Are Clinical Practice Guidelines for Low Back Pain interventions of high quality and updated? A systematic review using the AGREE II instrument

Abstract BACKGROUND: Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded.METHODS: Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted. RESULTS: A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31 – 84%), Scope and Purpose (median 64%, IQR 22 – 83%), Rigour of Development (median 50%, IQR 21 – 72%), Clarity and Presentation (median 50%, IQR 28 – 79%), Stakeholder Involvement (median 36%, IQR 10 – 74%), and Applicability (median 11%, IQR 0 – 46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88 – 0.91). The median time span was 2 years (range, 1-4), however, 38% of the CPGs did not report the coverage dates for systematic searches.CONCLUSIONS: We found methodological limitations that affect CPGs quality. A universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence. LEVEL OF EVIDENCE: 1REGISTRATION PROSPERO DETAILS: CRD42019127619.

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Are Clinical Practice Guidelines of Low Back Pain interventions of high quality and updated? A systematic review using the AGREE II instrument

10.21203/rs.3.rs-42082/v3 ◽

2020 ◽

Author(s):

Greta Castellini ◽

Valerio Iannicelli ◽

Matteo Briguglio ◽

Davide Corbetta ◽

Luca Maria Sconfienza ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Grey Literature ◽

Pharmacological Intervention ◽

Low Back ◽

Agree Ii

Abstract BACKGROUND: Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded. METHODS: Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted. RESULTS: A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31 – 84%), Scope and Purpose (median 64%, IQR 22 – 83%), Rigour of Development (median 50%, IQR 21 – 72%), Clarity and Presentation (median 50%, IQR 28 – 79%), Stakeholder Involvement (median 36%, IQR 10 – 74%), and Applicability (median 11%, IQR 0 – 46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88 – 0.91). The median time span was 2 years (range, 1-4), however, 38% of the CPGs did not report the coverage dates for systematic searches. CONCLUSIONS: We found methodological limitations that affect CPGs quality. In our opinion, a universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence. LEVEL OF EVIDENCE: 1 REGISTRATION PROSPERO DETAILS: CRD42019127619.

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Are clinical practice guidelines for low back pain interventions of high quality and updated? A systematic review using the AGREE II instrument

BMC Health Services Research ◽

10.1186/s12913-020-05827-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

G. Castellini ◽

V. Iannicelli ◽

M. Briguglio ◽

D. Corbetta ◽

L. M. Sconfienza ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Grey Literature ◽

Pharmacological Intervention ◽

Low Back ◽

Agree Ii

Abstract Background Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded. Methods Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted. Results A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31–84%), Scope and Purpose (median 64%, IQR 22–83%), Rigour of Development (median 50%, IQR 21–72%), Clarity and Presentation (median 50%, IQR 28–79%), Stakeholder Involvement (median 36%, IQR 10–74%), and Applicability (median 11%, IQR 0–46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88–0.91). The median time span was 2 years (range, 1–4), however, 38% of the CPGs did not report the coverage dates for systematic searches. Conclusions We found methodological limitations that affect CPGs quality. In our opinion, a universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence. Level of evidence 1 Trial registration REGISTRATION PROSPERO DETAILS: CRD42019127619.

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Are Clinical Practice Guidelines of Low Back Pain interventions of high quality and updated? A systematic review using the AGREE II instrument

10.21203/rs.3.rs-42082/v1 ◽

2020 ◽

Author(s):

Greta Castellini ◽

Valerio Iannicelli ◽

Matteo Briguglio ◽

Davide Corbetta ◽

Luca Maria Sconfienza ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Systematic Reviews ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Grey Literature ◽

Time Span ◽

Low Back ◽

Agree Ii

Abstract BACKGROUND: Clinical practice guidelines (CPGs) provide specific recommendations for practice but, due to the increasing number of CPGs developed by multiple organisations over the last years, there are concerns about their quality. The aim is to systematically appraise the CPGs quality for low back pain (LBP) interventions and explore the inter-rater reliability (IRR) among quality appraisers. Time span intended as time from systematic reviews searches to CPGs publication was also assessed.METHODS: We undertook comprehensive searches in Pubmed, Embase, PEDro, TRIP, guideline organisation databases, websites and grey literature from January 2016 to March 2019 to identify all GPCs focus on rehabilitative, pharmacological or surgical interventions for LBP management. Four reviewers independently apprised the selected GPCs by using the Appraisal of Guidelines for Research and Evaluation II-AGREE II tool. Year of CPGs publication and year of search strategies were collected. RESULTS: 21 CPGs met the inclusion criteria and were appraised. Seven (33%) had a broad scope involving surgery, rehabilitative or pharmacological interventions. The guidelines achieved the following scores for each AGREE II item: Editorial Independence (median 67%, interquartile range [IQR] 31 – 84%), Scope and Purpose (median 64%, IQR 22 – 83%), Rigour of Development (median 50%, IQR 21 – 72%), Clarity and Presentation (median 50%, IQR 28 – 79%), Stakeholder Involvement (median 36%, IQR 10 – 74%) and Applicability (median 11%, IQR 0 – 46%). The IRR among assessors was nearly perfect (ICC 0.90; 95% CI 0.88 – 0.91). We observed a median time span of 2 years (range 1-4) however, 38% of CPGs did not report the coverage dates for systematic searches.CONCLUSIONS: We found methodological limitations affecting the CPGs quality. We call for a universal database where all guidelines can be registered and recommendations can be dynamically developed through a living systematic reviews approach ensuring the most updated evidence. LEVEL OF EVIDENCE: 1REGISTRATION PROSPERO DETAILS: CRD42019127619.

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Poor overall quality of clinical practice guidelines for musculoskeletal pain: a systematic review

British Journal of Sports Medicine ◽

10.1136/bjsports-2017-098375 ◽

2017 ◽

Vol 52 (5) ◽

pp. 337-343 ◽

Cited By ~ 18

Author(s):

Ivan Lin ◽

Louise K Wiles ◽

Robert Waller ◽

Roger Goucke ◽

Yusuf Nagree ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Critical Appraisal ◽

Low Back ◽

Agree Ii ◽

The Usa

ObjectivesUndertake a systematic critical appraisal of contemporary clinical practice guidelines (CPGs) for common musculoskeletal (MSK) pain conditions: spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis) and shoulder.DesignSystematic review of CPGs (PROSPERO number: CRD42016051653).Included CPGs were written in English, developed within the last 5 years, focused on adults and described development processes. Excluded CPGs were for: traumatic MSK pain, single modalities (eg, surgery), traditional healing/medicine, specific disease processes (eg, inflammatory arthropathies) or those that required payment.Data sources and method of appraisalFour scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used for critical appraisal.Results4664 records were identified, and 34 CPGs were included. Most were for osteoarthritis (n=12) or low back pain (n=11), most commonly from the USA (n=12). The mean overall AGREE II score was 45% (SD=19.7). Lowest mean domain scores were for applicability (26%, SD=19.5) and editorial independence (33%, SD=27.5). The highest score was for scope and purpose (72%, SD=14.3). Only 8 of 34 CPGS were high quality: for osteoarthritis (n=4), low back pain (n=2), neck (n=1) and shoulder pain (n=1).

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Clinical practice guidelines for the treatment and management of low back pain: A systematic review of quantity and quality

Musculoskeletal Science and Practice ◽

10.1016/j.msksp.2020.102295 ◽

2020 ◽

pp. 102295

Author(s):

Jeremy Y. Ng ◽

Uzair Mohiuddin ◽

Ashlee M. Azizudin

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Low Back

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How Current Clinical Practice Guidelines for Low Back Pain Reflect Traditional Medicine in East Asian Countries: A Systematic Review of Clinical Practice Guidelines and Systematic Reviews

PLoS ONE ◽

10.1371/journal.pone.0088027 ◽

2014 ◽

Vol 9 (2) ◽

pp. e88027 ◽

Cited By ~ 11

Author(s):

Hyun-Woo Cho ◽

Eui-Hyoung Hwang ◽

Byungmook Lim ◽

Kwang-Ho Heo ◽

Jian-Ping Liu ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

East Asian ◽

Low Back ◽

Current Clinical Practice ◽

Asian Countries

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HOW GOOD ARE LOW BACK PAIN GUIDELINES? A CRITICAL APPRAISAL OF THE QUALITY OF CLINICAL PRACTICE GUIDELINES USING THE AGREE II TOOL

10.14293/s2199-1006.1.sor-.ppvkw6l.v1 ◽

2020 ◽

Author(s):

Valerio Iannicelli ◽

Greta Castellini ◽

Matteo Briguglio ◽

Davide Corbetta ◽

Luca Maria Sconfienza ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Low Back ◽

Agree Ii ◽

National Systems ◽

Back Pain Management

Clinical practice guidelines (CPGs) provide evidence-based recommendations for clinical practice, but their increasing number in the last few years arises possible concerns about their quality. Preliminary results on the methodological quality of CPGs for low back pain management (LBP) are here presented. The results of this review can help researchers and Italian policymakers select and adopt the highest quality Clinical Practice Guidelines (CPGs) for Low Back Pain (LBP) management in the CPG National Systems (Sistema Nazionale Linee Guida).

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