Practice guidelines (guidelines) have an growing role in healthcare delivery and are increasingly published. 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. The goal of this paper is to introduce physical therapists to the GRADE approach for guideline development. GRADE offers a consistent approach for guideline development, transparency in communication of how guidelines were developed and how the recommendations were reached leading to informed choices by patients, clinicians, and policymakers in healthcare. GRADE leads to a clear distinction between the strength of the evidence and the recommendation. The recommendation is comprised of both the direction (for or against) and strength (weak or strong) of the recommendation. To determine the strength of the recommendation, GRADE considers: the quality of evidence, the balance of benefit and harm, the uncertainty or variability in patient values and preferences, and uncertainty if the intervention is a wise use of resources. The GRADE approach has primarily been used with interventions and clinical questions and less with questions related to diagnosis and prognosis.
The publication of guidelines is increasing. To make informed choices in the healthcare 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 make it possible for physical therapists to make informed clinical choices.