The methodological quality is insufficient in clinical practice guidelines in the context of COVID-19: systematic review

Tanja A Stamm; Margaret R Andrews; Erika Mosor; Valentin Ritschl; Linda C Li; Jasmin K Ma; Adalberto Campo-Arias; Sarah Baker; Nicola W Burton; Mohammad Eghbali; Natalia Fernandez; Ricardo J O Ferreira; Gabriele Gäbler; Souzi Makri; Sandra Mintz; Rikke Helene Moe; Elizabeth Morasso; Susan L Murphy; Simiso Ntuli; Maisa Omara; Miguel Angel Simancas-Pallares; Jen Horonieff; Gerald Gartlehner

doi:10.1016/j.jclinepi.2021.03.005

The methodological quality is insufficient in clinical practice guidelines in the context of COVID-19: systematic review

J Clin Epidemiol. 2021 Jul:135:125-135. doi: 10.1016/j.jclinepi.2021.03.005. Epub 2021 Mar 7.

Authors

Tanja A Stamm¹, Margaret R Andrews², Erika Mosor², Valentin Ritschl², Linda C Li³, Jasmin K Ma³, Adalberto Campo-Arias⁴, Sarah Baker⁵, Nicola W Burton⁶, Mohammad Eghbali⁷, Natalia Fernandez⁸, Ricardo J O Ferreira⁹, Gabriele Gäbler¹⁰, Souzi Makri¹¹, Sandra Mintz¹², Rikke Helene Moe¹³, Elizabeth Morasso¹⁴, Susan L Murphy⁸, Simiso Ntuli¹⁵, Maisa Omara¹⁶, Miguel Angel Simancas-Pallares¹⁷, Jen Horonieff¹⁸, Gerald Gartlehner¹⁹

Affiliations

¹ Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, 1090, Vienna, Austria. Electronic address: tanja.stamm@meduniwien.ac.at.
² Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
³ Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Richmond, British Columbia, Canada.
⁴ Medicine Program, Faculty of Health Sciences, University of Magdalena, Santa Marta, Colombia.
⁵ Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
⁶ School of Applied Psychology, Griffith University, Mt. Gravatt, Australia.
⁷ Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
⁸ Department of Physical Medicine and Rehabilitation, University of Michigan and VA Ann Arbor Health Care System, Ann Arbor, MI, USA.
⁹ Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
¹⁰ Austrian Association of Dietitians, Vienna, Austria.
¹¹ The Cyprus League Against Rheumatism and Platform Organization for People for Rheumatic Diseases in Southern Europe, Nicosia, Cyprus.
¹² Office of Patient Experience, Children's Hospital Los Angeles, Los Angeles, CA, USA.
¹³ Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
¹⁴ Department of Radiation Oncology, UCLA Health, Los Angeles, CA, USA.
¹⁵ Department of Podiatry, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa.
¹⁶ Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, 1090, Vienna, Austria.
¹⁷ Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁸ Savvy Cooperative, Queens, NY, USA.
¹⁹ Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria; RTI International, Research Triangle Park, NC, USA.

Abstract

Objectives: The number of published clinical practice guidelines related to COVID-19 has rapidly increased. This study explored if basic methodological standards of guideline development have been met in the published clinical practice guidelines related to COVID-19.

Study design and setting: Rapid systematic review from February 1 until April 27, 2020 using MEDLINE [PubMed], CINAHL [Ebsco], Trip and manual search, including all types of healthcare workers providing any kind of healthcare to any patient population in any setting.

Results: There were 1342 titles screened and 188 guidelines included. The highest average AGREE II domain score was 89% for scope and purpose, the lowest for rigor of development (25%). Only eight guidelines (4%) were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality). The majority (156; 83%) was solely built on an informal expert consensus. A process for regular updates was described in 27 guidelines (14%). Patients were included in the development of only one guideline.

Conclusion: Despite clear scope, most publications fell short of basic methodological standards of guideline development. Clinicians should use guidelines that include up-to-date information, were informed by stakeholder involvement, and employed rigorous methodologies.

Keywords: COVID-19; Clinical practice guidelines; Coronavirus; Guidelines; Recommendations; SARS CoV-2.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

COVID-19 / therapy*
Humans
Practice Guidelines as Topic / standards*
SARS-CoV-2