How do I record GRADE downgrade reasons in footnotes that trace to evidence?

Write one footnote per downgraded domain that names the outcome, the specific studies, and the statistic that triggered the judgement, so each certainty rating traces back to the underlying data.

GRADE rates certainty at the outcome level using explicit criteria, so the footnote should sit beside the outcome row it explains and cite the same studies the profile already lists.

1. Anchor the footnote to the outcome and domain. State the outcome, the starting certainty, and the domain being downgraded (risk of bias, inconsistency, indirectness, imprecision, or publication bias). Result: a reader sees which row and which criterion the note explains.
2. Name the triggering studies. List the study identifiers whose data drove the decision, for example the trials with high attrition for risk of bias or the trials with conflicting directions of effect for inconsistency. Result: the reader can open those studies and check the pattern.
3. Quote the statistic that crossed the threshold. For imprecision, give the confidence interval and the absolute and relative effect the review reports; for inconsistency, give the measure of heterogeneity and the conflicting estimates. Cochrane guidance on interpreting results treats confidence intervals, exact P values, and absolute and relative effects as the quantities to report. Result: the note shows the number that justified the downgrade.
4. State the judgement in one clause. Write what changed and by how much, such as a one-level downgrade for serious imprecision because the confidence interval spans both appreciable benefit and harm. Result: the rating and the reason match.
5. Cross-check the footnote against the Summary of Findings table. Confirm the cited studies appear in the table and that the downgrade total matches the final rating. Result: the profile is internally consistent.

Keep each footnote short enough to read in the table and specific enough that a reader can locate the study and the statistic without leaving the profile. Where a domain was not downgraded, a brief note on why can sit in the same column so the reader sees the full judgement set.