Table 5.
Linking Strength of Recommendation, Quality of Evidence, Rating of Magnitude, and Preponderance of Risk Versus Harm to the Language of Obligation
| Recommendation Strength | Quality of Evidence and Rating of Magnitude | Preponderance of Benefit or Risk, Harm, or Cost | Level of Obligation to Follow the Recommendation |
|---|---|---|---|
| Strong | High quality and moderate-to-substantial magnitude or | Benefit | Must or Should |
| Moderate quality and substantial magnitude | Risk, harms, or cost | Must not or Should not | |
| Moderate | High quality and slight-to-moderate magnitude or | Benefit | Should |
| Moderate quality and moderate magnitude | Risk, harms, or cost | Should not | |
| Weak | Moderate quality and slight magnitude or | Benefit | May |
| Low quality and moderate-to-substantial magnitude | Risk, harms, or cost | May not | |
| Theoretical/ foundational | N/A | Benefit | May |
| Risk, harms, or cost | May not | ||
| Best Practice | Insufficient quality and clear magnitude | Benefit | Should or May |
| Risk, harms, or cost | Should not or May not | ||
| Research | Insufficient quality and unclear magnitude or Conflicting high-to-moderate quality and conflicting magnitude |
Varies | N/A |