Going from evidence to recommendations .Gordon H Guyatt, Andrew D Oxman, Regina Kunz, Yngve Falck-Ytter, Gunn E Vist, Alessandro Liberati, Holger J Schünemann for the GRADE Working Group.BMJ 2008 336: 1049-1051.
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. Strong recommendations mean that most informed patients would choose the recommended management and that clinicians can structure their interactions with patients accordingly.Weak recommendations mean that patients’ choices will vary according to their values and preferences, and clinicians must ensure that patients’ care is in keeping with their values and preferences. 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.