Evaluation of the Quality of Clinical Guidelines for Cardiac Rehabilitation

Serón, Pamela; Lanas, Fernando; Ríos, Eddy; Bonfill, Xavier; Alonso‐Coello, Pablo

doi:10.1097/hcr.0000000000000075

Cited by 16 publications

(11 citation statements)

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“…A recent study [7] which appraised the quality of a number of cardiac rehabilitation guidelines, did so for only nine publications (7 of which were included in our sample) due to strict inclusion criteria and a failure to search the resources of professional associations. Of these publications, only four provided detailed exercise protocols, and one has since been archived due to its age.…”

Section: Discussionmentioning

confidence: 99%

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Exploration of the methodological quality and clinical usefulness of a cross-sectional sample of published guidance about exercise training and physical activity for the secondary prevention of coronary heart disease

Abell¹,

Glasziou²,

Hoffmann³

2017

BMC Cardiovasc Disord

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BackgroundClinicians are encouraged to use guidelines to assist in providing evidence-based secondary prevention to patients with coronary heart disease. However, the expanding number of publications providing guidance about exercise training may confuse cardiac rehabilitation clinicians. We therefore sought to explore the number, scope, publication characteristics, methodological quality, and clinical usefulness of published exercise-based cardiac rehabilitation guidance.MethodsWe included publications recommending physical activity, exercise or cardiac rehabilitation for patients with coronary heart disease. These included systematically developed clinical practice guidelines, as well as other publications intended to support clinician decision making, such as position papers or consensus statements. Publications were obtained via electronic searches of preventive cardiology societies, guideline databases and PubMed, to November 2016. Publication characteristics were extracted, and two independent assessors evaluated quality using the 23-item Appraisal of Guidelines Research and Evaluation II (AGREE) tool.ResultsFifty-four international publications from 1994 to 2016 were identified. Most were found on preventive cardiology association websites (n = 35; 65%) and were freely accessible (n = 50; 93%). Thirty (56%) publications contained only broad recommendations for physical activity and cardiac rehabilitation referral, while 24 (44%) contained the necessary detailed exercise training recommendations. Many were labelled as “guidelines”, however publications with other titles (e.g. scientific statements) were common (n = 24; 44%). This latter group of publications contained a significantly greater proportion of detailed exercise training recommendations than clinical guidelines (p = 0.017). Wide variation in quality also existed, with ‘applicability’ the worst scoring AGREE II domain for clinical guidelines (mean score 53%) and ‘rigour of development’ rated lowest for other guidance types (mean score 33%).ConclusionsWhile a large number of guidance documents provide recommendations for exercise-based cardiac rehabilitation, most have limitations in either methodological quality or clinical usefulness. The lack of rigorously developed guidelines which also contain necessary detail about exercise training remains a substantial problem for clinicians.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0589-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

“…A previous examination [7] included only clinical practice guidelines, and was limited by strict inclusion criteria to 9 publications. Many documents which are produced by professional associations, and potentially used by clinicians to guide practice, were not included.…”

Section: Introductionmentioning

confidence: 99%

Exploration of the methodological quality and clinical usefulness of a cross-sectional sample of published guidance about exercise training and physical activity for the secondary prevention of coronary heart disease

Abell¹,

Glasziou²,

Hoffmann³

2017

BMC Cardiovasc Disord

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“…Low scoring was most consistently reported for the following domains: stakeholder involvement (specifically very restricted patient participation and involvement in the guideline development)[44,48,50], rigor of development (guidelines were mostly based on expert opinion rather than evidence) [41,44,49], applicability [41,43,44,46,48-51], editorial independence [41,44,49]. These findings are comparable to those we obtained while assessing the CPGs on vitamin D replacement in patients undergoing bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

“…These organizations include the National Institute for Health and Clinical Excellence (NICE) [46,50,53,54], the Scottish Intercollegiate Guidelines Network (SIGN) [53,55], the New Zealand Guidelines Group [43], the Royal College of Physicians of London [55], and the Canadian Task Force on Prevention Health Care group [55]. The American College of Chest Physicians (ACCP) evidence-based CPGs on anti-thrombotic therapy and prevention of thrombosis, rigorously addressed several of the aforementioned caveats encountered in many CPGs [56-59].…”

Section: Discussionmentioning

confidence: 99%

Guidelines on vitamin D replacement in bariatric surgery: Identification and systematic appraisal

et al. 2016

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Introduction Bariatric surgery is the most effective therapeutic option to reduce weight in morbidly obese individuals, but it results in a number of mineral and vitamin deficiencies. Clinical Practice Guidelines (CPGs) attempt to balance those benefits and harms to provide guidance to physicians and patients. Objectives We compare and evaluate the quality of the evidence and of the development process of current CPGs that provide recommendations on vitamin D replacement in patients undergoing bariatric surgery, using a validated tool. Methods We searched 4 databases, with no time restriction, to identify relevant and current CPGs. Two reviewers assessed eligibility and abstracted data, in duplicate. They evaluated the quality of CPGs development process using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) tool that consists of 6 domains. A content expert verified those assessments. Results We identified 3 eligible CPGs: (1) the Endocrine Society (ES) guidelines (2010); (2) the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), and the American Society for Metabolic & Bariatric Surgery (ASBMS) guidelines (update 2013); and (3) the Interdisciplinary European (IE) guidelines on Metabolic and Bariatric Surgery (latest update 2014). The ES and the AACE/TOS/ASBMS guidelines recommended high doses of vitamin D, varying from 3,000 IU daily to 50,000 IU 1-3 times weekly. Vitamin D doses were not mentioned in the IE guidelines. The recommendations were based on a low quality of evidence, if any, or limited to a single high quality trial, for some outcomes. In terms of quality, only the IE guidelines described their search methodology but none of the CPGs provided details on evidence selection and appraisal. None of the three CPGs rigorously assessed the preferences of the target population, resource implications, and the applicability of these guidelines. According to the AGREE II tool, we rated the ES guidelines as average in quality, and the other two as low in quality. Conclusion Current CPGs recommendations on vitamin D supplementation in bariatric surgery differ between societies. They do not fulfill criteria for optimal guideline development, in part possibly due to limited resources, and are based on expert opinion. Thus, the pressing need for high quality randomized trials to inform CPGs, to be developed based on recommended standards.

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“…AGREE-II;23,25,245,246,251,252,[256][257][258][259] no entanto, muito pouco se sabe sobre a qualidade da GPCs em países de baixa renda.23 No Brasil, os medicamentos dispensados pelo SUS na atenção primária são selecionados e dispensados pelos municípios 260. Idealmente, todos os medicamentos incluídos no SUS devem ser incorporados em conjunto com um guia de prática clínica (GPCs) para auxiliar os profissionais de saúde.…”

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

Molino¹

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AGRADECIMENTOS À Deus por sempre ter colocado as pessoas certas na hora certa na minha vida e, por ter me dado saúde e força para seguir meus sonhos. À todas as pessoas que trilharam comigo não somente o desenvolvimento desta tese, mas sim de cada momento que me levou a escolher a vida acadêmica. À Profa. Raquel Marques Braga, que me aceitou como aluna de IC e proporcionou meu primeiro contato com a pesquisa. Às minhas orientadoras de IC, TCC e mestrado, Profa. Priscila Gava Mazzola e Profa.Patricia Moriel, que me aceitaram em seu grupo de pesquisa e possibilitaram que eu realizasse meu sonho de ser farmacêutica clínica. Agradeço ainda à Profa. Priscila por sua amizade, conselhos e apoio durante todos esses anos. À minha orientadora Profa. Eliane Ribeiro que desde a residência tem me orientado e me ensinado tanto. Agradeço ainda à Profa. Eliane pela amizade, confiança no meu trabalho e apoio em todos os momentos. À Profa. Daniela Oliveira de Melo, que me ensinou sobre o cuidado do paciente, pesquisa e trabalho em grupo. Agradeço também à Dani pela parceria nesses anos intensos, pela enorme paciência, amizade e carinho. À Profa. Nicolina Silvana Romano-Lieber, que me ensinou muito sobre docência durante a monitoria e, sempre esteve disponível para me ajudar e dar conselhos valiosos. Agradeço demais à Profa. Nicolina pelas conversas e trocas de mensagens. Aos membros do Chronide por todo empenho e esforço nesses anos e, por facilitarem a elaboração desta tese. Agradeço também à Nathalia Celini Leite Santos e Franciele Cordeiro Gabriel por acreditarem em mim, sempre me incentivando e estando dispostas a ajudar. Ao Prof. Airton Tetelbom Stein que sempre compartilhou seus conhecimentos e contribuiu imensamente com o desenvolvimento desse projeto. À Profa. Valentina Porta pela atenção, conversas e ajuda no ingresso no Programa de Pós-Graduação em Fármaco e Medicamentos. Ao Prof. Humberto Gomes Ferraz por mostrar a importância da participação dos pósgraduandos nas atividades do departamento e nas comissões da faculdade, por incentivar a produção científica e o EPIFAR e, pelas reuniões e transparência sobre o Programa de Pós-Graduação Fármaco e Medicamentos. Aos Professores Yeda Aparecida de Oliveira Duarte, Maria Lúcia Lebrão (in memoriam), Ruy Laurenti (in memoriam) e Jair Lício Ferreira Santos por conduzirem e possibilitarem a existência do Estudo SABE. Agradeço ainda à Profa. Yeda por compartilhar o banco do Estudo SABE, pela disponibilidade e atenção. Aos idosos e toda equipe do Estudo SABE por participarem e viabilizarem o desenvolvimento do Estudo e dessa tese. Aos Professores da pós-graduação do Departamento de Medicina Preventiva, da Faculdade de Saúde Pública e da Faculdade de Ciências Farmacêuticas, que contribuíram na minha formação como pesquisadora. To Prof. Heike A. Bischoff-Ferrari for accepting me as a visitor student. Thank you for being so nice and sharing your knowledge with me. I would like to thank my colleagues from the Zentrum Alter und Mobilität (ZAM), Universität Zürich, for their friendship and...

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Evaluation of the Quality of Clinical Guidelines for Cardiac Rehabilitation

Abstract: Clinical guidelines consistently recommended aerobic and resistance exercises. Overall, our critical review showed that the quality of CGs was at least moderate, with the greatest deficiencies being related to applicability and rigor of development domains.

Cited by 16 publications

References 11 publications

Exploration of the methodological quality and clinical usefulness of a cross-sectional sample of published guidance about exercise training and physical activity for the secondary prevention of coronary heart disease

Exploration of the methodological quality and clinical usefulness of a cross-sectional sample of published guidance about exercise training and physical activity for the secondary prevention of coronary heart disease

Guidelines on vitamin D replacement in bariatric surgery: Identification and systematic appraisal

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

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