Further research is very unlikely to change our confidence in the estimate of effect.Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Any estimate of effect is uncertain.Factors influencing the strength of the recommendation included the quality of the evidence, presumed patient important outcomes, and cost.Variability in preferences and values, or more uncertainty. Recommendation is made with less certainty; higher cost or resource consumption.