title: Introduction to the GRADE approach for guideline development: considerations for physical therapist practice.
abstract: BACKGROUND
  Practice guidelines (guidelines) have an increasing role in health care delivery and are being published more frequently. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is an approach for guideline development. The GRADE approach has been adopted by multiple national and international organizations producing guidelines related to physical therapist care.
  
  
  OBJECTIVE
  The purpose of this article is to introduce physical therapists to the GRADE approach for guideline development.
  
  
  RESULTS
  GRADE provides a consistent approach for guideline development and transparency in the communication of how the guidelines were developed and how the recommendations were reached, leading to informed choices by patients, clinicians, and policy makers in health care. GRADE leads to a clear distinction between the strength of the evidence and the recommendation. Both the direction (for or against) and the strength (weak or strong) of the recommendation are considered. For determining the strength of the recommendation, GRADE takes into account the quality of evidence, the balance of benefit and harm, uncertainty about or variability in patients' values and preferences, and uncertainty about whether the intervention is a wise use of resources.
  
  
  CONCLUSIONS
  The GRADE approach has been used primarily with interventions and clinical questions and less often with questions related to diagnosis and prognosis.
  
  
  CONCLUSIONS
  The frequency of publication of guidelines is increasing. To make informed choices in the health care system, physical therapists should understand how guidelines are developed. The GRADE approach has been adopted by national and international organizations that produce guidelines relevant to physical therapist practice. Understanding the GRADE approach will enable physical therapists to make informed clinical choices.
authors.affiliation: T.M. Austin, PT, PhD, ATC, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, 3437 Caroline St, Room 1026, St Louis, MO 63104 (USA). austintm@slu.edu.
authors.forename: Tricia M
authors.initials: TM
authors.lastname: Austin
authors.affiliation: R.R. Richter, PT, PhD, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University.
authors.forename: Randy R
authors.initials: RR
authors.lastname: Richter
authors.affiliation: C.A. Sebelski, PT, DPT, OCS, CSCS, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Sebelski
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D026761:Physical Therapy Specialty; D017410:Practice Guidelines as Topic