Letters to the Editor   |    
Revised Grades of Recommendation for Summaries or Reviews of Orthopaedic Surgical Studies
James G. Wright, MD, MPH, FRCSC1
1 The Hospital for Sick Children 555 University Avenue, Room 1254 Toronto, ON M5G 1X8, Canada james.wright@sickkids.ca
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This letter originally appeared, in slightly different form, on jbjs.org. It is still available on the web site in conjunction with the article to which it refers.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 May 01;88(5):1161-1162
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To The Editor:Grades of Recommendation, introduced to readers of The Journal in September 20051, are a method of summarizing the quality of the literature. Grades of Recommendation are used in practice guidelines and in review articles to summarize the evidence on clinical questions.In response to concerns raised by some that the designation of a Grade-C recommendation was not sufficiently clear, we revised the definition to read: "poor-quality evidence (Level-IV or V studies with consistent findings) for or against recommending intervention." The amended Grades of Recommendation are presented in Table I. We hope that this minor revision will make the Grades of Recommendation even easier for authors to use.
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