Department of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, Canada T2N1N1; Institute of Health Policy, Management and Evaluation, University of Toronto, 63 George Street, Toronto, Ontario M5S2Z9, Canada.
Division of Rheumatology, Mount Sinai Hospital, University of Toronto, 60 Murray Street, Toronto, Ontario M5T3L9, Canada.
J Clin Epidemiol. 2014 Nov;67(11):1274-85. doi: 10.1016/j.jclinepi.2014.07.005. Epub 2014 Sep 16.
To assess how well treatment recommendations for rheumatoid arthritis (RA) address Grading of Recommendations Assessment, Development and Evaluation (GRADE) steps and determine whether these steps can be adequately appraised using Appraisal of Guidelines Research & Evaluation II (AGREE-II).
We systematically reviewed English-language treatment recommendations for the pharmacologic management of RA since 2000, assessed how well GRADE steps were addressed, rated AGREE-II quality, and compared the findings.
GRADE steps were poorly addressed by the 44 included guidelines. Few guidelines discussed study limitations and/or risk of bias (23%), inconsistency (50%), indirectness (39%), imprecision (23%), or potential for publication bias (0%). Observational evidence was cited in 96% but rarely evaluated systematically. Only one guideline considered evidence on patients' preferences for health outcomes, and few provided an explicit justification for the strength of evidence or recommendation. The five GRADE steps that overlapped with AGREE-II questions were addressed more frequently (by 54-100% of guidelines) than the 13 GRADE steps not directly assessed by AGREE-II (0-50%). Among the nine guidelines rated as "Recommended for use" by AGREE-II, 8 of 13 GRADE steps were not addressed consistently by any guideline.
GRADE's steps are poorly addressed by RA recommendations. AGREE-II provides a broad assessment of quality but lacks sufficient granularity to assess how well a guideline addresses GRADE's steps.
评估类风湿关节炎 (RA) 治疗建议在评估、制定和评估 (GRADE) 步骤方面的表现，并确定这些步骤是否可以通过评估指南研究与评估 II (AGREE-II) 进行充分评估。
我们系统地回顾了自 2000 年以来治疗 RA 的药物管理的英语治疗建议，评估了 GRADE 步骤的实施情况，对 AGREE-II 质量进行了评级，并比较了研究结果。
44 项纳入的指南对 GRADE 步骤的处理较差。很少有指南讨论研究局限性和/或偏倚风险 (23%)、不一致性 (50%)、间接性 (39%)、不精确性 (23%) 或发表偏倚的可能性 (0%)。96%的研究引用了观察性证据，但很少进行系统评估。只有一项指南考虑了患者对健康结果的偏好的证据，很少有指南明确为证据或建议的强度提供依据。与 AGREE-II 问题重叠的五个 GRADE 步骤比未直接评估的 13 个 GRADE 步骤被更频繁地处理 (54%-100%的指南) (0-50%)。在被 AGREE-II 评为“推荐使用”的 9 项指南中，没有任何一项指南始终如一地处理了 13 个 GRADE 步骤中的 8 个步骤。
RA 建议对 GRADE 步骤的处理较差。AGREE-II 提供了对质量的广泛评估，但缺乏足够的粒度来评估指南在多大程度上解决了 GRADE 的步骤。
