The quality of clinical practice guidelines in traditional medicine in Korea: appraisal using the AGREE II instrument

Abstract

BackgroundThis study aimed to evaluate the quality of the current clinical practice guidelines (CPGs) in traditional medicine (TM) in South Korea using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument to further enhance the CPG development.MethodsA search was performed for guidelines in Korea from inception until March 2014 in the major Korean guideline websites [the Korean Medical Guideline Information Centre (KoMGI), the Korean Guideline Clearing House (KGC)], PubMed and seven Korean electronic databases; the Association of Korean Oriental Medicine (AKOM) was also consulted. Five independent assessors rated the quality of each CPG using the AGREE II instrument and calculated the mean score of each AGREE item. The overall agreement amongst reviewers was evaluated using the intra-class correlation coefficient (ICC).ResultsInitially, 17 CPGs were examined for TM in Korea, and only 8 CPGs satisfied the inclusion criteria. The mean scores for each AGREE II domain were as follows: (1) scope and purpose, 60.0 % (CIs, 45.05-74.94 %); (2) stakeholder involvement, 56.11 % (41.28-70.94 %); (3) rigour of development, 42.7 % (23.48-61.92 %); (4) clarity and presentation, 62.50 % (50.89-74.10 %); (5) applicability, 20.31 % (13.96-26.66 %); and (6) editorial independence, 44.58 % (10.78-78.38 %). All of the CPGs were rated as “recommended with provisos or modifications”. The ICC values for CPG appraisal using the AGREE II ranged from 0.230 to 0.993.ConclusionsTo improve clinical practice and health outcomes, well-developed CPGs are needed. The quality of CPGs for TM in Korea has remained suboptimal according to the AGREE II instrument evaluation. Therefore, guideline developers in Korea should make more of an effort to ensure high-quality CPGs.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0294-1) contains supplementary material, which is available to authorized users.

Appraising the quality of clinical practice guidelines in traditional Chinese medicine using AGREE II instrument: A systematic review

“…The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was published by a group of international guideline developers and researchers . The AGREE is a reliable and useful tool for assessment of guidelines, and the purpose is to provide a framework for assessing the quality of guidelines, provide a methodological strategy for the development of guidelines and inform what information and how information ought to be reported in guidelines AGREE instrument has been used widely in many countries to assess and validate the quality of CPGs, including CPGs for the management of particular diseases …”

“…5 The AGREE is a reliable and useful tool for assessment of guidelines, and the purpose is to provide a framework for assessing the quality of guidelines, provide a methodological strategy for the development of guidelines and inform what information and how information ought to be reported in guidelines 6 AGREE instrument has been used widely in many countries to assess and validate the quality of CPGs, including CPGs for the management of particular diseases. [7][8][9][10][11][12] China has maintained a dual healthcare delivery system that incorporates both Traditional Chinese Medicine (TCM) and Western medicine. Over past two decades, an increasing number of TCM CPGs have been developed by some academic associations and the government providing the normative diagnostic and therapeutic methods for the clinical practitioners in China.…”

Quality assessment of clinical guidelines for the treatment of obesity in adults: application of the AGREE II instrument

“…It requires a clear description of the strengths and limitations of the body of evidence, consideration of the benefits, side effects, health risks in the formulation of the recommendations, the procedure for updating the guidelines, and external expert review. This domain has eight items (7)(8)(9)(10)(11)(12)(13)(14) and maximum score per appraiser is 56. Domain (4), "clarity of presentation", assesses whether the different options for approaching the health condition or problem are clearly presented, and more specifically whether the recommendations are clear, unambiguous, and easily identifiable.…”

“…Taba et al 12 found that physicians do not consider the use of clinical guidelines as a hindrance to their professional autonomy, which theoretically facilitates their adherence to (and use of) such guidelines. Good-quality guidelines can provide less uncertainty in clinical decision-making and support health professionals in their health education process and in dealing with questions on their clinical practice 13 .…”

Evaluation of the clinical application of a leaflet for clinical practice guidelines in patients with herniated intervertebral discs: a study protocol for a randomized controlled trial

“…A CPG can be defined as “A statement developed through a systematic procedure to promote the decision-making process between health care practitioners and patients in a specific situation.” 8 The previous study was conducted over a 3-year period from January 2013 to December 2015 for the purpose of developing evidence-based CPGs for TKM as initiated by the Korean Institute of Oriental Medicine and to standardize the therapeutic technology of TKM through evidence-based clinical approaches 9, 10. Based on the above rationale, this study followed the protocol described in this report to develop evidence-based CPGs for the treatment of frequently diagnosed diseases in the field of TKM.…”