Methodological quality of guidelines for management of Lyme neuroborreliosis

Abstract

BackgroundMany aspects of clinical management of Lyme neuroborreliosis are subject to intense debates. Guidelines show considerable variability in their recommendations, leading to divergent treatment regimes. The most pronounced differences in recommendations exist between guidelines from scientific societies and from patient advocacy groups. Assessment of the methodological quality of these contradictory guideline recommendations can be helpful for healthcare professionals.MethodsSystematic searches were conducted in MEDLINE and databases of four international and national guideline organizations for guidelines on Lyme neuroborreliosis published from 1999–2014. Characteristics (e.g., year of publication, sponsoring organization) and key recommendations were extracted from each guideline. Two independent reviewers assessed the methodological quality of each guideline according to the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. AGREE II scores from guidelines developed by scientific societies and from patient advocacy groups were compared across domains.ResultsWe identified eight eligible guidelines of which n = 6 were developed by scientific societies and n = 2 by patient advocacy groups. Agreement on AGREE II scores was good (Cohen’s weighted kappa = 0.87, 95 % CI 0.83–0.92). Three guidelines, all from scientific societies, had an overall quality score of ≥ 50 %. Two of them were recommended for use according to the AGREE II criteria. Across all guidelines, the AGREE II domain with the highest scores was “Clarity of Presentation” (65, SD 19 %); all other domains had scores < 50 % with the domain “Applicability” having the lowest scores (4, SD 4 %). Guidelines developed by scientific societies had statistically significantly higher scores regarding clarity of presentation than guidelines from patient advocacy groups (p = 0.0151). No statistically significant differences were found in other domains.ConclusionsCurrent guidelines on Lyme neuroborreliosis vary in methodological quality and content. Health care providers and patients need to be aware of this variability in quality when choosing recommendations for their treatment decisions regarding Lyme neuroborreliosis. No statement can be given on quality of content and validity of recommendations, as these issues are not subject to assessment with the AGREE II tool and are prone to individual interpretation of the available evidence by the corresponding guideline panels. To enhance guideline quality, guideline panels should put more emphasis on linking recommendations to the available evidence, transparency in reporting how evidence was searched for and evaluated, and the implementation of recommendations into clinical practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0501-3) contains supplementary material, which is available to authorized users.

The quality of clinical practice guidelines for chronic respiratory diseases and the reliability of the AGREE II: an observational study

“…Our mean domain scores are consistent with several previous studies that used the AGREE II instrument to evaluate guidelines for other areas of healthcare. The domain with the lowest score in our survey, applicability (37%), was at the upper end of the range of values from other studies: 5% to 47% [12][13][14][15][16][17]30]. The domains with the highest scores, clarity of presentation (79%) and scope and purpose (79%), also compared well to other studies: 51% to 87% [10,[13][14][15][16][17]30] and 65% to 92% [9,11,12], respectively.…”

“…In 72% of responses the guidelines were recommended with modification. This difficulty of interpretation was also seen in other studies, with some establishing cut-off values for the AGREE II domains in order to score the second overall item [10][11][12]14,17], another seeking consensus among assessors [13], and others not reporting this item [9,16]. This variation on the analysis and interpretation of this item makes it difficult to compare between studies and could be the focus of future research.…”

“…Another limitation of our survey was the identification of guidelines using a single bibliographic database with stringent inclusion criteria (only evidence-based guidelines developed by an organisation are indexed on PEDro). Despite this, our survey evaluated a larger sample (n = 33) compared to previous evaluations of English guidelines in other areas of medicine (n = 5 to 17) [11][12][13][14][15].…”

“…Many clinical practice guidelines have been developed for the management of chronic respiratory diseases. Unfortunately, the quality of guidelines in healthcare varies widely, particularly in the areas of stakeholder involvement [9][10][11], rigour of development [9][10][11][12][13][14][15], applicability [9][10][11][12][13][14][15][16][17], and editorial independence [9][10][11]16]. One explanation for this variability is that the development process is complex, requiring diverse skills from guideline developers including analysis of scientific evidence and synthesis of recommendations [8].…”

Common and uncommon neurological manifestations of neuroborreliosis leading to hospitalization

“…Detection of pleocytosis, blood-CSF-barrier dysfunction, intrathecal production of immunoglobulins (Ig) and especially an intrathecal synthesis of Borrelia specific antibodies in CSF are the best indicators for definitive diagnosis [10]. Once diagnosed, the majority of patients with neuroborreliosis experience a favorable outcome after antibiotic treatment [11–15]. However, in a small number of patients residual symptoms remain [16].…”