针刺临床实践指南的质量评价

Quality assessment of clinical practice guidelines on acupuncture

目的评价国内外针刺临床实践指南的方法学及报告质量,为研发高质量的针刺临床实践指南提供参考。方法计算机检索GIN、NICE、AHRQ、PubMed、EMbase、AMED、CINAHL、WanFang Data、CNKI、VIP和CBM数据库,搜集国内外针刺临床实践指南,检索时限均为建库至2018年9月。由2名研究者独立筛选文献、提取资料后,使用AGREEⅡ和RIGHT评价纳入指南的方法学质量和报告质量。结果共纳入23部指南,3部由国外机构制订,其余20部均由WHO西太区与中国针灸学会联合发布。AGREEⅡ评价结果显示:国内指南在“范围和目的”、“参与人员”、“制订严谨性”、“应用”、“表达清晰性”方面得分较国外指南高,仅“编辑独立性”较国外指南低,总体推荐意见较国外指南强。RIGHT评价结果显示:国外指南报告项目占52.38%、未报告占38.09%、部分报告(不适用)占6.66%;国内指南报告项目占45.71%、未报告占40%、部分报告(不适用)占14.28%。由于针刺干预的特殊性,使用AGREEⅡ和RIGHT评价针刺临床实践指南在适用性方面仍存在一定程度的障碍。结论针刺临床实践指南的方法学及报告质量均较低,亟需进一步提高指南方法学水平及报告规范,并研发针对针刺领域指南的评价工具。

Objectives To analyze the current methodological and reporting quality of both domestic and overseas clinical practice guidelines on acupuncture,and to provide reference for the development of high quality acupuncture clinical practice guidelines.Methods GIN,NICE,AHRQ,PubMed,EMbase,AMED,CINAHL,WanFang Data,CNKI,VIP and CBM databases were electronically searched to collect domestic and overseas clinical practice guidelines on acupuncture from inception to September,2018.Two reviewers independently screened literature,extracted data and evaluated the methodological and reporting quality by using AGREEⅡand RIGHT tools.Results A total of 23 acupuncture clinical practice guidelines were included,in which three were developed by foreign institutions,and the remaining 20 guidelines were jointly developed by WHO Western Pacific Region and China Institute of Acupuncture and Moxibustion.Three foreign and two domestic guidelines were selected for evaluation.The AGREEⅡevaluation showed that the domestic guidelines have higher scores in terms of“scope and purpose”,“stakeholder involvement”,“rigor of development”,“applicability”and“clarity of presentation”,while only“editorial independence”is lower.The overall recommendation is stronger than the foreign guidelines.The RIGHT evaluation showed that for three foreign guidelines,the“reported”items accounted for 52.38%,“unreported”items accounted for 38.09%,“partly reported”items accounted for 6.66%%;however,for domestic guidelines,the“reported”accounted for 45.71%,“unreported”items accounted for 40%,and“partly reported”items accounted for 14.28%respectively.Overall,the difference is not significant(SD<10%).Due to the specificity of acupuncture interventions,the use of AGREEⅡand RIGHT to evaluate acupuncture clinical practice guidelines still had barriers to some extend on its applicability.Conclusion The methodological and reporting quality of acupuncture clinical practice guidelines are relatively low.It is urgent to further improve the methodological level and reporting standards of the guidelines,and to develop evaluation tools for the acupuncture field guidelines.