GRADE方法：體育與運動科學領域中系統性回顧之證據可信度和建議強度的評估工具

GRADE approach: An assessment tool for the certainty of evidence and strength of recommendations in systematic reviews in the fields of physical education, sport, and exercise sciences

建議、測量、發展、評估之等級(Grading of Recommendations, Assessment, Development, and Evaluations, GRADE)方法係用於評估系統性回顧與指引方針證據可信度(certainty of evidence)及建議強度(strength of recommendation)之工具。過去，系統性回顧在評估證據可信度時，常以偏誤風險(risk of bias)和發表偏誤(publication bias)作為依據，然仍有可能降低(downgrade)或提升(upgrade)證據可信度之因素，包括結果之間接性(indirectness)、不一致性(inconsistency)、不精確性(imprecision)等，或效果大小與混淆因素(confounding)排除等。值得注意的是，GRADE方法不僅能全面地考量多種可能提升或降低證據可信度之因素外，更可依據證據可信度與考量其他因素，進一步提出建議強度，提供臨床決策者參考。具體而言，GRADE方法大致可分成五個步驟，包括決定初始證據可信度、考量降級或升級因素、評估證據可信度、考量其它因素，以及提出建議強度。近年，國際已有許多體育與運動科學領域之研究者採用GRADE方法，評估系統性回顧之證據可信度與建議強度，然在國內體育與運動科學領域則仍未有研究採用GRADE方法於系統性回顧。鑑於GRADE方法之優勢和當前國際之趨勢，簡介GRADE方法有其必要性之存在。因此，本文旨在簡介GRADE方法，並以體育與運動科學領域之研究為例，簡要介紹GRADE方法之起源、內容、影響與評估方法，並提出其優勢與限制，期望提供國內體育與運動科學領域之研究者對GRADE方法之總覽，且更好地將其運用於系統性回顧中。

The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach is a tool used to assess the certainty of evidence and the strength of recommendations in systematic reviews and guidelines. In the past, systematic reviews often relied on the risk of bias and publication bias as key criteria for assessing the certainty of evidence. However, there are factors that may either upgrade or downgrade the certainty of evidence, including indirectness, inconsistency, imprecision, as well as considerations such as the magnitude of effects and the exclusion of confounding factors. It is worth noting that the GRADE approach not only comprehensively considers various factors that may impact the certainty of evidence but also provides the strength of recommendation for clinical decision-makers based on the certainty of the evidence and other factors. This offers valuable guidance for clinical decision-makers to consider. Specifically, the GRADE approach can be broadly categorized into five steps, encompassing the determination of the initial certainty of evidence, consideration of downgrading or upgrading factors, assessment of the certainty of evidence, consideration of other factors, and the proposal of the strength of recommendation. In recent years, many researchers in the fields of physical education, sport, and exercise sciences have adopted the GRADE approach to assess the certainty of evidence and the strength of recommendations in systematic reviews. However, there have been no systematic reviews from the fields of physical education, sport, and exercise sciences that have utilized the GRADE approach in Taiwan. Given the advantages of the GRADE approach and the current international trend, it is necessary to provide an overview of the GRADE approach. This article aims to introduce the GRADE approach and using examples from research in the fields, briefly explain its origins, content, influence, assessment methods, advantages, and limitations. We hope that the article provides researchers in the fields of physical education, sport, and exercise sciences with an overview of the GRADE approach and enables them to better apply it in systematic reviews.