Repair inconsistent conclusions by comparing each conclusion sentence with its outcome's GRADE certainty rating, then rewording claims to match the evidence strength. GRADE rates certainty at the outcome level using explicit criteria, so a downgrade for one outcome does not automatically apply to every statement in your discussion.
Run the alignment check
- Build a table with one row per conclusion sentence and columns for the outcome it addresses, the GRADE certainty rating for that outcome, and the wording used (for example "reduces," "may reduce," "is uncertain"). Mark any sentence whose wording implies more certainty than its outcome's rating supports.
- Rewrite each flagged sentence so its verb and qualifiers match the rating, and record the original wording, the revised wording, and the rating that justified the change. This log shows reviewers how the conclusion follows from the certainty judgement.
Match wording to certainty
Use the GRADE Working Group's explicit criteria and outcome-level judgements as the reference for what each rating supports. Cochrane Handbook Chapter 15 guidance on confidence intervals, exact P values, absolute and relative effects, applicability, and indirectness helps you phrase conclusions around the size and precision of effects. When a downgrade came from indirectness or applicability limits, state the population or setting the finding applies to.
Report the repair
PRISMA 2020 covers transparent reporting of why a review was done, its methods, and the studies found and included. Use that structure to keep the revised conclusions consistent with the methods and results sections, and note in the review where certainty ratings shaped the final wording.