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Table 2 Writing guide to phrase endorsements (adapted from the Philippine Academy of Rehabilitation Medicine [14]; Gonzalez-Suarez et al. [9], with permission)

From: An innovative method for clinical practice guideline contextualisation for chronic musculoskeletal pain in the South African context

Phrase for strength of evidence

Description of type level of evidence

Guide for writing endorsements

There is strong evidence

Consistent grades of high level of evidence with uniform thought,a and at least a moderate volume of references to support the recommendation.

We strongly recommend

There is evidence

A mix of moderate- and high levels of evidence with uniform thought and at least a low volume of references.

A mix of high- and low - levels of evidence with uniform thought and high volume of references.

High level of evidence coupled with good practice points (GPPs), and at least moderate volume of references.

Consistent grades of high level of evidence with uniform thought, and at least a low volume of references.

One high level of evidence study (systematic review) and at least a moderate volume of references.

We recommend

There is some evidence

One moderate level of evidence study (Randomised controlled trial).

Inconsistent high and low levels of evidence with uniform thought and a moderate volume of references.

Inconsistent moderate and low levels of evidence with uniform thought and a moderate volume of references.

Consistent grades of moderate levels of evidence and GPP with uniform thought and at least a moderate volume of references.

Consistent grades of low levels of evidence with uniform thought and at least a moderate volume of references.

There is conflicting evidence

Mixed levels of evidence with non-uniform thought, irrespective of the volume of references.

We suggest that clinicians considerb

There is limited evidence

A mix of levels of evidence with uniform thought, irrespective of the volume of references with or without GPPs.

Consistent grades of moderate levels of evidence with uniform thought and a low volume of references.

There is expert consensus that it is good practice

GPP only (no evidence): based on expert consensus.

There is insufficient/no evidence

Low or mixed levels of evidence with a low volume of references with or without GPPs.

Absence of evidence.

We do not endorse

  1. (GPP = General practice point)
  2. aWhere only one recommendation is present, the criterion of uniformity of thought cannot be adhered to and therefore does not apply
  3. bIn the absence of a strong evidence base, but where plausible hypotheses exist for a particular recommendation (such as theoretical explanations, physiological rationale, expert consensus or other forms of such data), the clinician should use his/her own discretion by applying clinical reasoning to make a decision
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BMC Medical Research Methodology

ISSN: 1471-2288

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