Quality assessment of Clinical Practice Guidelines (CPG) for the diagnosis and treatment of inflammatory bowel disease using the AGREE II instrument: a systematic review

Abstract

Background The incidence and diagnosis of inflammatory bowel disease (IBD) has increased considerably in recent years. Many clinical practice guidelines (CPG) have been developed for the management of this disease across different clinical contexts, however, little evidence exists on their methodological quality. Therefore, we aimed to systematically evaluate the quality of CPGs for the diagnosis and treatment of IBD using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Methods We identified CPGs by searching databases (MEDLINE - PubMed, EMBASE, CINAHL, LILACS) and other sources of gray literature on January 2022. We included guidelines with specific recommendations for the diagnosis and treatment of IBD and evaluated them with the AGREE II instrument to assess their methodological quality. Six independent reviewers assessed the quality of the guidelines and resolved conflicts by consensus. We assessed the degree of agreement using the intraclass correlation coefficient (ICC) and change in quality over time was appraised in two periods: from 2012 to 2017 and from 2018 to 2022. Results We analyzed and evaluated 26 CPGs that met the inclusion criteria. The overall agreement among reviewers was moderate (ICC: 0.74; 95% CI 0.36 - 0.89). The mean scores of the AGREE II domains were: “Scope and purpose” 84.51%, “Stakeholder involvement” 60.90%, “Rigor of development” 69.95%, “Clarity of presentation” 85.58%, “Applicability” 26.60%, and “Editorial independence” 62.02%. No changes in quality were found over time. Conclusions The quality of the CPGs evaluated was generally good, with a large majority of the assessed guidelines being “recommended” and “recommended with modifications”; despite this, there is still room for improvement, especially in terms of stakeholder involvement and applicability. Efforts to develop high quality CPGs for IBD need to be further optimized.

Complementary and alternative medicine mention and recommendations in inflammatory bowel disease guidelines: systematic review and assessment using AGREE II

“…One study conducted a systematic review of IBD diagnosis and/or treatment CPGs, applying the AGREE II instrument and finding similar average scaled domain percentage findings: clarity of presentation (85.58%), scope and purpose (84.51%), editorial independence (62.02%), rigour of development (69.95%), stakeholder involvement (60.90%), and applicability (26.60%) [ 87 ]. The study’s authors concluded that the quality of most evaluated CPGs was acceptable, though there was room for improvement in the domains of stakeholder participation and applicability [ 87 ].…”

“…One study conducted a systematic review of IBD diagnosis and/or treatment CPGs, applying the AGREE II instrument and finding similar average scaled domain percentage findings: clarity of presentation (85.58%), scope and purpose (84.51%), editorial independence (62.02%), rigour of development (69.95%), stakeholder involvement (60.90%), and applicability (26.60%) [ 87 ]. The study’s authors concluded that the quality of most evaluated CPGs was acceptable, though there was room for improvement in the domains of stakeholder participation and applicability [ 87 ]. Another systematic review applied the AGREE II instrument to pharmacological therapy recommendations in IBD CPGs, though the pharmacological review differed considerably in domains of editorial independence (94.0%), applicability (45.8%), and stakeholder involvement (38.9%) [ 88 ] as compared to this present review.…”

GP preferences for, access to, and use of evidence in clinical practice: a mixed-methods study

“… 19 Other barriers exist such as the quantity of guidelines available and variations in the quality and the possibility of contradictory evidence. 20 , 21 …”

“…A recent systematic review categorises the barriers into political and social factors (requirement of a leader to champion implementation), health system organisation factors (lack of time), guideline factors (clarity and access), health professional factors (confidence and knowledge) and patient factors (social and cultural influence) [19]. Other barriers exist such as the quantity of guidelines available and variations in the quality and the possibility of contradictory evidence [20,21].…”