A Systematic Critical Appraisal of Clinical Practice Guidelines in Juvenile Idiopathic Arthritis Using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) Instrument

Abstract

ObjectivesThe objectives of this review are to: 1) appraise the methodological quality of clinical practice guidelines (CPGs) in juvenile idiopathic arthritis (JIA) providing pharmacological and/or non-pharmacological intervention recommendations, and 2) summarize the recommendations provided by the included CPGs and compare them where possible.MethodsA systematic search was performed. Three trained appraisers independently evaluated the methodological quality of the CPGs using a validated and reliable instrument, the Appraisal of Guidelines in Research and Evaluation II. Six domains were considered: 1) score and purpose; 2) stakeholder involvement; 3) rigor of development; 4) clarity of presentation; 5) applicability; and 6) editorial independence. The domains consist of a total of 23 items each scored on a 7-point scale. High quality CPGs were identified if they had a domain score above 60% in rigor of development, and two other domains.ResultsOf the three included CPGs, the Royal Australian College of General Practitioners (RACGP) and American College of Rheumatology (ACR) CPGs were considered to be of high quality, but the German Society for Pediatric Rheumatology was of lower quality. Domains one to four had high domain scores across the guidelines (mean (standard deviation)): 72.76 (13.80); 66.67 (9.81); 64.67 (7.77); and 87.00 (9.64), respectively. Lower scores were obtained for applicability (14.00 (5.57)) and editorial independence (43.44 (7.02)). Recommendations varied across CPGs due to differences in context, target audience (general practitioners, rheumatologists, and other multidisciplinary healthcare professionals) and patients’ disease presentations. Despite this variability, progression of pharmacological treatment did not conflict between CPGs. Recommendations for non-pharmacological interventions were vague and the interventions considered varied between CPGs.ConclusionsOverall, recommendations were based on a paucity of evidence and weak study designs. Further research is needed on interventions in JIA, as well as higher quality CPGs to facilitate implementation of the best evidence-based recommendations in clinical practice.

Non-Communicable Disease Clinical Practice Guidelines in Brazil: A Systematic Assessment of Methodological Quality and Transparency

“…We prioritized domain 3 for classifying the overall quality since this domain evaluates methodological rigor during CPG development. Other studies have used different classification metrics for determining overall quality [16,46,47]. Then, to differentiate CPGs’ quality regarding other domain scores, we divided it into high, moderate, and low categories with A to C grading.…”

“…For instance, the Appraisal of Guidelines Research and Evaluation instrument [21] version II (AGREE II), published in 2009, has been extensively used, validated in several languages, and covers essential information for comprehensive CPG evaluation [19,20]. Several studies worldwide have been conducted for assessing CPG quality using the AGREE II [9–11,16–18,22–25]; however, very little is known regarding CPG quality among low income countries [10]. To date, only one study has evaluated CPG quality in Brazil [18], and none have critically assessed CPGs for NCD treatment quality within a Brazilian sample.…”

Analyzing the clinical actionability of germline pharmacogenomic findings in oncology

“…It is important to note that we adopted a stringent requirement of unanimous recommendation for clinical deployment among our 4 independent AGREE scorers for guideline implementation. Although certain CDS summaries scored lower on the domains of clarity of presentation and applicability, several previous studies have placed a particular emphasis on the rigour of development domain, suggesting that this domain is indicative of high‐quality guidelines . Notably, all of our guidelines scored well above the common “high‐quality” threshold of 60% on this domain.…”

“…Although certain CDS summaries scored lower on the domains of clarity of presentation and applicability, several previous studies have placed a particular emphasis on the rigour of development domain, suggesting that this domain is indicative of high-quality guidelines. [46][47][48][49] Notably, all of our guidelines scored well above the common "high-quality" threshold of 60% on this domain. Furthermore, many past studies have classified guidelines as "recommended" for implementation if the overall quality score exceeded 50%.…”

Estudo da prevalência de competições terapêuticas entre idosos com multimorbidades do estudo SABE (Saúde, Bem-estar e Envelhecimento)

“…[242][243][244] No entanto, vários estudos identificaram GPCs que possuem baixa a moderada qualidade, o que reduz a confiabilidade de tais medidas entre profissionais e gestores de saúde. 23,25,[245][246][247][248][249][250][251][252] Diversas ferramentas foram desenvolvidas em todo o mundo para avaliar a qualidade da GPCs. 253…”