中国骨科临床实践指南及共识的质量评价

Quality assessment of Chinese clinical practice guidelines and consensus in orthopedics

目的了解近年我国骨科已发表的指南与共识的评级现状,帮助使用者遴选临床指南和共识,指导临床实践,并推动我国骨科指南和共识质量的针对性提升。方法计算机检索CNKI、WanFang Data、SinoMed数据库,搜集相关的中国骨科临床实践指南与共识,检索时限为2016年1月至2023年10月。由2位评价员独立筛选文献、提取资料后,采用指南科学性、透明性和适用性的评级工具(scientific,transparent and applicable rankings,STAR)对2016年后在中国医学期刊发表的中国骨科指南和共识进行了综合评级。若两位评价员存在争议,则由第三位评价员裁定。采用Kappa值评估两位评价员的结果一致性。结果共获得191篇骨科相关指南和共识,其中指南74篇,共识117篇。纳入评价的指南平均得分为34.4分,共识平均得分为21.7分。纳入指南在注册、计划书、工作组、临床问题、证据、共识方法、推荐意见、可及性及其他领域得分均高于共识。Kappa值检验结果为0.684。结论近年来国内已发表的骨科临床实践指南与共识虽然方法学评分逐年增加,但是总体质量有待进步。未来的指南需要在资助透明、推荐意见形成、指南发布与传播方面进一步提高。

Objective To understand the current national status of the rating of published orthopedic guidelines and consensus in China,to help users select the appropriate use of these clinical guidelines,to guide clinical practice,and to promote the targeted improvement of the quality of Chinese orthopedic guidelines and consensus.Methods Chinese biomedical databases,including CNKI,WanFang Data,and SinoMed were searched electronically from January 2016 to October 2023,and relevant Chinese orthopedic clinical practice guidelines and consensus documents were collected.Two evaluators independently screened the retrieved literature and extracted data.The scientificity,transparency,and applicability rankings(STAR)tool was used to comprehensively rate Chinese orthopedic guidelines and consensus documents published in medical journals since 2016.Any dispute between the two evaluators was resolved by consulting a third evaluator.Kappa values were used to evaluate the consistency of the results between the two evaluators.Results A total of 191 orthopedic-related guidelines and consensus documents were obtained,including 74 guidelines and 117 consensus documents.The average score of the guidelines included in the evaluation was 34.4 points,while the average score of consensus documents included in the evaluation was 21.7 points.Guidelines scored higher than consensus documents in areas such as registration,planning,workgroups,clinical issues,evidence,consensus methods,recommendations,accessibility,and other fields.The Kappa value test result was 0.684.Conclusion There has been a progressive increase in methodological scores of Chinese orthopedic clinical practice guidelines and consensus documents published in recent years,but the overall quality is not high.Future guidelines development needs to improve methodology further,especially in terms of transparent funding,formation of recommendations,guidelines release,and dissemination.