How to assess the overall quality of guidelines using the AGREE instrument

Tags: Oral
Wang J1, Wan M2, Hu Y1, Zhang D3, Li Z1, Chang C1, Luo X2, Wang Z3, Wei D4, Yang K4
1School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China, 2The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China;, 3School of Public Health, Lanzhou University, Lanzhou 730000, China;, 4Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Chinese GRADE Center, Lanzh

Background:The Appraisal of Guidelines for REsearch & Evaluation (AGREE) instrument is a tool for development, assessment and reporting of guidelines. There are 6 domains (23 items) and the item(s) of overall guideline assessment in the original and second version of the AGREE instrument. There is no criterion of overall guideline assessment in the two versions, however, researchers using AGREE to assess guidelines have defined the standard.

Objectives: We aimed to collect the criteria of overall assessment of guidelines through reviewing research using the AGREE instrument to assess guidelines.

Methods:We searched MEDLINE (via PubMed) and Web of Science to identify studies using the AGREE instrument to assess guidelines. Two independent reviewers screened titles and abstracts, reviewed full-text, and extracted data.

Results: A total 61 studies were included, which were published from 2003 to 2015. Of those, 55.7% (34/61) studies used AGREE I, and the remainder (44.3%, 27/61) AGREE II. 63.9% (39/61) studies completed the overall assessment of guidelines. Of which, 39.3% (24/61) reported the criteria. We summarised 13 criteria. Most of the criteria (77%, 10/13) consisted of the special score of each domain and the number of domains with the special score.

Conclusions: The criteria for assessing the overall quality of guidelines using the AGREE instruments are not consistent but most are based on the special score of each domain and the number of domains with the special score. We suggest that the following five factors should be considered for overall assessment of guidelines: 1) the method and process of collecting the evidence; 2) the grading of quality of evidence and strength of recommendations; 3) the management of conflicts of interest; 4) the reporting of recommendations; and, 5) the release date of the guideline.