Castellini G, Iannicelli V, Briguglio M, Corbetta D, Sconfienza L M, Banfi G, Gianola S
Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
BMC Health Serv Res. 2020 Oct 22;20(1):970. doi: 10.1186/s12913-020-05827-w.
Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded.
Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted.
A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31-84%), Scope and Purpose (median 64%, IQR 22-83%), Rigour of Development (median 50%, IQR 21-72%), Clarity and Presentation (median 50%, IQR 28-79%), Stakeholder Involvement (median 36%, IQR 10-74%), and Applicability (median 11%, IQR 0-46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88-0.91). The median time span was 2 years (range, 1-4), however, 38% of the CPGs did not report the coverage dates for systematic searches.
We found methodological limitations that affect CPGs quality. In our opinion, a universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence.
1 TRIAL REGISTRATION: REGISTRATION PROSPERO DETAILS: CRD42019127619 .
临床实践指南（CPG）为临床实践提供建议，但近年来多个组织发布的CPG数量激增，引发了对其质量的担忧。本研究旨在系统评价针对腰痛（LBP）干预措施的CPG质量，并探讨质量评估者之间的评分者间信度（IRR）。记录系统评价检索与CPG发布之间的时间间隔。
检索2016年1月至2020年1月期间的电子数据库（PubMed、Embase、PEDro、TRIP）、指南组织数据库、网站及灰色文献，以识别关于LBP管理的康复、药物或手术干预的CPG。四位独立评审员使用《研究与评价指南评估II》（AGREE II）工具评估CPG质量，并记录CPG发布年份及检索策略实施年份。
共有21份CPG符合纳入标准并接受评估。其中7份（33%）范围广泛，涉及手术、康复或药物干预。AGREE II各项目得分如下：编辑独立性（中位数67%，四分位间距[IQR] 31 - 84%）、范围和目的（中位数64%，IQR 22 - 83%）、制定的严谨性（中位数50%，IQR 21 - 72%）、清晰性和呈现方式（中位数50%，IQR 28 - 79%）、利益相关者参与度（中位数36%，IQR 10 - 74%）以及适用性（中位数11%，IQR 0 - 46%）。评估者之间的IRR近乎完美（组内相关系数0.90；95%置信区间0.88 - 0.91）。时间跨度中位数为2年（范围1 - 4年），然而，38%的CPG未报告系统检索的覆盖日期。
我们发现了影响CPG质量的方法学局限性。我们认为，需要一个通用数据库，可在其中注册指南，并通过实时系统评价方法动态制定建议，以确保指南基于最新证据。
1 试验注册：注册PROSPERO详情：CRD42019127619
