BACKGROUND Current methods for assessing strength of evidence prioritize the contributions of randomized controlled trials (RCTs). The objective of this study was to characterize strength of evidence (SOE) tools in recent use, identify their application to lifestyle interventions for improved longevity, vitality, or successful aging, and to assess implications of the findings. METHODS The search strategy was created in PubMed and modified as needed for four additional databases: Embase, AnthropologyPlus, PsycINFO, and Ageline, supplemented by manual searching. Systematic reviews and meta-analyses of intervention trials or observational studies relevant to lifestyle intervention were included if they used a specified SOE tool. Data was collected for each SOE tool. Conditions necessary for assigning the highest SOE grading and treatment of prospective cohort studies within each SOE rating framework were summarized. The expert panel convened to discuss the implications of findings for assessing evidence in the domain of lifestyle medicine. RESULTS AND CONCLUSIONS A total of 15 unique tools were identified. Ten were tools developed and used by governmental agencies or other equivalent professional bodies and were applicable in a variety of settings. Of these 10, four require consistent results from RCTs of high quality to award the highest rating of evidence. Most SOE tools include prospective cohort studies only to note their secondary contribution to overall SOE as compared to RCTs. We developed a new construct, Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM), to illustrate the feasibility of a tool based on the specific contributions of diverse research methods to understanding lifetime effects of health behaviors. Assessment of evidence relevant to lifestyle medicine requires a potential adaptation of SOE approaches when outcomes and/or exposures obviate exclusive or preferential reliance on RCTs. This systematic review was registered with the International Prospective Register of Systematic Reviews, PROSPERO [CRD42018082148].

中文翻译：

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适用于生活方式医学的证据层次（HEALM）：引入基于方法系统评价的证据强度方法。

背景技术目前评估证据强度的方法优先考虑随机对照试验（RCT）的贡献。本研究的目的是描述最近使用的证据强度（SOE）工具，确定它们在生活方式干预中的应用，以延长寿命、活力或成功老龄化，并评估研究结果的影响。方法 检索策略在 PubMed 中创建，并根据四个附加数据库的需要进行修改：Embase、AnthropologyPlus、PsycINFO 和 Ageline，并辅以手动检索。如果使用特定的 SOE 工具，则包括与生活方式干预相关的干预试验或观察性研究的系统评价和荟萃分析。为每个 SOE 工具收集数据。总结了在每个 SOE 评级框架内分配最高 SOE 评级和前瞻性队列研究处理的必要条件。专家小组召开会议讨论研究结果对评估生活方式医学领域证据的影响。结果和结论 总共确定了 15 种独特的工具。十种工具是由政府机构或其他同等专业机构开发和使用的，适用于各种环境。在这 10 项中，有 4 项需要来自高质量随机对照试验的一致结果才能授予最高级别的证据。大多数 SOE 工具都包含前瞻性队列研究，只是为了指出与随机对照试验相比，它们对整体 SOE 的次要贡献。我们开发了一种新的结构，即应用于生活方式医学的证据层次（HEALM），以说明基于不同研究方法对理解健康行为的终生影响的具体贡献的工具的可行性。当结果和/或暴露消除了对随机对照试验的排他或优先依赖时，与生活方式医学相关的证据评估需要对 SOE 方法进行潜在的调整。该系统评价已在国际前瞻性系统评价登记册 PROSPERO [CRD42018082148] 注册。