基于AGREE Ⅱ和AGREE-China的中国脆性骨折指南与共识的质量评价

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

目的对中国脆性骨折临床实践指南(简称“指南”)和专家共识(简称“共识”)的方法学质量进行评价,验证AGREE-China的适用性,并遴选出高质量的指南/共识。方法计算机检索CBM、CNKI、WanFang Data、VIP数据库和相关指南网站,由2名评价者独立筛选文献、提取资料并交叉核对。分别采用AGREEⅡ和AGREE-China评价指南/共识,并采用加权κ值、组内相关系数(ICC)评估2种评价工具的一致性。结果本研究共纳入指南9部、共识16部。在使用AGREEⅡ评价的6个领域中,范围和目的(62.22%)得分率较高,清晰性(45.67%)次之,参与人员(34.89%)和应用性(38.17%)均超过30%,制定的严谨性(18.79%)和编辑的独立性(13.33%)偏低。在使用AGREE-China评价的5个领域中,利益冲突(72.80%)得分率较高,可用性/可行性(49.87%)次之,科学性/严谨性(20.36%)、有效性/安全性(25.20%)、经济性(14.40%)偏低。2个评价工具指南推荐级别的加权Kappa值为0.694(P<0.001),呈现中度一致性;相同条目、评价者间ICC均大于0.85(P<0.001),一致性均较好。2个评价工具共同遴选出了3部高质量指南。结论AGREEⅡ和AGREE-China的一致性较高,但AGREE-China更适合作为中国指南/共识的质量评价工具。中国脆性骨折指南与共识的方法学质量有待进一步提高。

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 AGREEⅡand 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 AGREEⅡ,"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 AGREEⅡholds 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.