Quality appraisal of clinical practice guidelines and consensus for the management of fragility fractures in China by AGREE <b>Ⅱ</b> and AGREE-China_Chinese Journal of Evidence-Based Medicine

Authors：

SHENG Yongcheng ¹ , LI Li ¹ , WANG Qin ¹ ,  KANG Deying ^1,2

1. Chinese Evidence-Based Medicine Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Center of Biostatistics, Design, Measurement and Evaluation (CBDME), Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

KANG Deying, Email: deyingkang@126.com

Keywords：

AGREE Ⅱ; AGREE-China; China; Fragility fractures; Clinical practice guideline; Consensus

DOI：

10.7507/1672-2531.202110101

Video：

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Objective To verify the applicability of AGREE-China and select high-quality clinical practice guidelines (CPGs) or consensus for the management of fragility fractures (FF) in China by evaluating their methodological quality. Methods CBM, CNKI, WanFang Data, VIP databases and related CPGs websites were electronically searched. Two reviewers independently screened literature, extracted data, and checked each other. Quality appraisal of CPGs or consensus were evaluated by AGREE Ⅱ and AGREE-China, and weighted Kappa value and intraclass correlation coefficients (ICC) were calculated to illustrate the consistency of the two tools. Results Nine CPGs and sixteen consensuses were included. Among the six domains in AGREE Ⅱ, "scope and purpose" domain (62.22%) scored higher than "clarity of presentation" domain (45.67%). The "stakeholder involvement" domain (34.89%) and "applicability" domain (38.17%) both exceeded 30%, while "rigor of development" domain (18.79%) and "editorial independence" domain (13.33%) were lower. Among the five domains in AGREE-China, "conflict of interest" domain (72.80%) was higher, followed by "usability/feasibility" domain (49.87%), while "scientificity/preciseness" domain (20.36%), "effectiveness/safety" domain (25.20%) and "economic efficiency" domain (14.40%) were lower. The weighted Kappa value of recommendations from the two tools was 0.694 (P<0.001), showing moderate consistency. ICC values of the same items and two evaluators were all greater than 0.85 (P<0.001) with high consistency. Three high-quality CPGs were consistently selected by the two tools. Conclusion AGREE Ⅱ holds high consistency with AGREE-China; however, AGREE-China is more suitable for the quality appraisal of Chinese CPGs or consensus. The methodological quality of CPGs or consensus for the management of FF in China needs to be further improved.

Citation： SHENG Yongcheng, LI Li, WANG Qin, KANG Deying. Quality appraisal of clinical practice guidelines and consensus for the management of fragility fractures in China by AGREE Ⅱ and AGREE-China. Chinese Journal of Evidence-Based Medicine, 2022, 22(3): 351-359. doi: 10.7507/1672-2531.202110101 Copy

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1. Tarrant SM, Balogh ZJ. The global burden of surgical management of osteoporotic fractures. World J Surg, 2020, 44(4): 1009-1019.
2. Si L, Winzenberg TM, Jiang Q, et al. Projection of osteoporosis-related fractures and costs in China: 2010-2050. Osteoporos Int, 2015, 26(7): 1929-1937.
3. Ferreira ML, March L. Vertebral fragility fractures - How to treat them. Best Pract Res Clin Rheumatol, 2019, 33(2): 227-235.
4. Yu F, Xia W. The epidemiology of osteoporosis, associated fragility fractures, and management gap in China. Arch Osteoporos, 2019, 14(1): 32.
5. Yoo JH, Moon SH, Ha YC, et al. Osteoporotic fracture: 2015 position statement of the Korean Society for Bone and Mineral Research. J Bone Metab, 2015, 22(4): 175-181.
6. Li N, Zheng B, Liu M, et al. Cost-effectiveness of antiosteoporosis strategies for postmenopausal women with osteoporosis in China. Menopause, 2019, 26(8): 906-914.
7. Orjuela AM, Olarte ÓR, Plata PNR, et al. Second Colombian consensus on the management of post-menopausal osteoporosis: 2017 update. Revista Colombiana de Reumatología (English Edition). 2018, 25(3): 184-210.
8. Migliorini F, Colarossi G, Baroncini A, et al. Pharmacological management of postmenopausal osteoporosis: a level I evidence based - expert opinion. Expert Rev Clin Pharmacol, 2021, 14(1): 105-119.
9. Wu J, Qu Y, Wang K, et al. Healthcare resource utilization and direct medical costs for patients with osteoporotic fractures in China. Value Health Reg Issues, 2019, 18: 106-111.
10. Adams J, Wilson N, Hurkmans E, et al. 2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older. Ann Rheum Dis, 2021, 80(1): 57-64.
11. 吴梦佳, 张士靖, 周志超, 等. 我国临床实践指南利用和需求调查. 中华医学图书情报杂志, 2016, 25(1): 37-42.
12. Wan KR, Zeng GQ, Li Y, et al. Quality changes of clinical practice guidelines for respiratory diseases in China: a systematic review. Clin Respir J, 2021, 15(9): 983-991.
13. 詹思延. 临床指南研究与评价工具简介. 中国循证儿科杂志, 2007, 2(5): 375-377.
14. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. J Clin Epidemiol, 2010, 63(12): 1308-1311.
15. 王吉耀, 王强, 王小钦, 等. 中国临床实践指南评价体系的制定与初步验证. 中华医学杂志, 2018, 98(20): 1544-1548.
16. 中华医学会骨科学分会创伤骨科学组, 中华医学会骨科学分会外固定与肢体重建学组, 国家骨科与运动康复临床医学研究中心, 等. 中国脆性骨折术后规范化抗骨质疏松治疗指南(2021). 中华创伤骨科杂志, 2021, 23(2): 93-101.
17. 陈耀龙, 罗旭飞, 王吉耀, 等. 如何区分临床实践指南与专家共识. 协和医学杂志, 2019, 10(4): 403-408.
18. Zhang Z, Guo J, Su G, et al. Evaluation of the quality of guidelines for myasthenia gravis with the AGREE II instrument. PLoS One, 2014, 9(11): e111796.
19. 周亚平, 杨敏, 要鹏韬, 等. 肺癌化疗领域指南与共识的质量评价. 中华肿瘤杂志, 2020, 42(12): 1025-1033.
20. 郭轶斌, 郭威, 秦宇辰, 等. 基于Kappa系数的一致性检验及其软件实现. 中国卫生统计, 2016, 33(1): 169-170.
21. 余红梅, 罗艳虹, 萨建, 等. 组内相关系数及其软件实现. 中国卫生统计, 2011, 28(5): 497-500.
22. 李晓松. 医学统计学(第2版). 北京: 高等教育出版社, 2008.
23. 李宁, 李新萍, 杨明辉, 等. 老年髋部骨折的骨质疏松症诊疗专家共识. 中华骨与关节外科杂志. 2021, 14(8): 657-663.
24. 黄强, 张玉富, 李庭, 等. 加速康复外科理念下肱骨近端骨折诊疗规范的专家共识. 中华创伤骨科杂志, 2020, 22(3): 187-196.
25. 中国脆性骨折联盟, 中国老年医学学会骨与关节分会创伤骨科学术工作委员会, 白求恩骨科加速康复联盟, 等. 老年股骨转子间骨折诊疗指南. 中华创伤骨科杂志, 2020, 22(2): 93-99.
26. 中华护理学会骨科护理专业委员会. 老年髋部骨折综合管理与二次骨折预防的专家共识. 中华创伤骨科杂志, 2020, 22(6): 461-469.
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Chinese Journal of Evidence-Based Medicine

Quality appraisal of clinical practice guidelines and consensus for the management of fragility fractures in China by AGREE Ⅱ and AGREE-China

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