title: Improving GRADE evidence tables part 3: detailed guidance for explanatory footnotes supports creating and understanding GRADE certainty in the evidence judgments.
abstract: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is widely used and reliable and accurate for assessing the certainty in the body of health evidence. The GRADE working group has provided detailed guidance for assessing the certainty in the body of evidence in systematic reviews and health technology assessments (HTAs) and how to grade the strength of health recommendations. However, there is limited advice regarding how to maximize transparency of these judgments, in particular through explanatory footnotes or explanations in Summary of Findings tables and Evidence Profiles (GRADE evidence tables).
  
  
  
  We conducted this study to define the essential attributes of useful explanations and to develop specific guidance for explanations associated with GRADE evidence tables. We used a sample of explanations according to their complexity, type of judgment involved, and appropriateness from a database of published GRADE evidence tables in Cochrane reviews and World Health Organization guidelines. We used an iterative process and group consensus to determine the attributes and develop guidance.
  
  
  
  Explanations in GRADE evidence tables should be concise, informative, relevant, easy to understand, and accurate. We provide general and domain-specific guidance to assist authors with achieving these desirable attributes in their explanations associated with GRADE evidence tables.
  
  
  
  Adhering to the general and GRADE domain-specific guidance should improve the quality of explanations associated with GRADE evidence tables, assist authors of systematic reviews, HTA reports, or guidelines with information that they can use in other parts of their evidence synthesis. This guidance will also support editorial evaluation of evidence syntheses using GRADE and provide a minimum quality standard of judgments across tables.
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; McMaster GRADE Center, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Santesso
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; McMaster GRADE Center, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Sergio Livingstone Pohlhammer 943, Independencia, Santiago, Chile.
authors.forename: Alonso
authors.initials: A
authors.lastname: Carrasco-Labra
authors.affiliation: Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, PO Box 22660, J1B-211, 1100 DD Amsterdam, The Netherlands.
authors.forename: Miranda
authors.initials: M
authors.lastname: Langendam
authors.affiliation: Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Sergio Livingstone Pohlhammer 943, Independencia, Santiago, Chile; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada; Department of Medicine/Nephrology, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108-2792, USA.
authors.forename: Romina
authors.initials: R
authors.lastname: Brignardello-Petersen
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine/Nephrology, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108-2792, USA; Department of Biomedical & Health Informatics, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108-2792, USA.
authors.forename: Reem A
authors.initials: RA
authors.lastname: Mustafa
authors.affiliation: Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispostnummer Street 6.131, Postbus 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Pauline
authors.initials: P
authors.lastname: Heus
authors.affiliation: Cochrane Editorial Unit, St Albans House, 57-59 Haymarket, London SW1Y 4QX, UK.
authors.forename: Toby
authors.initials: T
authors.lastname: Lasserson
authors.affiliation: Cochrane Editorial Unit, St Albans House, 57-59 Haymarket, London SW1Y 4QX, UK.
authors.forename: Newton
authors.initials: N
authors.lastname: Opiyo
authors.affiliation: Department of General Practice and Primary Health Care, Duodecim Medical Publications Ltd and University of Helsinki, PO Box 874, Kaivokatu 10 A, 7th Floor, FIN-00101 Helsinki, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Kunnamo
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
authors.forename: David
authors.initials: D
authors.lastname: Sinclair
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK; Cochrane Infectious Diseases Group, Pembroke Place, Liverpool L3 5QA, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Garner
authors.affiliation: Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK.
authors.forename: Shaun
authors.initials: S
authors.lastname: Treweek
authors.affiliation: Cochrane Editorial Unit, St Albans House, 57-59 Haymarket, London SW1Y 4QX, UK.
authors.forename: David
authors.initials: D
authors.lastname: Tovey
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Internal Medicine, American University of Beirut, Riad-El-Solh, PO Box 11-0236, Beirut 1107 2020, Lebanon.
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
authors.affiliation: Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Tugwell
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; McMaster GRADE Center, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
authors.forename: Jan L
authors.initials: JL
authors.lastname: Brozek
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; McMaster GRADE Center, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; McMaster GRADE Center, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. Electronic address: schuneh@mcmaster.ca.
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
mesh_terms: D000328:Adult; D000368:Aged; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D007600:Judgment; D008297:Male; D008875:Middle Aged; D058028:Research Report / Q000592:standards*; D012196:Review Literature as Topic; D013673:Technology Assessment, Biomedical; D035501:Uncertainty; D055815:Young Adult
keywords: Evidence Profile; Explanations; GRADE; GRADEpro; Guidelines; Levels of evidence; Summary of Findings table; Systematic reviews