Recommendation [Neurosurgery Wiki]

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====== Recommendation ======

A **recommendation** is a formal statement advising a specific course of action in **clinical practice**, **policy**, or **research**, based on an appraisal of the **available evidence**, **benefits and harms**, and **contextual factors** such as feasibility and patient values.

===== Characteristics =====
  * Informed by **systematic review of the evidence**
  * Weighs **benefits vs. risks**
  * Considers **quality of evidence**, **patient preferences**, and **resource implications**
  * Typically issued by expert panels, guideline committees, or health organizations

===== Types =====
  * **Strong recommendation:** Benefits clearly outweigh risks (or vice versa); applicable to most patients in most settings
  * **Conditional (weak) recommendation:** Balance of benefits and harms is uncertain, or evidence is low quality; may vary depending on context or values

===== Example (Clinical) =====
  * "We strongly recommend offering cognitive behavioral therapy (CBT) to patients with chronic tinnitus-related distress."  
  * "We conditionally recommend using nortriptyline–topiramate in patients with refractory tinnitus, based on limited evidence."

===== Grading Systems =====
  * **GRADE** (Grading of Recommendations, Assessment, Development and Evaluation)  
    * Grades strength of recommendation (strong/conditional) and quality of evidence (high/moderate/low/very low)

===== Why It Matters =====
  * Guides **clinical decision-making**
  * Promotes **standardization and quality of care**
  * Supports **shared decision-making** with patients
  * Ensures that actions are **evidence-informed** and **ethically justified**

===== Related Concepts =====
  * [[guideline|Clinical Practice Guideline]]
  * [[grade_system|GRADE Framework]]
  * [[levels_of_evidence|Levels of Evidence]]
  * [[clinical_usefulness|Clinical Usefulness]]
  * [[bias|Bias in Recommendation Development]]

===== See Also =====
  * [[ebm_principles|Evidence-Based Medicine Principles]]
  * [[critical_review|How to Evaluate Recommendations in Literature]]