Research

Hierarchies of Evidence: Database of Hierarchies

33 minute read

An evidence pyramid (Glover et al., 2011), one of the hierarchies of evidence in the database

This post is now outdated as a new systematic review has replaced this database. See here for the full database, and see here for more details of the changes.

Hierarchies of Evidence are a tool employed by many advocates of Evidence-Based Medicine. They are used to appraise evidence from a range of sources, as well as to teach medical students about evidence and evidence appraisal. My PhD thesis concerns the variation in hierarchies defended, and the range of philosophical interpretations of those hierarchies. In order to complete this project, it is necessary to create and maintain a database of hierarchies of evidence. This database is available here for the benefit of other researchers interested in Evidence-Based Medicine and hierarchies of evidence. Where possible, links are provided to a pdf of the relevant source. If not, links are provided to the journal listing or to google books. Please contact me if you notice any broken links. This database is up-to-date as of 29/06/16. If you know of any hierarchies not included in this list, please contact me. I am particularly interested in non-English hierarchies which are not available in English translation. The database currently only includes hierarchies available in English. For the purposes of this database, quite a broad selection criterion has been employed to maximise scope. The definition used here is:

“A procedure for making an inference about some epistemic property of the evidence provided by studies, or some epistemic relation which holds between the evidence provided by two or more studies, primarily based on a ranking of the design or methodology used in the studies.”

I also include for reference purposes a number of sources which are commonly called or cited as hierarchies or precursors to hierarchies, but which do not meet any reasonable definition of a hierarchy of evidence, in a separate section.

Date Author Source Reference
1979 Canadian Task Force CMAJ Canadian Task Force on the Periodic Health Examination. (1979) “The Periodic Health Examination”. CMAJ 121 1193-1252”
1981 Anonymous CMAJ (1981) “How to read clinical journals: IV. To determine etiology or causation”. CMAJ, 124, 985-990.
1986 Sackett Chest Sackett, D. L. (1986) “Rules of evidence and clinical recommendations on the use of antithrombotic agents”. Chest, 89(2 Suppl), 2S-3S.
1987 LaForce JAMA LaForce, F. M. (1987) “Immunizations, immunoprophylaxis, and chemoprophylaxis to prevent selected infections. US Preventive Services Task Force”. JAMA, 257(18), 2464-2470
1989 Sackett Chest Sackett, D. L. (1989) “Rules of evidence and clinical recommendations on the use of antithrombotic agents”. Chest, 95(2 Suppl), 2S-4S.
1992 Cook et al. Chest Cook, D. J., et al. (1992) “Rules of evidence and clinical recommendations on the use of antithrombotic agents”. Chest, 102(4 Suppl), 305S-311S
1992 McGowan et al. Infectious Disease McGowan, J.E. et al. (1992) “Guidelines for the use of systemic glucocorticosteroids in the management of selected infections”. Journal of Infectious Disease, 165, 1-13
1993 Carruthers et al. CMAJ Carruthers G.S., et al. (1993) “Report of the Canadian Hypertension Conference: 1. Introduction.” CMAJ. 149(3), pp.289-293.
1994 Bigos et al. AHCRP Bigos, S., Bowyer, O., & Braen, G. et al. (1994) Acute low back problems in adults. Clinical practice guideline. AHCPR Pub. No. 95–0643. Rockville (MD): US Department of Health and Human Services. Public Health Service, Agency for Health Care Policy and Research.
1994 Oxman BMJ Oxman, A.D. (1994) “Checklists for review articles”, in BMJ, 309(6955): 648-651
1995 Anonymous Bandolier Anonymous. (1995) “Evidence-Based Everything”. Bandolier, 12, 91-98
1995 Byar/Piantadosi Controlled Clinical Trials Piantadosi, S. (1995). “David Byar as a teacher.” Controlled Clinical Trials, 16 (4), p. 202 ~~ Byar’s hierarchy is referenced by Olgin and Clarke but never published by Byar. Piantadosi published a version.
1995 Guyatt et al. JAMA Guyatt, G. H., et al. (1995) “Users’ guides to the medical literature. IX. A method for grading health care recommendations. Evidence-Based Medicine Working Group”. JAMA, 274(22), 1800-1804
1995 Olkin JCE Olkin, I. (1995) “Statistical and theoretical considerations in meta-analysis”. Journal of clinical epidemiology (0895-4356), 48 (1), p. 133. ~~ An expansion of Byar’s hierarchy as published by Piantadosi.
1996 Hadorn et al. JCE Hadorn, D. C., Baker, D., Hodges, J. S., & Hicks, N. (1996). “Rating the quality of evidence for clinical practice guidelines.” Journal of clinical epidemiology, 49(7), 749-754.
1997 Evans et al. J clin oncol Evans, W. K., et al. (1997) “Lung cancer practice guidelines: lessons learned and issues addressed by the Ontario Lung Cancer Disease Site Group”. J Clin Oncol, 15(9), 3049-3059
1997 Goldbloom J clin oncol Goldbloom, R. (1997) “Weighing the Evidence: the Canadian Experience.” American Journal of Clinical Nutrition 65, pp.584S-586S
1997 Granados et al. EUR-ASSESS Granados, A., Jonsson, E., Banta, H. D., Bero, L., Bonair, A., Cochet, M. C., … Espinas, J. A. (1997) “EUR-ASSESS Project Subgroup Report on Dissemination and Impact.” International Journal of Technology Assessment in Health Care, 13(02), 220–286.
1997 Gray Gray, J.A. Muir. (1997) Evidence-Based Healthcare. NYC: Churchill-Livingstone
1997 Greenhalgh BMJ Greenhalgh, T. (1997) “How to read a paper. Getting your bearings (deciding what the paper is about)”. BMJ, 315(7102), 243-246
1997/2001 Greenhalgh BMJ Greenhalgh, Trisha. (1997) How to read a paper : the basics of evidence based medicine. London: BMJ Pub. Group ~~ Greenhalgh uses nearly-identical hierarchies in her book as in her paper, but to quite different effect.
1997 Liddle, Williamson & Irwig NSW Pub Heal Bull Liddle, J., Williamson, M., & Irwig, L. (1997) “Method for evaluating research and guideline evidence.” New South Wales Public Health Bull, 8, 5.
1997 Lloyd-Smith BJOT Lloyd-Smith, W. (1997). “Evidence-based practice and occupational therapy.” British Journal of Occupational Therapy, 60(11), 474-478.
1997/2000 Van Tulder et al. Spine van Tulder, M., et al. (2000) “Exercise therapy for low back pain: a systematic review within the framework of the cochrane collaboration back review group”. Spine (Phila Pa 1976), 25(21), 2784-2796
1997 Wagoner et al. SUNY Wagoner, B. et al. (1997) “Guide to Research Methods: The Evidence Pyramid”. SUNY Downstate Medical Center EBM Tutorial, first known publication at latest 11 May 2000, available via Internet Archive at https://web.archive.org/web/20000511202739/http://www.servers.medlib.hscbklyn.edu/ebm/2100.htm
1998 Clarke BMJ Clarke, M.J. (1998) ‘Ovarian ablation in breast cancer, 1896 to 1998: milestones along hierarchy of evidence from case report to Cochrane Review’ BMJ, 317 (7167): 1246-8
1998 Edwards, Russell & Stott Fam Pract Edwards, A. G., Russell, I. T. & Stott, N. C. (1998) “Signal versus noise in the evidence base for medicine: an alternative to hierarchies of evidence?”. Fam Pract, 15(4), 319-322
1998 McPeek et al. B. McPeek, H. Troidl, M.F. McKneally (1998) “Turning clinical problems into research studies”, in: H. Troidl, M.F. McKneally, D.S. Mulder, A.S. Wechsler, B. McPeek, W.O. Spitzer (Eds.), Surgical Research. Basic Principles and Clinical Practice, 3rd ed., Springer, pp. 191–196.
1998 Meltzer et al. CMAJ Meltzer S, Leiter L, Daneman D, Gerstein HC, Yale J-F, Zinman B et al (1998) “Clinical Practice Guidelines for the Management of Diabetes in Canada.” CMAJ 159(8), pp.S1-S29.
1998 Phillips et al. CEBM Phillips, R. et al. (1998) “Levels of Evidence”. Centre for Evidence-Based Medicine, www.cebm.net. ~~ no longer easily available online - pdf stored”
1999 Australian NHMRC ANHMRC Australian National Health and Medical Research Council (ANHMRC). (1999) A Guide to the Development, Implementation and Evaluation of Clinical Practice Guidelines. Commonwealth of Australia: available at: http://www.health.gov.au/nhmrc/publicat/synopses/cp30syn.html”
1999 Beckmann Sem Thromb & Hemo Beckmann, J. (1999, February). Basic aspects of risk-benefit analysis. In Seminars in thrombosis and hemostasis (Vol. 25, No. 01, pp. 89-95).
1999 Chesson et al. Sleep Chesson, A. L., Jr., et al. (1999) “Practice parameters for the treatment of restless legs syndrome and periodic limb movement disorder. An American Academy of Sleep Medicine Report. Standards of Practice Committee of the American Academy of Sleep Medicine”. Sleep, 22(7), 961-968
1999 Chestnut et al. AHCPR Chestnut R.M., Carney N., Maynard H. et al (1999) “Rehabilitation for Traumatic Brain Injury.” Rockville (MD): Agency for Health Care Policy and Research (US). Evidence Reports/Technology Assessments, No. 2.
1999 Hoogendoorn et al. Scand J Work Environ Health Hoogendoorn, W. E., et al. (1999) “Physical load during work and leisure time as risk factors for back pain”. Scand J Work Environ Health, 25(5), 387-403
1999 McAlister et al. JAMA McAlister, F. A., et al. (1999) “Users’ Guides to the Medical Literature: XIX. Applying clinical trial results B. Guidelines for determining whether a drug is exerting (more than) a class effect”. JAMA, 282(14), 1371-1377
1999 Shekelle et al. BMJ Shekelle, P. G., et al. (1999) “Clinical guidelines: developing guidelines”. BMJ, 318(7183), 593-596
1999 Wilkinson Trans. Am Opthal. Soc Wilkinson, C.P. (1999) “Evidence Based Medicine Regarding the Prevention of Retinal Detachment.” Transactions of the American Ophthalmological Society. XCVII, 397-406.
2000 American Heart Association AHA American Heart Association (2000) “Part 1: Introduction to the International Guidelines 2000 for CPR and EEC: A Consensus on Science.” Circulation 102(Supplement 1): I1-I11.
2000 Ariens et al. SJWEH Ariens GAM, van Mechelen W, Bongers PM, Bouter LM, van der Wal G. (2000) “Physical risk factors for neck pain.” Scand J Work Environ Health, 26(1): pp.7-19
2000 Bennett & Bennett Aus Occ Therapy J Bennett, S., & Bennett, J. W. (2000) “The process of evidence‐based practice in occupational therapy: Informing clinical decisions.” Australian Occupational Therapy Journal, 47(4), 171-180.
2000 Briss et al. AM J Prev Med Briss, P. A., et al. (2000) “Developing an evidence-based Guide to Community Preventive Services–methods. The Task Force on Community Preventive Services”. Am J Prev Med, 18(1 Suppl), 35-43
2000 Ellis Adv Nursing Ellis, J. (2000). Sharing the evidence: clinical practice benchmarking to improve continuously the quality of care. Journal of advanced nursing, 32(1), 215-225.
2000 Greer et al. Joint Commission Greer, N., Mosser, G., Logan, G., & Halaas, G. W. (2000) “A Practical Approach to Evidence Grading.” The Joint Commission Journal on Quality Improvement, 26(12), 700–712.
2000 Guyatt et al. JAMA Guyatt, G. H., et al. (2000) “Users’ Guides to the Medical Literature: XXV. Evidence-based medicine: principles for applying the Users’ Guides to patient care. Evidence-Based Medicine Working Group”. JAMA, 284(10), 1290-1296
2000 Opie, Yusuf & Kübler Progr in Cardio Dis Opie, L. H., Yusuf, S., & Kübler, W. (2000) “Current status of safety and efficacy of calcium channel blockers in cardiovascular diseases: a critical analysis based on 100 studies.” Progress in cardiovascular diseases, 43(2), 171-196.
2000 Roman, Silberzweig & Siu Eff Clin Pract Roman, S. H., Silberzweig, S. B. & Siu, A. L. (2000) “Grading the evidence for diabetes performance measures”. Eff Clin Pract, 3(2), 85-91
2000 Sackett et al. EBM Sackett, David L. (2000) Evidence-based medicine: how to practice and teach EBM (2nd ed.). Edinburgh: Churchill Livingstone
2000 Weightman, Barker & Lancaster Health Evidence Bull. Wales Weightman A.L., Barker J., & Lancaster J. (2000) “A systematic approach to identifying the evidence. Project Methodology 3.” Health Evidence Bulletins Wales. Cardiff: Department of Information Services, University of Wales College of Medicine
2001 Craven EJ Onc Nursing Craven, O. (2001) “Screening for colorectal cancer using the faecal occult blood test: a critical literature review.” European Journal of Oncology Nursing, 5(4), 234-243.
2001 Eccles, Freemantle & Mason Eccles, M., Freemantle, N., & Mason, J. (2001) “Using systematic reviews in clinical guideline development.” Systematic Reviews in Health Care: Meta-Analysis in Context, Second Edition, 400-409.
2001 Harbour & Miller BMJ Harbour, R. & Miller, J. (2001) “A new system for grading recommendations in evidence based guidelines”. BMJ, 323(7308), 334-336
2001 Harris et al. Preventive Services Task Force Harris, R. P., et al. (2001) “Current methods of the US Preventive Services Task Force: a review of the process”. Am J Prev Med, 20(3 Suppl), 21-35
2001 Haynes ACP J Club Haynes, R. B. (2001) “Of studies, syntheses, synopses, and systems: the 4S evolution of services for finding current best evidence”. ACP J Club, 134(2), A11-13
2001 Jonas WJM Jonas, W.B. (2001) ‘The evidence house: How to build an inclusive base for complementary medicine’, in Western Journal of Medicine, 175: (2) 79-80
2001 Khan, Dinnes & Kleijnen EJ Obst Gyn Rep Bio Khan, Khalid S, Dinnes, Jacqueline & Kleijnen, Jos. (2001) “Systematic reviews to evaluate diagnostic tests”. European Journal of Obstetrics & Gynecology and Reproductive Biology, 95(1), 6-11
2001 McAlister & Sackett Am J M McAlister, F. A., & Sackett, D. L. (2001) “Active-control equivalence trials and antihypertensive agents.” American journal of medicine, 111(7), 553-558.
2001 McLeod McLeod R.S. (2001) “Evidence-Based Surgery.” In: Norton J.A. et al. (eds) Surgery. Springer, Berlin, Heidelberg
2001/2008 Guyatt et al. Chest Guyatt, G., et al. (2001) “Grades of recommendation for antithrombotic agents”. Chest, 119(1 Suppl), 3S-7S
2002 Ball & Phillips EBonCall Ball, C.M. & Phillips, R. (2002). “Levels of Evidence - March 2002”, Evidence Based On Call. Retrieved from http://www.eboncall.org/content/levels.html; No longer available online. Superseded by Howick et al. 2009.
2002 Bandelow et al. WFSBP Bandelow, B. et al. (2002) “WFSBP Guidelines for the Pharmacological Treatment of Anxiety, obsessive-compulsive and posttraumatic stress disorders.” World J Biol Psychiatry, 3: pp.-171-199
2002 Furlan et al. Spine Furlan, A. D., Brosseau, L., Imamura, M., & Irvin, E. (2002) “Massage for low-back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group.” Spine, 27(17), 1896-1910.
2002 Guyatt et al. UGML Guyatt, G.H. et al. (2002) Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice: American Medical Association Press ~~ Uses the Guyatt et al. 2000 hierarchy but with different interpretation and discussion
2002 Higginson et al. J Pain & Sympt Man. Higginson, I. J., Finlay, I., Goodwin, D. M., Cook, A. M., Hood, K., Edwards, A. G., … & Norman, C. E. (2002) “Do hospital-based palliative teams improve care for patients or families at the end of life?” Journal of pain and symptom management, 23(2), 96-106.
2002 Weaver et al. J Epid & Comm Heal Weaver, N., Williams, J. L., Weightman, A. L., Kitcher, H. N., Temple, J. M. F., Jones, P., & Palmer, S. (2002) “Taking STOX: developing a cross disciplinary methodology for systematic reviews of research on the built environment and the health of the public.” Journal of Epidemiology & Community Health, 56(1), 48-55.
2003 Davies & Nutley Public Money & M Davies, H.T.O. & Nutley, S.M. (1999) ‘The Rise and Rise of Evidence in Health Care’, Public Money & Management, 19(1): 9-16
2003 Davies Dental Update Davies, R. M. (2003). “The prevention of dental caries and periodontal disease from the cradle to the grave: what is the best available evidence?” Dental update, 30(4), 170-179.
2003 Devereaux & Yusuf J Int Med Devereaux, PJ & Yusuf, S. (2003) “The evolution of the randomized controlled trial and its role in evidence‐based decision making”. Journal of internal medicine, 254(2), 105-113.
2003 Evans J Clin Nurs Evans, D. (2003) “Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions”. J Clin Nurs, 12(1), 77-84
2003 Hess et al. Respiratory Care Hess, D.R. et al. (2003). “AARC Evidence-Based Clinical Practice Guideline: Care of the ventilator circuit and its relation to ventilator-associated pneumonia.” Respir Care, 48(9), 869-879.
2003 ICSI ICSI Institute for Clinical Systems Improvement. (2003) Evidence Grading System. available at: http://www.icsi.org ~~ No longer available online. ICSI adopted GRADE in 2011.”
2003 Leys Health Policy Leys, M. (2003) “Health care policy: qualitative evidence and health technology assessment.” Health Policy, 65(3), 217-226.
2003 Madden Proc. Nutrition Society Madden, A. M. (2003). “Changing perspectives in the nutritional management of disease.” Proceedings of the Nutrition Society, 62(4), 765-772.
2003 Mason & Eccles GREG Mason, J. & Eccles, M.,. (2003) Guideline Recommendation and Evidence Grading (GREG). Newcastle, UK: University of Newcastle Centre for Health Services Research
2003 Petticrew & Roberts J Epi & Comm Heal Petticrew, M., & Roberts, H. (2003). “Evidence, hierarchies, and typologies: horses for courses.” Journal of Epidemiology & Community Health, 57(7), 527-529.
2004 Anonymous Thorax Anonymous (2004) ‘Hierarchy of Evidence and Grading of Recommendations’, in Thorax, 59: 13-4
2004 Ebell et al. SORT Ebell, M. H., et al. (2004) “Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature”. Am Fam Physician, 69(3), 548-556
2004 Edlund et al. AAN Edlund, W. et al. (2004) Clinical Practice Guideline Process Manual, Appendix 9. American Academy of Neurology: available at: www.aan.com”
2004 GRADE Working Group GRADE GRADE Working Group. (2004) “Grading quality of evidence and strength of recommendations”. British Medical Journal, 328, 1490
2004 Hess Respiratory Care Hess, D. R. (2004). “What is evidence-based medicine and why should I care?” Respiratory care, 49(7), 730-741.
2004 Lang McGill J Med Lang, E. (2004) “The Why and How of Evidence-Based Medicine”. McGill Journal of Medicine, 8, 90-94
2004 Montori Treatments in Endocrinology Montori, V. M. (2004). “Evidence-based endocrinology.” Treatments in endocrinology, 3(1), 1-10.
2004 NICE NICE National Institute for Health and Clinical Excellence (NICE). (2004) NICE: Guideline Development Methods (Vol. Vol.7: Reviewing and Grading the Evidence) ~~ No longer easily accessible online.
2004 Reid Cleft palate-craniofacial J Reid, J. (2004) “A review of feeding interventions for infants with cleft palate.” Cleft palate-craniofacial journal, 41(3), 268-278.
2004 Vardy & Tannock Annals of Oncology Vardy, J., & Tannock, I. F. (2004). “Quality of cancer care.” Annals of oncology, 15(7), 1001-1006.
2005 Akobeng Arch. dis in childhood Akobeng, A. K. (2005). “Understanding randomised controlled trials.” Archives of disease in childhood, 90(8), 840-844.
2005 Anderson & Matzen Andersen I, & Matzen P. (2005) Evidensbaseret Medicin [Evidence-based medicine]. Gads Forlag. ~~ German language publication, unverified, cited by Kristensen et al. 2011.
2005 Cooper et al. JHSRP Cooper, N., Coyle, D., Abrams, K., Mugford, M., & Sutton, A. (2005) “Use of evidence in decision models: an appraisal of health technology assessments in the UK since 1997.” Journal of health services research & policy, 10(4), 245-250.
2005 Harding et al. STI Harding, R., Karus, D., Easterbrook, P., Raveis, V. H., Higginson, I. J., & Marconi, K. (2005). “Does palliative care improve outcomes for patients with HIV/AIDS? A systematic review of the evidence.” Sexually Transmitted Infections, 81(1), 5-14.
2005 Haynes ACP J Club Haynes, R Brian. (2005) “Of studies, syntheses, synopses, summaries, and systems: the 5S evolution of information services for evidence-based health care decisions”. ACP J Club, 145(3), A8-A8
2005 Melnyk & Fineout-Overholt Melnyk, B.M. & Fineout-Overholt, E.,. (2005) Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice. Philadelphia: Lippincoot, Williams & Wilkins
2005 Spindler et al. JAAOS Spindler, K. P., Kuhn, J. E., Dunn, W., Matthews, C. E., Harrell Jr, F. E., & Dittus, R. S. (2005). “Reading and Reviewing the Orthopaedic Literature: A Systematic, Evidence‐based Medicine Approach.” Journal of the American Academy of Orthopaedic Surgeons, 13(4), 220-229.
2005 Weightman et al. NICE Weightman, Alison*, et al.* (2005) Grading evidence and recommendations for public health interventions: developing and piloting a framework: Health Development Agency London, UK
2005 Wiegand & Carlson AACN Wiegand, D. & Carlson, K. (2005) AACN Procedure Manual for Critical Care, 5th ed. (Philadelphia, PA: Elsevier)
2005 Williams et al. Physio. Res. Int. Williams, M. T., Hardy, F., Tucker, B., Smith, M., & Maxwell, L. (2005). “Cardiothoracic physiotherapy: levels of evidence underpinning entry‐level curricula.” Physiotherapy Research International, 10(2), 72-80.
2005 Zhang et al. Ann. Rheum. Dis. Zhang, W., Doherty, M., Arden, N., Bannwarth, B., Bijlsma, J., Gunther, K. P., … & Leeb, B. (2005) “EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT).” Annals of the rheumatic diseases, 64(5), 669-681.
2006 Banwell Dermatology Banwell, H. (2006). “What is the evidence for tissue regeneration impairment when using a formulation of PVP-I antiseptic on open wounds?” Dermatology, 212(Suppl. 1), 66-76.
2006 Bhandari & Giannoudis Injury Bhandari, M. & Giannoudis, P. V. (2006) “Evidence-based medicine: what it is and what it is not”. Injury, 37(4), 302-306
2006 Busse & Heetveld Injury Busse, J. W., & Heetveld, M. J. (2006) “Critical appraisal of the orthopaedic literature: Therapeutic and economic analysis.” Injury, 37(4), 312-320.
2006 Clarke SAGE Clarke A. (2006) “Evidence-based evaluation in different professional domains: similarities, differences and challenges.” In: Shaw IF, Greene JC and Mark MM (eds) The Sage handbook of evaluation. London: Sage
2006 Dagenais et al. J Chinese Integrative Med Dagenais, S., Tricco, A. C., Bian, Z. X., Huang, W. H., & Moher, D. (2006) “Critical appraisal of clinical studies in Chinese herbal medicine.” Zhong xi yi jie he xue bao, Journal of Chinese integrative medicine, 4(5), 455-466.
2006 Fuster et al. Europace Fuster, Valentin*, et al.* (2006) “ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society”. Europace, 8(9), 651-745
2006 Guyatt et al. Chest Guyatt, G.H. et al. (2006) “Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines”. Chest, 129, 174-178
2006 Haynes et al. Haynes, R.B., Sackett, D.L., Guyatt, G.H. & Tugwell, P. (2006) Clinical Epidemiology: how to do clinical practice research, 3rd edition, Lippincott, Williams & Wilkins: Philadelphia
2006 NICE NICE National Institute for Health and Clinical Excellence (NICE). (2006) Hypertension: Management of Hypertension in Adults in Primary Care, NICE Clinical Guideline 34
2006 Petrisor, Keating & Schmetish Injury Petrisor, B. A., Keating, J. & Schemitsch, E. (2006) “Grading the evidence: levels of evidence and grades of recommendation”. Injury, 37(4), 321-327
2006 Schunemann, Fretheim & Oxman WHO Schunemann, H. J., Fretheim, A. & Oxman, A. D. (2006) “Improving the use of research evidence in guideline development: 9. Grading evidence and recommendations”. Health Res Policy Syst, 4, 21
2006 Schunemann et al. ATS Schunemann, H. J., et al. (2006) “An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations”. Am J Respir Crit Care Med, 174(5), 605-614
2006 Tucker & Roth Addiction Tucker, J. A., & Roth, D. L. (2006) “Extending the evidence hierarchy to enhance evidence‐based practice for substance use disorders.” Addiction, 101(7), 918-932.
2006 Zlowodski, Jonsson & Bhandari Med Prin & Prac Zlowodzki, M., Jönsson, A., & Bhandari, M. (2006). “Common pitfalls in the conduct of clinical research.” Medical Principles and Practice, 15(1), 1-8.
2007 ACOEM ACOEM American College of Occupational and Enviromental Medicine (ACOEM) (2007) Low back disorders. Occupational medicine practice guidelines: evaluation and management of common health problems and functional recovery in workers. 2nd ed. Elk Grove Village (IL): American College of Occupational and Environmental Medicine (ACOEM); 2007.
2007 Broom & Tovey JCE Broom, A., & Tovey, P. (2007). “Therapeutic pluralism? Evidence, power and legitimacy in UK cancer services.” Sociology of Health & Illness, 29(4), 551-569.
2007 Daly et al. JCE Daly, J., et al. (2007) “A hierarchy of evidence for assessing qualitative health research”. J Clin Epidemiol, 60(1), 43-49
2007 Lewis, Graham & Stanford Scan. J Rheum Lewis, K. A., Graham, E. M., & Stanford, M. R. (2007). “Systematic review of ethnic variation in the phenotype of Behcet’s disease.” Scandinavian journal of rheumatology, 36(1), 1-6.
2007 Petrisor & Bhandari Indian J Orthop Petrisor, B. & Bhandari, M. (2007) “The hierarchy of evidence: Levels and grades of recommendation”. Indian J Orthop, 41(1), 11-15
2007 Thachil, Mohan & Bhugra J Affective Disorders Thachil, A. F., Mohan, R., & Bhugra, D. (2007) “The evidence base of complementary and alternative therapies in depression.” Journal of affective disorders, 97(1), 23-35.
2007 Virgilio, Chiapi & Palmarozzi J Am Ost Ass Virgilio, R.F., Chiapa, A.L. & Palmarozzi, E.A. (2007) ‘Evidence-Based Medicine, Part 1. An introduction to Creating an Answerable Question and Searching the Evidence’, in Journal of the American Osteopathy Association, 107:295-7
2008 Arbesman, Scheer & Lieberman OT Practice Arbesman, M., Scheer, J. & Lieberman, D. (2008) ‘Using AOTA’s Critically Appraised Topic (CAT) and Critically Appraised Paper (CAP) series to link evidence to practice’, OT Practice, 13(5): 18-22
2008 Guyatt et al. UGML Guyatt, G.H. et al. (2008) ‘How to use a patient management recommendation’ in UGML, pp.595-618
2008 Guyatt et al. Chest Guyatt, G. H., et al. (2008) “Grades of recommendation for antithrombotic agents: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)”. Chest, 133(6 Suppl), 123S-131S
2008 Ho, Peterson & Masoudi Circulation Ho, P. M., Peterson, P. N. & Masoudi, F. A. (2008) “Evaluating the evidence: is there a rigid hierarchy?”. Circulation, 118(16), 1675-1684
2008 Manchikanti et al. Pain Physician Manchikanti, L., Singh, V., Derby, R., Helm, S., Trescot, A. M., Staats, P. S., … & Hirsch, J. A. (2008). “Review of occupational medicine practice guidelines for interventional pain management and potential implications.” Pain Physician, 11(3), 271-289.
2008 SIGN 50 SIGN Scottish Intercollegiate Guidelines Network (SIGN). (2008) SIGN 50: A Guideline Developer’s Handbook. available at: www.sign.ac.uk”
2008 Sprague, McKay & Thoma Clinics in Plastic Surgery Sprague, S., McKay, P., & Thoma, A. (2008) “Study design and hierarchy of evidence for surgical decision making.” Clinics in plastic surgery, 35(2), 195-205.
2008 Sullivan & Cambron NUHS Sullivan, B.M. & Cambron, J.A. (2008) ‘Overview of Study Designs in Clinical Research’ [Presentation] (EBP@NUHS CH5 Study Design)
2008 Tang & Beaglehole J Epid Comm Health Tang, KC, Choi, BCK & Beaglehole, R. (2008) “Grading of evidence of the effectiveness of health promotion interventions”. J Epidemiol Community Health, 62(9), 832-834
2008 US Preventive Services Task Force USPSTF U.S. Preventive Services Task Force. (2008) U.S. Preventive Services Procedure Manual. AHRQ Publication No. 08-05118-EF
2009 Armola et al. Am J Crit Care Armola, R. R., Bourgault, A. M., Halm, M. A., Board, R. M., Bucher, L., Harrington, L., … & Medina, J. (2009) “Upgrading the American association of critical-care nurses’ evidence-leveling hierarchy.” American Journal of Critical Care, 18(5), 405-409.
2009 Bigby Bigby, M. (2009) “The Hierarchy of Evidence”, in Williams, H., Bigby, M., Diepgen, T., Herxheimer, A., Naldi, L., & Rzany, B. (Eds.). (2009). Evidence-based dermatology. John Wiley & Sons.
2009 Centre for Reviews and Dissemination CRD Centre for Reviews and Dissemination, University of York (2009) Systematic Reviews: CRD’s guidance for undertaking reviews in health care, 3rd edition, CRD: York.
2009 Croswell & Kramer J Hepatology Croswell, J.M., & Kramer, B.S. (2009) “Clinical trial design and evidence-based outcomes in the study of liver diseases.” Journal of hepatology, 50(4), 817-826.
2009 DiCenso, Bayley & Haynes Ann Int Med DiCenso, A., Bayley, L. & Haynes, R. B. (2009) “ACP Journal Club. Editorial: Accessing preappraised evidence: fine-tuning the 5S model into a 6S model”. Ann Intern Med, 151(6), JC3-2, JC3-3
2009 Grunze et al. WFSBP Grunze H, Vieta E, Goodwin GM, Bowden C, Licht R W et al. (2009) “The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2009 on the Treatment of Acute Mania.” The World Journal of Biological Psychiatry, 10: pp.85-116
2009 Hoppe et al. JBJS Hoppe, D. J., Schemitsch, E. H., Morshed, S., Tornetta III, P., & Bhandari, M. (2009) “Hierarchy of evidence: where observational studies fit in and why we need them.” JBJS, 91(Supplement_3), 2-9.
2009 Howick et al. CEBM Howick, J. et al. (2009) “CEBM Levels of Evidence”. Centre for Evidence-Based Medicine, www.cebm.org”
2009 Manchikanti et al. Pain Physician Manchikanti, L., Datta, S., Smith, H. S., & Hirsch, J. A. (2009) “Evidence-based medicine, systematic reviews, and guidelines in interventional pain management: part 6. Systematic reviews and meta-analyses of observational studies.” Pain physician, 12(5), 819.
2010 Marchevsky & Wick Am J Clin Pathol Marchevsky, A. M. & Wick, M. R. (2010) “Evidence levels for publications in pathology and laboratory medicine”. Am J Clin Pathol, 133(3), 366-367
2009 Merlin, Weston & Tooher BMC Merlin, T., Weston, A. & Tooher, R. (2009) “Extending an evidence hierarchy to include topics other than treatment: revising the Australian ‘levels of evidence’”. BMC Med Res Methodol, 9, 34
2010 Booth Health Info & Lib J Booth, A. (2010) “On hierarchies, malarkeys and anarchies of evidence.” Health Information & Libraries Journal, 27(1), 84-88.
2010 Niederman & Richards J Am Coll Dent Niederman, R. & Richards, D. (2010) “The challenge, access, risks, and deficits of evidence-based dentistry”. J Am Coll Dent, 77(4), 20-24
2010 Sayre et al. AHA Sayre M R, O’Connor R E, Atkins D L, Billi J E, Callaway C W, Shuster M et al (2010) “Part 2: Evidence Evaluation and Management of Potential or Perceived Conflicts of Interest. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.” Circulation,122(Suppl 3): pp.S657-S664
2010 Swanson, Schmicz & Chung Plast Reconstr Surg Swanson, J.A., Schmicz, D. & Chung, K.C.,. (2010) “How to practice evidence based medicine”. Plast Reconstr Surg, 126, 286
2010 Tidy Tidy, C. (2010) “Different Levels of Evidence” Retrieved 06, 2012, from htttp://www.patient.co.uk/doctor/Different-Levels-of-Evidence-%28Critical-Reading%29.htm ~~ Tidy offers a number of different hierarchies here, some old, some novel.
2011 Balshem et al. GRADE Balshem, H., et al. (2011) “GRADE guidelines: 3. Rating the quality of evidence”. J Clin Epidemiol, 64(4), 401-406
2011 Biondi-Zoccai, Landoni & Modena HSR Biondi-Zoccai, G., Lotrionte, M., Biondi-Zoccai, G., Landoni, G., & Modena, M. G. (2011) “A journey into clinical evidence: from case reports to mixed treatment comparisons.” HSR proceedings in intensive care & cardiovascular anesthesia, 3(2), 93.
2011 Biondi-Zoccai et al. HSR Biondi-Zoccai, G., Lotrionte, M., Landoni, G., & Modena, M. G. (2011). “The rough guide to systematic reviews and meta-analyses.” HSR proceedings in intensive care & cardiovascular anesthesia, 3(3), 161.
2011 Eaves Aesthet Surg J Eaves, F. F., 3rd. (2011) “Got evidence? Stem cells, bias, and the level of evidence ladder: commentary on: ASAPS/ASPS position statement on stem cells and fat grafting”. Aesthet Surg J, 31(6), 718-722
2011 Glover et al. EBM Page Generator Glover, J. et al. (2011) “EBM Page Generator”. Formerly available at http://www.ebmpyramid.org ~~ One of the most replicated images of evidence hierarchies - this is the earliest source I have been able to locate. Can be viewed elsewhere, e.g. here.
2011 Gronsett Woodroffe & Getchius AAN Gronseth, G.S., Woodroffe, L.M & Getchius, T.S. (2011) Clinical Practice Guideline Process Manual. AAN: available at: http://tools.aan.com/globals/axon/assets/9023.pdf.
2011 Guyatt et al. GRADE Guyatt, G.H. et al. (2011) “GRADE Guidelines: 1. Introduction–GRADE evidence profiles and summary of findings tables”. Journal of Clinical Epidemiology, 64, 383-394
2011 Howick et al. CEBM Howick, J., et al. (2011) “The Oxford 2011 Levels of Evidence”. Oxford Centre for Evidence-Based Medicine, available at www.cebm.net”
2011 Khan et al. CRC Khan, Khalid. (2011) Systematic reviews to support evidence based medicine: How to review and apply findings of healthcare research: CRC Press, p.19
2011 Kristensen et al. CRC Kristensen, H. K., Persson, D., Nygren, C., Boll, M., & Matzen, P. (2011) “Evaluation of evidence within occupational therapy in stroke rehabilitation.” Scandinavian journal of occupational therapy, 18(1), 11-25.
2011 Mitchell & Friese ONS Mitchell, S.A. & Friese, C.R. (2011) “Decision Rules for Summative Evaluation of a Body of Evidence”, ONS: Oncology Nursing Society, available at: https://www.ons.org/explore-resources/pep/decision-rules-summative-evaluation-body-evidence
2011 NICE NICE National Institute for Health and Clinical Excellence (NICE). (2011) CG117: Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control. London: RCP
2011 Tomlin & Borgetto Am J Occup. Therapy Tomlin, G. & Borgetto, B. (2011) “Research Pyramid: A New Evidence-Based Practice Model for Occupational Therapy.” American Journal of Occupational Therapy, 65, pp.189-196.
2011 Turner EBVMA Turner, S. (2011) ‘Hierarchy of Evidence’ in EBVMA, formerly available at: ebvma.org/home/content/part-1-hierarchy-evidence ~~ no longer available online.
2011 Wright, Swiontkowski & Heckman Orth Trauma Directions Wright, J., Swiontkowski, M., & Heckman, J. (2011) “Introducing levels of evidence to the journal.” Orthopedic Trauma Directions, 9(04), 27-28.
2012 Baral et al. HASTE Baral, Stefan D*, et al.* (2012) “The highest attainable standard of evidence (HASTE) for HIV/AIDS interventions: toward a public health approach to defining evidence”. Public Health Reports, 127(6), 572
2012 Gethin Acta Medica Croatica Gethin, G. (2012) “Understanding Data; An introduction to critical appraisal.” Acta medica Croatica, 66, 147-151.
2012 Haigh Group Analysis Haigh, R. (2012) ‘Being Economical with the Evidence’, in Group Analysis, 45: 70-83
2013 Elangovan et al. J Periodontology Elangovan, S., Avila-Ortiz, G., Johnson, G. K., Karimbux, N., & Allareddy, V. (2013) “Quality assessment of systematic reviews on periodontal regeneration in humans.” Journal of periodontology, 84(2), 176-185.
2013 Goldet & Howick JEBM Goldet, Gabrielle & Howick, Jeremy. (2013) “Understanding GRADE: an introduction”. Journal of Evidence*‐Based Medicine,* 6(1), 50-54
2013 Gugiu et al. Eval & the heal profs Gugiu, P. C., Westine, C. D., Coryn, C. L., & Hobson, K. A. (2013) “An application of a new evidence grading system to research on the chronic care model.” Evaluation & the health professions, 36(1), 3-43.
2013 Joanna Briggs Institute JBI Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Group (October 2013) JBI Levels of Evidence, available at Joanna Briggs Institute: https://joannabriggs.org/sites/default/files/2019-05/JBI-Levels-of-evidence_2014_0.pdf
2013 La Rochelle EBM La Rochelle, P. (2013) “Basic learning concepts in EBM: the bidimentional hierarchy of evidence.” Evidence-based medicine, ebmed-2013.
2013 Wells et al. BMC Wells, C., Kolt, G. S., Marshall, P., Hill, B., & Bialocerkowski, A. (2013). “Effectiveness of Pilates exercise in treating people with chronic low back pain: a systematic review of systematic reviews.” BMC medical research methodology, 13(1), 7.
2014 Canadian Task Force CTFPHE Canadian Task Force on the Periodic Health Examination. (2014) Procedure Manual. http://canadiantaskforce.ca/methods/ ~~ endorses GRADE but also offers an additional novel hierarchy.”
2014 Hansen Scan. J Social Med Hansen, H.F. (2014) “Organisation of evidence-based knowledge production: Evidence hierarchies and evidence typologies.” Scandinavian Journal of Social Medicine, 42(13_suppl), 11-17.
2014 Spruce et al. AORN Spruce, L. et al. (2014) “Introducing AORN’s new model for evidence rating.” AORN Journal, 99(2): 243-255
2014 Steele & Tiffin CTFPHE Steele, R., & Tiffin, P. A. (2014) “‘Personalised evidence’for personalised healthcare: integration of a clinical librarian into mental health services–a feasibility study.” Psychiatric Bulletin, 38(1), 29-35.
2015 Costantino, Montano & Casazza Int & Emerg Med Costantino, G., Montano, N., & Casazza, G. (2015) “When should we change our clinical practice based on the results of a clinical study? The hierarchy of evidence.” Internal and emergency medicine, 10(6), 745-747.
2015 Feldman et al. Ann. Rev. Pharma & Tox Feldman, R. D., Hussain, Y., Kuyper, L. M., McAlister, F. A., Padwal, R. S., & Tobe, S. W. (2015) “Intraclass differences among antihypertensive drugs.” Annual review of pharmacology and toxicology, 55, 333-352.
2015 Gugiu Eval & Prog. Plan. Gugiu, P. C. (2015). “Hierarchy of evidence and appraisal of limitations (HEAL) grading system.” Evaluation and program planning, 48, 149-159.
2015 Habib et al. ESC Habib, G. et al. for ESC Scientific Document Group (2015) “ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM)”, European Heart Journal, 36(44) pp.3075–3128
2015 Pinnock et al. BMC Pinnock, H., Epiphaniou, E., Pearce, G., Parke, H., Greenhalgh, T., Sheikh, A., … & Taylor, S. J. (2015) “Implementing supported self-management for asthma: a systematic review and suggested hierarchy of evidence of implementation studies.” BMC medicine, 13(1), 127.
2015 Puligandla et al. J Ped Surgery Puligandla, P. S., Grabowski, J., Austin, M., Hedrick, H., Renaud, E., Arnold, M., … & Lopez, M. E. (2015) “Management of congenital diaphragmatic hernia: A systematic review from the APSA outcomes and evidence based practice committee.” Journal of pediatric surgery, 50(11), 1958-1970.
2015 van Ballmoos, Ware & Harding J Clin Med Res von Ballmoos, M.C.W., Ware, J.H., & Haring, B. (2015) “Clinical research quo vadis? Trends in reporting of clinical trials and observational study designs over two decades.” Journal of clinical medicine research, 7(6), 428.
2015 Walach & Loef J Clin Epid Walach, H., & Loef, M. (2015) “Using a matrix-analytical approach to synthesizing evidence solved incompatibility problem in the hierarchy of evidence.” Journal of clinical epidemiology, 68(11), 1251-1260.
2016 Garattini et al. Eur J Int Med Garattini, S., Jakobsen, J. C., Wetterslev, J., Bertelé, V., Banzi, R., Rath, A., … & Eikermann, M. (2016) “Evidence-based clinical practice: Overview of threats to the validity of evidence and how to minimise them.” European journal of internal medicine, 32, 13-21.
2016 Handu et al. AND Handu, D., Moloney, L., Wolfram, T., Ziegler, P., Acosta, A., & Steiber, A. (2016) “Academy of Nutrition and Dietetics Methodology for Conducting Systematic Reviews for the Evidence Analysis Library.” Journal of the Academy of Nutrition and Dietetics, 116(2), 311–318.
2016 Izzo et al. Phytotherapy Izzo, A. A., Hoon‐Kim, S., Radhakrishnan, R., & Williamson, E. M. (2016) “A critical approach to evaluating clinical efficacy, adverse events and drug interactions of herbal remedies.” Phytotherapy Research, 30(5), 691-700.
2016 Mupepele et al. Ecological Applications Mupepele, A. C., Walsh, J. C., Sutherland, W. J., & Dormann, C. F. (2016) “An evidence assessment tool for ecosystem services and conservation studies.” Ecological Applications, 26(5), 1295-1301.
2016 Murad et al. EBM Murad MH, Asi N, Alsawas M, & Alahdab F. (2016) “New evidence pyramid.” Evid Based Med. 21(4): pp.125-7.
2016 Spruce, Van Wicklin & Wood AORN Spruce, L., Van Wicklin, S. A., & Wood, A. (2016) “AORN’s revised model for evidence appraisal and rating.” AORN journal, 103(1), 60-72.
2016 Thompson et al. J Am Assoc Nurse Prac Thompson, N., Mansfield, B., Stringer, M., Stewart, B., Potter, J., & Fernengel, K. (2016) “An evidence‐based resource for the management of comorbidities associated with childhood overweight and obesity.” Journal of the American Association of Nurse Practitioners, 28(10), 559-570.
2017 Featherstone et al. Health Communication Featherstone, R. M., Leggett, C., Knisley, L., Jabbour, M., Klassen, T. P., Scott, S. D., … & Hartling, L. (2017) “Creation of an Integrated Knowledge Translation Process to Improve Pediatric Emergency Care in Canada.” Health Communication, 1-8.
2017 Pennington et al. EJPH Pennington, A., Dreaves, H., Scott-Samuel, A., Haigh, F., Harrison, A., Verma, A., & Pope, D. (2017) “Development of an Urban Health Impact Assessment methodology: indicating the health equity impacts of urban policies.” European Journal of Public Health, 27(suppl_2):56-61
2017 Salimi et al. Ann. Plastic Surgery Salimi, N., Aleksejuniene, J., Yen, E. H., & Loo, A. Y. (2017) “Fistula in Cleft Lip and Palate Patients—A Systematic Scoping Review.” Annals of plastic surgery, 78(1), 91-102.
2018 Gil, Piva & Irrgang Clin in Sports Med Gil, A. B., Piva, S. R., & Irrgang, J. J. (2018) “Considerations for Assessment and Applicability of Studies of Intervention.” Clinics in sports medicine, 37(3), 427–440.
2018 Paez EBM Paez, A. (2018) “The “architect analogy” of evidence-based practice: Reconsidering the role of clinical expertise and clinician experience in evidence-based health care.” Journal of Evidence-Based Medicine 2018:1-8
2019 Katz et al. HEALM Katz, D.L., Karlsen, M.C., Chung, M. et al. (2019) “Hierarchies of evidence applied to lifestyle Medicine (HEALM): introduction of a strength-of-evidence approach based on a methodological systematic review.” BMC Med Res Methodol 19, 178
2020 Gray et al. Drug Saf Gray, C.M., Grimson, F., Layton, D. et al. (2020) “A Framework for Methodological Choice and Evidence Assessment for Studies Using External Comparators from Real-World Data.” Drug Saf 43, pp.623–633.
2020 Jeffcoat & Sollecito Compend Contin Educ Dent. Jeffcoat, M., & Sollecito T. (2020) “Evidence, Junk Science, and Hope in a Time of Pandemic: On the Front Lines in Dentistry.” Compend Contin Educ Dent. 41(8):420-424; PMID: 32870698.
2020 Tsiklakis et al. Eur Arch Paed Dent Tsiklakis, K., Mitsea, A., Tsichlaki, A. et al. (2020) “A systematic review of relative indications and contra-indications for prescribing panoramic radiographs in dental paediatric patients.” Eur Arch Paediatr Dent 21, 387–406

First published 20/12/2011, last update 29/06/16.

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