Article type
Abstract
Background: The treatment of mental disorders and epilepsy during the gestational period provokes concern about the risks and benefits. Clinical Practice Guidelines (CPGs) are documents that should support decisions, presenting recommendations formulated based on the best available evidence and considering other aspects.
Objective: To evaluate the quality of recommendations from high methodological quality guidelines that provide recommendations on treating mental disorders and epilepsy during the gestational period.
Methods: We performed a systematic review and identified and evaluated 38 CPGs on the care of mental health disorders during pregnancy, published or updated between 2015 and 2022. Only CPGs of high methodological quality (score ≥ 60% in domains 3 [rigor development] and 6 [editorial independence] of the second version of AGREE-II) were included in the study to analyze the quality of their recommendations using the AGREE-REX instrument.
Results: Of the 38 CPGs evaluated using the AGREE-II instrument, 17 (44.74%) were considered of high methodological quality and were assessed with AGREE-REX. In this AGREE-REX evaluation, a score variation was observed in each domain between CPGs and between domains for the same CPG. Domain 1 (Clinical Applicability) was the best evaluated, with only one CPG with a score of 22%, as it did not include the minimum criteria required by the domain. Domain 2 (Values and Preferences) analyzes the participation of interested parties. In formulating recommendations, the lowest median was 36% because although some CPGs mentioned the importance of including stakeholders, they still need to include them in the development process. Finally, domain 3 (Implementability) assesses the purpose of local application and local adoption. One CPG scored 92% in this domain, and 13 CPGs had scores equal to or greater than 50%.
Conclusion: In the CPGs for mental health and epilepsy evaluated, even high-quality ones do not result in high-quality recommendations. There are many aspects to be improved, mainly concerning values and preferences, the domain in which CPGs presented the lowest scores, especially in aspects of patient involvement.
Objective: To evaluate the quality of recommendations from high methodological quality guidelines that provide recommendations on treating mental disorders and epilepsy during the gestational period.
Methods: We performed a systematic review and identified and evaluated 38 CPGs on the care of mental health disorders during pregnancy, published or updated between 2015 and 2022. Only CPGs of high methodological quality (score ≥ 60% in domains 3 [rigor development] and 6 [editorial independence] of the second version of AGREE-II) were included in the study to analyze the quality of their recommendations using the AGREE-REX instrument.
Results: Of the 38 CPGs evaluated using the AGREE-II instrument, 17 (44.74%) were considered of high methodological quality and were assessed with AGREE-REX. In this AGREE-REX evaluation, a score variation was observed in each domain between CPGs and between domains for the same CPG. Domain 1 (Clinical Applicability) was the best evaluated, with only one CPG with a score of 22%, as it did not include the minimum criteria required by the domain. Domain 2 (Values and Preferences) analyzes the participation of interested parties. In formulating recommendations, the lowest median was 36% because although some CPGs mentioned the importance of including stakeholders, they still need to include them in the development process. Finally, domain 3 (Implementability) assesses the purpose of local application and local adoption. One CPG scored 92% in this domain, and 13 CPGs had scores equal to or greater than 50%.
Conclusion: In the CPGs for mental health and epilepsy evaluated, even high-quality ones do not result in high-quality recommendations. There are many aspects to be improved, mainly concerning values and preferences, the domain in which CPGs presented the lowest scores, especially in aspects of patient involvement.