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

Sabharwal, Sanjeeve; Patel, Vishal; Nijjer, Sukhjinder; Kirresh, Ali; Darzi, Ara; Chambers, John C.; Malik, Iqbal; Kooner, Jaspal S.; Athanasiou, Thanos

doi:10.1177/0141076813486261

Cited by 38 publications

(34 citation statements)

References 29 publications

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“…First, the comprehensive size of each guideline meant that they were more descriptive in their methods than those that are published in peer-reviewed journals and also have been subjected to quality assessment [24]. Second, it was clear to the assessors that these guidelines had a predefined structure that reflected key aspects of the developmental rigor domain.…”

Section: Discussionmentioning

confidence: 99%

“…These are whether facilitators and barriers to implementation are described, if advice or tools to aid implementation are provided, consideration of potential resource implications of applying the guideline, and the presentation of a monitoring or auditing criteria. Studies of guideline quality that use AGREE II commonly cite this deficiency, which implies guideline developers throughout medicine ignore its importance [24,25]. Guidelines that fail to address these areas may be vulnerable to poor uptake by healthcare professionals and therefore have a limited effect on improving healthcare quality [9].…”

Section: Discussionmentioning

confidence: 99%

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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%

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

Self Cite

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“…Evaluations of guidelines showed that they were high in quality for scope and purpose, stakeholder involvement, rigor of development and clarity of presentation, but consistently lacking in applicability. [10][11][12][13][14] This refers to guideline implementation tools (GItools) such as training material (e.g., workshop slides, self-directed learning kits), guideline summaries or algorithms, patient information, or guidance for evaluation (e.g., quality indicators, audit instructions). Focus groups found that health professionals were frustrated and uncertain about how to implement guidelines.…”

mentioning

confidence: 99%

The development of guideline implementation tools: a qualitative study

2015

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Background:Research shows that guidelines featuring implementation tools (GItools) are more likely to be used than those without GItools, however few guidelines offer GItools and guidance on developing GItools is lacking. The objective of this study was to identify common processes and considerations for developing GItools. Methods:Interviews were conducted with developers of 4 types of GItools (implementation, patient engagement, point-of-care decision-making and evaluation) accompanying guidelines on various topics created in 2008 or later identified in the National Guideline Clearinghouse. Participants were asked to describe the GItool development process and related considerations. A descriptive qualitative approach was used to collect and analyze data.Results: Interviews were conducted with 26 GItool developers in 9 countries. Participants largely agreed on 11 broad steps, each with several tasks and considerations. Response variations identified issues lacking uniform approaches that may require further research including timing of GItool development relative to guideline development; decisions about GItool type, format and content; and whether and how to engage stakeholders. Although developers possessed few dedicated resources, they relied on partnerships to develop, implement and evaluate GItools.Interpretation: GItool developers employed fairly uniform and rigorous processes for developing GItools. By supporting GItool development, the GItool methods identified here may improve guideline implementation and use. Abstract E128CMAJ OPEN, 3(1) Research CMAJ OPENwere not accompanied by implementation tools. [16][17][18] We interviewed 30 guideline developers from 7 countries who said that their target users had requested GItools, but they required direction for developing GItools. 19 Existing guideline development instructional manuals lack details on how to develop GItools. 20,21 The purpose of this study was to identify common processes and considerations for developing GItools. Methods ApproachGItool developers were interviewed to learn how they developed GItools. Qualitative research is useful for revealing tacit knowledge. 22 A descriptive qualitative approach was used along with various strategies to optimize rigor. 23,24 Consolidated criteria for reporting qualitative research 25 guided the reporting of study findings. Conduct of this study was approved by the University Health Network Research Ethics Board (12-0091-AE). Participants gave informed consent before being interviewed. Sampling and recruitmentThe National Guideline Clearinghouse (US Department of Health and Human Services, Agency for Healthcare Research and Quality; www.guideline.gov) was searched for Englishlanguage guidelines published in 2008 or later on the management of prevalent conditions that affect both men and women (e.g., arthritis, asthma, cancer, depression, diabetes, heart failure, stroke) and topics relevant to guideline developers who were collaborators on this research (e.g., chiropractic, dermatology, neurology, nephrol...

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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%

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

Cited by 38 publications

References 29 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

The development of guideline implementation tools: a qualitative study

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

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