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Table 2:

Levels of evidence for intervention studiesa

Levels of EvidenceType of Evidence
1aHigh-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias
1bWell-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias
1cMeta-analyses, systematic reviews of RCTs, or RCTs with a high risk of biasb
2aHigh-quality systematic reviews of case–control or cohort studies; high-quality case–control or cohort studies with a very low risk of confounding, bias, or chance and a high probability that the relationship is causal
2bWell-conducted case–control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal
3Case–control or cohort studies with a high risk of confounding bias or chance and a significant risk that the relationship is not causalb
4Nonanalytic studies (for example, case reports, case series)
5Expert opinion, formal consensus
  • Note:—RCT indicates randomized controlled trial.

  • a Adapted from Reference 3a.

  • b Studies with a level of evidence indicated by—should not be used as a basis for making a recommendation.