Article Text

Download PDFPDF
GRADE system in systematic reviews of prevalence or incidence studies evaluating sport-related injuries: why is GRADE important?
  1. Javier Martínez-Calderon1,2,
  2. Cristina García-Muñoz2,3
  1. 1 Instituto de Biomedicina de Sevilla, IBiS, Departamento de Fisioterapia, Universidad de Sevilla, Sevilla, Spain
  2. 2 CTS 1110: Understanding Movement and Self in health from Science (UMSS) Research Group, Andalusia, Spain
  3. 3 Departamento de Ciencias de la Salud y Biomédicas, Universidad Loyola de Andalucía, Sevilla, Spain
  1. Correspondence to Dr Javier Martínez-Calderon, Departamento de Fisioterapia, Universidad de Sevilla, Sevilla, Spain; jmcalderon{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Epidemiological systematic reviews are increasing in the field of sport and exercise medicine (SEM). For example, the prevalence or incidence rates of lower extremity (eg, knee), upper extremity (eg, hands), and head and neck injuries have been synthetised in different types of sports (eg, basketball).1–4 The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system is a rigorous and transparent approach that allows researchers to rate the certainty of evidence based on analysis of the risk of bias, inconsistency, indirectness, imprecision and publication bias.5 Although there are other approaches apart from GRADE to rate this certainty,6 GRADE is considered the gold standard for this purpose.

GRADE was primarily designed to rate the certainty of evidence from clinical trials, but the GRADE Working Group also stated that this system can be used in observational studies.5 Specific guidelines have been developed for rating the evidence from prognostic factors7 and diagnostic accuracy.8 However, there is currently no available guideline for rating the evidence from epidemiological studies. The GRADE Working Group proposes randomised clinical trials begin with high evidence and can be downgraded by up to three levels (moderate, low or very-low evidence) depending on the presence of serious (−1 level) or very serious (−2 levels) risk of bias, …

View Full Text


  • Contributors All authors made an important contribution to the development of this editorial.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JM-C is an associated editor for BJSM.

  • Provenance and peer review Not commissioned; externally peer reviewed.