Guidelines for the management of pelvic pain associated with endometriosis: a systematic appraisal of their quality

Abstract

Background Guidelines exist for the management of endometriosis. Validated and reliable appraisal tools exist to assess the quality of guidelines.Objectives To systematically appraise the quality of guidelines for the management of pelvic pain associated with endometriosis.Search strategy Guidelines were identified using a prospective protocol through a systematic search of MEDLINE (1951MEDLINE ( -2005, EMBASE (1974EMBASE ( -2005, the Cochrane Library (2005, issue 2), known guideline websites and the World Wide Web.Selection criteria Type of document: guideline, consensus statement, care protocol or healthcare technology assessment produced by national or international professional organisations and societies or governmental agencies; subject: managemant of pelvic pain associated with endometriosis.Data collection and analysis Two validated appraisal tools, Cluzeau and The Appraisal of Guidelines and Research and Evaluation (AGREE), were used to quantitatively assess the quality of guidelines. Areas evaluated included 'rigour of development ', 'context and content' and 'application.' Main results Eight of 596 potentially relevant citations identified met our inclusion criteria. The Cluzeau instrument quality score were the following: rigour of development, 53% (range 5-65%); context and content, 69% (range 29-79%) and application 20% (range 0-20%). The aplication dimension achieved significantly lower quality scores (P = 0.026 versus rigour of development and P = 0.017 versus context and content). The AGREE instrument quality scores were the following: scope and purpose, 68% (range 17-89%); stakeholder involvement, 33% (range 13-63%); rigour of development, 49% (range 10-81%); clarity of presentation, 55% (range 42-67%); applicability, 14% (range 0-28%) and editorial independence, 28% (range 8-67%). The applicability domain achieved significantly lower quality scores (P = 0.001 versus scope and purpose and P = 0.009 versus rigour of development).Author's conclusions Guidelines for the management of pelvic pain associated with endometriosis do not comply with the recommendations for high-quality standards.Keywords Appraisal instruments, endometriosis, guideline, review.Please cite this paper as: Appleyard T, Mann C, Khan K. Guidelines for the management of pelvic pain associated with endometriosis: a systematic appraisal of their quality. BJOG 2006; 113:749-757. IntroductionEndometriosis is a common gynaecological condition among women of reproductive age that results in an array of problems including pelvic pain, dysmenorrhoea, dyspareunia and subfertility. There is a lack of consensus about its best management, particularly in dealing with symptoms of chronic pelvic pain. Guidelines are systematically developed statements to assist practitioner and patients' decisions about appropriate health care for specific clinical circumstances. 1 Their specific purpose is to make explicit recommendations with a definite intent to influence what clinicians do. 2 It is believed that guidelines can improve the quality, a...

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