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. 2013 Dec 9;8(12):e82915.
doi: 10.1371/journal.pone.0082915. eCollection 2013.

Appraisal tools for clinical practice guidelines: a systematic review

Ulrich Siering  1 , Michaela Eikermann  2 , Elke Hausner  1 , Wiebke Hoffmann-Eßer  1 , Edmund A Neugebauer  2
Affiliations

Appraisal tools for clinical practice guidelines: a systematic review

Ulrich Siering et al. PLoS One. .

Abstract

Introduction: Clinical practice guidelines can improve healthcare processes and patient outcomes, but are often of low quality. Guideline appraisal tools aim to help potential guideline users in assessing guideline quality. We conducted a systematic review of publications describing guideline appraisal tools in order to identify and compare existing tools.

Methods: Among others we searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from 1995 to May 2011 for relevant primary and secondary publications. We also handsearched the reference lists of relevant publications. On the basis of the available literature we firstly generated 34 items to be used in the comparison of appraisal tools and grouped them into thirteen quality dimensions. We then extracted formal characteristics as well as questions and statements of the appraisal tools and assigned them to the items.

Results: We identified 40 different appraisal tools. They covered between three and thirteen of the thirteen possible quality dimensions and between three and 29 of the possible 34 items. The main focus of the appraisal tools were the quality dimensions "evaluation of evidence" (mentioned in 35 tools; 88%), "presentation of guideline content" (34 tools; 85%), "transferability" (33 tools; 83%), "independence" (32 tools; 80%), "scope" (30 tools; 75%), and "information retrieval" (29 tools; 73%). The quality dimensions "consideration of different perspectives" and "dissemination, implementation and evaluation of the guideline" were covered by only twenty (50%) and eighteen tools (45%) respectively.

Conclusions: Most guideline appraisal tools assess whether the literature search and the evaluation, synthesis and presentation of the evidence in guidelines follow the principles of evidence-based medicine. Although conflicts of interest and norms and values of guideline developers, as well as patient involvement, affect the trustworthiness of guidelines, they are currently insufficiently considered. Greater focus should be placed on these issues in the further development of guideline appraisal tools.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart for selection of appraisal tools.
Figure 2
Figure 2. Percentage (total number) of quality dimensions / items covered by the guideline appraisal tools.
Figure 3
Figure 3. Percentage (total number) of appraisal tools with questions that can be attributed to the respective quality dimension / item.
See this image and copyright information in PMC

References

    1. Graham RM, Mancher M, Miller-Wolman D, Greenfield S, Steinberg E (2011) Clinical practice guidelines we can trust. Washington: National Academies Press. - PubMed
    1. Shiffman RN, Shekelle P, Overhage JM, Slutsky J, Grimshaw J et al. (2003) Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization. Ann Intern Med 139: 493-498. doi: 10.7326/0003-4819-139-6-200309160-00013. PubMed: 13679327. - DOI - PubMed
    1. Haines A, Jones R (1994) Implementing findings of research. BMJ 308: 1488-1492. doi: 10.1136/bmj.308.6942.1488. PubMed: 8019284. - DOI - PMC - PubMed
    1. Shekelle PG, Kravitz RL, Beart J, Marger M, Wang M et al. (2000) Are nonspecific practice guidelines potentially harmful? A randomized comparison of the effect of nonspecific versus specific guidelines on physician decision making. Health Serv Res 34: 1429-1448. PubMed: 10737446. - PMC - PubMed
    1. Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J (1999) Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ 318: 527-530. doi: 10.1136/bmj.318.7182.527. PubMed: 10024268. - DOI - PMC - PubMed

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