HomeStrong recommendation: (“We strongly recommend…”)
Meaning: The action/intervention should be performed in most situations and would be the preferred choice for most individuals. The authors have little doubt that the benefits of the intervention exceed the harms (recommendation “for” the intervention) or that the harms exceed the benefits (recommendation “against” the intervention). The authors judged it unlikely that future studies of the intervention would result in a significant change in the direction or magnitude of the estimated effects (risks and benefits).
These recommendations are usually based on “GOOD” evidence as defined in the following section. Other considerations include greater magnitude of effect and/or magnitude of difference between benefits and harms, alignment with patient values and preferences and strong feasibility based on available resources. These are summarized in the following sections.
Conditional recommendation: (“We conditionally recommend…”)
Meaning: The action/intervention should be considered, based on the likelihood of benefits and harms in an individual patient. The authors concluded that there is likely a net benefit of the intervention, but there is uncertainty about the magnitude of the benefits and/or about whether benefits outweigh the risks. There is reasonable likelihood that new studies could change estimates of the magnitude of risks and benefits (and hence result in modified recommendations).
These recommendations were usually based on “POOR” (or low-quality) evidence. Other considerations included smaller magnitude of differences between benefits and harms, uncertain consistency with individual patient values and preferences and/or uncertain feasibility with respect to resource requirements.
Good practice statement
Meaning: The authors would use the intervention/perform the action in most situations and for most patients. These statements are based on a clear consensus of expert opinion that this action should be beneficial (or harmful, if “against”), but there is minimal or no evidence in support of this. This type of statement is reserved for topics/actions for which there is minimal or no published evidence, and it is considered unlikely that any evidence will be available in the future.
Regulation
A recommendation identified as “regulation” is supported by federal, provincial or territorial legislation from the relevant field of authority (eg, building codes, occupational health and safety) so no strength of evidence is assigned. Regulations are a form of law which define the application and enforcement of legislation. Regulations are made under the authority of an Act and are enacted by the body to whom the authority to make regulations has been delegated, such as a minister, etc.
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