Advancing guideline quality through country-wide and regional appraisal of CPGs: a scoping review

Abstract

Background and Objective: Clinical practice guidelines (CPGs) are evaluated for quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) tool(s), and this is increasingly done for different countries and regional groupings. This study aimed to describe, map, and compare these geographical synthesis studies, that assessed CPG quality using the AGREE tool(s). This allowed for a global interpretation of the current landscape of these country-wide or regional quality reviews, and a closer look at their methodology and results. Study design and Methods: A scoping review was conducted searching databases Medline, Embase, Epistemonikos, and grey literature on 5 October 2021 for review studies using the latest AGREE tool(s) to evaluate country-wide or regional CPG quality. Country-wide or regional reviews were the units of analysis, and simple descriptive statistics was used to conduct the analysis. AGREE scores were analysed across subgroups into one of the seven SDG regions, to allow for meaningful interpretation. Results Fifty-seven studies fulfilled our eligibility criteria, including 2918 CPGs. Regions of the Global North, and Eastern and South-East Asia were best represented. Studies were consistent in reporting and presenting their AGREE domain and overall results, but only 18% (n = 10) reported development methods and 19% (n = 11) reported use of GRADE. Overall scores for domains Rigor of development and Editorial independence were low, notably in middle-income countries. There were no reviews from low-income countries. Editorial Independence, especially, were low across all regions with a maximum domain score of 46%. Conclusion There is an increasing tendency to appraise country-wide and regional CPGs using quality appraisal tools, and this will expectantly improve quality of CPGs globally. The AGREE tool(s), evaluated in this study, were used well and consistently across studies. Findings of low report rates of development of CPGs and of use of GRADE is concerning, as is low domain scores globally for Editorial Independence. Transparent reporting of funding and competing interests, as well as highlighting evidence-to-decision processes, should assist in further improving quality as Clinicians (especially those from lower income regions) are in dire need of high-quality guidelines.