• Miranda Langendam, Alonso Carrasco-Labra, Nancy Santesso, Reem A Mustafa, Romina Brignardello-Petersen, Matthew Ventresca, Pauline Heus, Toby Lasserson, Rasmus Moustgaard, Jan Brozek, and Holger J Schünemann.
• Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, PO Box 22660, J1B-211, 1100 DD Amsterdam, The Netherlands.
• J Clin Epidemiol. 2016 Jun 1; 74: 19-27.

ObjectivesThe Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group has developed GRADE evidence profiles (EP) and summary of findings (SoF) tables to present evidence summaries in systematic reviews, clinical guidelines, and health technology assessments. Explanatory notes are used to explain choices and judgments in these summaries, for example, on rating of the quality of evidence.Study Design And SettingA systematic survey of the explanations in SoF tables in 132 randomly selected Cochrane Intervention reviews and in EPs of 10 guidelines. We analyzed the content of 1,291 explanations using a predefined list of criteria.ResultsMost explanations were used to describe or communicate results and to explain downgrading of the quality of evidence, in particular for risk of bias and imprecision. Addressing the source of baseline risk (observational data or control group risk) was often missing. For judgments about downgrading the quality of evidence, the percentage of informative explanations ranged between 41% (imprecision) and 79% (indirectness).ConclusionWe found that by and large explanations were informative but detected several areas for improvement (e.g., source of baseline risk and judgments on imprecision). Guidance about explanatory footnotes and comments will be provided in the last article in this series.Copyright © 2016 Elsevier Inc. All rights reserved.

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