Background Clinical practice guidelines are systematically created documents that summarize knowledge and assist in delivering high-quality medicine by identifying evidence that supports best clinical care. They are produced not only by international professional groups but also by local professionals to address locally-relevant clinical practice. We evaluated the methodological rigour and transparency of guideline development in neurology formulated by professionals in a local medical community. Methods We analyzed clinical guidelines in neurology publicly available at the web-site of the Physicians’ Assembly in Croatia in 2012: 6 guidelines developed by Croatian authors and 1 adapted from the European Federation of Neurological Societies. The quality was assessed by 2 independent evaluators using the AGREE II instrument. We also conducted a search of the Cochrane Library to identify potential changes in recommendation from Cochrane systematic reviews included in guideline preparation. Results The methodological quality of the guidelines greatly varied across different domains. ？Scope and Purpose” and ？Clarity of Presentation“ domains received high scores (100% [95% confidence interval (CI) 98.5–100] and 97% [77.9–100], respectively), the lowest scores were in “Stakeholder Involvement“ (19% [15.5–34.6]) and “Editorial Independence” (0% [0–19.2]). Conclusions of 3 guidelines based on Cochrane systematic reviews were confirmed in updated versions and one update provided new information on the effectiveness of another antidepressant. Two Cochrane reviews used in guidelines were withdrawn and split into new reviews and their findings are now considered to be out of date. Conclusion Neurological guidelines used in Croatia differ in structure and their methodological quality. We recommend to national societies and professional groups to develop a more systematic and rigorous approach to the development of the guidelines, timely inclusion of best evidences and an effort to involve target users and patients in the guideline development procedures.
References
[1]
Wolf JS Jr, Hubbard H, Faraday MM, Forrest JB (2011) Clinical practice guidelines to inform evidence based clinical practice. World J Urol 29: 303–309.
[2]
Shinohara Y, Nagayama M, Origasa H (2009) Postpublication external review of the Japanese guidelines for the management of stroke 2004. Stroke 40: 1439–1443.
[3]
Chen YL, Yao L, Xiao XJ, Wang Q, Wang ZH, et al. (2012) Quality assessment of clinical guidelines in China: 1993–2010. Chin Med J (Engl) 125: 3660–3664.
[4]
Zhang ZW, Liu XW, Xu BC, Wang SY, Li L, et al. (203) Analysis of quality of clinical practice guidelines for otorhinolaryngology in China. PLoS One 8: e53566.
[5]
The AGREE Collaboration (2001) Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument, 2001. Available: http://www.agreecollaboration.org. Accessed 2012 Aug 1.
[6]
Polus S, Lerberg P, Vogel J, Watananirun K, Souza JP, et al. (2012) Appraisal of WHO guidelines in maternal health using the AGREE II assessment tool. PLoS One 7: e38891.
[7]
Legido-Quigley H, Panteli D, Brusamento S, Knai C, Saliba V, et al. (2012) Clinical guidelines in the European Union: mapping the regulatory basis, development, quality control, implementation and evaluation across member states. Health Policy 107: 146–156.
[8]
Knai C, Brusamento S, Legido-Quigley H, Saliba V, Panteli D, et al. (2012) Systematic review of the methodological quality of clinical guideline development for the management of chronic disease in Europe. Health Policy 107: 157–167.
[9]
Azermai M, Petrovic M, Elseviers MM, Bourgeois J, Van Bortel LM, et al. (2012) Systematic appraisal of dementia guidelines for the management of behavioural and psychological symptoms. Ageing Res Rev 11: 78–86.
[10]
Croatian Physicians’ Assembly. Professional Societies. Available: http://www.hlz.hr/portal/index.php?optio？n=com_content&view=article&id=40&Itemid=？79. Accessed 2012 Feb 1.
[11]
Delaney A, Bagshaw SM, Ferland A, Laupland K, Manns B, et al. (2007) The quality of reports of critical care meta-analyses in the Cochrane Database of Systematic Reviews: an independent appraisal. Crit Care Med 35: 589–94.
[12]
Olsen O, Middleton P, Ezzo J, G？tzsche PC, Hadhazy V, et al. (2001) Quality of Cochrane reviews: assessment of sample from 1998. BMJ 323: 829–32.
[13]
Demarin V, Lovren？i？- Huzjan A, Vargek-Solter V, Vukovi？ V, Mi？kov S, et al. (2005) Consensus opinion on diagnosing brain death – Guidelines for use of confirmatory tests. Acta Clinica Croat 44: 5–79.
[14]
Demarin V, Basi？-Kes V, Zavoreo I, Bosnar-Pureti？ M, Rotim K, et al. (2008) Recommendations for neuropathic pain treatment. Acta Clin Croat 47: 181–91.
[15]
Demarin V, Lovren？i？- Huzjan A, Trkanjec Z, et al. (2006) Recommendations for stroke management 2006 update. Acta Clinica Croat 45: 219–285.
[16]
Demarin V, Vukovi？ V, Lovren？i？- Huzjan A, Lu？i？ I, Jan？uljak D, et al. (2005) Evidence based guidelines for treatment of primary headaches. Acta Clinica Croat 44: 139–183.
[17]
Petelin ？, Hajn？ek S, Wellmer J, Mrak G, Rado？ M, et al. (2010) Guidelines for preoperative diagnostic evaluation of patients with pharmacoresistant epilepsy. Neurol Croat 59: 23–34.
Attal N, Cruccu G, Haanp？？ M, Hansson P, Jensen TS, et al. (2006) EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol 13: 1153–69.
[20]
The AGREE Next Steps Consortium. Appraisal of guidelines for research & evaluation II instrument. Available: http://www.agreecollaboration.org. Accessed 2012 Aug 1.
[21]
Altman DG (1991) Practical statistics for medical research. London: Chapman and Hall.
[22]
Saarto T, Wiffen P (2007) Antidepressants for neuropathic pain. Cochrane Database Syst Rev 4: CD005454.
[23]
Wiffen P, McQuay H, Edwards JE, Moore RA (2011) Withdrawn: Gabapentin for acute and chronic pain. Cochrane Database Syst Rev 3: CD005452.
[24]
Wiffen P, Collins S, McQuay H, Carroll D, Jadad A, et al. (2010) Withdrawn: Anticonvulsant drugs for acute and chronic pain. Cochrane Database Syst Rev 1: CD001133.
[25]
Shojania KG, Sampson M, Ansari MT, Ji J, Doucette S, et al. (2007) How quickly do systematic reviews go out of date? A survival analysis. Ann Intern Med 147: 224–233.
[26]
Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, et al. (2010) Development of the AGREE II, part 2: assessment of validity of items and tools to support application. CMAJ 182: E472–478.
[27]
Rashidian A, Yousefi-Nooraie R (2012) Development of a Farsi translation of the AGREE instrument, and the effects of group discussion on improving the reliability of the scores. J Eval Clin Pract 18: 676–681.
[28]
Glasziou PP, Sawicki PT, Prasad K (2011) Montori VM; International Society for Evidence-Based Health Care (2011) Not a medical course, but a life course. Acad Med 86: e4.
[29]
Maru？i？ A, Sambunjak D, Jeron？i？ A, Mali？ki M, Maru？i？ M (2013) No health research without education for research - experience from an integrated course in undergraduate medical curriculum. Med Teach Mar 6. [Epub ahead of print].
