Table 2.
GRADE quality of evidence assessment
| Certainty assessment | No of patients | Effect | Certainty | Importance | ||||||||
| No of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | FRID deprescribing strategy | Usual care | Relative (95% CI) | Absolute (95% CI) | ||
| Falls rate | ||||||||||||
| 4 | Randomised trials | Seriousa | Seriousb | Not serious | Seriousc | None | 353 | 340 | Rate ratio 0.98 (0.63 to 1.51), p=0.92 | – | ⨁◯◯◯ very low | Important |
| Falls incidence | ||||||||||||
| 4 | Randomised trials | Seriousa | Seriousd | Not serious | Seriousc | None | 190/499 (38.1%) | 170/472 (36.0%) | RR 1.04 (0.86 to 1.26), p=0.66 | 14 more per 1000 (from 50 fewer to 94 more) | ⨁◯◯◯ very low | Important |
| 33.7% | 13 more per 1000 (from 47 fewer to 88 more) | |||||||||||
| Fall-related injuries | ||||||||||||
| 1 | Randomised trials | Seriousa | Not serious | Not serious | Seriousc | None | 93 | 93 | Rate ratio 0.89 (0.57 to 1.39), p=0.61 | – | ⨁⨁◯◯ low | Critical |
a. Most information is from studies at high risk of bias due to lack of blinding (performance and detection bias) and incomplete outcome data (attrition bias).
b. Considerable heterogeneity (p < 0.0001 and I2 >75%) is present and variability in the direction of effect.
c. The 95% CI is very wide and includes appreciable benefit or harm. Recommendation or clinical course of action would differ if the upper versus the lower boundary of the CI represented the truth. In addition, optimalinformation size likely not met as fewer than 2000 participants and 400 events.
d. Low to moderate heterogeneity is present (p > 0.1 and I2 >= 40%) and variability in the direction of effect.
FRID, fall-risk increasing drug; GRADE, Grading of Recommendations, Assessment, Development and Evaluation; RR, relative risk.