17
W/M
Desirable effects
closely balanced with
undesirable effects
Evidence from RCTs
with important
limitations
(inconsistent results,
methodological
flaws, indirect,
or imprecise)
or exceptionally
strong evidence
from unbiased
observational studies
Alternative approaches
likely to be better for
some patients under some
circumstances. Further
research (if performed) is
likely to have an important
impact on our confidence
in the estimate of effect and
may change the estimate.
W/L
Uncertainty in the
estimates of desirable
effects, harms, and
burden; desirable
effects, harms, and
burden may be
closely balanced
Evidence for at least
one critical outcome
from observational
studies, from RCTs
with serious flaws or
indirect evidence
Other alternatives may be
equally reasonable. 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.
W/VL
Major uncertainty
in the estimates of
desirable effects,
harms, and burden;
desirable effects
may or may not
be balanced with
undesirable effects
Evidence for at least
one critical outcome
from unsystematic
clinical observations
or very indirect
evidence
Other alternatives may be
equally reasonable. Any
estimate of effect, for at
least one critical outcome, is
very uncertain.
Strength of Recommendation Quality of Evidence
S=strong H=high L=low
W=weak M=moderate VL=very low
Table 1. Strength of Recommendation and Quality of
Evidence (cont'd)
Strength of
Recommendation/
Quality of Evidence
Clarity of Balance
Between Desirable
and Undesirable
Effects
Methodological
Quality of
Supporting
Evidence (examples) Implications
