Open access under CC BY-NC-ND license. Recommendation Notes Grading Strong patient-important outcomes, and cost 1 Weak Variability in preferences and values, or more uncertainty. Recommendation is made with less certainty, higher cost or resource consumption 2 Further research is very unlikely to change our confidence in the estimate of effect Further research is likely to have an important impact on our confidence in the estimate of effect and may Further research is very likely to have an important impact on our confidence in the estimate of effect and Factors influencing the strength of the recommendation included the quality of the evidence, presumed