Systematic review of current guideline appraisals performed with the Appraisal of Guidelines for Research &amp; Evaluation II instrument—a third of AGREE II users apply a cut-off for guideline quality

Hoffmann-Eßer, Wiebke; Siering, Ulrich; Neugebauer, Edmund; Lampert, Ulrike; Eikermann, Michaela

doi:10.1016/j.jclinepi.2017.12.009

Cited by 85 publications

(68 citation statements)

References 62 publications

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“…Guidelines were then ranked on the basis of their overall assessment scores. Since the AGREE II instrument does not provide a specific cut‐off to distinguish between high‐ and low‐quality guidelines, its users often apply a cut‐off based on either the domain scores or overall guideline quality . For this overview, guidelines with overall assessment scores greater than or equal to 6 points were rated as high quality, those with 4 to 5.9 points as moderate quality, and those with less than 4 points as low quality.…”

Section: Methodsmentioning

confidence: 99%

Management of overweight and obesity in primary care—A systematic overview of international evidence‐based guidelines

et al. 2019

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Summary Overweight and obesity are increasing worldwide. In general practice, different approaches exist to treat people with weight problems. To provide the foundation for the development of a structured clinical pathway for overweight and obesity management in primary care, we performed a systematic overview of international evidence‐based guidelines. We searched in PubMed and major guideline databases for all guidelines published in World Health Organization (WHO) “Stratum A” nations that dealt with adults with overweight or obesity. Nineteen guidelines including 711 relevant recommendations were identified. Most of them concluded that a multidisciplinary team should treat overweight and obesity as a chronic disease. Body mass index (BMI) should be used as a routine measure for diagnosis, and weight‐related complications should be taken into account. A multifactorial, comprehensive lifestyle programme that includes reduced calorie intake, increased physical activity, and measures to support behavioural change for at least 6 to 12 months is recommended. After weight reduction, long‐term measures for weight maintenance are necessary. Bariatric surgery can be offered to people with a BMI greater than or equal to 35 kg/m2 when all non‐surgical interventions have failed. In conclusion, there was considerable agreement in international, evidence‐based guidelines on how multidisciplinary management of overweight and obesity in primary care should be performed.

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Section: Methodsmentioning

confidence: 99%

Management of overweight and obesity in primary care—A systematic overview of international evidence‐based guidelines

et al. 2019

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“…The same procedure is performed for the total overall score, using the total domain scores for the computation. As previously suggested, we considered domain and overall scores under 50% to indicate lower quality 29–31. Two academic and practising physiotherapists (RA and RP) performed the methodological quality appraisals independently according to the AGREE II instrument 28.…”

Section: Methodsmentioning

confidence: 99%

How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines (CPGs) with a focus on quality appraisal (AGREE II)

et al. 2019

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ObjectivesTo summarise recommendations and appraise the quality of international clinical practice guidelines (CPGs) for rehabilitation after ACL reconstruction.DesignSystematic review of CPGs (PROSPERO number: CRD42017020407).Data sourcesPubmed, EMBASE, Cochrane, SPORTDiscus, PEDro and grey literature databases were searched up to 30 September 2018.Eligibility criteriaEnglish-language CPGs on rehabilitation following ACL reconstruction that used systematic search of evidence to formulate recommendations.MethodsWe followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to report the systematic review. Two appraisers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument to report comprehensiveness, consistency and quality of CPGs. We summarised recommendations for rehabilitation after ACL reconstruction.ResultsSix CPGs with an overall median AGREE II total score of 130 points (out of 168) and median overall quality of 63% were included. One CPG had an overall score below the 50% (poor quality score) and two CPGs scored above 80% (higher quality score). The lowest domain score was ‘applicability’ (can clinicians implement this in practice?) (29%) and the highest ‘scope and purpose’ (78%) and ‘clarity of presentation’ (75%). CPGs recommended immediate knee mobilisation and strength/neuromuscular training. Early full weight-bearing exercises, early open and closed kinetic-chain exercises, cryotherapy and neuromuscular electrostimulation may be used according individual circumstances. The CPGs recommend against continuous passive motion and functional bracing.ConclusionThe quality of the CPGs in ACL postoperative rehabilitation was good, but all CPGs showed poor applicability. Immediate knee mobilisation and strength/neuromuscular training should be used. Continuous passive motion and functional bracing should be eschewed.

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“…CPG quality was judged by three independent appraisers on the basis of the six domains of the AGREE-II, as described previously [12]. Of these six domains, domain 3 (rigor of development) is considered the most relevant for the reliability of the recommendations [15][16][17]. The AGREE II does not suggest a cutoff value denoting acceptable or high quality; instead, cutoff values were determined by groups assessing CPG quality [17].…”

Section: Identification Of Clinical Practice Guidelinesmentioning

confidence: 99%

“…Of these six domains, domain 3 (rigor of development) is considered the most relevant for the reliability of the recommendations [15][16][17]. The AGREE II does not suggest a cutoff value denoting acceptable or high quality; instead, cutoff values were determined by groups assessing CPG quality [17]. The domain 3 cut-off of �80% was adopted for this study to indicate high quality, as proposed in prior studies [18][19][20].…”

Section: Identification Of Clinical Practice Guidelinesmentioning

confidence: 99%

Pharmacological treatment of depression: A systematic review comparing clinical practice guideline recommendations

et al. 2020

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Depression affects over 300 million individuals worldwide and is responsible for most of the 800,000 annual suicides. Clinical practice guidelines (CPGs) for treatment of depression, founded on scientific evidence, are essential to improve patient care. However, economic and sociocultural factors may influence CPG elaboration, potentially leading to divergences in their recommendations. Consequently, we analyzed pharmacological recommendations for the treatment of depression from the most relevant CPGs. We included four CPGs with scores � 80% for Domain 3 (rigor of development) on the Appraisal of Guidelines for Research and Evaluation and two other commonly used CPGs. The recommendations, their strengths, and the level of evidence were extracted from each CPG by two independent researchers and grouped as follows: (1) general recommendations for the pharmacological treatment for depression (suicide risk, acute treatment, continuation and maintenance phases, and treatment discontinuation); (2) treatment of non-responsive or partially responsive patients; and (3) treatment for subtypes of depression (chronic, psychotic, catatonic, melancholic, seasonal, somatic, mixed, and atypical). Only 50% of CPGs included recommendations for the risk of suicide associated with pharmacotherapy. All CPGs included serotonin selective reuptake inhibitors (SSRIs) as first-line treatment; however, one CPG also included agomelatine, milnacipran, and mianserin as first-line alternatives. Recommendations for depression subtypes (catatonic, atypical, melancholic) were included in three CPGs. The strength of recommendation and level of evidence clearly differed among CPGs, especially regarding treatment augmentation strategies. We conclude that, although CPGs converged in some recommendations (e.g., SSRIs as first-line treatment), they diverged in cardinal topics including the absence of recommendations regarding the risk of suicide associated with pharmacotherapy. Consequently, the recommendations listed in a specific CPG should be followed with caution.

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Systematic review of current guideline appraisals performed with the Appraisal of Guidelines for Research & Evaluation II instrument—a third of AGREE II users apply a cut-off for guideline quality

Cited by 85 publications

References 62 publications

Management of overweight and obesity in primary care—A systematic overview of international evidence‐based guidelines

Management of overweight and obesity in primary care—A systematic overview of international evidence‐based guidelines

How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines (CPGs) with a focus on quality appraisal (AGREE II)

Pharmacological treatment of depression: A systematic review comparing clinical practice guideline recommendations

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