Citation of randomized evidence in support of guidelines of therapeutic and preventive interventions

Giannakakis, I; Haidich, Anna Bettina; Contopoulos‐Ioannidis, Despina G.; Papanikolaou, George N; Baltogianni, Maria; Ioannidis, John P. A.

doi:10.1016/s0895-4356(02)00395-5

Cited by 31 publications

(12 citation statements)

References 30 publications

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“…Furthermore, each guideline explicitly linked the recommendations to the supporting evidence, guidelines all were reviewed externally, and a procedure for updating the guideline was consistently described. Common criticisms of clinical practice guidelines are that they fail to cite high levels of evidence [11]; however, although the volume of Levels I and II evidence has increased in orthopaedics during the last 10 years [8], areas remain in the specialty where high-quality evidence is lacking [6]. Recommendations, although often inconclusive, were based on the best available evidence.…”

Section: Discussionmentioning

confidence: 99%

High Methodologic Quality But Poor Applicability: Assessment of the AAOS Guidelines Using The AGREE II Instrument

Sabharwal

Patel

Gauher

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The American Academy of Orthopaedic Surgeons (AAOS) is a globally recognized leader in musculoskeletal and orthopaedic education. Clinical guidelines are one important focus of the AAOS' educational efforts. Although their recommendations sometimes generate controversy, a critical appraisal of the overall quality of these guidelines has not, to our knowledge, been reported. Questions/purposes We wished to assess the overall quality of the AAOS guidelines using the AGREE II (Advancing Guideline Development, Reporting and Evaluation in Health Care) instrument. Methods All 14 guidelines available on the AAOS website as of August 2, 2013 were evaluated. Appraisal was performed by three reviewers, independently, using the AGREE II instrument. This is an internationally recognized and validated assessment tool for evaluating guideline quality. Interrater reliability was calculated and descriptive statistics were performed. Strong interrater reliability was shown using a Spearman's Rho test (correlation coefficient C 0.95). Results The overall results for AGREE II domains across all 14 guidelines were: scope and purpose (median score, 95%), stakeholder involvement (median score, 83%), rigor of development (median score, 94%), clarity of presentation (median score, 92%), applicability (median score, 48%), and editorial independence (median score, 79%). Conclusions This study showed that the overall quality of the AAOS guidelines is high, however their applicability was found to be poor. The value of guidelines that have a high quality but that are difficult for clinicians to implement is questionable. Numerous suggestions have been proposed to improve applicability including; health economist involvement in guideline production, implementation of pilot studies and audit to monitor uptake of the guidelines and clinician feedback sessions and barrier analysis studies. Future AAOS guidelines should consider and implement steps that can improve their applicability.

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Section: Discussionmentioning

confidence: 99%

High Methodologic Quality But Poor Applicability: Assessment of the AAOS Guidelines Using The AGREE II Instrument

Sabharwal

Patel

Gauher

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…7 Many guidelines, however, fail to cite randomized controlled trials and appear to be developed from lower levels of evidence or expert opinion. 6,8 Although this may occur because of a lack of available evidence within a certain field, concern on guideline quality can arise because guideline committees may be subject to bias which affects the recommendations they make. 9 Furthermore, recommendations on a single subject by different organizations have also been variable.…”

Section: Introductionmentioning

confidence: 99%

Guidelines in cardiac clinical practice: evaluation of their methodological quality using the AGREE II instrument

et al. 2013

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SummaryAlthough clinical guidelines have an influential role in healthcare practice, their development process and the evidence they cite has been subject to criticism. This study evaluates the quality of guidelines in cardiac clinical practice by examining how they adhere to validated methodological standards in guideline development. A structured review of cardiac clinical practice guidelines published in seven cardiovascular journals between January 2001 and May 2011 was performed. The AGREE II assessment tool was used by two researchers to evaluate guideline quality. A total of 101 guidelines were identified. Assessment of guidelines using AGREE II found methodological quality to be highly variable (median score, 58.70%; range, 45.34-76.40%). 'Scope and purpose' (median score, 86.1%) and 'clarity of development' (median score, 83.3 %) were the two domains within AGREE II that received the highest scores. Applicability (median score, 20.80%; range, 4.20-54.20%) and editorial independence (median score, 33.30%; range, 0-62.50%) had the lowest scores. There is considerable variability in the quality of cardiac clinical practice guidelines and this has not improved over the last 10 years. Incorporating validated guideline assessment tools, such as AGREE II, may improve the quality of guidelines.

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“…It is widely recognized that CPG can be important tools for improving health care, and efforts to develop them are continuously increasing. However, as several authors have pointed out, the quality of many guidelines is dubious [19,22,47,51]. There are deficiencies in many areas of guideline development, but the biggest problems reside in the identification, evaluation, and synthesis of the scientific evidence [44] that forms the basis for the recommendations and assures their validity for specific health care settings [23].…”

Section: Discussionmentioning

confidence: 99%

A critical review of guidelines for low back pain treatment

et al. 2005

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Main problem: Little is known about the methodological quality of guidelines for low back pain treatment. We evaluated the methods used by the developers according to established standards. Methods: PubMed, guideline databases, and the World Wide Web were used to identify guidelines. Seventeen guidelines met the inclusion criteria: interventions for low back pain stated, recommendations based on or explicitly linked to evidence, and English version available. Guidelines were evaluated independently by two appraisers using a practical tool for this purpose, Users' Guides to the Medical Literature, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Results: Thirteen guidelines (76%) specified the most important therapies applied, but only nine (53%) included a complete description of the target population. Explicit processes to identify, select, and combine evidence were described in only six guidelines (35%). Few guidelines (3; 18%) explicitly considered all main outcomes when formulating therapeutic recommendations, and none contained a process to determine the relative value of different outcomes. Methodological criteria for grading the strength of the recommendations varied, and were often insufficiently specified. None of the guidelines assessed the impact of uncertainty associated with the evidence and values used. According to AGREE the quality score was highest for the scope and purpose, and clarity and presentation domains, and lowest for editorial independence and applicability. With regard to the recommendations, there was consensus for some of the interventions for acute pain (analgesics and NSAIDs, maintaining physical activity, and avoiding excessive bed rest), but explicit recommendations were lacking or ambiguous for 41% of the interventions. Most of the guidelines did not contemplate specific recommendations for chronic pain. Conclusions: A small number of the available guidelines for low back pain treatment achieved acceptable results for specific quality criteria. In general, the methods to develop the guidelines' therapeutic recommendations need to be more rigorous, more explicit and better explained. In addition, greater importance should be placed on the recommendations for chronic pain.

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Citation of randomized evidence in support of guidelines of therapeutic and preventive interventions

Cited by 31 publications

References 30 publications

High Methodologic Quality But Poor Applicability: Assessment of the AAOS Guidelines Using The AGREE II Instrument

High Methodologic Quality But Poor Applicability: Assessment of the AAOS Guidelines Using The AGREE II Instrument

Guidelines in cardiac clinical practice: evaluation of their methodological quality using the AGREE II instrument

A critical review of guidelines for low back pain treatment

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