The Grades of Recommendation Assessment, Development and Evaluation (GRADE) framework was used for determining the strength of recommendation and the quality of evidence.
The strength of recommendation is graded based on the quality of evidence, balance between benefits and harms, patients’ values, preferences, and clinical context. Recommendations are graded as:
The term "we recommend" is used with strong recommendations, and the term "we suggest" is used with conditional recommendations.
The quality of evidence rating is based on the risk of bias, precision, directness, consistency, and the size of the effect and is rated as: