Assessment of the quality of recommendations from 161 clinical practice guidelines using the Appraisal of Guidelines for Research and Evaluation–Recommendations Excellence (AGREE-REX) instrument shows there is room for improvement

Abstract

Objective To assess the quality of recommendations from 161 clinical practice guidelines (CPGs) using AGREE-REX-D (Appraisal of Guidelines REsearch and Evaluation-Recommendations Excellence Draft). Design Cross-sectional study Setting International CPG community. Participants Three hundred twenty-two international CPG developers, users, and researchers. Intervention Participants were assigned to appraise one of 161 CPGs selected for the study using the AGREE-REX-D tool Main outcome measures AGREE-REX-D scores of 161 CPGs (7-point scale, maximum 7). Results Recommendations from 161 CPGs were appraised by 322 participants using the AGREE-REX-D. CPGs were developed by 67 different organizations. The total overall average score of the CPG recommendations was 4.23 (standard deviation (SD) = 1.14). AGREE-REX-D items that scored the highest were (mean; SD): evidence (5.51; 1.14), clinical relevance (5.95; SD 0.8), and patients/population relevance (4.87; SD 1.33), while the lowest scores were observed for the policy values (3.44; SD 1.53), local applicability (3,56; SD 1.47), and resources, tools, and capacity (3.49; SD 1.44) items. CPGs developed by government-supported organizations and developed in the UK and Canada had significantly higher recommendation quality scores with the AGREE-REX-D tool (p < 0.05) than their comparators. Conclusions We found that there is significant room for improvement of some CPGs such as the considerations of patient/population values, policy values, local applicability and resources, tools, and capacity. These findings may be considered a baseline upon which to measure future improvements in the quality of CPGs.

Quality assessment of clinical practice guidelines for neonatal sepsis using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument: A systematic review of neonatal guidelines

“…Nevertheless, some limitations were identified in our work. Earlier disadvantages of the AGREE II instrument have been addressed in the “AGREE-REX” (Recommendation EXcellence) tool, which addresses the clinical credibility of the CPG recommendations ( 46 , 47 ). Language limitation (i.e., searching only English or Arabic language CPGs) may have resulted in the exclusion of relevant neonatal sepsis CPGs that were intended for use in non-English-speaking and non-Arabic contexts.…”

Quality of 2019 American optometric association clinical practice guideline for diabetic eye care

“…While a high methodological quality is necessary in a guideline development process, it may not directly translate into credible and acceptable guideline recommendations 23,24 . A newly developed AGREE‐II complement tool called AGREE‐REX (Appraisal of Guidelines REsearch and Evaluation ‐ Recommendations EXcellence) may be useful in examining the quality of the guideline recommendations 25 . In addition, this study is limited to the evaluation of two versions of a single guideline developed by one organisation.…”

“…23,24 A newly developed AGREEII complement tool called AGREE-REX (Appraisal of Guidelines REsearch and Evaluation -Recommendations EXcellence) may be useful in examining the quality of the guideline recommendations. 25 In addition, this study is limited to the evaluation of two versions of a single guideline developed by one organisation. For a broader contextual evidence of the quality of the diabetic eye care guidelines, a systematic review and appraisal of all available clinical practice guidelines is required.…”

Quality of clinical practice guidelines for gestational and congenital toxoplasmosis: A systematic review of the literature

“…31,32 In addition, further developments of CPGs in this area must ensure a minimum of the 11 key components for high-quality and trustworthyT A B L E 2…”