From evidence to recommendations: Developing health care guidelines following the GRADE approach

Clinical practice guidelines (CPGs) are systematically developed statements (recommendations) to assist practitioners and other health care providers in making optimal decision regarding patient care in specific clinical situations. They also play an important role in health policy. Every year numerous medical societies and other professional organizations publish documents which they call "guidelines". Not all of them are developed correctly and in a systematic way. The article describes the methodology of CPG development which increases the probability that CPGs are valid and clinically useful. This methodology was developed and is still being improved by the international working group of methodologists called GRADE. The role of GRADE is to frame clinical questions, decide on important outcomes, rate the quality of evidence, interpret the results (mainly the estimated relative and absolute effects), and provide judgments on the strength of recommendation (namely, confidence that particular recommendations should be followed).