Quality of chronic pain interventional treatment guidelines from pain societies: Assessment with the AGREE II instrument

Abstract

Background and Objective Procedures to relieve pain are performed frequently but there are concerns about patient selection, appropriate image guidance, frequency and training for physicians. Patients, healthcare providers, policymakers and licensing bodies seek evidence‐based recommendations to use these interventions judiciously. In this review we appraised the methodological quality of recent clinical practice guidelines (CPGs) for interventional pain procedures. Database and Data Treatment A systematic search of the medical literature was performed. Three trained appraisers independently evaluated the methodological quality of the CPGs using a validated instrument, the Appraisal of Guidelines in Research and Evaluation II (AGREE II). Six domains were considered: 1) score and purpose; 2) stakeholder involvement; 3) rigour of development; 4) clarity of presentation; 5) applicability and 6) editorial independence. A total of 23 items were scored. CPGs were deemed ‘high quality’ if a mean scaled score above 60% for rigour of development and for two other domains was obtained. Results Mean scaled domain quality scores ranged from 61.72% to 69.99%. Despite being based on modest levels of evidence, two of the four included CPGs were considered to be of high methodological quality. The AGREE II scores across the four guidelines exhibited good inter‐rater reliability. None of the guidelines involved key stakeholders such as patients, other healthcare providers, and payers. Conclusions All four CPGs were limited by a weak execution of the guideline development process. There is a need to develop methodologically sound evidence‐based guidelines for the use of interventional pain procedures using a rigorous process that involves all relevant stakeholders. Significance This systematic review appraises the methodological quality of existing CPGs on interventional procedures using a validated epidemiological tool (AGREE II). The aims of this review were to identify methodological and knowledge gaps in existing CPGs. Findings of this study will help in development of a high‐quality CPG that can assist healthcare providers and patients in making informed decisions while ensuring that the right intervention is performed for the right patient at the right time. The quality of the evidence provided by the CPGs provided in support of their recommendations was also evaluated.

Quality assessment of the guidelines for the management of malignant pleural effusions and ascites

“…The findings of quality assessment for the guidelines in this study are similar to the results in previous studies [ 10 , 12 , 14 ], which are mainly related to the different methodologies adopted by different guideline development teams.…”

Quality of recent clinical practice guidelines in anaesthesia publications using the Appraisal of Guidelines for Research and Evaluation II instrument

“…Both of these domains have historically underperformed during guideline assessment. 32,38 Guideline development groups are unlikely to have access to the multitude of resources to comprehensively address these two areas. The low level of stakeholder involvement is disappointing considering the current era of patient-centred outcomes, and importance of understanding patient motivations and preferences in delivering optimal care.…”

“…Although patient bias regarding cost, expectations, and cultural background may be introduced, patients are key stakeholders who should be involved in CPG development. 32 Applicability is another universally neglected domain. This domain is concerned with aspects of guideline 'after-care': the identification of facilitators and barriers, provision of tools to aid guideline application, identification of potential resource issues, and generation of auditing criteria.…”

More than one third of clinical practice guidelines on low back pain overlap in AGREE II appraisals. Research wasted?

“…The rating of all six domains was reported in 14 appraisals (82.4%) [ 17 , 25 – 35 , 37 , 40 ] and the rating of 23 item scores in two [ 36 , 39 ]. Overall assessment 1 (overall CPG quality) was reported in 11 appraisals (64.7%) [ 25 – 30 , 32 – 34 , 37 , 40 ] and overall assessment 2 (recommendation for use) in four (23.5%) [ 25 , 27 , 28 , 32 ]. A quality rating (not part of the AGREE II tool) was given in nine appraisals (53%) [ 17 , 26 , 28 , 29 , 33 , 34 , 36 , 37 , 39 ].…”