APPENDIX

Definition of Grades for Recommendation and Suggestion for Practice

GradeDefinitionSuggestion for Practice
AThis intervention is recommended. There is a high certainty that the net benefit is substantialOffer and administer this intervention
BThis intervention is recommended. There is a moderate certainty that the net benefit is moderate to substantialOffer and administer this intervention
CThis intervention is recommended. There may be considerations that support the use of this intervention in an individual patient. There is a moderate to high certainty that the net benefit is smallOffer and administer this intervention only if other considerations support this intervention in an individual patient
DThis intervention is not recommended. There is a moderate to high certainty that the intervention has no net benefit and that the harms outweigh the benefitsDiscourage use of this intervention
IThe current evidence is insufficient to assess the balance of benefits against and harms of this intervention. There is a moderate to high certainty that the intervention has no net benefit and that the harms outweigh the benefits. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determinedIf this intervention is conducted, the patient should understand the uncertainty about the balance of benefits and harms