Ng Jeremy Y, Hilal Arwa, Maini Ishana
Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Centre for Learning and Discovery, McMaster University, Hamilton, Ontario, Canada.
Integr Med Res. 2022 Jun;11(2):100803. doi: 10.1016/j.imr.2021.100803. Epub 2021 Oct 28.
Traditional, complementary and integrative medicine (TCIM) is sought by more than 50% of patients with osteoporosis. Despite this, many healthcare providers lack the knowledge to adequately counsel patients on safe and effective TCIM use. The purpose of this study was to determine the quantity and quality of TCIM recommendations in clinical practice guidelines (CPGs) for the treatment and/or management of osteoporosis.
MEDLINE, EMBASE and CINAHL databases, in addition to the Guidelines International Network, and the National Center for Complementary and Integrative Health website were searched from 2009-2020. CPGs making TCIM recommendations for the treatment/management of osteoporosis were assessed with the AGREE II instrument.
Of 536 unique search results, 27 osteoporosis CPGs made mention of TCIM therapies. From highest to lowest, scaled domain percentages of all eligible CPGs averaged to 92.59% for scope and purpose, 88.79% for clarity in presentation, 55.04% for stakeholder involvement, 47.84% for editorial independence, 46.53% for rigor of development, and 36.96% for applicability. Of the 27 CPGs assessed, 4 CPGs were recommended as is by both appraisers, while 23 CPGs were recommended with modifications.
Recommendations pertaining to calcium and vitamin D supplementation and exercise were favorably recommended across nearly all CPGs. In the case of other TCIM interventions, recommendations varied greatly, which may present challenges for CPGs target users due to a lack of consistency. Given the varying quality of osteoporosis CPGs found, those requiring improvement may benefit from their guideline development panel utilizing the AGREE II instrument to inform future updates.
超过50%的骨质疏松症患者寻求传统、补充和整合医学（TCIM）治疗。尽管如此，许多医疗服务提供者缺乏足够的知识，无法就安全有效地使用TCIM为患者提供充分的咨询。本研究的目的是确定骨质疏松症治疗和/或管理的临床实践指南（CPG）中TCIM建议的数量和质量。
检索2009年至2020年期间的MEDLINE、EMBASE和CINAHL数据库，以及指南国际网络和国家补充与整合健康中心网站。使用AGREE II工具评估针对骨质疏松症治疗/管理提出TCIM建议的CPG。
在536个独特的搜索结果中，27份骨质疏松症CPG提到了TCIM疗法。所有符合条件的CPG按比例计算的领域百分比从高到低依次为：范围和目的92.59%，表述清晰度88.79%，利益相关者参与度55.04%，编辑独立性47.84%，制定严谨性46.53%，适用性36.96%。在评估的27份CPG中，两位评估者均原样推荐了4份CPG，而23份CPG在修改后被推荐。
几乎所有CPG都积极推荐了与补充钙和维生素D以及运动相关的建议。对于其他TCIM干预措施，建议差异很大，由于缺乏一致性，这可能给CPG的目标用户带来挑战。鉴于所发现的骨质疏松症CPG质量参差不齐，那些需要改进的CPG可能会受益于其指南制定小组使用AGREE II工具为未来更新提供参考。
