The Somatic Connection. J Am Osteopath Assoc 2011;111(1):7–12. doi: 10.7556/jaoa.2011.111.1.7.
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Domains that may decrease the quality of the evidence are: 1) the study design, 2) risk of bias, 3) consistency of results, 4) directness (generalizability), 5) precision (sufficient data), and 6) reporting of the results for studies that measure one particular outcome. Domains that may increase the quality of the evidence are 1) large magnitude of effect, 2) all residual confounding [variables that] would have reduced the observed effect, and 3) a dose-response gradient is evident. High quality evidence was defined as RCTs [randomized, controlled trials] with low risk of bias that provided consistent, direct and precise results for the outcome. The quality of the evidence was reduced by a level for each of the domains not met or increased by factors such as large magnitude of effect; all plausible confounding [variables that] would reduce a demonstrated effect and dose-response gradient.
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