AGREE II appraisals of clinical practice guidelines in rehabilitation showed poor reporting and moderate variability in quality ratings when users apply different cuff-offs: a methodological study

Bargeri, Silvia; Iannicelli, Valerio; Castellini, Greta; Cinquini, Michela; Gianola, Silvia

doi:10.1016/j.jclinepi.2021.08.021

Cited by 24 publications

(18 citation statements)

References 31 publications

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“…Though not mandatory in the AGREE II tool, a quality rating (high, moderate, low) was reported in 53% of appraisals but agreement was perfect in only half of the appraisals. Our findings are consistent with a previous study on CPG appraisals in rehabilitation in which reporting of the two overall assessments was poor and the quality ratings differed from low to high in more than one fourth of approaisals when different cut-offs were applied to rate the same CPG [ 21 ].…”

Section: Discussionsupporting

confidence: 91%

“…This cautious strategy meant that we could not measure the variability of overall assessments for the whole sample since the data were missing from 35% (overall assessment 1) to 76% (overall assessment 2) of appraisals. The percentages of poor reporting are known [ 97 , 101 , 102 ] and similar findings were documented for a large sample of CPGs on rehabilitation (35% overall assessment 1 and 58% overall assessment 2) [ 21 ].…”

Section: Discussionmentioning

confidence: 63%

“…For overall assessment 2, we collected information about the number of raters who selected the categories “yes”, “yes with modification” or “no” (e.g., 75% raters judged “yes”; 25% “yes with modifications” and 0% “no”) labeling this “raw recommendation for use”. In appraisals that reported only a single recommendation (such as yes) without the percentage for all three categories, we assigned this category by default, labeling this “final recommendation for use” [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

More than one third of clinical practice guidelines on low back pain overlap in AGREE II appraisals. Research wasted?

Gianola

Bargeri

Cinquini

et al. 2022

BMC Med Res Methodol

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Background Systematic reviews can apply the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool to critically appraise clinical practice guidelines (CPGs) for treating low back pain (LBP); however, when appraisals differ in CPG quality rating, stakeholders, clinicians, and policy-makers will find it difficult to discern a unique judgement of CPG quality. We wanted to determine the proportion of overlapping CPGs for LBP in appraisals that applied AGREE II. We also compared inter-rater reliability and variability across appraisals. Methods For this meta-epidemiological study we searched six databases for appraisals of CPGs for LBP. The general characteristics of the appraisals were collected; the unit of analysis was the CPG evaluated in each appraisal. The inter-rater reliability and the variability of AGREE II domain scores for overall assessment were measured using the intraclass correlation coefficient and descriptive statistics. Results Overall, 43 CPGs out of 106 (40.6%) overlapped in seventeen appraisals. Half of the appraisals (53%) reported a protocol registration. Reporting of AGREE II assessment was heterogeneous and generally of poor quality: overall assessment 1 (overall CPG quality) was rated in 11 appraisals (64.7%) and overall assessment 2 (recommendation for use) in four (23.5%). Inter-rater reliability was substantial/perfect in 78.3% of overlapping CPGs. The domains with most variability were Domain 6 (mean interquartile range [IQR] 38.6), Domain 5 (mean IQR 28.9), and Domain 2 (mean IQR 27.7). Conclusions More than one third of CPGs for LBP have been re-appraised in the last six years with CPGs quality confirmed in most assessments. Our findings suggest that before conducting a new appraisal, researchers should check systematic review registers for existing appraisals. Clinicians need to rely on updated CPGs of high quality and confirmed by perfect agreement in multiple appraisals. Trial Registration Protocol Registration OSF: https://osf.io/rz7nh/

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 63%

Section: Methodsmentioning

confidence: 99%

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More than one third of clinical practice guidelines on low back pain overlap in AGREE II appraisals. Research wasted?

Gianola

Bargeri

Cinquini

et al. 2022

BMC Med Res Methodol

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“…Then six domain scores were calculated by summing up all the scores of the individual items in a domain and by scaling the total as a percentage (0–100%) of the maximum possible score for that domain. As the AGREE II does not include explicit cut-off levels to determine levels of overall guideline quality, a 3-step cut-off system was applied based on previous studies [ 17 , 18 , 19 ]. Guidelines were classified based on their domain scores, with all domains being given equal importance: high quality if all domains scored ≥70%; moderate quality if any domain scored ≥50% and <70%, and low quality if any domain scored <50% [ 19 ].…”

Section: Methodsmentioning

confidence: 99%

Weight Gain and Nutrition during Pregnancy: An Analysis of Clinical Practice Guidelines in the Asia-Pacific Region

Aoyama

Bay

2022

Nutrients

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Nutrition and weight gain during pregnancy can influence the life-course health of offspring. Clinical practice guidelines play an important role in ensuring appropriate nutrition and weight gain among pregnant women. This study aims to identify clinical practice guidelines on gestational weight gain and/or maternal nutrition across the Asia-Pacific region and to determine the quality of the guidelines and variability in the recommendations. Through a systematic search of grey literature from 38 Asia-Pacific countries, 23 published guidelines were obtained. Of these, 10 eligible clinical practice guidelines reporting nutrition- or/and weight-related recommendations for pregnant women were selected and reviewed. Guideline quality was determined using the Assessment of Guidelines for Research Evaluation II (AGREE II) instrument. Of the 10 guidelines, 90% were classified as low-quality in the AGREE II appraisal. Several variations were found with respect to recommendations on gestational weight gain, including those specific to Asian populations. The recommendations on dietary advice, additional energy intake, and nutritional supplementation during pregnancy were varied. Clinical practice guidelines on weight gain and nutrition in pregnancy across the Asia-Pacific region are generally of poor quality, reflecting significant variation, and need to be improved to ensure pregnant women receive appropriate advice. (PROSPERO registration no. CRD42021291395).

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“…AGREE II outlines the stakeholders that CPGs must address to enhance quality. As a result, AGREE II assures the predicted trustworthiness of CPGs and their beneficial influence on healthcare outcomes [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Evidence-based clinical practice guidelines for the management of perioperative hypothermia: Systematic review, critical appraisal, and quality assessment with the AGREE II instrument

Mohamed¹,

Abdelkarim

Aabdeen³

et al. 2022

Annals of Medicine &Amp; Surgery

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AGREE II appraisals of clinical practice guidelines in rehabilitation showed poor reporting and moderate variability in quality ratings when users apply different cuff-offs: a methodological study

Cited by 24 publications

References 31 publications

More than one third of clinical practice guidelines on low back pain overlap in AGREE II appraisals. Research wasted?

More than one third of clinical practice guidelines on low back pain overlap in AGREE II appraisals. Research wasted?

Weight Gain and Nutrition during Pregnancy: An Analysis of Clinical Practice Guidelines in the Asia-Pacific Region

Evidence-based clinical practice guidelines for the management of perioperative hypothermia: Systematic review, critical appraisal, and quality assessment with the AGREE II instrument

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