The updating of clinical practice guidelines: A systematic review of the research evidence

Article type
Authors
Martínez García L1, Ar ’ evalo-Rodríguez I2, Solí I1, Hemens B3, Vandvik P4, Haynes B3, Alonso-Coello P1
1Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
2Clinical Research Institute, GETS, Universidad Nacional de Colombia, Bogot’, Colombia
3McMaster University, Hamilton, Canada
4Norwegian Knowledge Centre for the Health Services, Oslo, Norway
Abstract
Background: Scientific knowledge is in constant change. The flow of new information requires a frequent revaluation of the available research results. Clinical practice guidelines (CPGs)are not exempted from this phenomenon and need to be kept updated to maintain the validity of their recommendations.

Objectives: To identify, describe and compare methods for updating CPGs.

Methods: Selection criteria: We included methodological research studies evaluating: 1) Strategies to evaluate if CPGs are out of date; 2) Strategies to update CPGs; and 3) Living CPGs strategies. Search strategy: The search strategy included MEDLINE (March 2011) and The Cochrane Methodology Register (the Cochrane Library Issue 3 2011). There were no restrictions concerning language or type of publication. Data collection and analysis: Authors independently selected studies and extracted data. The results are presented narratively due to differences in methodology between thestudies.

Results: The review included eight studies. Most of them described a method for updating one or more CPGs, except one study that applied it on 6 topics and another on 15 recommendations. Four studies described strategies to evaluate if CPGs were out of date, three studies described strategies to update CPGs and one study described a living CPG strategy. Five studies described a single method and three studies compared two methods. Regarding the literature searches for new evidence, those evaluating whether guidelines were out of date or those designed for the use in living guidelines applied more limited approaches. On the other hand strategies addressed to update CPGs included more exhaustive literature searches.

Conclusions: There is scarce and heterogeneous research about the updating of CPG. The development of efficient strategies to identifynew relevant evidence is needed to improve the timeliness and reduce the burden of updating CPGs.