Levels of Quantitative Evidence

Chapter 1 in the Evidence-Based Geriatric Nursing Protocols for Best Practice (2008) outlines the process in which the clinical practice guidelines were developed and how they complied with the AGREE items for rigor of development (AGREE Collaboration, 2001). Levels of Evidence were applied to selected assessment and management recommendations. The chapter authors rated the level of evidence based on the work of Melnyk and Fineout-Overholt (2005) and Stetler, Morsi, Rucki et.al. (1998) as follows:

Level I: Systematic Reviews (Integrative/Meta-analyses/Clinical Practice Guidelines based on systematic reviews)

Level II: Single experimental study (RCTs)

Level III: Quasi-experimental studies

Level IV: Non-experimental studies

Level V: Care report/program evaluation/narrative literature reviews

            Level VI: Opinions of respected authorities/Consensus panels


AGREE Collaboration. (2001). Appraisal of Guidelines Research and Evaluation, AGREE Instrument. Retrieved November 21, 2006 from the World Wide Web: http://www.agreecollaboration.org/instrument/

Capezuti, E. Zwicker, D., Mezey, M.,. & Fulmer, T. (Eds.). (2008). Evidence-based geriatric nursing protocols for best practice, 3rd ed. Springer Publishing Company: New York.

Melnyck, B.M. & Fineout-Overholt, E. (2005). Evidence-based practice in healthcare. Philadelphia: Lippincott.

Stetler, C.B., Morsi, D., Rucki, S., Broughton, S., Corrigan, B., Fitzgerald, J., et al.(1998). Utilization-focused integrative reviews in a nursing service. Applied Nursing Research, 11, 195-206.