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Gillespie BM, Latimer S, Walker RM, McInnes E, Moore Z, Eskes AM, Li Z, Schoonhoven L, Boorman RJ, Chaboyer W. The quality and clinical applicability of recommendations in pressure injury guidelines: A systematic review of clinical practice guidelines. Int J Nurs Stud 2021; 115:103857. [PMID: 33508730 DOI: 10.1016/j.ijnurstu.2020.103857] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/10/2020] [Accepted: 12/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pressure injuries are one of the most frequently occurring, yet preventable hospital-acquired adverse events. Given there are many clinical practice guidelines available on the prevention and treatment of pressure injuries, it is useful to understand the quality of these guidelines and the clinical application of their recommendations. OBJECTIVE To critically evaluate the quality and applicability of the recommendations in pressure injury prevention and treatment clinical practice guidelines. DESIGN Systematic review, reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES We systematically searched the literature published from 2005 to 2020 using MEDLINE, EMBASE, CINAHL, the Cochrane Library, ProQuest and PubMed electronic databases, and nine guideline repositories. REVIEW METHODS We assessed overall quality using the validated Appraisal of Guidelines for Research and Evaluation II (AGREE II) and AGREE Recommendation Excellence (AGREE-REX) tools. Overall % mean scores across AGREE II and AGREE-REX domains were calculated for each guideline. Clinical practice guidelines were then ranked in tertiles based on "high", "moderate" or "low" quality. The review protocol was registered in the International Prospective Register of Systematic Reviews. RESULTS Initial combined database and repository searches yielded 3247 documents. Of these,73 full text documents were reviewed. The final analysis included 12 complete guidelines and 14 related documents. Overall AGREE II scores ranged from 32% to 96% while AGREE-REX scores were generally lower ranging from 10% to 75%. Combined % mean scores across AGREE II and AGREE-REX criteria suggest that four guidelines were ranked as "high" (range 69% to 85%) and are recommended without modification. These included; the 2019 International Guideline, the 2016 Canadian Guideline, the 2014 NICE Guideline, and the 2013 Belgian Guideline. CONCLUSIONS There is disparity in the quality of the included guidelines, however four high quality guidelines are available. These guidelines could ideally be implemented in daily practice and adapted to local policies.
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Affiliation(s)
- Brigid M Gillespie
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia; Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia.
| | - Sharon Latimer
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia; Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
| | - Rachel M Walker
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia; Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Division of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia.
| | - Elizabeth McInnes
- St Vincent's Health Australia, Sydney, NSW, Australia; St Vincent's Hospital, Melbourne, VIC, Australia; Australian Catholic University, Melbourne, VIC, Australia.
| | - Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Anne M Eskes
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Zhaoyu Li
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia.
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Ultrecht University, Ultrecht, The Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, United Kingdom.
| | - Rhonda J Boorman
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia.
| | - Wendy Chaboyer
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia; Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
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Grimmer K, Machingaidze S, Dizon J, Kredo T, Louw Q, Young T. South African clinical practice guidelines quality measured with complex and rapid appraisal instruments. BMC Res Notes 2016; 9:244. [PMID: 27121107 PMCID: PMC4848797 DOI: 10.1186/s13104-016-2053-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/19/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Critically appraising the quality of clinical practice guidelines (CPGs) is an essential element of evidence implementation. Critical appraisal considers the quality of CPG construction and reporting processes, and the credibility of the body of evidence underpinning recommendations. To date, the focus on CPG critical appraisal has come from researchers and evaluators, using complex appraisal instruments. Rapid critical appraisal is a relatively new approach for CPGs, which targets busy end-users such as service managers and clinicians. This paper compares the findings of two critical appraisal instruments: a rapid instrument (iCAHE) and a complex instrument (AGREE II). They were applied independently to 16 purposively-sampled, heterogeneous South African CPGs, written for eleven primary health care conditions/health areas. Overall scores, and scores in the two instruments' common domains Scope and Purpose, Stakeholder involvement, Underlying evidence/Rigour of Development, Clarity), were compared using Pearson r correlations and intraclass correlation coefficients. CPGs with differences of 10 % or greater between scores were identified and reasons sought for such differences. The time taken to apply the instruments was recorded. RESULTS Both instruments identified the generally poor quality of the included CPGs, particularly in Rigour of Development. Correlation and agreement between instrument scores was moderate, and there were no overall significant score differences. Large differences in scores for some CPGs could be explained by differences in instrument construction and focus, and CPG construction. The iCAHE instrument was demonstrably quicker to use than the AGREE II instrument. CONCLUSIONS Either instrument could be used with confidence to assess the quality of CPGs. The choice of appraisal instrument depends on the needs and time of end-users. Having an alternative (rapid) critical appraisal tool will potentially encourage busy end-users to identify and use good quality CPGs to inform practice decisions.
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Affiliation(s)
- Karen Grimmer
- />International Centre for Allied Health Evidence (iCAHE), University of South Australia, City East Campus, P4-18 North Terrace, Adelaide, 5000 Australia
- />Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
| | - Shingai Machingaidze
- />European and Developing Countries Clinical Trial Partnership (EDCTP), Francie van Zijl Drive, Parow Valley, Cape Town, 7505 South Africa
- />South African Cochrane Centre (SACC), South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505 South Africa
| | - Janine Dizon
- />Centre for Evidence-Based Health Care (CEBHC), Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
- />Center for Health Research and Movement Science, University of Santo Tomas, Espana, 1018 Manila, Philippines
| | - Tamara Kredo
- />European and Developing Countries Clinical Trial Partnership (EDCTP), Francie van Zijl Drive, Parow Valley, Cape Town, 7505 South Africa
| | - Quinette Louw
- />Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
- />South African Cochrane Centre (SACC), South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505 South Africa
| | - Taryn Young
- />Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
- />Centre for Evidence-Based Health Care (CEBHC), Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
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Grimmer K, Dizon JM, Milanese S, King E, Beaton K, Thorpe O, Lizarondo L, Luker J, Machotka Z, Kumar S. Efficient clinical evaluation of guideline quality: development and testing of a new tool. BMC Med Res Methodol 2014; 14:63. [PMID: 24885893 PMCID: PMC4033487 DOI: 10.1186/1471-2288-14-63] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 04/22/2014] [Indexed: 11/16/2022] Open
Abstract
Background Evaluating the methodological quality of clinical practice guidelines is essential before deciding which ones which could best inform policy or practice. One current method of evaluating clinical guideline quality is the research-focused AGREE II instrument. This uses 23 questions scored 1–7, arranged in six domains, which requires at least two independent testers, and uses a formulaic weighted domain scoring system. Following feedback from time-poor clinicians, policy-makers and managers that this instrument did not suit clinical need, we developed and tested a simpler, shorter, binary scored instrument (the iCAHE Guideline Quality Checklist) designed for single users. Methods Content and construct validity, inter-tester reliability and clinical utility were tested by comparing the new iCAHE Guideline Quality Checklist with the AGREE II instrument. Firstly the questions and domains in both instruments were compared. Six randomly-selected guidelines on a similar theme were then assessed by three independent testers with different experience in guideline quality assessment, using both instruments. Per guideline, weighted domain and total AGREE II scores were calculated, using the scoring rubric for three testers. Total iCAHE scores were calculated per guideline, per tester. The linear relationship between iCAHE and AGREE II scores was assessed using Pearson r correlation coefficients. Score differences between testers were assessed for the iCAHE Guideline Quality Checklist. Results There were congruent questions in each instrument in four domains (Scope & Purpose, Stakeholder involvement, Underlying evidence/Rigour, Clarity). The iCAHE and AGREE II scores were moderate to strongly correlated for the six guidelines. There was generally good agreement between testers for iCAHE scores, irrespective of their experience. The iCAHE instrument was preferred by all testers, and took significantly less time to administer than the AGREE II instrument. However, the use of only three testers and six guidelines compromised study power, rendering this research as pilot investigations of the psychometric properties of the iCAHE instrument. Conclusion The iCAHE Guideline Quality Checklist has promising psychometric properties and clinical utility.
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Affiliation(s)
- Karen Grimmer
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, City East Campus, School of Health Sciences, Centenary, GPO box 2471, Adelaide 5001, Australia.
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Sanclemente G, Acosta JL, Tamayo ME, Bonfill X, Alonso-Coello P. Clinical practice guidelines for treatment of acne vulgaris: a critical appraisal using the AGREE II instrument. Arch Dermatol Res 2013; 306:269-77. [DOI: 10.1007/s00403-013-1394-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/17/2013] [Accepted: 07/22/2013] [Indexed: 01/22/2023]
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Mar Seguí MD, Ronda E, Wimpenny P. Inconsistencies in guidelines for visual health surveillance of VDT workers. J Occup Health 2011; 54:16-24. [PMID: 22156323 DOI: 10.1539/joh.11-0186-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES In Europe, 25% of workers use video display terminals (VDTs). Occupational health surveillance has been considered a key element in the protection of these workers. Nevertheless, it is unclear if guidelines available for this purpose, based on EU standards and available evidence, meet currently accepted quality criteria. The aim of this study was to appraise three sets of European VDT guidelines (UK, France, Spain) in which regulatory and evidence-based approaches for visual health have been formulated and recommendations for practice made. METHODS Three independent appraisers used an adapted AGREE instrument with seven domains to appraise the guidelines. A modified nominal group technique approach was used in two consecutive phases: first, individual evaluation of the three guidelines simultaneously, and second, a face-to-face meeting of appraisers to discuss scoring. Analysis of ratings obtained in each domain and variability among appraisers was undertaken (correlation and kappa coefficients). RESULTS All guidelines had low domain scores. The domain evaluated most highly was Scope and purpose, while Applicability was scored minimally. The UK guidelines had the highest overall score, and the Spanish ones had the lowest. The analysis of reliability and differences between scores in each domain showed a high level of agreement. CONCLUSIONS These results suggest current guidelines used in these countries need an update. The formulation of evidence-base European guidelines on VDT could help to reduce the significant variation of national guidelines, which may have an impact on practical application.
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Affiliation(s)
- María Del Mar Seguí
- Optic, Pharmacology and Anatomy Department, Public Health Research Group, University of Alicante.
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Harstall C, Taenzer P, Angus DK, Moga C, Schuller T, Scott NA. Creating a multidisciplinary low back pain guideline: anatomy of a guideline adaptation process. J Eval Clin Pract 2011; 17:693-704. [PMID: 20846284 DOI: 10.1111/j.1365-2753.2010.01420.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES A collaborative, multidisciplinary guideline adaptation process was developed to construct a single overarching, evidence-based clinical practice guideline (CPG) for all primary care practitioners responsible for the management of low back pain (LBP) to curb the use of ineffective treatments and improve patient outcomes. METHODS The adaptation strategy, which involved multiple committees and partnerships, leveraged existing knowledge transfer connections to recruit guideline development group (GDG) members and ensure that all stakeholders had a voice in the guideline development process. Videoconferencing was used to coordinate the large, geographically dispersed GDG. Information services and health technology assessment experts were used throughout the process to lighten the GDG's workload. RESULTS The GDG reviewed seven seed guidelines and drafted an Alberta-specific guideline during 10 half-day meetings over a 12-month period. The use of ad hoc subcommittees to resolve uncertainties or disagreements regarding evidence interpretation expedited the process. Challenges were encountered in dealing with subjectivity, guideline appraisal tools, evidence source limitations and inconsistencies, and the lack of sophisticated evidence analysis inherent in guideline adaptation. Strategies for overcoming these difficulties are discussed. CONCLUSION Guideline adaptation is useful when resources are limited and good-quality seed CPGs exist. The Ambassador Program successfully utilized existing stakeholder interest to create an overarching guideline that aligned guidance for LBP management across multiple primary care disciplines. Unforeseen challenges in guideline adaptation can be overcome with credible seed guidelines, a consistently applied and transparent methodology, and clear documentation of the subjective contextualization process. Multidisciplinary stakeholder input and an open, trusting relationship among all contributors will ensure that the end product is clinically meaningful.
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Affiliation(s)
- Christa Harstall
- Health Technology Assessment Unit, Institute of Health Economics, Edmonton, Alberta, Canada
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Abstract
BACKGROUND Clinical practice guidelines have blossomed in the last 10 years in medicine as well as wound care. The physician practicing wound care and attempting to use published clinical practice guidelines may, however, have difficulty judging the quality of these guidelines given legitimate concerns that many aspects of clinical practice guidelines are not being properly addressed. METHODS Guidelines were located using the National Guideline Clearinghouse Web site, PubMed, and the Cochrane database for reviews on diabetic foot ulcers, venous ulcers, and pressure ulcers. The Appraisal of Guidelines for Research and Evaluation instrument was used to evaluate guidelines. RESULTS Search engines returned many irrelevant guidelines. Many guidelines would be difficult to evaluate by clinicians not versed in guideline evaluation and were cumbersome in format or were presented more as reference works. Too little attention is focused on such issues as clarity of presentation, consideration of multidisciplinary panels, stakeholder involvement, validity, testing, settings, resources required, cost impact, methods of addressing guideline implementation, and a means of tracking important criteria for feedback once the guideline is in the field. The venous and diabetic ulcer guidelines that were formally evaluated scored poorly in many of these areas despite using relatively sound methods for gathering and evaluating the evidence. Only the developers of one guideline made a commitment for regular update. CONCLUSION Although progress has been made in regard to wound care clinical practice guidelines, much more work will be required before such guidelines are highly accepted by wound care clinicians.
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[Is "evidence-based medicine" followed by "confidence-based medicine"?]. ACTA ACUST UNITED AC 2010; 105:560-6. [PMID: 20824414 DOI: 10.1007/s00063-010-1095-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
Abstract
In an appeal concerning accusations of defamation, the England and Wales Court of Appeal Decisions determined that evidence-based statements are to be judged as opinions and not statements of fact. Since the authors consider it probable that this legal judgment will exert influence on physicians' decisions about the provision of health care services, they have compiled the implications of the judgment and discuss its consequences. The own analyses and considerations lead to the conclusion that confidence-based medicine follows evidence-based medicine. This extension is necessary because evidence-based medicine has not been able to generate the required trust. Therefore, it will be demanded to underpin the existing concept with additional data. These data will be necessary because it is no longer sufficient to convince scientists with data which are obtained under ideal conditions, but to convince critical members of society with additional data which have been obtained under everyday conditions.
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Three practical approaches to EBP. Nurs Manag (Harrow) 2010; 41:10-3. [PMID: 20216139 DOI: 10.1097/01.numa.0000369490.46556.2f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Scott NA, Moga C, Harstall C. Making the AGREE tool more user-friendly: the feasibility of a user guide based on Boolean operators. J Eval Clin Pract 2009; 15:1061-73. [PMID: 20367706 DOI: 10.1111/j.1365-2753.2009.01265.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rationale, aims and objectives The Appraisal of Guidelines Research and Evaluation (AGREE) instrument is a generic tool for assessing guideline quality. This feasibility study aimed to reduce the ambiguity and subjectivity associated with AGREE item scoring, and to augment the tool's capacity to differentiate between good- and poor-quality guidelines. Methods A literature review was conducted to ascertain what AGREE instrument adjustments had been reported to date. The AGREE User Guide was then modified by: 1 constructing a detailed set of instructions, or dictionary, using Boolean operators, and 2 overlaying seven criteria to categorize guideline quality. The feasibility of the Boolean-based dictionary was tested by three appraisers using three randomly selected guidelines on low back pain management. The dictionary was then revised and re-tested. Results Of the 52 published studies identified, 14% had modified the instrument by adding or deleting items and 35% had adopted strategies, such as using a consensus approach, to overcome inconsistencies and ensure identical item scoring among appraisers. For the feasibility test, Pearson correlation coefficients ranged from 0.27 to 0.81. Revision and re-testing of the dictionary increased the level of agreement (range 0.41 to 0.94). Application of the revised dictionary not only decreased the variability of the domain scores, but also reduced the tool's reliability among inexperienced appraisers. Conclusion Appraisers found the Boolean-based AGREE User Guide easier to use than the original, which improved their confidence in the tool. Good reliability was achieved in the feasibility test, but the reliability and validity of some of the changes will require further evaluation.
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Affiliation(s)
- N Ann Scott
- Health Technology Assessment Unit, Institute of Health Economics, Edmonton, AB, Canada
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American College of Surgeons Guidelines Program: A Process for Using Existing Guidelines to Generate Best Practice Recommendations for Central Venous Access. J Am Coll Surg 2008; 207:676-82. [DOI: 10.1016/j.jamcollsurg.2008.06.340] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 06/19/2008] [Accepted: 06/19/2008] [Indexed: 11/30/2022]
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