Quality of clinical practice guidelines on interventional management of low back pain: A systematic review

Abstract

ObjectiveTo appraise the quality of low back pain (LBP) clinical practice guidelines (CPG) that include interventional management recommendations and to associate their quality with characteristics including publication year and creating organization.TypeSystematic Review.Literature SurveyLBP (subacute or chronic) CPGs in English (symptom based, governmental or professional society created, January 1990‐May 2020) were found using MEDLINE, EMBASE, CINAHL, Ortho Guidelines, CPG Infobase, ECRI, Guidelines International Network, NICE, and SIGN.MethodologyIn this third order systematic review, search results were deduplicated, title and abstract screened by two independent reviewers, and full texts reviewed by four reviewers. Discrepancies were resolved by a third reviewer. Resulted CPGs were appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Tool by four appraisers each. Association of their quality with creating organization, geographical region, and year of creation was calculated.SynthesisSeven hundred fourteen screened documents resulted in 21 final CPGs. On appraisal, average overall CPG quality was 5.2 (range 2.5‐6.75). Domain 5 (applicability) had the lowest average (44%) and domain 4 (clarity of presentation) had the highest average score (82%). For overall recommendation, 16 received “yes” or “yes with modifications,” six received unanimous “yes” and two unanimous “no” votes. The interrater agreement of domain scoring was excellent (0.8‐1.0; p < .001). There was no association found between quality of CPG and (1) year of publication (R2 = 0.0006), (2) whether the CPG was updated or new (p = .17), and (3) region of publication (p = .37).ConclusionsThe majority of the 21 CPGs identified in this systematic review were of high quality, but overall quality and recommendation ratings were variable. The quality of appraised CPGs showed no association with their characteristics. Some domains such as “applicability” scored uniformly lower, revealing opportunity for improvement in future CPG development. LBP CPGs should be scrutinized before adopting their recommendations.

Clinical practice guidelines on interventional management of low back pain: A synthesis of recommendations

“…This systematic review was registered with PROS-PERO (registration number: CRD42020185582) and followed the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (Figure 1). 10,11 Detailed methodology for the quality assessment of the CPGs has been previously published 10 and is summarized here. In brief, we searched for all pertinent CPGs in several databases.…”

“…The gathered recommendations were then organized within each treatment category based on AGREE II recommendation scores (described previously 10 ). CPGs that received "yes" only votes were included in the high-quality group, CPGs that received a mix of "yes" and "yes with modification" votes were included in the moderate-quality group, and any CPG that received a "no" vote was in the low-quality group.…”

“…The goals of this paper were to provide a synthesis and summary of the recommendations from the 21 CPGs appraised in our previously published paper. 10 We did not attempt to review the source articles that informed the CPGs or resolve discrepancies in the recommendations made in those CPGs. Although those objectives are worth pursuing, they were beyond the scope of this study.…”

“…9 In our earlier paper, "Quality of Clinical Practice Guidelines on Interventional Management of Low Back Pain: A Systematic Review," we appraised the quality of 21 LBP CPGs that included interventional management recommendations, using the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE) II tool. 10 There was a wide range of overall quality scores, though most were recommended for clinical use (albeit some with recommendation of modification). The quality of appraised CPGs showed no association with characteristics including year of publication, whether the CPG was updated or new, and region of publication.…”

Involvement of methodological experts and the quality of clinical practice guidelines: a critical appraisal of clinical practice guidelines and a questionnaire survey of the development groups in Japan

“…The AGREE II instrument was published in 2009 as a revised version of the original AGREE instrument issued in 2001 20. Previous studies have shown that the quality of CPGs has varied 21–47. Some studies have indicated that the quality of CPGs depends on the publication year,25 type of development organisation21 and version of CPGs 26…”