Quality assessment of conventional and traditional oriental medicine clinical practice guidelines for knee osteoarthritis using AGREE II instrument

Background: High-quality clinical practice guidelines are necessary for effective use of resources both at an individual patient- and national-level. Nordic clinical practice guidelines recommendations for orthotic treatment of knee osteoarthritis vary and little is known about their quality. Objectives: The aim of the study was to critically evaluate the quality of clinical practice guidelines in orthotic management of knee osteoarthritis in the Nordic countries. Study Design: Systematic review. Methods: Four national clinical practice guidelines for treatment of knee osteoarthritis were assessed for methodological rigour and transparency by four independent assessors using the AGREE II instrument. Summary domain scores and inter-rater agreement (Kendall’s W) were calculated. Results: Domain scores indicate that many guidelines have not sufficiently addressed stakeholder involvement (average score: 55%), applicability (20%) and editorial independence (33%) in the development process. Inter-rater agreement for assessors indicated ‘good’ agreement for clinical practice guidelines from Finland, Norway and Sweden ( W = 0.653, p < 0.001; W = 0.512, p = 0.003 and W = 0.532, p = 0.002, respectively) and ‘strong’ agreement for the clinical practice guideline from Denmark ( W = 0.800, p < 0.001). Conclusion: Quality of clinical practice guidelines for orthotic treatment of knee osteoarthritis in the Nordic region is variable. Future guideline development should focus on improving methodology by involving relevant stakeholders (e.g. certified prosthetist/orthotists (CPOs)), specifying conflicts of interest and providing guidance for implementation. Clinical relevance The current review suggests that, for the Nordic region, there are areas of improvement which can be addressed, which ensure clinical practice guidelines are developed under stringent conditions and based on sound methods. These improvements would ensure knee osteoarthritis patients are receiving orthotic interventions based on appropriate guidance from published guidelines.

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THU0557 QUALITY ASSESSMENT OF CLINICAL PRACTICE GUIDELINES IN AXIAL AND PERIPHERAL SPONDYLOARTHRITIS: A SYSTEMATIC APPRAISAL

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5520 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 519.2-520

Author(s):

W. Bautista-Molano ◽

E. Jauregui ◽

L. Saldarriaga ◽

M. X. Rojas ◽

J. R. Pieschacón

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Quality Assessment ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Care Providers ◽

Agree Ii ◽

Clinical Scenarios ◽

Agree Ii Instrument

Background:Clinical practice guidelines (CPG) in spondyloarthritis (SpA) serves as a tool for rheumatologists, health-care providers and patients in the selection of appropriate treatment framework in common clinical scenarios guiding decision-making processes. However, the quality of these guidelines has not yet been evaluated systematically in the field.Objectives:The aim of the study was to evaluate the quality of the CPG available for the treatment of axial and peripheral SpA.Methods:A systematic and scientific literature search between 2014 and 2019 was performed in order to identify and select CPG focused on the treatment of axial and peripheral SpA. The authors systematically searched the main guideline databases and guideline developer websites completing the search in PUBMED/MEDLINE and EMBASE. Four independent reviewers with methodological and clinical expertise in the field of SpA, assessed the eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Their degree of agreement was evaluated with the intra-class correlation coefficient (ICC). The statistical analyses as done using the R psych package.Results:Twelve CPG were selected for evaluation. The scores for each of the AGREE II domains were: scope and purpose 86% (range: 67–99%); stakeholder involvement 71% (range: 22–93%); rigour of development 61% (range: 29–82%); clarity and presentation 79% (range: 68–86%); applicability 48% (range: 21–71%); and editorial independence 72% (range: 19–92%). Most of the appraised guidelines could be recommended (n=12) or recommended with limitations (n=12) for use in clinical practice. The overall agreement among reviewers was moderate (ICC: 0.40; 95% CI 0.16 to 0.82). The CPG with the best quality assessment using the AGREE II instrument was the NICE guideline developed by the National Institute for Health and Care Excellence. A slightly higher quality assessment of CPG developed by research agencies or guideline developers was observed, in comparison to those developed by scientific societies. Figure 1..ssessment cientific societies.eld of ocieties and XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXConclusion:Quality assessment of guidelines for the treatment of axial and peripheral SpA is good with an average of 69%. However, a cut-off point has not been clearly established. Measures should be taken to assure that CPGs are based on the best available evidence and rigorously developed and reported. Additional efforts are needed to provide high-quality guidelines that serve as a useful and reliable instrument for clinical decision-making process in the field of SpA.Disclosure of Interests:None declared

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