important. The size of the effect needed to be determined, as well as whether the 95%CI included only clinically important effects. The outcomes being measured in this report were assessed as to whether they were appropriate and clinically relevant (). Stage 3: Assessment of the body of evidence Appraisal of the body of evidence was conducted along the lines suggested by the NHMRC in their guidance on clinical practice guideline development (). The five components considered essential by the NHMRC when judging the body of evidence are the: evidence-base—which includes the number of studies sorted by their methodological quality and relevance to patients consistency of the study results—whether the better quality studies had results of a similar magnitude and in the same direction i.e. homogenous or heterogeneous findings potential clinical impact—appraisal of the precision, size and clinical importance or relevance of the primary outcomes used to determine the safety and effectiveness of the test generalisability of the evidence to the target population applicability of the evidence—integration of this evidence for conclusions about the net clinical benefit of the intervention in the context of Australian clinical practice. A matrix for assessing the body of evidence for each research question, according to the components above, was used for this assessment (Table 15). Table 15 Body of evidence matrix Component A B C D Excellent Good Satisfactory Poor Evidence-base a One or more level I One or two level II One or two level III Level IV studies, or studies with a low risk studies with a low risk studies with a low risk level I to III of bias or several of bias, or an SR or of bias, or level I or II studies/SRs with a level II studies with a several level III studies with a high risk of bias low risk of bias studies with a low risk moderate risk of bias of bias Most studies Some inconsistency Evidence is Consistency b All studies consistent consistent and reflecting genuine inconsistent inconsistency may be uncertainty around explained clinical question Clinical impact Very large Substantial Moderate Slight or restricted Generalisability Population(s) studied Population(s) studied Population(s) studied Population(s) studied in body of evidence in the body of in body of evidence in body of evidence are the same as evidence are similar differ to target differ from target target population to target population population for population and it is guideline but it is hard to judge whether clinically sensible to it is sensible to
important. The size of the effect needed to be determined, as well as whether the 95%CI included only clinically important effects. The outcomes being measured in this report were assessed as to whether they were appropriate and clinically relevant (). Stage 3: Assessment of the body of evidence Appraisal of the body of evidence was conducted along the lines suggested by the NHMRC in their guidance on clinical practice guideline development (). The five components considered essential by the NHMRC when judging the body of evidence are the: evidence-base—which includes the number of studies sorted by their methodological quality and relevance to patients consistency of the study results—whether the better quality studies had results of a similar magnitude and in the same direction i.e. homogenous or heterogeneous findings potential clinical impact—appraisal of the precision, size and clinical importance or relevance of the primary outcomes used to determine the safety and effectiveness of the test generalisability of the evidence to the target population applicability of the evidence—integration of this evidence for conclusions about the net clinical benefit of the intervention in the context of Australian clinical practice. A matrix for assessing the body of evidence for each research question, according to the components above, was used for this assessment (Table 15). Table 15 Body of evidence matrix Component A Excellent B Good C Satisfactory D Poor Evidence-base a One or more level I studies with a low risk of bias or several level II studies with a low risk of bias One or two level II studies with a low risk of bias, or an SR or several level III studies with a low risk of bias One or two level III studies with a low risk of bias, or level I or II studies with a moderate risk of bias Level IV studies, or level I to III studies/SRs with a high risk of bias Consistency b All studies consistent Most studies consistent and inconsistency may be explained Some inconsistency reflecting genuine uncertainty around clinical question Evidence is inconsistent Clinical impact Very large Substantial Moderate Slight or restricted Generalisability Population(s) studied in body of evidence are the same as target population Population(s) studied in the body of evidence are similar to target population Population(s) studied in body of evidence differ to target population for guideline but it is clinically sensible to Population(s) studied in body of evidence differ from target population and it is hard to judge whether it is sensible to