The strength of a recommendation reflects the extent to which we can be confident that desirable effects of an intervention outweigh undesirable effects. GRADE classifies recommendations as strong or weak.
Strength of recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, quality of evidence, variability in values and preferences, and resource use (see Table)
|Balance between desirable and undesirable effects||The larger the difference between the desirable and undesirable effects, the higher the likelihood that a strong recommendation is warranted. The narrower the gradient, the higher the likelihood that a weak recommendation is warranted|
|Quality of evidence||The higher the quality of evidence, the higher the likelihood that a strong recommendation is warranted|
|Values and preferences||The more values and preferences vary, or the greater the uncertainty in values and preferences, the higher the likelihood that a weak recommendation is warranted|
|Costs (resource allocation)||The higher the costs of an intervention — that is, the greater the resources consumed — the lower the likelihood that a strong recommendation is warranted|
The implications of a strong recommendation are:
The implications of a weak recommendation are:
Source: Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, Schünemann HJ, GRADE Working Group. Going from evidence to recommendations. BMJ 2008 May 10;336(7652):1049-51 «PMID: 18467413»PubMed.
GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group «http://www.gradeworkinggroup.org»1