Evidence map›Paper›PMID 35790902›Full record

ArticleBMC medical research methodology2022

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

Silvia Gianola, Silvia Bargeri, Michela Cinquini, Valerio Iannicelli, Roberto Meroni, Greta Castellini

Abstract read
In one paragraph

Article in BMC medical research methodology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–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

1 citing paper in PubMed.

  1. Article
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

6 authors.

Silvia Gianola *Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Via R.Galeazzi 4, 20162, Milan, Italy. silvia.gianola@grupposandonato.it.
Silvia Bargeri *Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Via R.Galeazzi 4, 20162, Milan, Italy.
Michela CinquiniIstituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
Valerio IannicelliIRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Roberto MeroniDepartment of Physiotherapy, LUNEX International University of Health, Differdange, Luxembourg.
Greta CastelliniUnit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Via R.Galeazzi 4, 20162, Milan, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSystematic 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.

methodsFor 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.

resultsOverall, 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).

conclusionsMore 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.

trial registrationProtocol Registration OSF: https://osf.io/rz7nh/.

Indexed as

Low Back PainDatabases, FactualHumansReproducibility of ResultsAGREE instrumentGuidelinesLow back painMethodological guideline appraisalMethodological qualityPractice guidelines

Identifiers

PMID35790902
PMCPMC9254584

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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.