中国康复临床实践指南的质量评价

Quality assessment of clinical practice guidelines on Chinese rehabilitation medicine

目的评价中国康复临床实践指南的方法学质量。方法计算机检索CBM、VIP、CNKI、WanFang Data和医脉通数据库,搜集国内发表的康复医学指南,检索时限为1979年1月至2018年5月。由4名评价者独立采用AGREEⅡ工具对纳入指南进行质量评价。结果共纳入11篇指南,包括神经系统康复5篇,骨关节系统康复1篇,儿科康复、内科系统康复、烧伤康复、地震康复和康复诊疗规范各1篇。AGREEⅡ评分显示:纳入11篇指南在6个领域(范围和目的、参与人员、制订严谨性、清晰性、应用性、独立性)的平均得分分别为:65.3%、28.0%、9.3%、42.1%、6.3%和4.0%。A级(推荐)0篇,B级(修改完善后推荐)2篇,C级(不推荐)9篇。结论现有中国康复临床实践指南数量较少,且方法学质量较低,与国际公认的临床实践指南制定和报告规范差距较大。在未来我国康复指南的制订过程中,要重视指南的报告规范和指南制订的方法学,包括指南开发过程的严谨性、报告的清晰性、应用性和独立性,提升临床实践指南的质量和应用性,从而指导和规范中国康复医学临床实践。

Objectives To evaluate the methodological quality of clinical practice guidelines(CPGs) of Chinese rehabilitation medicine. Methods CBM, VIP, CNKI, WanFang Data and Medlive databases were electronically searched to collect CPGs of Chinese rehabilitation medicine from January 1979 to May 2018. Four reviewers evaluated the methodological quality of the CPGs by AGREE Ⅱ. Results A total of 11 CPGs were included, which involved 5 CPGs on nervous system rehabilitation, 1 CPG on bone and joint system rehabilitation, 1 CPG each on pediatric rehabilitation,internal medicine system rehabilitation, burn rehabilitation, earthquake rehabilitation and rehabilitation diagnosis and treatment criteria respectively. The results of AGREE Ⅱ score showed that the average scores on six domains were 65.3%,28.0%, 9.3%, 42.1%, 6.3% and 4.0%. There were not any level A(recommended) guidelines. Two guidelines were level B(recommended after being revised). The other nine guidelines were level C(not recommended). Conclusions There are a few rehabilitation CPGs in China and the quality of methodology is low. AGREE’s methods and concepts have not been fully used for formulation. The rigor of development, clarity of presentation, applicability and editorial independence of guidelines should be emphasized, so as to produce high level CPGs and improve clinical practice quality in rehabilitation medicine.