GRADE Strength of Recommendations and Implications
Quality Grade Definition
High We are very confident that the true effect lies close to the estimate of
the effect.
Moderate We are moderately confident in the effect estimate. e true effect
is likely to be close to the estimate of effect, but there is a possibility
that it is substantially different.
Low Our confidence in the estimate is limited. e true effect may be
substantially different from the estimate of effect.
Very low We have very little confidence in the effect estimate. e true effect
is likely to be substantially different from the estimate of effect.
Knowledge gap Available evidence is insufficient to determine true effect.
Grade Strength of recommendation
For the patient For the clinician For policy makers
Strong
"AGA
recommends..."
Most individuals
in this situation
would want the
recommended
course and only a
small proportion
would not.
Most individuals
should receive the
recommended
course of action.
Formal decision
aids are not likely to
be needed to help
individuals make
decisions consistent
with their values and
preferences.
The recommendation
can be adapted
as policy or
performance measure
in most situations.
Conditional (weak)
"AGA suggests..."
e majority of
individuals in this
situation would
want the suggested
course, but many
would not.
Different choices
would be appropriate
for different patients.
Decision aids may
be useful in helping
individuals in
making decisions
consistent with
their values and
preferences.
Clinicians should
expect to spend more
time with patients
when working
towards a decision.
Policy making
will require
substantial debate
and involvement of
various stakeholders.
Performance
measures should
assess whether
decision making is
appropriate.
No
recommendation
"AGA makes no
recommendation..."
The confidence in
the effect estimate is
so low that any effect
estimate is speculative
at this time.
