Statement	Definition	Implication
Strong   recommendation	A strong recommendation means the benefits of the recommended   approach clearly exceed the harms (or that the harms clearly exceed   the benefits in the case of a strong negative recommendation) and that   the quality of the supporting evidence is excellent (grade A or B). In some   clearly identified circumstances, strong recommendations may be made based   on lesser evidence when high-quality evidence is impossible to obtain and the   anticipated benefits strongly outweigh the harms.	Clinicians should follow a strong recommendation   unless a clear and compelling rationale for an   alternative approach is present.
Moderate   recommendation	A moderate recommendation means the benefits exceed the harms (or that the   harms clearly exceed the benefits in the case of a negative recommendation),   but the quality of evidence is not as strong (grade B or C). In some clearly identified   circumstances, recommendations may be made based on lesser evidence when   high-quality evidence is impossible to obtain and the anticipated benefits outweigh   the harms.	Clinicians also should generally follow a moderate   recommendation but should remain alert to new   information and sensitive to patient values and   preferences.
Weak   recommendation	A weak recommendation means that the quality of evidence that exists is suspect   (grade D) or that well-done studies (grade A, B, or C) show little clear advantage   to one approach vs another.	Clinicians should be flexible in their decision   making regarding appropriate practice, although   they may set bounds on alternatives; patient values   and preferences should have a substantial influencing role.
No recommendation	No recommendation means there is a lack of pertinent evidence (grade D) and an   unclear balance between benefits and harms.	Clinicians should feel little constraint in their decision   making and be alert to new published evidence that   clarifies the balance of benefit vs harm; patient   preferences and values should have a substantial   influencing role.