What factors can downgrade the quality of evidence for a clinical outcome?
The quality of evidence for a clinical outcome can be downgraded due to factors such as a high risk of bias, imprecision, indirectness, heterogeneity, and if the confidence interval crosses one or both MIDs. If the majority of the evidence is at high risk of bias, the evidence is downgraded by 1 increment, and if the majority of the evidence is at very high risk of bias, the evidence is downgraded by 2 increments. 