Conclusions: It is important to recognise that although Cochrane reviews provide rigorous summaries of the evidence there is a gap between what the evidence states and what a panel of clinical experts and patient representatives have to balance with respect to contextual issues (local settings and healthcare system), clinical relevance, cost effectiveness and statistical findings. In order to find equilibrium between the different aims of the two organisations, the commissioned reviews will inform the development of at least six clinical recommendations and the lessons learnt from this process will be discussed.