Users' guides to the Medical Literature. VIII. How to use clinical practice guidelines. B. what are the recommendations and will they help you in caring for your patients? The Evidence-Based Medicine Working Group

Mc, Wilson; Rs, Hayward; Tunis,; Eb, Bass; Guyatt, G

doi:10.1001/jama.274.20.1630

Cited by 126 publications

(82 citation statements)

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“…This is a source of concern, since these aspects are crucial for users of medical literature [29,59] to decide whether a clinical practice guideline is suitable for incorporation as ''standard of care.'' It is widely recognized that CPG can be important tools for improving health care, and efforts to develop them are continuously increasing.…”

Section: Discussionmentioning

confidence: 99%

“…Many guidelines are not published in peer review journals and, apparently, many are not submitted to other external quality control processes. The need for systematic, rigorous evaluation of guideline quality is paramount, and several checklist approaches have been suggested to assess the methods used in their development and to formulate their recommendations [14,25,27,29,49,59].…”

Section: Discussionmentioning

confidence: 99%

“…All guidelines were reviewed independently by two authors (appraisers) and were scored for methodological quality according to the following publications: (a) the How to Use CPG (HUCPG) [29,59] published in JA-MA's Users' Guides to the Medical Literature series; (b) the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument [49]. Assessment of recommendations only included those referring to therapeutic interventions.…”

Section: Methodological Evaluation and Data Extractionmentioning

confidence: 99%

“…However, favorable results with their application can be expected only if the guidelines have been properly designed and implemented [24,29,59]. The task of designing low back pain guidelines is particularly complex because of the large number and wide variety of therapeutic interventions used for this condition, and because developers are often faced with a limited number, if any, of adequate studies upon which to base the recommendations for some of these interventions.…”

Section: Introductionmentioning

confidence: 99%

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A critical review of guidelines for low back pain treatment

et al. 2005

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Main problem: Little is known about the methodological quality of guidelines for low back pain treatment. We evaluated the methods used by the developers according to established standards. Methods: PubMed, guideline databases, and the World Wide Web were used to identify guidelines. Seventeen guidelines met the inclusion criteria: interventions for low back pain stated, recommendations based on or explicitly linked to evidence, and English version available. Guidelines were evaluated independently by two appraisers using a practical tool for this purpose, Users' Guides to the Medical Literature, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Results: Thirteen guidelines (76%) specified the most important therapies applied, but only nine (53%) included a complete description of the target population. Explicit processes to identify, select, and combine evidence were described in only six guidelines (35%). Few guidelines (3; 18%) explicitly considered all main outcomes when formulating therapeutic recommendations, and none contained a process to determine the relative value of different outcomes. Methodological criteria for grading the strength of the recommendations varied, and were often insufficiently specified. None of the guidelines assessed the impact of uncertainty associated with the evidence and values used. According to AGREE the quality score was highest for the scope and purpose, and clarity and presentation domains, and lowest for editorial independence and applicability. With regard to the recommendations, there was consensus for some of the interventions for acute pain (analgesics and NSAIDs, maintaining physical activity, and avoiding excessive bed rest), but explicit recommendations were lacking or ambiguous for 41% of the interventions. Most of the guidelines did not contemplate specific recommendations for chronic pain. Conclusions: A small number of the available guidelines for low back pain treatment achieved acceptable results for specific quality criteria. In general, the methods to develop the guidelines' therapeutic recommendations need to be more rigorous, more explicit and better explained. In addition, greater importance should be placed on the recommendations for chronic pain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodological Evaluation and Data Extractionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A critical review of guidelines for low back pain treatment

et al. 2005

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“…Assessment of the three COST documents with the instruments [7,9,11] used in previous systematic reviews [2,10], allows an evaluation according to standard criteria such as rigor in the development of the guidelines, as well as guarantees of the validity, clarity, strength, and applicability of the recommendations. With regard to rigor in development and guarantees of validity, the authors performed an excellent review of the available evidence from the viewpoint of identification, selection and updating, and highly accurate synthesis and grading of the evidence.…”

mentioning

confidence: 99%

Editorial Comment: European guidelines for low back pain – A necessary step forward and an opportunity not to be missed

et al. 2006

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Analysis of Overall Level of Evidence Behind Infectious Diseases Society of America Practice Guidelines

Lee¹,

Vielemeyer²

2011

Arch Intern Med

149

107

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