Grimmer Karen, Dizon Janine Margarita, Milanese Steve, King Ellena, Beaton Kate, Thorpe Olivia, Lizarondo Lucylynn, Luker Julie, Machotka Zuzana, Kumar Saravana
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.
BMC Med Res Methodol. 2014 May 10;14:63. doi: 10.1186/1471-2288-14-63.
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.
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.
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.
The iCAHE Guideline Quality Checklist has promising psychometric properties and clinical utility.
在决定哪些临床实践指南最能为政策或实践提供依据之前，评估其方法学质量至关重要。当前评估临床指南质量的一种方法是聚焦研究的AGREE II工具。该工具使用23个评分从1至7的问题，分为六个领域，需要至少两名独立测试者，并采用公式化的加权领域评分系统。鉴于时间紧张的临床医生、政策制定者和管理人员反馈该工具不适合临床需求，我们开发并测试了一种更简单、更简短的二元评分工具（iCAHE指南质量检查表），供单人使用。
通过将新的iCAHE指南质量检查表与AGREE II工具进行比较，测试其内容效度、结构效度、测试者间信度和临床实用性。首先比较两种工具的问题和领域。然后，由三名在指南质量评估方面经验不同的独立测试者，使用这两种工具对六个随机选择的类似主题指南进行评估。对于每个指南，使用三名测试者的评分标准计算加权领域和AGREE II总分。为每个指南、每个测试者计算iCAHE总分。使用Pearson相关系数评估iCAHE与AGREE II分数之间的线性关系。评估iCAHE指南质量检查表测试者之间的分数差异。
在四个领域（范围与目的、利益相关者参与、基础证据/严谨性、清晰度）的每个工具中都有一致的问题。六个指南的iCAHE和AGREE II分数呈中度至高度相关。无论测试者经验如何，iCAHE分数在测试者之间总体上具有良好的一致性。所有测试者都更喜欢iCAHE工具，并且使用该工具进行评估的时间明显少于AGREE II工具。然而，仅使用三名测试者和六个指南削弱了研究效能，使本研究成为对iCAHE工具心理测量特性的初步调查。
iCAHE指南质量检查表具有良好的心理测量特性和临床实用性。
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