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A first version of recommendations was elaborated using the GRADE method (Grade of Recommendation, Assessment, Development and Evaluation) [ 7, 8].
The GRADE method (Grading of Recommendations, Assessment, Development, and Evaluation) provides a tool for rating the quality of evidence for systematic reviews and clinical guidelines.
The GRADE method (Grading of Recommendations, Assessment, Development and Evaluation) aims to provide a tool for rating the quality of evidence (particularly for effectiveness) and grading the strength of recommendations (1, 2).
In cases of very high risk of bias, the grade of evidence should be decreased by three grades (e.g. from high level to very low level) instead of decreasing by only two grades, as suggested by the GRADE method.
It is here proposed that the grade for the internal validity of a study could in some instances justifiably decrease the overall grade by three grades (e.g. from high to very low) instead of the up to two grade decrease, as suggested by the GRADE method.
Kyrch et al.'s review, according to the GRADE method, started from a "low" quality level, while Prodromos et al.'s review, including case series with historic (non-concurrent) controls, started from a "very low" quality level.
In this context, and after observing the limitations of the pre-existing grading systems with regard to evidence appraisal and the development of CPG recommendations[ 4], the GRADE method constitutes an initiative in which the principal stakeholders are participating in order to reach a consensus on a new method to develop recommendations simply, explicitly and systematically.
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The experts summarized the work and applied the GRADE® method, resulting in 30 recommendations: 3 recommendations were strong (Grade 1), 13 were weak (Grade 2), and 14 were expert opinions.
Among all recommendations, 9 were strong (Grade 1±) and 16 were weak (Grade 2±), and for eight questions, it was impossible to apply the GRADE® method.
The method used to elaborate these recommendations was the GRADE® method [12].
The working method used to elaborate these recommendations is the GRADE® method.
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