Blanchette Virginie, Patry Jérôme, Brousseau-Foley Magali
Department of Physical Activity Sciences and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Centre de recherche du Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada.
Department of Physical Activity Sciences and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Centre de recherche du Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada; Faculty of Medicine, Family Medicine and Emergency Medicine Department, Université Laval, Québec, Canada.
Can J Diabetes. 2021 Dec;45(8):761-767.e12. doi: 10.1016/j.jcjd.2021.03.004. Epub 2021 Mar 26.
Although quality of care in the prevention and management of diabetic foot ulcer (DFU) has improved with the use of comprehensive evidence-based clinical practice guidelines, disparities between national and international guidelines have been demonstrated in one study conducted in Western Pacific regions. Although there are challenges of systematic implementation of evidence-based care in some clinical settings, their applications have demonstrated positive outcomes on DFU-associated burdens in many countries. The aim of this study was to review and evaluate 3 Canadian clinical practice guidelines and recommendations (CPGRs) in comparison with the 2019 International Working Group on the Diabetic Foot (IWGDF) guidelines.
Extraction of all 85 recommendations from the IWGDF guidelines was performed and 3 independent investigators used a rating recommendations adequacy method with descriptive statistics. The Appraisal of Guidelines REsearch & Evaluation (AGREE) II instrument was used for quality appraisal, and reliability scores were noted using intraclass correlation coefficients.
The Wounds Canada CPGR had the higher adequacy with the IWGDF guidelines. However, its development method was poor to fair. The Registered Nurses' Association of Ontario CPGR was superior for its development and implementation strategies, but major gaps were found in all chapters. The Diabetes Canada CPGR obtained a good quality appraisal evaluation, but was not dedicated exclusively to DFU and some important recommendations were absent. Reliability scores of AGREE II were good between investigators (p<0.0001). Some disparities were noted between Canadian and international recommendations.
Some disparities were noted, future orientations for development should include various health-care professionals involved in the team approach, patient-oriented research, recommendations published along with their level of evidence and strength of recommendations (such as with the Grading of Recommendations, Assessment, Development and Evaluations system) and implementation strategies to enhance evidence-based practice in Canada.
尽管在糖尿病足溃疡（DFU）的预防和管理中，基于循证的综合临床实践指南的应用提高了护理质量，但在西太平洋地区开展的一项研究表明，国内和国际指南之间存在差异。尽管在某些临床环境中，循证护理的系统实施存在挑战，但在许多国家，其应用已在与DFU相关的负担方面显示出积极效果。本研究的目的是将3项加拿大临床实践指南和建议（CPGR）与2019年国际糖尿病足工作组（IWGDF）指南进行比较审查和评估。
从IWGDF指南中提取了所有85条建议，3名独立研究人员采用推荐意见充分性评分方法并进行描述性统计。使用指南研究与评价（AGREE）II工具进行质量评估，并使用组内相关系数记录可靠性得分。
加拿大伤口护理协会CPGR与IWGDF指南的充分性更高。然而，其制定方法较差至一般。安大略省注册护士协会CPGR在制定和实施策略方面更胜一筹，但在所有章节中都发现了重大差距。加拿大糖尿病协会CPGR获得了良好的质量评估，但并非专门针对DFU，并且缺少一些重要建议。AGREE II在研究人员之间的可靠性得分良好（p<0.0001）。加拿大和国际建议之间存在一些差异。
发现了一些差异，未来的发展方向应包括参与团队方法的各类医疗保健专业人员、以患者为导向的研究、随证据水平和推荐强度一同发表的建议（如采用推荐分级、评估、制定和评价系统）以及在加拿大加强循证实践的实施策略。
