AGREE evaluates ACOEM Guidelines

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1: Spine J. 2006 Jan-Feb;6(1):72-7. Related Articles,

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An independent AGREE evaluation of the Occupational

Medicine Practice Guidelines.

Cates JR, Young DN, Bowerman DS, Porter RC.

Private practice of chiropractic orthopedics, 200 N. 6th

Street, Oregon, IL 61061, USA. cates@...

BACKGROUND AND CONTEXT: A large number of practice

guidelines are being produced by numerous organizations.

Health-care professionals need to critically evaluate these

practice guidelines to understand whether they are well

constructed and representative of the preponderance of

evidence. The guideline development process should be

precise and rigorous to ensure that the results are

reproducible and not vague. PURPOSE: To evaluate the

quality of the second edition of the practice guidelines

published by the American College of Occupational and

Environmental Medicine (ACOEM Guidelines). STUDY

DESIGN/SETTING: Four appraisers used the AGREE (Appraisal

of Guidelines Research and Evaluation) guideline evaluation

instrument to evaluate the ACOEM Guidelines. METHODS: The

Guidelines were evaluated with the AGREE guideline

evaluation instrument. The AGREE instrument has been widely

adopted around the world, and the authors recommended that

it be adopted as the standard of guideline construction

process evaluation in the United States. The instrument

standardizes the quantitative assessment of quality for a

guideline's development process across six domains that

include: scope and purpose, stakeholder involvement, rigor

of development, clarity and presentation, application, and

editorial independence. Scores from four assessors were

collected and interpreted. Additionally, each evaluator

selected one of four global assessment choices: " strongly

recommended for use in practice, " " recommended for use with

some modification or proviso, " " not recommended as suitable

for use in practice, " or " unsure " . RESULTS: The ACOEM

Guidelines scored highest in the dimensions that evaluated

reporting of the guideline's scope and purpose (79.63) as

well as clarity and presentation (86.81). The guideline

scored much lower in the remaining areas that included

stakeholder involvement (46.06), rigor of development

(26.59), application (31.48), and editorial independence

(19.17). The global assessment was unanimous with all four

evaluators assessing the guideline as recommend with

proviso. CONCLUSIONS: Many of the Guidelines

recommendations were consistent with current literature and

guidelines; however, the AGREE assessment instrument

evaluates the guideline development process and not the

content. All the evaluators thought the content of the

guidelines was substantially better than the documentation

of the guideline construction process. The ACOEM Guidelines

appear to have content consistent with their stated

objectives, but the reporting of the guidelines

construction process, particularly the rigor of

recommendation development, is flawed, and the

recommendations may not be valid owing to possible evidence

selection deficiencies. The reader should consider these

flaws and limitations when using the guideline. The reader

should consider utilizing guidelines of higher quality when

possible. Future guidelines should incorporate better

reporting and give closer attention to guideline

construction.