Health and Social Sciences Cluster, Singapore Institute of Technology, 10 Dover Dr, Singapore 138682, Singapore; and Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.
School of Physiotherapy, Australian Catholic University, North Sydney, New South Wales, Australia.
Phys Ther. 2019 May 1;99(5):577-590. doi: 10.1093/ptj/pzz006.
The quality of clinical practice guidelines (CPGs) is important to ensure guideline adoption by clinicians.
The aim of this review was to identify CPGs for the management of limb amputations, appraise the quality of CPGs, and synthesize recommendations from comprehensive CPGs of high quality.
MEDLINE, EMBASE, CINAHL, PEDro, guideline-specific websites, websites for associations or networks for people with amputations, and Google Scholar were searched from April 2007 to April 2017.
Publications were included if they were CPGs or consensus statements/standards endorsed by a certified organization, covered the management of limb amputations, were freely accessible, and were written in English.
Two reviewers independently screened titles and abstracts for eligible CPGs and rated the quality of CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE-II) instrument.
Of the 15 included CPGs, 11 were of low to moderate quality and 4 were of high quality. Mean (or median) domain scores on AGREE-II were as follows: 83% for domain 1 (scope and purpose), 61% for domain 2 (stakeholder involvement), 7% for domain 3 (rigor of development), 65% for domain 4 (clarity and presentation), 24% for domain 5 (applicability), and 21% for domain 6 (editorial independence). Strong recommendations from comprehensive and high-quality CPGs were few and focused on the development of individualized treatment plans, exercises for improving physical function and the ability to perform activities of daily living, and the assessment of physical function and prognostic factors.
CPGs that were not written in English were excluded. Final recommendations from CPGs might differ if different criteria were used. Low domain scores on the AGREE-II might be due to poor reporting rather than poor methodology in the CPG development process.
Few CPGs for the management of limb amputations were of high quality, and few recommendations were strong. To improve the quality of future CPGs, guideline developers should report funding and competing interests of members, provide information to aid in the practical application of CPGs, and use a systematic approach to search for evidence and derive strength of recommendations.
临床实践指南（CPG）的质量对于确保临床医生采用指南非常重要。
本研究旨在确定肢体截肢管理的 CPG，评估 CPG 的质量，并综合高质量综合 CPG 的推荐意见。
从 2007 年 4 月至 2017 年 4 月，检索了 MEDLINE、EMBASE、CINAHL、PEDro、指南特定网站、与截肢者相关的协会或网络网站以及 Google Scholar。
如果 CPG 或经认证组织认可的共识声明/标准涵盖肢体截肢管理，可免费获取，且以英文书写，则将其纳入研究。
两位评审员独立筛选符合条件的 CPG 的标题和摘要，并使用评估指南研究和评估（AGREE-II）工具对 CPG 的质量进行评分。
15 项纳入的 CPG 中，11 项质量为低至中度，4 项质量为高度。AGREE-II 各领域的平均（或中位数）评分如下：领域 1（范围和目的）83%，领域 2（利益相关者参与）61%，领域 3（开发严谨性）7%，领域 4（清晰性和表述）65%，领域 5（适用性）24%，领域 6（编辑独立性）21%。综合和高质量 CPG 的强烈推荐建议很少，主要集中在制定个体化治疗计划、改善身体功能和日常生活活动能力的锻炼以及身体功能和预后因素的评估上。
排除了未用英文书写的 CPG。如果使用不同的标准，CPG 的最终推荐意见可能会有所不同。AGREE-II 各领域的低评分可能是由于 CPG 开发过程中报告质量较差，而不是方法学较差。
很少有肢体截肢管理的 CPG 为高质量，且很少有强烈的推荐建议。为了提高未来 CPG 的质量，指南制定者应报告成员的资助和利益冲突，提供有助于 CPG 实际应用的信息，并使用系统方法搜索证据并得出推荐意见的强度。
