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Levels of Evidence FAME

The Joanna Briggs Institute, our Collaborating Centres and Evidence Translation Groups currently assign a level of evidence to all conclusions drawn in JBI Systematic Reviews.

The JBI Levels of Evidence are:

Levels of Evidence	Feasibility F(1-4)	Appropriateness A(1-4)	Meaningfulness M(1-4)	Effectiveness E(1-4)	Economic Evidence
1	Metasynthesis of research with unequivocal synthesised findings	Metasynthesis of research with unequivocal synthesised findings	Metasynthesis of research with unequivocal synthesised findings	Meta-analysis(with homogeneity) of experimental studies (eg RCT with concealed randomisation) OR One or more large experimental studies with narrow confidence intervals	Metasynthesis (with homogeneity) of evaluations of important alternative interventions comparing all clinically relevant outcomes against appropriate cost measurement, and including a clinically sensible sensitivity analysis
2	Metasynthesis of research with credible synthesised findings	Metasynthesis of research with credible synthesised findings	Metasynthesis of research with credible synthesised findings	One or more smaller RCTs with wider confidence intervals OR Quasi-experimental studies(without randomisation)	Evaluations of important alternative interventions comparing all clinically relevant outcomes against appropriate cost measurement, and including a clinically sensible sensitivity analysis
3	a. Metasynthesis of text/opinion with credible synthesised findings b. One or more single research studies of high quality	a. Metasynthesis of text/opinion with credible synthesised findings b. One or more single research studies of high quality	a. Metasynthesis of text/opinion with credible synthesised findings b. One or more single research studies of high quality	a. Cohort studies (with control group) b. Case-controled c. Observational studies(without control group)	Evaluations of important alternative interventions comparing a limited number of appropriate cost measurement, without a clinically sensible sensitivity analysis
4	Expert opinion	Expert opinion	Expert opinion	Expert opinion, or physiology bench research, or consensus	Expert opinion, or based on economic theory

History of Levels of Evidence
From 2003-2004 The Joanna Briggs Institute used the levels of evidence from Australian National Health & Medical Research Council - NHMRC Development, implementation and evaluation for clinical practice guidelines published in 1999. These levels assess the validity of recommendations for clinical guidelines and focuses, understandably, on the effectiveness of treatment. As The Joanna Briggs Institute has a broader definition of what constitutes evidence, a more inclusive approach to the development and grading of levels of evidence and implications for practice was later developed. Until 2003 the Institute used the levels of evidence as specified by the NHMRC 1995 Guidelines for the Development and Implementation of Clinical Practice Guidelines.

Page last modified 17/01/2013

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