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NHMRC Grades of Recommendation - Explanation

The body of evidence for clinical questions and topics was assessed using the NHMRC Levels of Evidence and Grades for Recommendations for Developers of Guidelines [1]. The five components that are considered in judging the body of evidence are the volume of evidence, consistency of the results, potential clinical impact of the proposed recommendation, the generalisability and applicability of the body of evidence to the Australian healthcare context. Each component is given a grade A to D, and then an overall grade for the recommendation is formulated which provides an indication to the strength of each guideline recommendation. A recommendation cannot be graded as A or B unless the volume and consistency of the evidence components are both graded A or B.

Table: NHMRC Grades of Recommendation - Explanation

Grade Recommendation
A Body of evidence can be trusted to guide practice
B Body of evidence can be trusted to guide practice in most situations
C Body of evidence provides some support for recommendation(s) but care should be taken in its application
D Body of evidence is weak and recommendation(s) must be applied with caution

Practice points

Given the low volume and/or quality of evidence relating to some questions in guidelines, the working groups may identify several important practice recommendations for which there is not, nor is there likely to be, any research evidence. The working group considered these aspects of management to be ‘such sound clinical practice that nobody is likely to question it’ or ‘clinical common sense’. [2] These are identified as Practice Points (PP).

Grade Recommendation
PP* A ‘practice point’ – where there is no evidence, but it is ‘clinical common sense’.


  1. National Health and Medical Research Council. NHMRC levels of evidence and grades for recommendations for guideline developers. Canberra: National Health and Medical Research Council; 2009 Available from:
  2. Scottish Intercollegiate Guidelines Network. SIGN 50: A guideline developer’s handbook. Section 7. 2008;Accessed 21 October 2010. Available from: