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.

• 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

• 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

• “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.”

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

• 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

• Clinical Practice Guideline
• GRADE Framework
• Levels of Evidence
• Clinical Usefulness
• Bias in Recommendation Development

• Evidence-Based Medicine Principles
• How to Evaluate Recommendations in Literature