Analysis of Methodological Quality of The Process of Moving From Evidence to Recommendations in Chinese Clinical Practice Guidelines Between 2010 and 2020: A Cross-Sectional Study

Abstract

Background: The general situation of the methodological quality of the process of moving from evidence to recommendations (EtR) in Chinese CPGs and the main methodological factors affecting the rigor of EtR is still unclear. This study explored the status of the methodological characteristics of EtR by analyzing of all Chinese CPGs illustrating recognizable recommendations published during the period 2010-2020, and identified the relevant factors associated with the rigor of EtR in CPGs.Methods: We systematically searched two major Chinese databases, CNKI and WanFang Database to gather all CPGs illustrating recognizable recommendations from 2010 to 2020. A data-extraction form was designed to extract all the methodological characteristics of EtR. We used the M-K test to identify monotonically increasing or decreasing trends of each methodological characteristic over time, and compared the methodological characteristics between groups using Chi-square test. Multi-factor Binary Logistic regression analysis was used to analyze factors related to the rigor of the process of EtR in CPGs.Results: A total of 753 CPGs (EB-CPGs=386/1,127, CB-CPGs=367/1,527) were selected based on the selection criteria. EB-CPGs did better than CB-CPGs in most of the EtR methodological characteristics, and CPGs using GRADE were also superior to those not using GRADE. 43.69% (329/753) of CPGs considered relevant factors. The most frequently considered factors were the effectiveness of the intervention (398, 52.9%), safety (368, 48.9%), and balance of benefits and harms (193, 25.6%). Only 95 CPGs considered costs in the methods or the process of EtR, the proportion was even lower for the consideration of values and preferences (57, 7.6%) and feasibility (47, 6.2%). The rigor of EtR were significantly associated with GRADE or non-GRADE CPGs (OR 2.03, 95% CI 1.37-3.00, P< 0.001), EB-CPGs or CB-CPGs (OR 1.48, 95%CI 1.06-2.07, P=0.022) and the designated level of evidence (OR 1.64, 95% CI 1.15-2.34, P=0.006).Conclusion: Unsatisfactory: there is still much room for improvement in the rigor of EtR in Chinese CPGs over the last 11 years. In order to improve the rigor of EtR, guideline panels should try to consider all the relevant factors. Additionally, EB-CPGs using GRADE are preferable for enhancing the EtR rigor.