More than one third of clinical practice guidelines on low back pain overlap in AGREE II appraisals. Research wasted?

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Clinical Guidelines
Authored By
Gianola S, Bargeri S, Cinquini M, Iannicelli V, Meroni R, Castellini G
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Orthopedic
Internal/Family Medicine
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Orthopedic
Internal/Family Medicine
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volume
22
ISSN
1471-2288
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1471-2288
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Additional Info
["Gianola S, Bargeri S, Cinquini M, Iannicelli V, Meroni R, Castellini G","Publisher: BioMed Central Country of Publication: England NLM ID: 100968545 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2288 (Electronic) Linking ISSN: 14712288 NLM ISO Abbreviation: BMC Med Res Methodol Subsets: MEDLINE","Journal Article; Research Support, Non-U.S. Gov't","2022-07-05","BMC medical research methodology [BMC Med Res Methodol] 2022 Jul 05; Vol. 22 (1), pp. 184. Date of Electronic Publication: 2022 Jul 05.","English","1471-2288","Low Back Pain*\/diagnosis , Low Back Pain*\/therapy, Databases, Factual ; Humans ; Reproducibility of Results","Databases, Factual, Humans, Reproducibility of Results, Low Back Pain diagnosis, Low Back Pain therapy","BMC medical research methodology","22"]
Description
Background: Systematic reviews can apply the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool to critically appraise clinical practice guidelines (CPGs) for treating low back pain (LBP); however, when appraisals differ in CPG quality rating, stakeholders, clinicians, and policy-makers will find it difficult to discern a unique judgement of CPG quality. We wanted to determine the proportion of overlapping CPGs for LBP in appraisals that applied AGREE II. We also compared inter-rater reliability and variability across appraisals.<br />Methods: For this meta-epidemiological study we searched six databases for appraisals of CPGs for LBP. The general characteristics of the appraisals were collected; the unit of analysis was the CPG evaluated in each appraisal. The inter-rater reliability and the variability of AGREE II domain scores for overall assessment were measured using the intraclass correlation coefficient and descriptive statistics.<br />Results: Overall, 43 CPGs out of 106 (40.6%) overlapped in seventeen appraisals. Half of the appraisals (53%) reported a protocol registration. Reporting of AGREE II assessment was heterogeneous and generally of poor quality: overall assessment 1 (overall CPG quality) was rated in 11 appraisals (64.7%) and overall assessment 2 (recommendation for use) in four (23.5%). Inter-rater reliability was substantial/perfect in 78.3% of overlapping CPGs. The domains with most variability were Domain 6 (mean interquartile range [IQR] 38.6), Domain 5 (mean IQR 28.9), and Domain 2 (mean IQR 27.7).<br />Conclusions: More than one third of CPGs for LBP have been re-appraised in the last six years with CPGs quality confirmed in most assessments. Our findings suggest that before conducting a new appraisal, researchers should check systematic review registers for existing appraisals. Clinicians need to rely on updated CPGs of high quality and confirmed by perfect agreement in multiple appraisals.<br />Trial Registration: Protocol Registration OSF: https://osf.io/rz7nh/.<br /> (© 2022. The Author(s).)
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