Table 3 Summary of consensus statements for guideline developers

1. Guidelines for W.H.O. guidelines [7].

  A concise outline of the principles for guideline development, the statement emphasises the importance of considering local circumstances such as applicability of the research findings to the population and the feasibility and opportunity costs of implementing the guideline. Annex C provides a succinct yet comprehensive checklist for appraising treatment guidelines.

2. GRADE Grading of Recommendations Assessment, Development and Evaluation [18, 19, 32–44].

  Endorsed by the Cochrane Collaboration and W.H.O., GRADE is an internationally recognised system for evaluating and comparing alternative interventions. Recommendations are graded based on the quality of evidence (i.e. study design, bias, consistency of the results, and precision of the overall estimates); risks and benefits; resources used; and values and preferencesResources include the online software GRADEproGDT for producing guidelines, Summary of Findings tables and Evidence to Decision Frameworks [45].

3. AWMF Regelwerk/Guidance Manual and Rules for Guideline Development [67].

  The Association of the Scientific Medical Societies in Germany (AWMF) builds on the GRADE process. It also provides explicit guidance on how to structure consensus development, classify the strength of consensus and manage justified dissent to formulate a transparent set of recommendations. Accompanying statements included the DELBI 2.0 - Deutsche Leitlinien-Bewertungsinstrument/German Guideline Appraisal Instrument.

4. NHMRC: A guide to the development, evaluation and implementation of clinical practice guidelines [64].

  The Australian National Health and Medical Council (NHMRC) guidelines along with seven accompanying handbooks were published from 1999 to 2003. Together they provide detailed information about reviewing and appraising clinical, economic and socioeconomic evidence; implementing and disseminating guidelines; and presenting the information to consumers. Guidelines on appraising evidence and grading recommendations were updated in 2009 and included a Body of Evidence Matrix [65, 66]. A ‘hierarchy of evidence’ constrains the grading of recommendations.

5. NICE: Developing NICE guidelines - The manual [72].

  The National Institute for Health Care and Excellence (NICE) guidelines manual from the United Kingdom has evolved over time. Initially recommendations were rated according to a ‘hierarchy of evidence’ that reflected the quality of studies. This rating was replaced in 2006–7 with an approach that more closely aligns with GRADE. Differences to GRADE include modifications to the economic evidence profiles and the absence of ‘overall summary’ labels for the quality of evidence and strength of recommendations [74].

6. SIGN 50: A Guideline Developer’s Handbook [68].

  The Scottish Intercollegiate Guidelines Network (SIGN), first published their handbook in 1999. It was modified over the years to reflect methodological changes in appraising the evidence and grading recommendations. A hierarchy of evidence was used from 2001 to 2012 that was discontinued in line with the SIGN’s adoption of the GRADE process in 2013.

7. U.S. Preventive Services Task Force (USPSTF) system [69].

  The system is used to assess the quality, magnitude and confidence in the evidence about benefits and harms of an intervention and provide a graded recommendation [70]. An analytic structured causal framework of process and outcome is recommended to help guide the systematic evaluation of non-RCT study designs [71]. If the problem of insufficient evidence persists, the four “Domains of Information Pertinent to Clinical Decision making for Preventive Services” may be used [21].

8. SUPPORT Tools for evidence-informed health Policymaking (STP) [20, 46–63].

  STP was written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. The series addresses four broad areas: 1) Supporting evidence-informed policymaking 2) Identifying needs for research evidence in relation to three steps in policymaking processes, namely problem clarification, options framing, and implementation planning 3) Finding and assessing both systematic reviews and other types of evidence to inform these steps, and 4) Going from research evidence to decisions.