School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
PLoS One. 2014 May 19;9(5):e95369. doi: 10.1371/journal.pone.0095369. eCollection 2014.
Clinical practice guidelines (CPGs) have been developed to summarize evidence about the management of rheumatoid arthritis (RA) and facilitate the uptake of evidence-based knowledge by consumers, health professionals, health administrators and policy makers. The objectives of this review was to assess the quality of CPGS on non-pharmacological management of RA with a standardized and validated instrument--the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool and summarize the key recommendations from these CPGs. Scientific literature databases from 2001 to 2013 were systematically searched and a total of 13 CPGs for RA was identified. Only a minority of AGREE II domains were effectively addressed by the CPGS. Scope and purpose was effectively addressed in 10 out of 13 CPGs, stakeholder involvement in 11 CPGs, rigor of development in 6 CPGs, clarity/presentation in 9 CPGs, editorial independence in 1 CPGs, and applicability in none of the CPGs. The overall quality of the included CPGs according to the 7-point AGREE II scoring system was 4.8 ± 1.04. Patient education/self-management, aerobic, dynamic and stretching exercises were the commonly recommended for the non-pharmacological management of RA by the high-quality CPGs. The general clinical management recommendations tended to be similar among high-quality CPGs. Non-pharmacological management interventions were superficially addressed in more than half of the selected CPGs. CPGs creators should use the AGREE II criteria when developing guidelines. Innovative and effective methods of CPGs implementation to users are needed to ultimately enhance the quality of life of arthritic individuals. In addition, it was difficult to establish between strongly recommended, recommended and weakly recommended, as there is no consensus between the strength of the recommendations between the appraised CPGs.
临床实践指南（CPGs）旨在总结有关类风湿关节炎（RA）管理的证据，并促进消费者、卫生专业人员、卫生管理人员和政策制定者采用循证知识。本研究的目的是使用标准化和经过验证的评估工具——指南研究和评估工具（AGREE II）来评估非药物治疗 RA 的 CPG 质量，并总结这些 CPG 的关键建议。系统地检索了 2001 年至 2013 年的科学文献数据库，共确定了 13 项 RA 的 CPG。只有少数 CPG 有效地解决了 AGREE II 领域的问题。范围和目的在 13 项 CPG 中的 10 项中得到有效解决，利益相关者参与在 11 项 CPG 中，开发的严谨性在 6 项 CPG 中，清晰度/表述在 9 项 CPG 中，编辑独立性在 1 项 CPG 中，适用性在所有 CPG 中都没有。根据 7 点 AGREE II 评分系统，纳入的 CPG 整体质量为 4.8±1.04。高质量 CPG 通常建议对 RA 进行非药物治疗，包括患者教育/自我管理、有氧运动、动态和伸展运动。高、中质量 CPG 中的一般临床管理建议趋于相似。在选择的 CPG 中，超过一半的 CPG 仅对非药物干预措施进行了简单介绍。CPG 制定者在制定指南时应使用 AGREE II 标准。需要创新和有效的 CPG 实施方法来提供给用户，以最终提高关节炎患者的生活质量。此外，由于评估的 CPG 之间没有达成关于建议强度的共识，因此很难在强烈推荐、推荐和弱推荐之间建立联系。
