Evidence map›Paper›PMID 32948216›Full record

ArticleImplementation science : IS2020

Assessment of the quality of recommendations from 161 clinical practice guidelines using the Appraisal of Guidelines for Research and Evaluation-Recommendations Excellence (AGREE-REX) instrument shows there is room for improvement.

Ivan D Florez, Melissa C Brouwers, Kate Kerkvliet, Karen Spithoff, Pablo Alonso-Coello, Jako Burgers, Francoise Cluzeau, Beatrice Férvers, Ian Graham, Jeremy Grimshaw and 5 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Implementation science : IS, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 9 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 9 syntheses or guidelines pooled it.

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  12. Quality improvement in the management of degenerative spinal disorders: a systematic review of clinical practice guidelines.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Ivan D FlorezDepartment of Pediatrics, Universidad de Antioquia, Calle 67 # 53-108, 050001, Medellin, Colombia. ivan.florez@udea.edu.co.ORCID 0000-0002-0751-8932
Melissa C BrouwersSchool of Epidemiology and Public Health, University of Ottawa, 101F, 600 Peter Morand, Ottawa, Ontario, K1G 5Z3, Canada.
Kate KerkvlietDepartment of Oncology, McMaster University, Juravinski Site, G2 Wing, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.
Karen SpithoffDepartment of Oncology, McMaster University, Juravinski Site, G2 Wing, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.
Pablo Alonso-CoelloIberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/Sant Antoni M. Claret 167, Pavelló 18 planta 0, 08025, Barcelona, Spain.
Jako BurgersDutch College of General Practitioners, PO Box 3231, Utrecht, The Netherlands.
Francoise CluzeauImperial College London, St. Mary's Hospital (Room 1070, Queen Elizabeth the Mother Wing), Praed Street, London, W2 1NY, UK.
Beatrice FérversDépartement Cancer et Environnement, Centre Léon Bérard, 28 rue Laënnec, 69373, Cedex 08, Lyon, France.
Ian GrahamOttawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Box 711, Ottawa, Ontario, K1H 8L6, Canada.
Jeremy GrimshawOttawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Box 711, Ottawa, Ontario, K1H 8L6, Canada.
Steven HannaFaculty of Health Sciences, McMaster University, 2C Health Sciences Centre, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.
Monika KastnerNorth York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada.
Michelle KhoInstitute of Applied Health Sciences McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.
Amir QaseemAmerican College of Physicians, 190 N Independence Mall West, Philadelphia, PA, 19106-1572, USA.
Sharon StrausLi Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Shuter 2-026, Toronto, Ontario, M5B 1W8, Canada.

Funding

CIHR #201209MOP-285689-KTR-CEBA-40598
6 · The paper itself

Abstract

objectiveTo assess the quality of recommendations from 161 clinical practice guidelines (CPGs) using AGREE-REX-D (Appraisal of Guidelines REsearch and Evaluation-Recommendations Excellence Draft).

designCross-sectional study

settingInternational CPG community.

participantsThree hundred twenty-two international CPG developers, users, and researchers.

interventionParticipants were assigned to appraise one of 161 CPGs selected for the study using the AGREE-REX-D tool

main outcome measuresAGREE-REX-D scores of 161 CPGs (7-point scale, maximum 7).

resultsRecommendations from 161 CPGs were appraised by 322 participants using the AGREE-REX-D. CPGs were developed by 67 different organizations. The total overall average score of the CPG recommendations was 4.23 (standard deviation (SD) = 1.14). AGREE-REX-D items that scored the highest were (mean; SD): evidence (5.51; 1.14), clinical relevance (5.95; SD 0.8), and patients/population relevance (4.87; SD 1.33), while the lowest scores were observed for the policy values (3.44; SD 1.53), local applicability (3,56; SD 1.47), and resources, tools, and capacity (3.49; SD 1.44) items. CPGs developed by government-supported organizations and developed in the UK and Canada had significantly higher recommendation quality scores with the AGREE-REX-D tool (p < 0.05) than their comparators.

conclusionsWe found that there is significant room for improvement of some CPGs such as the considerations of patient/population values, policy values, local applicability and resources, tools, and capacity. These findings may be considered a baseline upon which to measure future improvements in the quality of CPGs.

Indexed as

Practice Guidelines as TopicCanadaCross-Sectional StudiesFemaleHumansMaleAGREE toolClinical practice guidelinesImplementabilityPractice guidelinesQuality of health careRecommendations

Identifiers

PMID32948216
PMCPMC7501649

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.