Cates Jeffrey R, Young David N, Bowerman Daniel S, Porter Robert C
Private practice of chiropractic orthopedics, 200 N. 6th Street, Oregon, IL 61061, USA.
Spine J. 2006 Jan-Feb;6(1):72-7. doi: 10.1016/j.spinee.2005.06.012.
A large number of practice guidelines are being produced by numerous organizations. Health-care professionals need to critically evaluate these practice guidelines to understand whether they are well constructed and representative of the preponderance of evidence. The guideline development process should be precise and rigorous to ensure that the results are reproducible and not vague.
To evaluate the quality of the second edition of the practice guidelines published by the American College of Occupational and Environmental Medicine (ACOEM Guidelines).
STUDY DESIGN/SETTING: Four appraisers used the AGREE (Appraisal of Guidelines Research and Evaluation) guideline evaluation instrument to evaluate the ACOEM Guidelines.
The Guidelines were evaluated with the AGREE guideline evaluation instrument. The AGREE instrument has been widely adopted around the world, and the authors recommended that it be adopted as the standard of guideline construction process evaluation in the United States. The instrument standardizes the quantitative assessment of quality for a guideline's development process across six domains that include: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, application, and editorial independence. Scores from four assessors were collected and interpreted. Additionally, each evaluator selected one of four global assessment choices: "strongly recommended for use in practice," "recommended for use with some modification or proviso," "not recommended as suitable for use in practice," or "unsure".
The ACOEM Guidelines scored highest in the dimensions that evaluated reporting of the guideline's scope and purpose (79.63) as well as clarity and presentation (86.81). The guideline scored much lower in the remaining areas that included stakeholder involvement (46.06), rigor of development (26.59), application (31.48), and editorial independence (19.17). The global assessment was unanimous with all four evaluators assessing the guideline as recommend with proviso.
Many of the Guidelines recommendations were consistent with current literature and guidelines; however, the AGREE assessment instrument evaluates the guideline development process and not the content. All the evaluators thought the content of the guidelines was substantially better than the documentation of the guideline construction process. The ACOEM Guidelines appear to have content consistent with their stated objectives, but the reporting of the guidelines construction process, particularly the rigor of recommendation development, is flawed, and the recommendations may not be valid owing to possible evidence selection deficiencies. The reader should consider these flaws and limitations when using the guideline. The reader should consider utilizing guidelines of higher quality when possible. Future guidelines should incorporate better reporting and give closer attention to guideline construction.
众多组织正在制定大量的实践指南。医疗保健专业人员需要严格评估这些实践指南，以了解它们是否构建良好且代表了大量证据。指南制定过程应精确且严谨，以确保结果具有可重复性且不模糊。
评估美国职业与环境医学学会发布的实践指南第二版（ACOEM指南）的质量。
研究设计/设置：四名评估者使用AGREE（指南研究与评估评价）指南评估工具来评估ACOEM指南。
使用AGREE指南评估工具对该指南进行评估。AGREE工具已在全球广泛采用，作者建议将其作为美国指南构建过程评估的标准。该工具对指南制定过程的质量进行定量评估，涵盖六个领域，包括：范围与目的、利益相关者参与、制定的严谨性、清晰度与呈现、应用以及编辑独立性。收集并解读了来自四名评估者的分数。此外，每位评估者从四个整体评估选项中选择其一：“强烈推荐在实践中使用”、“推荐在进行某些修改或附带条件的情况下使用”、“不推荐在实践中使用”或“不确定”。
ACOEM指南在评估指南范围和目的的报告（79.63）以及清晰度与呈现（86.81）方面得分最高。该指南在其余领域得分较低，包括利益相关者参与（46.06）、制定的严谨性（26.59）、应用（31.48）和编辑独立性（19.17）。整体评估结果一致，所有四名评估者都将该指南评估为附带条件推荐。
该指南的许多建议与当前文献和指南一致；然而，AGREE评估工具评估的是指南制定过程而非内容。所有评估者都认为该指南的内容明显优于指南构建过程的记录。ACOEM指南的内容似乎与其既定目标一致，但指南构建过程的报告，尤其是推荐意见制定的严谨性存在缺陷，并且由于可能的证据选择不足，这些建议可能无效。读者在使用该指南时应考虑这些缺陷和局限性。读者应尽可能考虑使用质量更高的指南。未来的指南应纳入更好的报告，并更加关注指南构建。
