Table 5.
Summary of questions, recommendations, quality of evidence and strength of recommendations from the new Australian guidelines
| Chapter | Questions | Recommendations | Quality of evidencea | Strength of Recommendationb | ||||
|---|---|---|---|---|---|---|---|---|
| High | Moderate | Low | Very Low | Strong | Weak | |||
| Prevention | 11 | 15 | 0 | 2 (13%) | 13 (87%) | 0 | 9 (60%) | 6 (40%) |
| Wound classification | 4 | 5 | 1 (20%) | 3 (60%) | 1 (20%) | 0 | 2 (40%) | 3 (30%) |
| PAD | 8 | 17 | 0 | 3 (18%) | 14 (82%) | 0 | 17 (100%) | 0 |
| Infection | 11 | 35 | 2 (6%) | 12 (34%) | 20 (57%) | 1 (3%) | 21 (60%) | 14 (40%) |
| Offloading | 9 | 13 | 0 | 1 (8%) | 9 (69%) | 3 (23%) | 4 (31%) | 9 (69%) |
| Wound healing | 8 | 13 | 0 | 3 (23%) | 10 (77%) | 0 | 3 (23%) | 10 (77%) |
| TOTAL | 51 | 98 | 3 (3%) | 24 (24%) | 67 (68%) | 4 (4%) | 56 (57%) | 42 (43%) |
PAD: Peripheral artery disease
a. Quality of evidence rating. The quality of evidence is defined as the extent of the confidence that the estimates of an effect from a body of evidence are adequate to support a particular recommendation [26, 38, 45]. Quality of evidence can be rated as:
High = Typically, this is based on a body of evidence containing either: a) randomised trial(s) reporting similar effects with minimal risk of bias, inconsistency, indirectness, imprecision or publication bias &/or b) observational study(s) reporting similar very large effects, evidence of a dose response gradient and minimal confounding. Therefore, we are very confident that the true effect lies close to the estimate of the effect and further research is very unlikely to change our confidence in the estimate of effect [38, 45]
Moderate = Typically, this is based on a body of evidence containing either: a) randomised trial(s) reporting mostly similar effects, but with some serious risk of bias, inconsistency, indirectness, imprecision or publication bias, &/or b) observational study(s) reporting similar large effects with minimal confounding. Therefore, we are moderately confident that the true effect is likely to be close to the estimate of the effect, but there is also a possibility that it is substantially different and further research is likely to have an important impact on our confidence in the estimate of effect [38, 45]
Low = Typically, this is based on a body of evidence containing either: a) randomised trial(s) reporting some similar effects, but with very serious risk of bias, inconsistency, indirectness, imprecision or publication bias, &/or b) observational study(s) reporting similar effects, but with confounding [45]. Therefore, we have limited confidence that the true effect is likely to be close to the estimate of the effect, and there is a high possibility that it is substantially different and further research is very likely to have an important impact on our confidence in the estimate of effect [38, 45]
Very Low = Typically, this is based on a body of evidence containing either: a) observational study(s) reporting similar effects, but with confounding, &/or expert opinion [45]. Therefore, we have very limited confidence that the true effect is likely to be close to the estimate of the effect, and there is a very high possibility that it is substantially different and further research is most likely to have an important impact on our confidence in the estimate of effect [38, 45]
b. Strength of recommendation ratings. The strength of a recommendation is defined as the extent to which we can be confident that the desirable effects (i.e. benefits, such as improved health outcome, improved quality of life, decreased costs) of an intervention outweigh the undesirable effects (i.e. harms, such as adverse events, decreased quality of life, increased costs) [26, 30, 38]. The strength of a recommendation can be rated as:
Strong = Typically, this is based on a body of evidence, supplemented by expert opinion if limited evidence is available, that the desirable effects of an intervention considerably outweigh the undesirable effects for an intervention or vice versa. Therefore, we are highly confident of the balance between desirable and undesirable consequences and we make a strong recommendation for (desirable outweighs undesirable) or against (undesirable outweighs desirable) an intervention [30, 38]
Weak = Typically, this is based on a body of evidence, supplemented by expert opinion if limited evidence is available, that the desirable effects of an intervention may outweigh the undesirable effects for an intervention or vice versa. Therefore, we are less confident of the balance between desirable and undesirable effects and we make a weak recommendation for (desirable outweighs undesirable) or against (undesirable outweighs desirable) an intervention [30, 38].