Systematic Appraisal of the American College of Rheumatology Clinical Practice Guidelines

Duarte‐García, Alí; Cavalcante, Milena L; Arabelovic, Senada; Wong, John B.

doi:10.1002/acr2.1027

Cited by 8 publications

(4 citation statements)

References 12 publications

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“…17,18 To our knowledge, there is no study that reviews the quality of published guidelines for clinical practice in the Middle East and North Africa (MENA) region. Several systematic reviews have been conducted to compare the quality of guidelines among high-income countries including the United states [19][20][21] and Europe. [22][23][24][25][26] Similar systematic reviews were also performed for low-and middle-income countries including Turkey, 7 China, 9 and Sri Lanka.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Quality of Clinical Practice Guidelines in the Middle East and North Africa (MENA) Region: A Systematic Review

Almazrou¹,

Alsubki²,

Alsaigh³

et al. 2021

JMDH

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Aim: Clinical practice guidelines (CPGs) have progressively become a popular tool for making optimal clinical decisions. The literature shows that the poor quality of CPGs can form a barrier against adhering to them, resulting in a suboptimal level of healthcare. The objective of this systematic review is to evaluate the quality of CPGs in the Middle East and North Africa (MENA) region using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument. Methods: The authors searched in the MEDLINE and EMBASE databases through the Ovid interface on May 25, 2019. Keywords relating to CPGs and MENA countries were combined using Boolean search operators. The search was not limited to specific diseases. The quality of guidelines was appraised by two reviewers independently using the AGREE II Instrument. Discrepancies within a group were resolved through the involvement of a principle investigator. Results: A total of 61 CPGs were appraised. These guidelines were mainly from Saudi Arabia, and the most covered disease topic was cancer. Among the six domains of the AGREE II Instrument, CPGs scored the highest on clarity of presentation (mean 82%), while the lowest score was granted to the rigor of development domain (mean 28%). This indicates substantial deficiencies in reporting the developmental processes of CPGs and the resources used for the synthesis of evidence. Conclusion: From this review, it was found that the number of retrieved guidelines published in the MENA region is limited considering the large geographical area of the MENA region. The main domains that have higher quality scores were clarity of presentation and scope and purpose, whereas domains with the lowest scores were rigor of development and applicability. The authors' findings will help policymakers identify areas for improvement in CPGs, which can lead them to implement strategies such as the training of individuals and recruitment of international experts to ultimately develop high-quality CPGs.

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Section: Introductionmentioning

confidence: 99%

Assessing the Quality of Clinical Practice Guidelines in the Middle East and North Africa (MENA) Region: A Systematic Review

Almazrou¹,

Alsubki²,

Alsaigh³

et al. 2021

JMDH

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“…Sub-optimal use of allopurinol is common, ULT is often underutilised by clinicians, or when it is initiated is often prescribed at a fixed dose, therefore underdosing [ 11 , 54 , 57 ]. Under-dosing may be due to fear of kidney damage, which has not been supported by evidence or allopurinol hypersensitivity, a rare yet highly fatal adverse reaction [ 4 , 58 – 60 ]. Clinicians should be aware of potential side effects and prescribe ULT in accordance with CPGs guidance, titrating dose as required.…”

Section: Discussionmentioning

confidence: 99%

What are the core recommendations for gout management in first line and specialist care? Systematic review of clinical practice guidelines

et al. 2023

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Background Gout is the most common inflammatory arthritis, increasing in prevalence and burden. Of the rheumatic diseases, gout is the best-understood and potentially most manageable condition. However, it frequently remains untreated or poorly managed. The purpose of this systematic review is to identify Clinical Practice Guidelines (CPG) regarding gout management, evaluate their quality, and to provide a synthesis of consistent recommendations in the high-quality CPGs. Methods Gout management CPGs were eligible for inclusion if they were (1) written in English and published between January 2015-February 2022; focused on adults aged ≥ 18 years of age; and met the criteria of a CPG as defined by the Institute of Medicine; and (2) were rated as high quality on the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Gout CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organisation of care and did not include interventional management recommendations; and/or included other arthritic conditions. OvidSP MEDLINE, Cochrane, CINAHL, Embase and Physiotherapy Evidence Database (PEDro) and four online guideline repositories were searched. Results Six CPGs were appraised as high quality and included in the synthesis. Clinical practice guidelines consistently recommended education, commencement of non-steroidal anti-inflammatories, colchicine or corticosteroids (unless contraindicated), and assessment of cardiovascular risk factors, renal function, and co-morbid conditions for acute gout management. Consistent recommendations for chronic gout management were urate lowering therapy (ULT) and continued prophylaxis recommended based on individual patient characteristics. Clinical practice guideline recommendations were inconsistent on when to initiate ULT and length of ULT, vitamin C intake, and use of pegloticase, fenofibrate and losartan. Conclusion Management of acute gout was consistent across CPGs. Management of chronic gout was mostly consistent although there were inconsistent recommendations regarding ULT and other pharmacological therapies. This synthesis provides clear guidance that can assist health professionals to provide standardised, evidence-based gout care. Trial registration The protocol for this review was registered with Open Science Framework (DOI https://doi.org/10.17605/OSF.IO/UB3Y7).

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“…The most commonly used tool to assess guideline quality is the AGREE II instrument [30], which appraises the methodological rigor and transparency in the development of guidelines across six domains: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. Two studies used the AGREE II instrument to evaluate 27 EULAR CPGs published between 2000 and 2014 and 13 ACR CPGs published between 1999 and 2015 across multiple rheumatologic diseases [31,32]. A third more recent study analyzed 16 rheumatology CPGs from a variety of organizations including ACR and EULAR published between 2016 and 2021 [33].…”

Section: Factors Affecting Guideline Qualitymentioning

confidence: 99%

Axial spondyloarthritis guidelines – aiming for maximum impact

Choufani,

Kay,

Ermann

2024

Current Opinion in Rheumatology

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Purpose of review This review discusses international clinical practice guidelines (CPGs) for axial spondyloarthritis (axSpA) focusing on methodology, guideline quality, and implementation. Recent findings The Assessment of SpondyloArthritis International Society/European Alliance of Associations for Rheumatology (ASAS/EULAR) and Pan-American League of Associations for Rheumatology (PANLAR) recently published axSpA CPGs and updates of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network (ACR/SAA/SPARTAN) and Asia-Pacific League of Associations for Rheumatology (APLAR) CPGs are expected. GRADE has emerged as the dominant framework for CPG development and has been used by three of the four international axSpA guidelines. Notable differences exist among these guidelines in the way that the recommendations are presented. Two of the four acknowledge the need for implementation strategies, but little detail about this is provided. The few studies that have evaluated the implementation of axSpA CPGs have identified poor adherence to recommendations on physical therapy/exercise and disease activity monitoring. Implementation science has identified many barriers and facilitators affecting guideline uptake, including those related to healthcare professionals and to the guidelines themselves. Creation of a tailored implementation plan simultaneously with the CPG is recommended. Summary While methodological rigor in the creation of evidence-based recommendations is the focus of CPG development, recommendations must be presented in a user-friendly format that makes them easy to apply. ‘Living guidelines’ could facilitate keeping content up to date. Implementation is critical for the success of a CPG and should be emphasized in future axSpA guideline updates. Further research is needed to better understand the factors impacting the successful implementation of axSpA CPGs.

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Systematic Appraisal of the American College of Rheumatology Clinical Practice Guidelines

Cited by 8 publications

References 12 publications

Assessing the Quality of Clinical Practice Guidelines in the Middle East and North Africa (MENA) Region: A Systematic Review

Assessing the Quality of Clinical Practice Guidelines in the Middle East and North Africa (MENA) Region: A Systematic Review

What are the core recommendations for gout management in first line and specialist care? Systematic review of clinical practice guidelines

Axial spondyloarthritis guidelines – aiming for maximum impact

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