Cardiovascular Center, Tufts Medical Center, Boston, Mass.
Department of Medicine, Tufts Medical Center, Boston, Mass.
J Vasc Surg Venous Lymphat Disord. 2020 Jul;8(4):685-692. doi: 10.1016/j.jvsv.2020.04.008. Epub 2020 Apr 23.
We assessed the quality of current clinical practice guidelines (CPGs) for lymphedema using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. CPGs provide recommendations for the management of medical conditions such as lymphedema. However, their evidentiary quality and methodology should determine their reliability. The AGREE II instrument was developed to externally and objectively evaluate the quality of CPGs and has been used to assess other nonvascular CPGs. A systematic review identified four CPGs for lymphedema of varying content: Lymphedema Framework's Best Practice for the Management of Lymphedema (LED F); Japanese Lymphedema Study Group-A Practice Guideline for the Management of Lymphedema (J LED); Clinical Resource Efficiency Support Team (CREST) Guidelines for the Diagnosis, Assessment and Management of Lymphedema; and Guidelines of the American Venous Forum (AVF). The quality of these CPGs appeared to vary.
The four CPGs were analyzed using the AGREE II instrument by three independent graders, who were unaware of each other's scores. Six domains with 23 items were graded using a Likert scale (1, strongly disagree; to 7, strongly agree) regarding whether the CPG had satisfied the requirements of each item. The score for each domain was calculated by summing the scores for each item in that domain and scaling the total as a percentage of the maximum possible score for that domain (ie, obtained score - minimum score/maximum possible score - minimum possible score × 100 = percentage).
CREST had the highest overall score (66.8%), as an average of all domains, and J LED had the lowest (37%). CREST also had five of five domains rated >50%. In contrast, J LED had only one and AVF had only two domains that scored >50%. Although two domains, rigor of development and applicability, scored low, with only one CPG scoring >50%, the editorial independence domain scored the lowest of all six domains.
In addition to limitations in content and the lack of contemporary references, the four CPGs studied were judged objectively to be of low quality using the AGREE II instrument. A contemporary CPG for lymphedema, guided by the AGREE II requirements, is needed.
我们使用评估指南研究与评估（AGREE）II 工具评估当前淋巴水肿临床实践指南（CPG）的质量。CPG 为淋巴水肿等医疗状况的管理提供建议。然而，其证据质量和方法学应决定其可靠性。AGREE II 工具旨在对外和客观地评估 CPG 的质量，并已用于评估其他非血管 CPG。系统评价确定了四个内容不同的淋巴水肿 CPG：淋巴水肿框架的淋巴水肿管理最佳实践（LED F）；日本淋巴水肿研究小组管理淋巴水肿实践指南（J LED）；临床资源效率支持团队（CREST）的淋巴水肿诊断、评估和管理指南；以及美国静脉论坛（AVF）指南。这些 CPG 的质量似乎有所不同。
三位独立评分员使用 AGREE II 工具分析了这四个 CPG，他们彼此之间不知道对方的评分。六个领域的 23 个项目使用李克特量表（1，强烈不同意；7，强烈同意）进行评分，以确定 CPG 是否满足每个项目的要求。每个领域的分数通过将该领域每个项目的分数相加并将总分除以该领域的最大可能分数（即，获得的分数-最小分数/最大可能分数-最小可能分数×100=百分比）来计算。
在所有领域的平均水平上，CREST 的总分最高（66.8%），而 J LED 的总分最低（37%）。CREST 还在五个领域中的五个领域的评分都超过了 50%。相比之下，J LED 只有一个领域，AVF 只有两个领域的评分超过了 50%。尽管两个领域，即制定的严谨性和适用性，得分较低，只有一个 CPG 的评分超过了 50%，但编辑独立性领域是所有六个领域中得分最低的。
除了内容上的局限性和缺乏当代参考资料外，使用 AGREE II 工具客观地判断这四个研究中的 CPG 质量较低。需要制定一个符合 AGREE II 要求的当代淋巴水肿 CPG。
