Critical Appraisal of the National Institute for Health and Care Excellence (NICE) Guidelines for Spine Disorders using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II)

Abstract

Introduction: Disorders of the spine (as defined by the musculoskeletal structures surrounding the spinal neural elements) require an evidence-based, approach to their care. This evaluation used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument to evaluate the methodological quality of evidence-based guidelines on spine disorders published by The National Institute for Health and Care Excellence (NICE).Materials and methods: We systematically searched clinical guidelines on spine disorders published by NICE until December 2019. Four appraisers across three international centers independently evaluated the quality of eligible clinical guidelines using AGREE II. Mean AGREE II scores for each domain were calculated. In higher quality domains scores for individual items were analysed. The guidelines were grouped according to type and year of publication. Comparative statistics and intraclass correlation (ICC) calculations were performed.Results: A total of 37 guidelines published by NICE on spine disorders were identified. Mean scores for all six domains were as follows: Scope and Purpose (73.2%), Stakeholder Involvement (63.9%), Rigour of Development (68.1%), Clarity of Presentation (73.6%), Applicability (53.2%) and Editorial Independence (64.5%). The mean score for overall quality of all NICE spinal-related guidelines was 68.8% (95% CI: 62.3–75.3). Interventional Procedure Guidelines were evaluated as possessing significantly lower overall quality than other types (p = 0.007). Overall quality was significantly associated with year of publication (rs=0.476, p = 0.0029). Evaluator ICC for each guideline ranged from 0.39 to 0.95.Conclusions: NICE guidelines on spine disorders demonstrated acceptable or good quality across most domains. Despite deficiencies in the applicability domain, their quality has improved over time. We recommend use of NICE guidelines for assessment and treatment of spine disorders.