BMJ  2008;336:1049-1051 (10 May), doi:10.1136/bmj.39493.646875.AE

Analysis

Rating quality of evidence and strength of recommendations

Going from evidence to recommendations

¹ CLARITY Research Group, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada L8N 3Z5, ² Norwegian Knowledge Centre for the Health Services, Oslo, Norway, ³ Basel Institute of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland, ⁴ Division of Gastroenterology, Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA, ⁵ University of Modena and Reggio Emilia and Agenzia Sanitaria Regionale, Bologna, Italy, ⁶ Department of Epidemiology, CLARITY Research Group, Italian National Cancer Institute Regina Elena, Rome, Italy

Analysis, doi: 10.1136/bmj.39490.551019.BEAnalysis, doi: 10.1136/bmj.39489.470347.AD

The GRADE system classifies recommendations made in guidelines as either strong or weak. This article explores the meaning of these descriptions and their implications for patients, clinicians, and policy makers

The first 150 words of the full text of this article appear below.

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

This is the third of a series of five articles describing the GRADE approach to developing and presenting recommendations for management of patients. In it, we deal with how GRADE suggests clinicians should interpret the strength of a recommendation.

The strength . . . [Full text of this article]

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Rapid Responses:

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Grading is possible only for simple (non-compound) and unambiguous recommendations

Michael Power
bmj.com, 13 May 2008 [Full text]

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