超过三分之一的腰痛临床实践指南在 AGREE II 评估中存在重叠。研究浪费了吗？
More than one third of clinical practice guidelines on low back pain overlap in AGREE II appraisals. Research wasted?
机构信息
Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Via R.Galeazzi 4, 20162, Milan, Italy.
Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
出版信息
BMC Med Res Methodol. 2022 Jul 5;22(1):184. doi: 10.1186/s12874-022-01621-w.
BACKGROUND
Systematic reviews can apply the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool to critically appraise clinical practice guidelines (CPGs) for treating low back pain (LBP); however, when appraisals differ in CPG quality rating, stakeholders, clinicians, and policy-makers will find it difficult to discern a unique judgement of CPG quality. We wanted to determine the proportion of overlapping CPGs for LBP in appraisals that applied AGREE II. We also compared inter-rater reliability and variability across appraisals.
METHODS
For this meta-epidemiological study we searched six databases for appraisals of CPGs for LBP. The general characteristics of the appraisals were collected; the unit of analysis was the CPG evaluated in each appraisal. The inter-rater reliability and the variability of AGREE II domain scores for overall assessment were measured using the intraclass correlation coefficient and descriptive statistics.
RESULTS
Overall, 43 CPGs out of 106 (40.6%) overlapped in seventeen appraisals. Half of the appraisals (53%) reported a protocol registration. Reporting of AGREE II assessment was heterogeneous and generally of poor quality: overall assessment 1 (overall CPG quality) was rated in 11 appraisals (64.7%) and overall assessment 2 (recommendation for use) in four (23.5%). Inter-rater reliability was substantial/perfect in 78.3% of overlapping CPGs. The domains with most variability were Domain 6 (mean interquartile range [IQR] 38.6), Domain 5 (mean IQR 28.9), and Domain 2 (mean IQR 27.7).
CONCLUSIONS
More than one third of CPGs for LBP have been re-appraised in the last six years with CPGs quality confirmed in most assessments. Our findings suggest that before conducting a new appraisal, researchers should check systematic review registers for existing appraisals. Clinicians need to rely on updated CPGs of high quality and confirmed by perfect agreement in multiple appraisals.
TRIAL REGISTRATION
Protocol Registration OSF: https://osf.io/rz7nh/.
背景
系统评价可以应用评估指南研究与评价（AGREE）II 工具对治疗腰痛（LBP）的临床实践指南（CPG）进行批判性评价；然而，当 CPG 质量评级的评价存在差异时，利益相关者、临床医生和决策者将难以辨别 CPG 质量的独特判断。我们想确定在应用 AGREE II 的评价中，用于腰痛的重叠 CPG 的比例。我们还比较了评价之间的内部一致性和变异性。
方法
在这项荟萃流行病学研究中，我们在六个数据库中搜索了对腰痛 CPG 的评价。收集评价的一般特征；分析单位是每个评价中评估的 CPG。使用组内相关系数和描述性统计测量整体评估的 AGREE II 域评分的内部一致性和变异性。
结果
总体而言，在十七项评价中有 43 项 CPG（40.6%）重叠。半数评价（53%）报告了方案注册。AGREE II 评估的报告具有异质性，且总体质量较差：总体评估 1（总体 CPG 质量）在 11 项评价中（64.7%）进行了评估，总体评估 2（使用推荐）在 4 项评价中（23.5%）进行了评估。在 78.3%的重叠 CPG 中，内部一致性是充分/完美的。变异性最大的域是第 6 域（平均四分位距[IQR]38.6）、第 5 域（平均 IQR 28.9）和第 2 域（平均 IQR 27.7）。
结论
在过去六年中，超过三分之一的腰痛 CPG 已经重新进行了评估，并且大多数评估都证实了 CPG 的质量。我们的研究结果表明，在进行新的评估之前，研究人员应该检查系统评价注册处以确定是否存在已有的评估。临床医生需要依赖高质量且在多个评估中具有完美一致性的最新 CPG。
试验注册
OSF 协议注册：https://osf.io/rz7nh/。
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