Table 2.

Examples of How to Apply the SORT in Practice

Example 1: Although a number of observational studies (level of evidence—2) suggested a cardiovascular benefit from vitamin E, a large, well-designed, randomized trial with a diverse patient population (level of evidence—1) showed the opposite. The strength of recommendation against routine, long-term use of vitamin E to prevent heart disease, based on the best available evidence, should be A.
Example 2: A Cochrane review finds 7 clinical trials that are consistent in their support of a mechanical intervention for low back pain, but the trials were poorly designed (ie, unblinded, nonrandomized, or with allocation to groups unconcealed). In this case, the strength of recommendation in favor of these mechanical interventions is B (consistent but lower quality clinical trials).
Example 3: A meta-analysis finds 9 high-quality clinical trials of the use of a new drug in the treatment of pulmonary fibrosis. Two of the studies find harm, 2 find no benefit, and 5 show some benefit. The strength of recommendation in favor of this drug would be B (inconsistent results of good-quality, randomized controlled trials).
Example 4: A new drug increases the forced expiratory volume in 1 second (FEV1) and peak flow rate in patients with an acute asthma exacerbation. Data on symptom improvement is lacking. The strength of recommendation in favor of using this drug is C (disease-oriented evidence only).