File
Kwah LK1, Green J2, Butler J2, Lam L3,4
1Singapore Institute of Technology, Health and Social Sciences Cluster, Singapore, Singapore, 2Australian Catholic University, School of Physiotherapy, Northern Sydney, Australia, 3Tung Wah College, Hong Kong, Hong Kong, 4University of Technology Sydney, Graduate School of Health, Sydney, Australia
Background: Clinical practice guidelines (CPGs) often include recommendations on patient care that are informed by research evidence, clinicians' expertise and patients' preferences. Trustworthy (or high quality) CPGs can therefore help to guide clinicians and patients in making decisions on appropriate care in specific circumstances. Despite the potential usefulness of CPGs, they are often not widely adopted in clinical practice as most CPGs (developed in various areas of medicine) have been shown to be of low quality. We do not know if CPGs for the management of limb amputations have similar limitations, and if clinicians can trust current guidelines.
Purpose: We aimed to identify CPGs for management of limb amputations, appraise the quality of CPGs and synthesize the recommendations from comprehensive and high quality CPGs
Methods: We searched MEDLINE, EMBASE, CINAHL, PEDro, guideline specific websites, amputee association/network websites and Google Scholar from April 2007 to April 2017. We included publications if they were CPGs or consensus statements/standards endorsed by a certified organisation, covered the management of limb amputations, were freely accessible and written in English. Two reviewers independently screened titles and abstracts for eligible CPGs, and rated the quality of CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE-II) instrument. We used a mean value of 60% as the threshold cut-off for an acceptable domain score to guide the reporting of domain scores for each CPG.
Results: CPGs were published from the United States of America, the United Kingdom, Australia, Canada, Netherlands and New Zealand. Of the 15 included CPGs, 4 were of high quality, and 11 were of low to moderate quality. Mean domain scores on AGREE-II were as follows: 83% for domain 1, 61% for domain 2, 34% for domain 3, 65% for domain 4, 24% for domain 5 and 21% for domain 6. Mean domain scores were lowest for domains 3 (rigour of development), 6 (editorial independence), and 5 (applicability), and highest for domains 1 (scope and purpose), 4 (clarity and presentation) and 2 (stakeholder involvement). Many recommendations from the comprehensive and high quality CPGs were weak, or were based on expert opinion/formal consensus of the CPG group. Strong recommendations were few and focused on the development of individualized treatment plans, exercises for improving physical function, and the assessment of physical function and prognostic factors.
Conclusion(s): Few CPGs for management of limb amputations were of high quality, and few recommendations were strong.
Implications: High quality CPGs have been identified, and clinicians can refer to their recommendations to guide clinical practice. As most of the recommendations are weak, clinicians will still need to exercise clinical judgement and provide care that is best suited to the individual patient. Most recommendations are weak due to no evidence, limited evidence or low quality evidence; hence researchers can refer to these areas of care to conduct more and better research. Guideline developers of future CPGs should also aim to report funding and competing interests of members, provide information to aid practical application of CPGs, and use a systematic approach to search for evidence and derive strength of recommendations.
Keywords: Amputation, guideline, quality
Funding acknowledgements:
None from Li Khim KWAH
None from Jordan GREEN
None from Jane BUTLER
None from Lawrence LAM
Purpose: We aimed to identify CPGs for management of limb amputations, appraise the quality of CPGs and synthesize the recommendations from comprehensive and high quality CPGs
Methods: We searched MEDLINE, EMBASE, CINAHL, PEDro, guideline specific websites, amputee association/network websites and Google Scholar from April 2007 to April 2017. We included publications if they were CPGs or consensus statements/standards endorsed by a certified organisation, covered the management of limb amputations, were freely accessible and written in English. Two reviewers independently screened titles and abstracts for eligible CPGs, and rated the quality of CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE-II) instrument. We used a mean value of 60% as the threshold cut-off for an acceptable domain score to guide the reporting of domain scores for each CPG.
Results: CPGs were published from the United States of America, the United Kingdom, Australia, Canada, Netherlands and New Zealand. Of the 15 included CPGs, 4 were of high quality, and 11 were of low to moderate quality. Mean domain scores on AGREE-II were as follows: 83% for domain 1, 61% for domain 2, 34% for domain 3, 65% for domain 4, 24% for domain 5 and 21% for domain 6. Mean domain scores were lowest for domains 3 (rigour of development), 6 (editorial independence), and 5 (applicability), and highest for domains 1 (scope and purpose), 4 (clarity and presentation) and 2 (stakeholder involvement). Many recommendations from the comprehensive and high quality CPGs were weak, or were based on expert opinion/formal consensus of the CPG group. Strong recommendations were few and focused on the development of individualized treatment plans, exercises for improving physical function, and the assessment of physical function and prognostic factors.
Conclusion(s): Few CPGs for management of limb amputations were of high quality, and few recommendations were strong.
Implications: High quality CPGs have been identified, and clinicians can refer to their recommendations to guide clinical practice. As most of the recommendations are weak, clinicians will still need to exercise clinical judgement and provide care that is best suited to the individual patient. Most recommendations are weak due to no evidence, limited evidence or low quality evidence; hence researchers can refer to these areas of care to conduct more and better research. Guideline developers of future CPGs should also aim to report funding and competing interests of members, provide information to aid practical application of CPGs, and use a systematic approach to search for evidence and derive strength of recommendations.
Keywords: Amputation, guideline, quality
Funding acknowledgements:
None from Li Khim KWAH
None from Jordan GREEN
None from Jane BUTLER
None from Lawrence LAM
Topic: Neurology
Ethics approval required: No
Institution: Singapore Institute of Technology
Ethics committee: Singapore Institute of Technology
Reason not required: Not required for a systematic review.
All authors, affiliations and abstracts have been published as submitted.
