Faculty of Health, Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom.
University of Bristol, Bristol, United Kingdom.
Neurourol Urodyn. 2018 Nov;37(8):2945-2950. doi: 10.1002/nau.23775. Epub 2018 Jul 30.
The process of identifying research questions, synthesizing and interpreting evidence, and weight given to health economics differs between the clinical guidelines (CGs) for neurogenic lower urinary tract dysfunction (NLUTD). Consequently, the quality also varies which can have implications for clinical practice.
We used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument to assess the quality of the National Institute for Health and Care Excellent (NICE), European Association of Urology (EAU), and the International Consultations on Incontinence (ICI) CGs on neurogenic bladder.
The NICE CGs were deemed to be of the highest quality (overall score of 92%). NICE were the only guidelines to systematically incorporate cost-effectiveness research into their recommendations. The EAU CGs received an overall score of 83% and the ICI CGs achieved the lowest overall score (75%). The highest scoring domain among all the CGs was scope purpose (86%) and the lowest scoring domain was applicability (69%). All guidelines were recommended for use (mostly with some modifications).
All CGs had their inherent advantages and disadvantages, though all were still deemed to be of high quality. Incorporating cost-effectiveness research would be near impossible for guidelines with a broad-country remit. Incorporating the AGREE II instrument in the development of CGs and better collaboration between the ICI, NICE, and EAU could improve the quality, and consistency between NLUTD CGs and ultimately improve health outcomes for this important patient group.
识别研究问题、综合和解释证据以及对健康经济学的重视程度在神经源性下尿路功能障碍（NLUTD）的临床指南（CG）之间存在差异。因此，质量也有所不同，这可能对临床实践产生影响。
我们使用评估指南研究和评估 II（AGREE II）工具来评估国家卫生与保健卓越研究所（NICE）、欧洲泌尿外科学会（EAU）和国际尿失禁咨询委员会（ICI）关于神经源性膀胱 CG 的质量。
NICE CG 被认为是质量最高的（总体得分为 92%）。NICE 是唯一将成本效益研究系统地纳入其建议的指南。EAU CG 的总体得分为 83%，ICI CG 的总体得分为最低（75%）。所有 CG 中得分最高的领域是范围和目的（86%），得分最低的领域是适用性（69%）。所有指南都被推荐使用（大多需要一些修改）。
所有 CG 都有其内在的优缺点，但都被认为是高质量的。对于具有广泛国家任务的指南来说，纳入成本效益研究几乎是不可能的。在 CG 的制定中纳入 AGREE II 工具，并在 ICI、NICE 和 EAU 之间更好地合作，可以提高质量，一致性，并最终改善这一重要患者群体的健康结果。
