Quality appraisal of clinical practice guidelines and consensus for the management of fragility fractures in China by AGREE <b>Ⅱ</b> and AGREE-China_Chinese Journal of Evidence-Based Medicine

Authors：

SHENG Yongcheng ¹ , LI Li ¹ , WANG Qin ¹ ,  KANG Deying ^1,2

1. Chinese Evidence-Based Medicine Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Center of Biostatistics, Design, Measurement and Evaluation (CBDME), Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

KANG Deying, Email: deyingkang@126.com

Keywords：

AGREE Ⅱ; AGREE-China; China; Fragility fractures; Clinical practice guideline; Consensus

DOI：

10.7507/1672-2531.202110101

Video：

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Objective To verify the applicability of AGREE-China and select high-quality clinical practice guidelines (CPGs) or consensus for the management of fragility fractures (FF) in China by evaluating their methodological quality. Methods CBM, CNKI, WanFang Data, VIP databases and related CPGs websites were electronically searched. Two reviewers independently screened literature, extracted data, and checked each other. Quality appraisal of CPGs or consensus were evaluated by AGREE Ⅱ and AGREE-China, and weighted Kappa value and intraclass correlation coefficients (ICC) were calculated to illustrate the consistency of the two tools. Results Nine CPGs and sixteen consensuses were included. Among the six domains in AGREE Ⅱ, "scope and purpose" domain (62.22%) scored higher than "clarity of presentation" domain (45.67%). The "stakeholder involvement" domain (34.89%) and "applicability" domain (38.17%) both exceeded 30%, while "rigor of development" domain (18.79%) and "editorial independence" domain (13.33%) were lower. Among the five domains in AGREE-China, "conflict of interest" domain (72.80%) was higher, followed by "usability/feasibility" domain (49.87%), while "scientificity/preciseness" domain (20.36%), "effectiveness/safety" domain (25.20%) and "economic efficiency" domain (14.40%) were lower. The weighted Kappa value of recommendations from the two tools was 0.694 (P<0.001), showing moderate consistency. ICC values of the same items and two evaluators were all greater than 0.85 (P<0.001) with high consistency. Three high-quality CPGs were consistently selected by the two tools. Conclusion AGREE Ⅱ holds high consistency with AGREE-China; however, AGREE-China is more suitable for the quality appraisal of Chinese CPGs or consensus. The methodological quality of CPGs or consensus for the management of FF in China needs to be further improved.

Citation： SHENG Yongcheng, LI Li, WANG Qin, KANG Deying. Quality appraisal of clinical practice guidelines and consensus for the management of fragility fractures in China by AGREE Ⅱ and AGREE-China. Chinese Journal of Evidence-Based Medicine, 2022, 22(3): 351-359. doi: 10.7507/1672-2531.202110101 Copy

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2. Si L, Winzenberg TM, Jiang Q, et al. Projection of osteoporosis-related fractures and costs in China: 2010-2050. Osteoporos Int, 2015, 26(7): 1929-1937.
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11. 吳夢佳, 張士靖, 周志超, 等. 我國臨床實踐指南利用和需求調查. 中華醫學圖書情報雜志, 2016, 25(1): 37-42.
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13. 詹思延. 臨床指南研究與評價工具簡介. 中國循證兒科雜志, 2007, 2(5): 375-377.
14. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. J Clin Epidemiol, 2010, 63(12): 1308-1311.
15. 王吉耀, 王強, 王小欽, 等. 中國臨床實踐指南評價體系的制定與初步驗證. 中華醫學雜志, 2018, 98(20): 1544-1548.
16. 中華醫學會骨科學分會創傷骨科學組, 中華醫學會骨科學分會外固定與肢體重建學組, 國家骨科與運動康復臨床醫學研究中心, 等. 中國脆性骨折術后規范化抗骨質疏松治療指南(2021). 中華創傷骨科雜志, 2021, 23(2): 93-101.
17. 陳耀龍, 羅旭飛, 王吉耀, 等. 如何區分臨床實踐指南與專家共識. 協和醫學雜志, 2019, 10(4): 403-408.
18. Zhang Z, Guo J, Su G, et al. Evaluation of the quality of guidelines for myasthenia gravis with the AGREE II instrument. PLoS One, 2014, 9(11): e111796.
19. 周亞平, 楊敏, 要鵬韜, 等. 肺癌化療領域指南與共識的質量評價. 中華腫瘤雜志, 2020, 42(12): 1025-1033.
20. 郭軼斌, 郭威, 秦宇辰, 等. 基于Kappa系數的一致性檢驗及其軟件實現. 中國衛生統計, 2016, 33(1): 169-170.
21. 余紅梅, 羅艷虹, 薩建, 等. 組內相關系數及其軟件實現. 中國衛生統計, 2011, 28(5): 497-500.
22. 李曉松. 醫學統計學(第2版). 北京: 高等教育出版社, 2008.
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Chinese Journal of Evidence-Based Medicine

Quality appraisal of clinical practice guidelines and consensus for the management of fragility fractures in China by AGREE Ⅱ and AGREE-China

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