Introduction
What is new?
Key points- •
The strength of a recommendation is defined as the extent to which one can be confident that the desirable consequences of an intervention outweigh its undesirable consequences.
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Grading of Recommendations Assessment, Development, and Evaluation GRADE has chosen a simple four-category classification of recommendations, a binary classification of recommendations as strong or weak (also known as conditional, discretionary, or qualified) recommendations for or against a management approach.
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The strength of a recommendation has specific implications for patients, the public, clinicians, and policy -makers.
In prior papers in this series devoted to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to systematic reviews and practice guidelines, we have dealt with the process before developing recommendations: framing the question [1], choosing critical and important outcomes [2], rating the confidence in effect estimates for each outcome [3], [4], [5], [6], [7], [8], [9], rating the confidence in effect estimates across outcomes [10], dealing with resource use [11], creating an evidence profile and a Summary of Findings (SoF) table [12], [13], and GRADE's approach to diagnostic test recommendations. This article addresses GRADE's approach to categorizing, labeling, and wording health care recommendations. As we did in the initial article in this series, we will define strong or weak recommendations for or against a particular management approach, and discuss the interpretation and presentation of these recommendations. In the next article in the series, we will focus on the process of going from the evidence to the recommendations. Throughout this article, we will refer to guideline developers as “the panel.”