At present, the network meta-analysis has been rapidly developed and widely used, and it has the characteristic of quantifying and comparing the relative advantages of two or more different interventions for a single health outcome. However, comparison of multiple interventions has increased the complexity of drawing conclusions from network meta-analysis, and ignorance of the certainty of evidence has also led to misleading conclusions. Recently, the GRADE (grading of recommendations assessment, development and evaluation) working group proposed two approaches for obtaining conclusions from a network meta-analysis of interventions, namely, the partially contextualised framework and the minimally contextualised framework. When using partially contextualised framework, authors should establish ranges of magnitudes of effect that represent a trivial to no effect, minimal but important effect, moderate effect, and large effect. The guiding principles of this framework are that interventions should be grouped in categories based on the magnitude of the effect and its benefit or harm; and that when classifying, consider the point estimates, the rankings, and the certainty of the evidence comprehensively to draw conclusions. This article employs a case to describe and explain the principles and four steps of partially contextualised framework to provide guidance for the application of this GRADE approach in the interpretation of results and conclusions drawing from a network meta-analysis.
The primary advantage of network meta-analysis is the capability to quantify and compare different interventions for the same diseases and rank their benefits or harms according to a certain health outcome. The inclusion of a variety of interventions has increased the complexity of the conclusions drawing from a network meta-analysis, and based on the ranking results alone may lead to misleading conclusions. At present, there are no accepted standards for the conclusion drawing from a network meta-analysis. In November 2020, based on the evidence certainty results of network meta-analysis, the GRADE (Grades of Recommendations Assessment, Development and Evaluation) working group proposed two approaches to draw conclusions from a network meta-analysis: the partially contextualised framework and the minimally contextualised framework. This paper aimed to introduce principles and procedures of the minimal contextualised framework through a specific example to provide guidance for the network meta-analysis authors in China to present and interpret the results using minimally contextualised framework.
背景虽然当前已有一些评估卫生保健指南可靠性的工具，但仍缺乏针对制定指南实际步骤的指导。针对指南制定者们所需考虑的相关资源和工具，我们系统研发了一份全面的条目清单，但这并不意味着每篇指南都需遵守该清单的所有条目。 方法我们检索了国际指南制定机构的指南制定手册、指南的指南（主要是来自国际和国家机构以及专业学会的方法学报告），以及提供系统指导的最新文章。经过反复评价这些资料，尽可能全面地罗列和提取条目，并制定与指南有关的重要主题。通过反复讨论，我们对条目进行评价以去重和补漏，同时邀请指南制定专家对所增加的条目进行修改并提出建议。 结果我们制定了一份包含18个主题、146个条目的清单，并建立了帮助指南制定者应用这些条目的网站。这些主题和条目涵盖了指南从规划、完成、实施和评估的全过程。最终的清单版本也包括了培训所需的资料以及应用这些条目时用到的方法学参考文献的链接。 解释本清单将提供给指南制定者用作参考。仔细考虑清单中的条目将有助于指南的制定、实施和评估，我们也将会通过大众反馈来修订并持续更新清单。