AGREE-II Appraisal of a clinical algorithm for hypotonia assessment

Abstract

ObjectiveThe objective of this study was to systematically appraise the quality of an evidenced-based clinical algorithm for the clinical assessment of hypotonia in children.DesignThe Appraisal of Guidelines for Research and Evaluation (AGREE) II tool with 23 items and six domains was used. The study was located in South Africa. Ten appraisers, who were recruited based on specific selection criteria, completed the assessment.ResultsNine appraisers recommended the EBCA without any modification. Scope and purpose (94%), stakeholder involvement (91%) and editorial independence (99%) were rated the highest with the lower scoring domains being clarity of presentation (85%) and applicability (86%) due to clarity required in areas of resource implications and auditing and monitoring criteria. Inter-rater reliability was strong (ICC 0.7) amongst the appraisers in this study.ConclusionThis is the first independent assessment of the methodological rigour and transparency of a clinical algorithm using the AGREE-II instrument. Determining the quality of the EBCA for practice is essential as this would ultimately aid clinicians towards more accurate clinical assessment of hypotonia which would inevitably impact outcomes and management of the child presenting with this symptom. Whilst the AGREE-II provided initial feedback on the methodological rigour of development, understanding that the AGREE-II instrument evaluates the guideline development process and not the content is also essential in order to consider the next stage which would be to consider clinicians feedback on the clinical utility of this EBCA.

Identifying and Evaluating Young Children with Developmental Central Hypotonia: An Overview of Systematic Reviews and Tools

“…After the removal of duplicates, and title and abstract screening, 35 were agreed to be reviewed full-text. Twelve articles [14,15,18,[20][21][22][23][24][41][42][43][44] reporting seven distinct studies met the inclusion criteria. In addition, two other hypotonia measurement scales were identified through citation and hand-searches.…”

“…In addition, an ordinal scale defining muscle tone in children from severe hypotonia to severe hypertonia was identified in a textbook [45] and a ten-point hypotonia screening tool for children 1-5 years of age (MPH-10) was described in conference proceedings [46,47]. Finally, an evidence-based clinical algorithm for comprehensive assessment of children up to age 5 years [24] was identified, along with four studies supporting its development and appraisal [18,20,21,44], in addition to the starting point of Naidoo's systematic review [15] and the study protocol [43].…”

“…Naidoo's 2013 systematic review [15] did not distinguish between peripheral and central hypotonia in the search for evaluation methods, and this was also a limitation of the two survey/consensus studies that the author identified as providing the most relevant evaluation data [17,19]. Likewise, Govender/Naidoo and colleagues' follow-up/algorithm development studies [18,20,21,44] and the clinical algorithm [24] include items relevant to distinguishing between central and peripheral hypotonia, as well as criteria to evaluate the level of functional impairment, regardless of the underlying cause.…”

“…Mixed-methodspublished over six studies [15,18,20,21,24,44]; Protocol [43] Develop and validate a clinical decision-making process to guide clinicians during the assessment of children with hypotonia from genetic or neurologic origins.…”

Progress in infections, reproductive health and non-communicable diseases

“…The are some interesting neurology papers such as: a case report on neuroleptic malignant syndrome in a young adult female36; hypotonia assessment37; MRI for solitary fibrous tumours38; endotracheal extubation and critical respiratory events in adult patients undergoing surgery39; utility of social media by physicians40; reaction time by medical students41; and nodding syndrome in India42.…”