Table 3. Definition of recommendation grading.

	Grade of recommendations	Explanation
A	Strong recommendation	The intervention can be strongly recommended in most clinical practice, considering greater benefit than harm, evidence level, value and preference and resources.
B	Conditional recommendation	The intervention can be conditionally recommended in clinical practice considering balance of benefit and harm, evidence level, value and preference and resources.
C	Not recommended	The harm of the intervention maybe greater than the benefit. Also considering evidence level, value and preference and resources, the intervention should not be recommended.
I	Inconclusive	Considering of very low or insufficient evidence level, uncertain or variable in balancing of benefit and harm, value and preference, and resources, it is not possible to determine the strength and direction of recommendation It means that intervention cannot be recommended or opposed and the decision depends on clinician's judgement.
E	Expert consensus	There is not enough evidence to give an evidence-based recommendation but a consensus-based recommendation can be given based on clinical experiences and expert consensus methods under considering given the benefit and harm, preference and value, and resources.

A, strong recommendation; B, conditional recommendation ; C, not recommended; I, inconclusive, E, expert Consensus.