GRADE Certainty Ratings: Thresholds Rather Than Categories of Contextualization (GRADE Guidance 41)

In 2017, the GRADE (Grading of Recommendations Assessment, Development and Evaluation) working group defined the certainty of evidence as the certainty that the true effect lies on one side of a threshold or in a particular range. This definition has proved useful as the basis for rating certainty, facilitating the interpretation of the results for the target audience. However, the categorization of suggested thresholds and ranges as levels of contextualization led to inconsistencies between the initial and subsequent papers and has proved confusing for some GRADE users. Although considering context in choosing thresholds remains worthwhile, the GRADE working group will no longer use the categorization of contextualization. It will instead refer simply to chosen thresholds or ranges for determining the target of certainty rating.