A critical appraisal of the quality of low back pain practice guidelines using the AGREE II tool and comparison with previous evaluations: a EuroAIM initiative

Doniselli, Fabio Martino; Zanardo, Moreno; Manfrè, L.; Papini, Giacomo Davide Edoardo; Sardanelli, Francesco; Sconfienza, Luca Maria; Arana, Estanislao

doi:10.1007/s00586-018-5763-1

Cited by 27 publications

(35 citation statements)

References 36 publications

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“…Following the AGREE II manual instructions, domain scores were “…calculated by summing up all the scores of the individual items in a domain and by scaling the total as a percentage of the maximum possible score for that domain” (17). Guideline overall quality was considered “high” when 5 or more domains scored more than 60%, “average” when 3 or 4 domains scored more than 60%, and “low” when no more than two domains scored more than 60%, as previously performed (13–16). Mean scores ± standard deviations of each guideline were then calculated.…”

Section: Methodsmentioning

confidence: 99%

“…The level of agreement among the four appraisers was assessed using the intraclass correlation coefficient (ICC) analysis and rated as: poor (ICC ≤ 0.20); fair (ICC from 0.21 to 0.40); moderate (ICC from 0.41 to 0.60); good (ICC from 0.61 to 0.80); and very good (ICC ≥ 0.81) (13–16). Scores collection and calculation as well as the statistical analysis were performed by an independent reviewer (SC) with 9 years of experience in scientific research and biostatistics.…”

Section: Methodsmentioning

confidence: 99%

“…A recent initiative to assess meticulously the quality of the current imaging guidelines has been promoted by the European Network for the Assessment of Imaging in Medicine (EuroAIM), founded by the European Institute for Biomedical Imaging Research (EIBIR) (12). First evaluations conducted in this matter revealed that the quality of imaging guideline is heterogeneous, ranging from low to high levels (13–16). In the context of the EuroAIM initiative, we aimed to evaluate the quality of the existing guidelines on the role of imaging in glioma patients.…”

Section: Introductionmentioning

confidence: 99%

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A Critical Appraisal of the Quality of Glioma Imaging Guidelines Using the AGREE II Tool: A EuroAIM Initiative

et al. 2019

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Background: Following the EuroAIM initiative to assess the quality of medical imaging guidelines by using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, we aimed to evaluate the quality of the current imaging guidelines in patients with gliomas. Methods: A literature search was conducted to identify eligible imaging guidelines considered in the management of adult patients with gliomas. The selected guidelines were evaluated using the AGREE II instrument by four independent appraisers. The agreement among the four appraisers was estimated using the intraclass correlation coefficient (ICC) analysis. Results: Seven guidelines were selected for the appraisal. Six out of the seven guidelines showed an average level of quality with only one showing a low quality. The highest scores were found in Domain 1 “Scope and purpose” (mean score = 81.2%) and Domain 4 “Clarity of presentation” (mean score = 77.6%). The remaining domains showed a low level of quality and, in particular, Domain 5 “Applicability” was the most critical with a mean score of 41.7%, mainly related to a minor attention to barriers and facilitators as well as costs and resources implications of applying the guidelines. The ICC analysis showed a very good agreement among the four appraisers with ICC values ranging from 0.907 to 0.993. Conclusions: The available guidelines on glioma imaging emerged as of average quality according to the AGREE II tool analysis. Based on these results, further efforts should be made in order to involve different professional bodies and stakeholders and increase patient and public involvement in any future guideline drafting as well as to improve the applicability of these guidelines into the clinical practice.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Critical Appraisal of the Quality of Glioma Imaging Guidelines Using the AGREE II Tool: A EuroAIM Initiative

et al. 2019

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“…Published CPGs appraisals report that the quality is generally poor, though it appears to have recently improved, and that their applicability is generally low [8,9]. Appraisals of CPGs for LBP [9][10][11][12][13][14] do not take into account the most recently published guidelines. Since CPGs provide a bridge between scientific literature and clinical decision making, their implementation in clinical practice should be based on recent evidence, and consider as much as possible a wide range of therapeutic choices [15].…”

Section: Introductionmentioning

confidence: 99%

Are clinical practice guidelines for low back pain interventions of high quality and updated? A systematic review using the AGREE II instrument

Castellini

Iannicelli

Briguglio

et al. 2020

BMC Health Serv Res

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Background 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. Methods 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. Results 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. Conclusions 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. Level of evidence 1 Trial registration REGISTRATION PROSPERO DETAILS: CRD42019127619.

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“…Neither is their relationship with each other. In the search for reliable LBP-markers, better diagnostic tools are warranted (4,5). The combination of HIZs, MCs and EP-changes could potentially be a stronger indicator of painful spine segments than the presence of these individual features alone.…”

Section: Introductionmentioning

confidence: 99%

Associations between high intensity zones, Modic and endplate changes in lumbar spine of low back pain patients

Lagerstrand

Brisby

Hebelka

2019

Preprint

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Background High intensity zones (HIZ), Modic and endplate changes have all been pointed out as potential markers of low back pain (LBP). If an association between these morphological features exist, it may not only deepen the understanding of the underlying patho-physiological mechanism of LBP but may also improve the diagnostics by enabling stratification between individuals with non-specific LBP as well as within individuals having multi-segmental changes. The aim was to investigate if HIZ, Modic and endplate changes are associated and if endplate and vertebral T2-values reflect functional tissue characteristics related to these morphological features.Methods 150 IVDs with corresponding endplates and vertebrae in 26 chronic LBP-patients (25-69y, mean 38y, 11 males) were examined with T1- and T2-weighted MRI, and T2-mapping. Associations between morphological features and between morphological features and functional T2-values were determined. Results HIZ (62% of patients, 1-2/patient) was associated with endplate changes (100% of patients, 1-7/patient) (p=0.0003 and 0.0004 for upper and lower endplates), with an occurrence of 91% for upper and 71% for lower endplates adjacent to discs with HIZ. Modic changes (81% of patients, 1-3/patient) was associated with endplate changes (p<0.0001) with an occurrence of 87% for endplates adjacent to vertebrae with Modic changes. The occurrence of both HIZ and Modic changes was 43% (p=0.0001) for upper and 29% (p=0.003) for lower vertebrae. Significantly higher T2-values (p<0.004) were found in the vertebral tissue with associated Modic changes and HIZ. Conclusions This study of LBP-patients suggests that HIZ is associated with simultaneous presence of both Modic and endplate changes in the same motion segment. If these three simultaneous morphological features are linked to an active inflammatory process, reflected as a clinical specific pain profile remains to be investigated.

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A critical appraisal of the quality of low back pain practice guidelines using the AGREE II tool and comparison with previous evaluations: a EuroAIM initiative

Abstract: Considering all guidelines, only one had a "low" overall score, while half of them were rated as of "high" quality. Future guidelines might take this into account to improve clinical applicability.

Cited by 27 publications

References 36 publications

A Critical Appraisal of the Quality of Glioma Imaging Guidelines Using the AGREE II Tool: A EuroAIM Initiative

A Critical Appraisal of the Quality of Glioma Imaging Guidelines Using the AGREE II Tool: A EuroAIM Initiative

Are clinical practice guidelines for low back pain interventions of high quality and updated? A systematic review using the AGREE II instrument

Associations between high intensity zones, Modic and endplate changes in lumbar spine of low back pain patients

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