Extending the grading of recommendations assessment, development and evaluation (GRADE) in traditional Chinese medicine (TCM): The GRADE-TCM

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Journal Article

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School of Nursing and Midwifery


International Standard Development Project of the World Federation of Chinese Medicine Societies / National Natural Science Foundation of China / Sichuan Natural Science Foundation General Project / Joint Science and Technology Innovation Project of Sichuan Province / Science and Technology Project of Sichuan Administration of Traditional Chinese Medicine / Edith Cowan University and Industry Collaboration Program / Xinglin Scholars Scientific Research Promotion Plan of Chengdu University of Traditional Chinese Medicine / Sanmenxia City Science and Technology Development Project / Research Capacity Enhancement Project (Hundred Talents Program) of Hospital of Chengdu University of Traditional Chinese Medicine


Fu, Q. W., Liu, Y., Chen, S. C., Zhang, L. Z., Liu, W. T., Liu, Z. Q., . . . Li, X. R. (2024). Extending the grading of recommendations assessment, development and evaluation (GRADE) in traditional Chinese medicine (TCM): The GRADE-TCM. Phytomedicine, 127, article 155487. https://doi.org/10.1016/j.phymed.2024.155487


Aim: To extend and form the “Grading of Recommendations Assessment, Development and Evaluation in Traditional Chinese Medicine” (GRADE-TCM). Methods: Methodologies were systematically reviewed and analyzed concerning evidence-based TCM guidelines worldwide. A survey questionnaire was developed based on the literature review and open-end expert interviews. Then, we performed expert consensus, discussion meeting, opinion collection, external examination, and the GRADE-TCM was formed eventually. Results: 265 Chinese and English TCM guidelines were included and analyzed. Five experts completed the open-end interviews. Ten methodological entries were summarized, screened and selected. One round of consensus was conducted, including a total of 22 experts and 220 valid questionnaire entries, concerning 1) selection of the GRADE, 2) GRADE-TCM upgrading criteria, 3) GRADE-TCM evaluation standard, 4) principles of consensus and recommendation, and 5) presentation of the GRADE-TCM and recommendation. Finally, consensus was reached on the above 10 entries, and the results were of high importance (with voting percentages ranging from 50 % to 81.82 % for “very important” rating) and strong reliability (with the Cr ranging from 0.93 to 0.99). Expert discussion meeting (with 40 experts), opinion collection (in two online platforms) and external examination (with 14 third-party experts) were conducted, and the GRADE-TCM was established eventually. Conclusion: GRADE-TCM provides a new extended evidence-based evaluation standard for TCM guidelines. In GRADE-TCM, international evidence-based norms, characteristics of TCM intervention, and inheritance of TCM culture were combined organically and followed. This is helpful for localization of the GRADE in TCM and internationalization of TCM guidelines.



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