What does the strength of the recommendation mean
With GRADE you have 2 strenghts of recommendation: Weak/conditional or Strong. The direction and strength of each recommendation is determined on the basis of four key factors: the balance between benefits and harms, quality of evidence, preferences and values and resource considerations.
Lately this concept have expanded and other subdomains have emerged, like equity and feasibility. In MAGICapp we have grouped these newer domains together with the resource consideration, in an expanded 'Resources and other considerations', to make it manageble for for authors and readers. To use the full walk-though of all domains, visit the interactive Evidence to Decision framework pages from the DECIDE project.
GRADE also have guidence on how to use non-graded practice statements/ advice, which is described in it's own paper. The strength of the recommendation is defined by the following principles:
• Strong recommendation (green in MAGICapp): It is clear that the benefits outweigh the drawbacks. This means that all or virtually all, patients will want the recommended treatment.
There are cases where it is warranted to make Strong recommendations based of low quality evidence: read more
• Weak recommendation (yellow in MAGICapp): It is less clear whether the benefits outweigh the drawbacks. It still means that most patients will want the recommended treatment. There is however a greater opportunity for variation in individual preferences.
In the MAGICapp we also have these possible settings:• Practice statements (light blue in MAGICapp): Best practice statements, Advice from expert opinion or just used as general information boxes to convey important concepts. These are not assessed according to GRADE as it is deemed uneccissary (especially true for the Best practice statements and general information boxes), due to lack of documentation, time or resources (in case of Advice and expert opinion). This means that they are essentially different from the recommendations and must be regarded to a greater extent based on individual discretion.
• Not set (gray in MAGICapp): The strength is not set. This is the the starting status of any recommendation.