Academic Section of Vascular Surgery, Division of Surgery, Department of Surgery & Cancer, Imperial College London, London, UK.
Academic Section of Vascular Surgery, Division of Surgery, Department of Surgery & Cancer, Imperial College London, London, UK.
Eur J Vasc Endovasc Surg. 2020 Aug;60(2):274-281. doi: 10.1016/j.ejvs.2020.04.028. Epub 2020 Jul 4.
Diabetic foot syndrome (DFS) contributes to significant morbidity in diabetic patients. Diagnostic and therapeutic approaches to DFS may be summarised in clinical practice guidelines (CPGs) to aid clinical practice but may only benefit patients if the CPG is of high quality. This study determines the methodological quality of DFS CPGs using a validated assessment tool to identify CPGs adequate for use in clinical practice.
Medline, EMBASE, and CPG databases were searched to 31 May 2019. Reference lists were also searched. Full text English evidence based DFS CPGs were included. CPGs based on expert consensus, guideline summaries, or those only available if purchased were excluded. Four reviewers independently assessed methodological quality using the Appraisal of Guidelines for Research and Evaluation II instrument. An overall guideline assessment scaled score of ≥80% was considered to be of adequate quality to recommend use.
Sixteen CPGs were identified. Good inter-reviewer reliability (ICC 0.985, 95% CI 0.980-0.989) was achieved. Poor scores were noted in domains 2 (stakeholder involvement), 5 (applicability), and 6 (editorial independence). Significant methodological heterogeneity was observed in all domains with the most noted in domain 6 (mean scaled score 43.2 ± 32.1%). Four CPGs achieved overall assessment scores of ≥80%.
Four CPGs were considered to be adequate for clinical practice based on methodological quality. However, elements of methodological quality were still lacking, and all CPGs had areas for improvement, potentially through increased multidisciplinary team involvement and trial application of recommendations. Methodological rigour may be improved using structured approaches with validated CPG creation tools in the future. Future work should also assess recommendation accuracy using available validated assessment tools.
糖尿病足综合征（DFS）会给糖尿病患者带来严重的发病率。DFS 的诊断和治疗方法可以总结在临床实践指南（CPG）中，以帮助临床实践，但只有当 CPG 质量高时，才会使患者受益。本研究使用经过验证的评估工具确定 DFS CPG 的方法学质量，以确定适合临床实践使用的 CPG。
检索了 Medline、EMBASE 和 CPG 数据库，截至 2019 年 5 月 31 日。还检索了参考文献列表。纳入了基于循证医学的完整英文 DFS CPG。排除了基于专家共识、指南摘要或仅在购买时可用的 CPG。四名审查员使用评估研究和评估 II 工具独立评估方法学质量。总体指南评估得分为≥80%被认为具有足够的质量，可以推荐使用。
确定了 16 项 CPG。良好的审查员间可靠性（ICC 0.985，95%CI 0.980-0.989）。在第 2 （利益相关者参与）、第 5 （适用性）和第 6 （编辑独立性）领域得分较差。在所有领域都观察到了显著的方法学异质性，其中最明显的是第 6 领域（平均评分 43.2±32.1%）。有 4 项 CPG 的总体评估得分≥80%。
根据方法学质量，有 4 项 CPG 被认为适合临床实践。然而，方法学质量仍存在不足之处，所有 CPG 都有改进的空间，可能通过增加多学科团队的参与和推荐的试验应用来实现。未来可以使用经过验证的 CPG 创建工具采用结构化方法来提高方法学严谨性。未来的工作还应使用现有的经过验证的评估工具评估建议的准确性。
