Through an iterative process, the committee developed guidelines based on the grading of recommendation assessment, development, and evaluation (GRADE) system (Table I).

The strength of the recommendations is related to:

1. The quality of evidence around that recommendation
2. Harm/benefit ratio of the therapy (e.g., minimally invasive intervention with few morbid events and a possible effect)
3. Patient preference

According to the the GRADE system:

The strength of the recommendation or the extent to which one can be confident that adherence to the recommendation will do more good than harm was divided into:

1. Strong (we recommend)
2. Weak (we suggest)

...with 1) favoring benefit over harm and 2) with benefits closely balanced by the risk.

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:

1. High
2. Moderate
3. Low

When there are no comparable alternatives to a recommendation or evidence is lacking, the Venous Ulcer Guidelines Committee has relied on case series supplemented by the best opinion of a panel of experts, and the recommendation was labeled (Best Practice).