Appraisal Tools for Clinical Practice Guidelines: A Systematic Review

Abstract

IntroductionClinical practice guidelines can improve healthcare processes and patient outcomes, but are often of low quality. Guideline appraisal tools aim to help potential guideline users in assessing guideline quality. We conducted a systematic review of publications describing guideline appraisal tools in order to identify and compare existing tools.MethodsAmong others we searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from 1995 to May 2011 for relevant primary and secondary publications. We also handsearched the reference lists of relevant publications.On the basis of the available literature we firstly generated 34 items to be used in the comparison of appraisal tools and grouped them into thirteen quality dimensions. We then extracted formal characteristics as well as questions and statements of the appraisal tools and assigned them to the items.ResultsWe identified 40 different appraisal tools. They covered between three and thirteen of the thirteen possible quality dimensions and between three and 29 of the possible 34 items. The main focus of the appraisal tools were the quality dimensions “evaluation of evidence” (mentioned in 35 tools; 88%), “presentation of guideline content” (34 tools; 85%), “transferability” (33 tools; 83%), “independence” (32 tools; 80%), “scope” (30 tools; 75%), and “information retrieval” (29 tools; 73%). The quality dimensions “consideration of different perspectives” and “dissemination, implementation and evaluation of the guideline” were covered by only twenty (50%) and eighteen tools (45%) respectively. ConclusionsMost guideline appraisal tools assess whether the literature search and the evaluation, synthesis and presentation of the evidence in guidelines follow the principles of evidence-based medicine. Although conflicts of interest and norms and values of guideline developers, as well as patient involvement, affect the trustworthiness of guidelines, they are currently insufficiently considered. Greater focus should be placed on these issues in the further development of guideline appraisal tools.

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“…These were reviewed and appraised individually by three reviewers. Appraisal tools selected were as follows: AGREE II-Appraisal of Guidelines, Research and Evaluation (Siering et al, 2013;McMaster University, 2013;McMaster University, 2013) for clinical practice guidelines; CASP-Critical Appraisal Skills Programme (CASP, 2006) for systematic reviews; Quantitative method forms and guidelines for randomised controlled trials (Law and MacDermid, 2014). Figure 1 depicts the methodology adopted.…”

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“…34 The items hew most closely to the National Academy of Medicine standards 47 and are critical for evaluating and recognizing flaws in the evidence development process, the relevance of recommendations to clinical practice, and the threats to the judgment process of creating recommendations from the evidence.…”

“…[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Tools are available to evaluate the quality of clinical practice guidelines. [33][34][35][36][37][38] These tools, however, are designed in part to guide guideline development and are difficult to use by nonresearchers without extensive training. None of these tools considers the need for a focus on patientoriented outcomes, and none allows users to conclude whether a guideline should be followed.…”

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“…Screen the CPGs and decide whether de novo development is necessary Check whether the CPG was published within the past 5 years and is of good quality using standardised tools [12][13] such as AGREE II [14] or the iCAHE tool. [15] (a) If a CPG is outdated or of poor quality, an update is recommended using formal de novo methods.…”