Evaluation of clinical practice guidelines (CPG) on the management of female chronic pelvic pain (CPP) using the AGREE II instrument

Vishalli Ghai; Venkatesh Subramanian; Haider Jan; Jemina Loganathan; Stergios K Doumouchtsis; CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women’s Health (i-chorus.org)

doi:10.1007/s00192-021-04848-1

Evaluation of clinical practice guidelines (CPG) on the management of female chronic pelvic pain (CPP) using the AGREE II instrument

Int Urogynecol J. 2021 Nov;32(11):2899-2912. doi: 10.1007/s00192-021-04848-1. Epub 2021 Jun 19.

Authors

Vishalli Ghai^{1

2}, Venkatesh Subramanian³, Haider Jan³, Jemina Loganathan³, Stergios K Doumouchtsis^{3

4

5

6}; CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women’s Health (i-chorus.org)

Affiliations

¹ Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, Dorking Road, London, KT18 7EG, UK. vishalli.ghai25@gmail.com.
² St George's University of London, Crammer Terrace, London, SW17 0RE, UK. vishalli.ghai25@gmail.com.
³ Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, Dorking Road, London, KT18 7EG, UK.
⁴ St George's University of London, Crammer Terrace, London, SW17 0RE, UK.
⁵ Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
⁶ School of Medicine, American University of the Caribbean, Cupecoy, Sint Maarten.

Abstract

Introduction and hypothesis: Variations in guidelines may result in differences in treatments and potentially poorer health-related outcomes. We aimed to systematically review and evaluate the quality of national and international guidelines and create an inventory of CPG recommendations on CPP.

Methods: We searched EMBASE and MEDLINE databases from inception till August 2020 as well as websites of professional organizations and societies. We selected national and international CPGs reporting on the diagnosis and management of female CPP. We included six CPGs. Five researchers independently assessed the quality of included guidelines using the AGREE II tool and extracted recommendations.

Results: Two hundred thirty-two recommendations were recorded and grouped into six categories: diagnosis, medical treatment, surgical management, behavioural interventions, complementary/alternative therapies and education/research. Thirty-nine (17.11%) recommendations were comparable including: a comprehensive pain history, a multi-disciplinary approach, attributing muscular dysfunction as a cause of CPP and an assessment of quality of life. Two guidelines acknowledged sexual dysfunction associated with CPP and recommended treatment with pelvic floor exercises and behavioural interventions. All guidelines recommended surgical management; however, there was no consensus regarding adhesiolysis, bilateral salpingo-oophorectomy during hysterectomy, neurectomy and laparoscopic uterosacral nerve ablation. Half of recommendations (106, 46.49%) were unreferenced or made in absence of good-quality evidence or supported by expert opinion. Based on the AGREE II assessment, two guidelines were graded as high quality and recommended without modifications (EAU and RCOG). Guidelines performed poorly in the "Applicability", "Editorial Independence" and "Stakeholder Involvement" domains.

Conclusion: Majority of guidelines were of moderate quality with significant variation in recommendations and quality of guideline development.

Keywords: AGREE II tool; Chronic pelvic pain; Guidelines; Sexual dysfunction; Systematic review.

Publication types

Systematic Review

MeSH terms

Chronic Pain* / etiology
Chronic Pain* / therapy
Consensus
Databases, Factual
Female
Humans
Pelvic Pain* / etiology
Pelvic Pain* / therapy
Practice Guidelines as Topic
Quality of Life*