精神科和心理治疗指南中证据等级的评估。

Evaluation of evidence grades in psychiatry and psychotherapy guidelines.

机构信息

Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336, München, Germany.

Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Institut für Medizinisches Wissensmanagement, c/o Philipps-Universität Marburg, Marburg, Germany.

出版信息

BMC Psychiatry. 2020 Oct 12;20(1):503. doi: 10.1186/s12888-020-02897-2.

DOI:10.1186/s12888-020-02897-2

PMID:33046040

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7552557/

Abstract

BACKGROUND

Information regarding the distribution of evidence grades in psychiatry and psychotherapy guidelines is lacking. Based on the German evidence- and consensus- based (S3) psychiatry and psychotherapy and the Scottish Intercollegiate Guidelines Network (SIGN) treatment guidelines, we aimed to specify how guideline recommendations are composed and to what extent recommendations are evidence-based.

METHODS

Data was collected from all published evidence- and consensus-based S3-classified psychiatry and psychotherapy guidelines. As control conditions, data from German neurology S3-classified guidelines as well as data from recent SIGN guidelines of mental health were extracted. Two investigators reviewed the selected guidelines independently, extracted and analysed the numbers and levels of recommendations.

RESULTS

On average, 45.1% of all recommendations are not based on strong scientific evidence in German guidelines of psychiatry and psychotherapy. A related pattern can be confirmed for SIGN guidelines, where the mean average of recommendations with lacking evidence is 33.9%. By contrast, in the German guidelines of neurology the average of such recommendations is 16.5%. A total of 24.5% of all recommendations in the guidelines of psychiatry and psychotherapy are classified as level A recommendations, compared to 31.6% in the field of neurology and 31.1% in the SIGN guidelines. Related patterns were observed for B and 0 level recommendations.

CONCLUSION

Guidelines should be practical tools to simplify the decision-making process based on scientific evidence. Up to 45% of all recommendations in the investigated guidelines of psychiatry and psychotherapy are not based on strong scientific evidence. The reasons for this high number remain unclear. Possibly, only a limited number of studies answer clinically relevant questions. Our findings thereby question whether guidelines should include non-evidence-based recommendations to be methodologically stringent and whether specific processes to develop expert-opinion statements must be implemented.

摘要

背景

缺乏关于精神病学和心理治疗指南中证据等级分布的信息。基于德国基于证据和共识的（S3）精神病学和心理治疗以及苏格兰校际指南网络（SIGN）治疗指南，我们旨在具体说明指南建议的组成方式以及建议在多大程度上基于证据。

方法

从所有已发表的基于证据和共识的 S3 分类的精神病学和心理治疗指南中收集数据。作为对照条件，提取了德国神经病学 S3 分类指南以及最近的 SIGN 心理健康指南的数据。两名调查员独立审查了所选指南，提取和分析了建议的数量和级别。

结果

平均而言，德国精神病学和心理治疗指南中 45.1%的建议没有基于强有力的科学证据。SIGN 指南中也可以确认相关模式，其中缺乏证据的建议的平均平均值为 33.9%。相比之下，在神经病学指南中，此类建议的平均水平为 16.5%。精神病学和心理治疗指南中所有建议的 24.5%被归类为 A 级建议，而神经病学领域的建议为 31.6%，SIGN 指南为 31.1%。B 级和 0 级建议也观察到相关模式。

结论

指南应该是基于科学证据简化决策过程的实用工具。在所调查的精神病学和心理治疗指南中，多达 45%的建议没有基于强有力的科学证据。造成这种高数字的原因尚不清楚。可能只有有限数量的研究回答了临床相关问题。我们的研究结果因此质疑指南是否应该包含非基于证据的建议，以保持方法上的严格性，以及是否必须实施制定专家意见陈述的具体流程。