Fotteler Marina L, Kocar Thomas D, Willems Jana, Voigt-Radloff Sebastian, Leinert Christoph, Dallmeier Dhayana, Hertneck Clara, Denkinger Michael
Institute for Geriatric Research Ulm, Ulm University Medical Center, Ulm, Germany; DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany.
Institute for Geriatric Research Ulm, Ulm University Medical Center, Ulm, Germany; Research Unit on Ageing, Geriatric Center at AGAPLESION Bethesda Clinic Ulm, Ulm, Germany.
J Clin Epidemiol. 2025 Aug;184:111830. doi: 10.1016/j.jclinepi.2025.111830. Epub 2025 May 13.
Clinical practice guidelines (CPGs) translate evidence into actionable recommendations to enhance care quality, improve clinical outcomes, reduce treatment variations, and make health-care delivery more cost-effective. CPGs primarily aid health-care practitioners but are also used by patients, policymakers, and organizations. The study aim was to assess CPG quality using the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument and to identify AGREE II items and domains that influence the overall assessment.
Medline and eight CPG databases were searched for guidelines applicable to older patients (≥60 years, frail, or with dementia/delirium) in acute orthopedic/traumatological settings, published in English or German since January 1, 2016, and using an evidence appraisal. Titles, abstracts, and full texts were independently screened by two reviewers using Covidence. AGREE II assessments were conducted across all 23 items in six domains by three reviewers with different professional backgrounds. Data were analyzed using descriptive statistics, Mann-Whitney U test, Pearson's r correlation matrix, variance inflation factor, univariable and multivariable regression (nonnegative least squares), and intraclass correlation coefficient. Significance was set at P < .05.
A total of 120 CPGs have been appraised, reaching a mean overall rating of 4.35 (±1.13). Most guidelines received an overall rating of five (n = 40, 33.33%), one guideline received an overall rating of one (0.8%). Using a standardized evidence rating framework (eg, Grading of Recommendations Assessment, Development and Evaluation) is significantly associated with a better overall rating (P < .001). The multivariable analysis showed that items 9, 12, and 15 had the highest influence on the overall AGREE II rating. Domain 6 (editorial independence) did not have an influence on the overall rating in a multivariable analysis.
Methodological rigor, particularly the use of a standardized evidence rating framework, is essential for a good overall AGREE II rating and thus for high-quality CPGs. The results from this analysis can assist different stakeholders who also conduct AGREE II appraisals, develop CPGs, or are charged with implementing CPG recommendations.
临床实践指南（CPG）将证据转化为可操作的建议，以提高护理质量、改善临床结果、减少治疗差异，并使医疗保健服务更具成本效益。CPG主要帮助医疗保健从业者，但患者、政策制定者和组织也会使用。本研究的目的是使用指南研究与评价（AGREE）II工具评估CPG质量，并确定影响总体评估的AGREE II项目和领域。
检索Medline和八个CPG数据库，查找自2016年1月1日以来以英文或德文发表的、适用于急性骨科/创伤科环境中年龄≥60岁、体弱或患有痴呆/谵妄的老年患者的指南，并采用证据评估。两名评审员使用Covidence独立筛选标题、摘要和全文。由三名具有不同专业背景的评审员对六个领域的所有23个项目进行AGREE II评估。使用描述性统计、曼-惠特尼U检验、皮尔逊r相关矩阵、方差膨胀因子、单变量和多变量回归（非负最小二乘法）以及组内相关系数对数据进行分析。显著性设定为P < 0.05。
共评估了120份CPG，总体平均评分为4.35（±1.13）。大多数指南的总体评分为五分（n = 40，33.33%），一份指南的总体评分为一分（0.
