The methodological quality is insufficient in clinical practice guidelines in the context of COVID-19: systematic review

Abstract

Key findings: Despite clear scope, most guidelines for SARS CoV-2 infections and for other care in the context of COVID-19 fell short of basic methodological standards. Only 4% were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality). Patients were included in the development of one guideline. A process for regular updates was described in 14%. What this adds to what is known: Our study explored if basic methodological standards of guideline development have been met in the published clinical practice guidelines related to COVID-19. What is the implication/what should change now: An insufficient consideration of appropriate methodologies in the guideline development process could lead to misleading information, uncertainty among the professionals, and potentially harmful actions for patients. This paper provides an important benchmark for the future assessment of the quality of COVID-19 guidelines. Abstract Objective: The number of published clinical practice guidelines related to COVID-19 has rapidly increased. This study explored if basic methodological standards of guideline development have been met in the published clinical practice guidelines related to COVID-19. Study Design and Setting: Rapid systematic review from February 1 st until April 27 th , 2020 using MEDLINE [PubMed], CINAHL [Ebsco], Trip and manual search, including all types of healthcare workers providing any kind of healthcare to any patient population in any setting. Results: There were 1342 titles screened and 188 guidelines included. The highest average AGREE II domain score was 89% for scope and purpose , the lowest for rigor of development (25%). Only eight guidelines (4%) were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality). The majority (156; 83%) was solely built on an informal expert consensus. A process for regular updates was described in 27 guidelines (14%). Patients were included in the development of only one guideline. Conclusion: Despite clear scope, most publications fell short of basic methodological standards of guideline development. Clinicians should use guidelines that include up-to-date information, were informed by stakeholder involvement, and employed rigorous methodologies.

Best practices for virtual care to support youth with chronic pain and their families: a rapid systematic review to inform health care and policy during COVID-19 and beyond

“… 27 , 64 Indeed, a systematic review of clinical practice guidelines developed rapidly and early in the COVID-19 pandemic (February–April 27, 2020) across different areas of health identified that most guidelines were of insufficient methodological quality due to a sole reliance on informal expert consensus (83% of 188 guidelines), with only 8 guidelines (4%) built on a systematic literature search and one guideline involving patients (<1%). 67 The objective of the current rapid systematic review was to rigorously review the published literature to identify recommendations, guidelines, and/or best practices for using virtual care to support youth with chronic pain and their families. High-quality knowledge syntheses, such as this article, serve to enhance knowledge about a particular topic, thereby enabling evidence-informed decision making to guide implementation and policy across the health system.…”

Analysis of COVID-19 Guideline Quality and Change of Recommendations: A Systematic Review

“…Among the published studies on COVID-19, CPGs and consensus statements accounted for one-fifth of the total [5]. However, previous studies have shown that CPGs developed early in the COVID-19 pandemic had methodological weaknesses [6][7][8]. And when there was no effective treatment against COVID-19, the treatment recommendations between some COVID-19 guidelines are highly consistent [9].…”

Guidelines developed under pressure. The case of the COVID-19 low-quality “rapid” guidelines and potential solutions

“…Previous publications have raised concerns about the quality of guidelines related to COVID-19. Two assessments of guidelines developed very early in the pandemic (guidelines published before April 2020) [ 6 , 7 ] found that their methodological quality was poor in almost all the cases. Stamm et al, found that only 8 out of 188 guidelines could be considered as of high quality [7] .…”