To help structure the toolkit, the consortium produced the 'EMMIE' framework for assessing five dimensions of evidence (Johnson et al. 2015).
Such refinement should, in particular, reflect those dimensions of evidence that are currently not explicitly addressed.
We believe that additional refinement is needed to explicitly address and quantify dimensions of evidence such as biological plausibility, reproducibility and generalizability.
As a consequence, in practice, the dimensions of evidence were often applied to individual studies and were complemented with a narrative synthesis of the overall findings from the body of evidence.
Medical decision-making, however, draws upon a broad spectrum of knowledge (or multiple dimensions of evidence), including scientific evidence, personal experience, personal values, economic and political considerations, and philosophical principles.
We also accept that a classification system should seek to quantify its components and that some of the additional dimensions of evidence that we propose may be difficult to quantify.
In the next few paragraphs, we would like to introduce additional dimensions of evidence, which we believe should be formally considered or addressed in future revised consensus systems, such as the GRADE system, for grading the quality of evidence from research.
Furthermore, the dimensions of evidence discussed in this editorial (study design, biological plausibility, reproducibility and generalizability) are difficult to simply measure and their impact on how the findings of an individual trial approximate the 'truth' is hard to quantify (Table 4).
We will argue that a refined system should ideally integrate several dimensions of evidence, in particular related to study design, conduct and applicability that were not explicitly discussed at the beginning of the EBM movement nor are presently considered or incorporated in widely accepted classification systems.
