基于AGREE II对青光眼临床指南质量评价

Assessment of the Methodological Quality of Glaucoma Clinical PracticeGuidelines Using the AGREE II Instrument

目的:了解青光眼临床指南的质量现状,为中国青光眼指南使用推荐提供参考。方法:文献研究。使用指南研究和评估工具AGREE II对美国眼科学会指南(AAO-PAC、AAO-POAG、AAO-POAGS)、欧洲青光眼指南(EGS)、国际眼科协会青光眼指南(ICO)、亚太青光眼指南(APGG)以及中国原发性青光眼诊断和治疗专家共识(CG)进行质量评价。对评估所得的各领域得分采用均数±标准差进行描述,通过组内相关系数对评估的可靠性进行分析。结果:组内相关系数均大于0.9。范围和目的及清晰性的得分较高,其余4项得分相对较低。各项领域得分分别为84%±19%(领域1,范围和目的),37%±18%(领域2,参与人员),25%±25%(领域3,严谨性),90%±16%(领域4,清晰性),34%±10%(领域5,应用性),40%±34%(领域6,独立性)。AAO-POAGS各领域得分为99%、42%、61%、97%、41%、77%。我国2014年版CG的各领域得分分别为47%、4%、8%、57%、17%、0%。结论:在目前各国的青光眼指南中,AAO-POAGS最值得优先推荐,2014年版CG尚未达到AGREE II关于指南推荐的标准,未来中国的青光眼循证指南制定过程需更加透明化和严谨,参与制定人员组成需更加多元化。

Objective:To evaluate and compare the methodological quality of the glaucoma clinical practice guidelines(CPGs)and to provide references and recommendations for glaucoma guidelines.Methods:The Appraisal of Guidelines for Research and Evaluation(AGREE)II instrument was used to assess the seven guidelines,including the AAO's Preferred Practice Pattern(PPP)in Primary Angle Closure(AAO-PAC),the AAO's PPP in Primary Open-Angle Glaucoma(AAO-POAG),the AAO's PPP in Primary Open-Angle Glaucoma Suspect(AAO-POAGS),the EGS's Terminology and Guidelines for Glaucoma(EGS),ICO Guidelines for Glaucoma Eye Care(ICO),and Asia Pacific Glaucoma Guidelines(APGG)and Consensus of Glaucoma:China(CG).Domain scores were compared and intraclass correlation coefficients(ICCs)and 95%confidence intervals(CI)were calculated.Results:The ICCs of the seven guidelines were above 0.9.In general,all the appraised guidelines scored favorably in domain 1(Scope and Purpose)and domain 4(Clarity of Presentation),whereas the other domains scored less favorably.The average scores of six domains involved in the included guidelines were 84%±19%(domain 1,Scope and Purpose),37%±18%(domain 2,Stakeholder Involvement),25%±25%(domain 3,Rigor of Development),90%±16%(domain 4,Clarity of Presentation),34%±10%(domain 5,Application),40%±34%(domain 6,Editorial).The six domains'respective scores for AAO-POAGS were 99%,42%,61%,97%,41%,77%,and for Consensus of Glaucoma:China were 47%,4%,8%,57%,17%,0%.Conclusions:AAO-POAGS were strongly recommended among the seven guidelines.There was much room for Chinese glaucoma guidelines to improve in formulating more rigorous guidelines.