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Table 2 Decisions about the strength of a recommendation

From: Improving the use of research evidence in guideline development: 9. Grading evidence and recommendations

Factors that can weaken the strength of a recommendation Explanation
Lower quality evidence Will create greater uncertainty about the size of the (relative) effects (benefits and harms)
Uncertainty about the balance of benefits versus harms and burdens Uncertainty about the baseline risk, prevalence of a problem or health status, which could affect the size of the (absolute) effects
Uncertainty or differences in values Uncertainty about the relative importance of the benefits and downsides to those affected, or differences in how important they are to different people, which could affect the balance between the benefits versus harms and burden
Marginal net benefits or downsides The anticipated net benefits or downsides are small (and uncertain)
Uncertainty about whether the net benefits are worth the costs Uncertainty related to lack of information about the cost or whether the resource expenditure is justified by the anticipated benefit