南的发布频率正在增加。为了在医疗保健系统中做出明智的选择，物理治疗师应该了解指南是如何制定的。制定指南的国家和国际组织已经采用了 GRADE 方法。了解 GRADE 方法将使物理治疗师能够做出明智的临床选择。
