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HERRERA ET AL .
TABLE 5 Strength of recommendations: Grading scheme (German Association of the Scientific Medical Societies (AWMF) & Standing Guidelines Commission, 2012)
• Collection and merging of amendments by an independent moderator. • Preliminary vote. • Assessment of the strength of consensus. • Opening debate, where no consensus was reached or reasonable need for discussion was identified. • Formulation of reasonable alternatives. • Final vote of each recommendation, recording the consensus and abstentions due to potential conflicts of interest.
Gradeof recommendation grade a
Description
Syntax
A
Strong
We recommend ( "" )/We recommend not to ( ## )
recommendation
B
Recommendation We suggest to ( " )/We suggest not to ( # )
0
Open
May be considered ( $ )
recommendation
3.3.6 | Plenary session 4 (online meeting, January 2022)
Societies (AWMF) and Standing Guidelines Commission (2012), taking into account not only the quality of evidence, but also considering a judgement guided by the following criteria: • relevance of outcomes and quality of evidence for each relevant outcome; • consistency of study results; • direct applicability of the evidence to the target population/PICOS specifics; • precision of effect estimates using confidence intervals; • magnitude of the effects; • balance of benefit and harm; • ethical, legal, economic considerations; • patient preferences. The grading of the quality of evidence and the strength of a recom- mendation may therefore differ, but where they do, the justification and context are clearly documented in the background narrative that follows each recommendation table. a If the group felt that evidence was not clear enough to support a recommendation, Statements were formulated, including the need (or not) of additional research.
• Presentation of pending recommendations and suggestions received. • Preliminary vote. • Assessment of the strength of consensus. • Opening debate, where no consensus was reached or reasonable need for discussion was identified. • Formulation of reasonable alternatives. • Final vote of each recommendation, recording abstentions due to potential conflicts of interest.
3.4
| Definitions: Rating the quality of evidence,
grading the strength of recommendations and determining the strength of consensus
For all recommendations and statements, this guideline makes transparent:
• the underlying quality of evidence, reflecting the degree of cer- tainty/uncertainty of the evidence and robustness of study results; • the grade of the recommendation, reflecting the criteria considered to make the judgement; the strength of consensus, indicating the degree of agreement within the guideline panel; the number of abstentions due to potential conflicts of interest.
3.4.3 | Strength of consensus
The consensus determination process followed the recommendations by the German Association of the Scientific Medical Societies (AWMF) and Standing Guidelines Commission (2012). Where consen- sus could not be reached, different points of view were documented in the guideline text (see Table 6).
3.4.1 | Quality of evidence
The quality of evidence was assessed using a recommended rating scheme (Balshem et al., 2011; Schunemann, Zhang, Oxman, & Expert Evidence in Guidelines, 2019).
3.5
Editorial independence
|
3.5.1 | Funding of the guideline
3.4.2 | Strength of recommendations
The development of this guideline and its subsequent publication was financed entirely by internal funds of the EFP, without any support from industry or other organizations.
The grading of the recommendations used the grading scheme (Table 5) by the German Association of the Scientific Medical
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