A critical appraisal of the quality of adult dual-energy X-ray absorptiometry guidelines in osteoporosis using the AGREE II tool: An EuroAIM initiative

Abstract

ObjectivesDual energy X-ray absorptiometry (DXA) is the most widely used technique to measure bone mineral density (BMD). Appropriate and accurate use of DXA is of great importance, and several guidelines have been developed in the last years. Our aim was to evaluate the quality of published guidelines on DXA for adults.MethodsBetween June and July 2016 we conducted an online search for DXA guidelines, which were evaluated by four independent readers blinded to each other using the AGREE II instrument. A fifth independent reviewer calculated scores per each domain and agreement between reviewers’ scores.ResultsFour out of 59 guidelines met inclusion criteria and were included. They were published between 2005 and 2014. Three out of four guidelines reached a high level of quality, having at least five domain scores higher than 60%. Domain 1 (Scope and Purpose) achieved the highest result (total score = 86.8 ± 3.7%). Domain 6 (Editorial Independence) had the lowest score (total score = 54.7 ± 12.5%). Interobserver agreement ranged from fair (0.230) to good (0.702).ConclusionsOverall, the quality of DXA guidelines is satisfactory when evaluated using the AGREE II instrument. The Editorial Independence domain was the most critical, thus deserving more attention when developing future guidelines.Main messages• Three of four guidelines on DXA had a high quality level (>60%).• Scope/purpose had the highest score (86.8 ± 3.7%).• Editorial Independence had the lowest score (54.7 ± 12.5%).• Interobserver agreement ranged from fair (0.230) to good (0.702).Electronic supplementary materialThe online version of this article (doi:10.1007/s13244-017-0553-6) contains supplementary material, which is available to authorized users.

A critical appraisal of the quality of head and neck cancer imaging guidelines using the AGREE II tool: A EuroAIM initiative

“…According to the AGREE II instructions, it would have been possible to prioritize one domain over the others before beginning the appraisal, based on the evaluation of the importance of the different domains and items in this context. Nevertheless, in agreement with the previous experiences we did not prioritize a specific domain over the others as we consider all quality domains to equally contribute in determining the clinical implications of guidelines while evaluating different guidelines attributes.…”

“…Interestingly, this domain score was also found to be low in previous appraisals of clinical guidelines published in HNC, suggesting that the applicability of recommendations is underestimated during guidelines drafting. Finally, as also occurred in previous evaluations, domain 6 “Editorial Independence” was the most critically underperforming with an average score of 27.08% and the lowest variability (SD 4.17%), since neither an explicit statement that the funding body interests have not influenced the final recommendations nor “no conflict of interest” statement were provided in two out of three guidelines. This is a crucial issue since the prevalence of conflicts of interest has been proved to be high among members of clinical practice guideline panels …”

“…To assess the agreement among the four appraisers, intraclass correlation coefficient (ICC) was used and classified as follows: poor (<0.20); fair (0.21‐0.40); moderate (0.41‐0.60); good (0.61‐0.80); and very good (0.81‐1.00), according to previous evidences …”

“…In this setting, the European Network for the Assessment of Imaging in Medicine (EuroAIM) was founded by the European Institute for Biomedical Imaging Research (EIBIR) with the purpose of seeking evidence for the best use of radiological technology. Recently, EuroAIM has focused its activity on the evaluation of the quality of guidelines in different fields of diagnostic imaging . Considering the well‐conducted previous experiences focused on specific organs belonging to the head and neck area (eg, thyroid cancer), we decided to embrace a wider approach focusing our analysis on guidelines dealing with head and neck in a more comprehensive view.…”

Quantitative imaging techniques for the assessment of osteoporosis and sarcopenia

“…Currently, DXA represents the gold standard for diagnosis (64). BMD is expressed in terms of SD comparing individual BMD measurement to a reference range derived from a population of healthy young adults (at peak bone mass) in the case of T-score, and from an age-matched population of the same gender and ethnic group in the case of Z-score.…”