Literature has been critically appraised throughout the life of the RBR. The time required to update the RBR has increased in step with the growing body of new literature, which creates a substantial challenge for busy clinicians.
Scientific rigour has been obtained by adding clinician epidemiology expertise to the core RBR team (Dr Evelyn Constantin from 2005 to 2011, Dr Patricia Li from 2011 onward, and Dr Imaan Bayoumi from 2020 onward). Recent collaboration with the McMaster Evidence Review and Synthesis Team (MERST) has further increased rigour, transparency, and documentation. Funding from the Government of Ontario has enabled the periodic updates to keep the RBR current.
The quality of evidence, originally classified using the former system of the Canadian Task Force on Preventive Health Care (CTFPHC), is now determined using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system. The level of evidence then establishes the strength of recommendation for each RBR item, which is reflected on the RBR Guides using the longstanding and clinician-friendly print scheme of Good, Fair, and Inconclusive evidence/Consensus.
Each new RBR edition is then subjected to extensive external review by the endorsing organizations and key stakeholders prior to endorsement, release, and dissemination.
