Luo Hao, Li Hui, Wang YangYang, Yao Sha, Xu WenJie
School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou 510000, China.
Research Office of Standardization, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Engineering and Technology Research Center of Standardization of Traditional Chinese Medicine, Guangzhou 510000, China.
J Tradit Chin Med. 2018 Jun;38(3):339-350.
To critically appraise the methodological quality of clinical practice guidelines for headache produced over the last two decades, including those covering specific interventions using Traditional Chinese Medicine.
The guidelines on headache disorders were obtained by searching a number of databases, including PubMed, EMBASE, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure Database, China Science and Technology Journal Database, and Wanfang database, three guideline-related databases [Guideline-International Network, National Guideline Clearinghouse, and Medlive], and the records of organizations that develop guidelines. The publication date was limited to the period from January 1996 to June 2015. The search terms ""headache"", ""headache disorders"", ""cephalalgia"", ""migraine"", ""tension-type headache"", ""practice guideline"", ""consensus "", ""statement"", ""regulation"", and ""recommendation"" were used in the ""MeSH"" and ""Free-text"" fields. The guidelines were independently appraised by four researchers using the Appraisal of Guidelines for Research and Evaluation Ⅱ instrument.
A total of 23 guidelines published between 1998 and 2014 were reviewed. The overall consistency of the four appraisers was good [interclass correlation coefficient 0.84; 95% confidence interval (CI) 0.82-0.86]. The mean (standard deviation) scores for scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence were 52.1 (18.0), 39.5 (17.1), 33.4 (21.0), 49.8 (21.9), 23.8 (19.3), and 24.2 (23.7). Only two guidelines were recommended, 12 were recommended with modification, and nine were not recommended.
Physical Traditional Chinese Medicine therapies were recommended to treat headache. The overall quality of headache guidelines was low in China, but evidence-based guidelines are gradually becoming mainstream. Guideline developers should carefully consider, in particular, three domains: rigor of development, applicability, and editorial independence.
严格评估过去二十年中制定的头痛临床实践指南的方法学质量，包括那些涵盖使用中医药进行特定干预的指南。
通过检索多个数据库获取头痛疾病指南，这些数据库包括PubMed、EMBASE、Web of Science、中国生物医学文献数据库、中国知网数据库、中国科技期刊数据库和万方数据库，三个与指南相关的数据库[指南国际网络、国家指南交换中心和医脉通]，以及制定指南的组织的记录。出版日期限制在1996年1月至2015年6月期间。在“医学主题词”和“自由文本”字段中使用检索词“头痛”“头痛疾病”“头痛症”“偏头痛”“紧张型头痛”“实践指南”“共识”“声明”“规范”和“推荐”。由四名研究人员使用《研究与评价指南Ⅱ》工具对指南进行独立评估。
共审查了1998年至2014年期间发表的23项指南。四名评估者的总体一致性良好[组内相关系数0.84；95%置信区间（CI）0.82 - 0.86]。范围和目的、利益相关者参与、制定的严谨性、表述的清晰度、适用性以及编辑独立性的平均（标准差）得分分别为52.1（18.0）、39.5（17.1）、33.4（21.0）、49.8（21.9）、23.8（19.3）和24.2（23.7）。仅两项指南被推荐，12项指南经修改后被推荐，9项指南不被推荐。
推荐使用中医物理疗法治疗头痛。中国头痛指南的总体质量较低，但循证指南正逐渐成为主流。指南制定者应特别仔细考虑三个领域：制定的严谨性、适用性和编辑独立性。
