Table 1

Summary of GRADE recommendations on rating the strength of recommendations and quality of evidence

Strength of recommendationQuality of evidence
1 (“Strong”) Desirable effects of an intervention clearly outweigh (or clearly do not outweigh) the undesirable effects A (“High”) Further research is unlikely to change our confidence in the estimate of effect 
2 (“Weak”) Tradeoffs between desirable and undesirable effects are less certain (eg, because of low-quality evidence or evidence suggesting closely balanced effects) B (“Moderate”) Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate 
  C (“Low”) Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate 
  D (“Very low”) Any estimate of effect is very uncertain 
Strength of recommendationQuality of evidence
1 (“Strong”) Desirable effects of an intervention clearly outweigh (or clearly do not outweigh) the undesirable effects A (“High”) Further research is unlikely to change our confidence in the estimate of effect 
2 (“Weak”) Tradeoffs between desirable and undesirable effects are less certain (eg, because of low-quality evidence or evidence suggesting closely balanced effects) B (“Moderate”) Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate 
  C (“Low”) Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate 
  D (“Very low”) Any estimate of effect is very uncertain 

Each recommendation consists of a numerical score denoting the strength of the recommendation and a letter denoting the quality of the evidence.12 

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