Sri Lankan clinical practice guidelines: A methodological quality assessment utilizing the AGREE II instrument. Issue 4 (15th October 2018)

• Record Type: Journal Article
• Authors: Talagala, Ishanka Ayeshwari; Samarakoon, Yasara; Senanayake, Sameera; Abeysena, Chrishantha
• Is Part Of: Journal of evaluation in clinical practice. Volume 25:Issue 4(2019)
• Page Start: 630
• Page End: 636
• Publication Date: 2018-10-15
• Subjects: AGREE II instrument -- clinical practice guidelines -- methodology -- patient care -- quality -- Sri Lanka; Clinical medicine -- Periodicals; 616.005
• DOI: 10.1111/jep.13048
• Languages: English
• ISSNs: 1356-1294

Abstract

Abstract: Rationale, aims, and objectives: Clinical practice guidelines (CPG) play a major role in patient care in Sri Lanka. This study evaluates the methodological quality of the Sri Lankan CPGs developed in 2007. Methods: A total of 94 CPGs developed by several professional colleges in Sri Lanka in the year 2007 were evaluated by 2 independent reviewers using AGREE II instrument for their methodological quality. Item score being ≤3 points was defined as "poor quality". Each domain score was calculated according to AGREE II. A guideline was labelled as "strongly recommended" if 4 or more domains scored above 60%, "recommended for use with certain modification" if only 3 domain scores were above 60% or if 4 or more domain scores were between 30% and 60%, and "not recommended" if 4 or more domains scored less than 30%. Results: Most (22.3%) guidelines were developed by the College of Pathologists. Most of the guidelines (>55%) poorly reported on all the items, except for items 1, 2, and 22 of AGREE II. Median domain scores [range] and the proportion of the guidelines with domain score of <30% were as follows: domain on scope and purpose (33.3% [2.8%‐83.3%]; 42.6%), stakeholder involvement (14.9% [0.0%‐61.1%]; 81.9%), rigour of development (6.1% [0.0%‐49%]; 98.9%), clarity and presentation (30.5% [8.3%‐61.1%]; 46.8%), and applicability (8.3% [4.2%‐14.6%]; 100%). All CPGs scored 50% for "editorial independence". Reviewers reported the overall quality was poor in 86 (91.5%). Based on the definitions used in the study, of 94 CPGs, 8 (8.5%) could be recommended to be used with modifications, while 86 (91.5%) could not be recommended for clinical practice. Conclusions: The methodological quality of the CPGs was poor irrespective of the source of development. Major efforts are essential to update the CPGs according to the principles of evidence based medicine.