Evidence map›Paper›PMID 29384078›Full record

ArticleImplementation science : IS2018

Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 3: how to assess methodological limitations.

Heather Munthe-Kaas, Meghan A Bohren, Claire Glenton, Simon Lewin, Jane Noyes, Özge Tunçalp, Andrew Booth, Ruth Garside, Christopher J Colvin, Megan Wainwright and 3 more

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In one paragraph

Article in Implementation science : IS, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 143 papers, 67 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
143citing papers in PubMed, 67 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

143 citing papers in PubMed, 67 syntheses or guidelines pooled it.

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  4. Patients' experiences with musculoskeletal spinal pain: a qualitative systematic review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
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  20. Examining the lived experience of dementia with Lewy bodies through qualitative research: A systematic review.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025
    Pooled it

83 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Heather Munthe-KaasNorwegian Institute of Public Health, Oslo, Norway. heather.munthe-kaas@fhi.no.
Meghan A BohrenUNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Claire GlentonNorwegian Institute of Public Health, Oslo, Norway.
Simon LewinNorwegian Institute of Public Health, Oslo, Norway.
Jane NoyesSchool of Social Sciences, Bangor University, Bangor, UK.
Özge TunçalpUNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Andrew BoothSchool of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
Ruth GarsideEuropean Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK.
Christopher J ColvinDivision of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Megan WainwrightDivision of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Arash RashidianDepartment of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Signe FlottorpNorwegian Institute of Public Health, Oslo, Norway.
Benedicte CarlsenUni Research Rokkan Centre, Bergen, Norway.

Funding

World Health Organization 001
6 · The paper itself

Abstract

backgroundThe GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. CERQual includes four components for assessing how much confidence to place in findings from reviews of qualitative research (also referred to as qualitative evidence syntheses): (1) methodological limitations, (2) coherence, (3) adequacy of data and (4) relevance. This paper is part of a series providing guidance on how to apply CERQual and focuses on CERQual's methodological limitations component.

methodsWe developed the methodological limitations component by searching the literature for definitions, gathering feedback from relevant research communities and developing consensus through project group meetings. We tested the CERQual methodological limitations component within several qualitative evidence syntheses before agreeing on the current definition and principles for application.

resultsWhen applying CERQual, we define methodological limitations as the extent to which there are concerns about the design or conduct of the primary studies that contributed evidence to an individual review finding. In this paper, we describe the methodological limitations component and its rationale and offer guidance on how to assess methodological limitations of a review finding as part of the CERQual approach. This guidance outlines the information required to assess methodological limitations component, the steps that need to be taken to assess methodological limitations of data contributing to a review finding and examples of methodological limitation assessments.

conclusionsThis paper provides guidance for review authors and others on undertaking an assessment of methodological limitations in the context of the CERQual approach. More work is needed to determine which criteria critical appraisal tools should include when assessing methodological limitations. We currently recommend that whichever tool is used, review authors provide a transparent description of their assessments of methodological limitations in a review finding. We expect the CERQual approach and its individual components to develop further as our experiences with the practical implementation of the approach increase.

Indexed as

Data AccuracySystematic Reviews as TopicBiomedical ResearchConfidence IntervalsDecision MakingEvidence-Based MedicineHumansPublishingQualitative ResearchConfidenceCritical appraisalEvidence-based practiceGuidanceMethodological limitations, GRADEMethodologyQualitative evidence synthesisQualitative researchResearch designSystematic review methodology

Identifiers

PMID29384078
PMCPMC5791044

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.