基于GRADE康复临床实践指南证据质量与推荐强度研究

doi:10.3969/j.issn.1006-9771.2020.02.005

《Chinese Journal of Rehabilitation Theory and Practice》 ›› 2020, Vol. 26 ›› Issue (2): 156-160.doi: 10.3969/j.issn.1006-9771.2020.02.005

Previous Articles Next Articles

Quality of Evidence and Strength of Recommendations of Clinical Practice Guidelines of Rehabilitation Based on GRADE

ZHOU Qi^1,^2,^3,^4,⁵,WANG Ling^2,^3,^4,^5,⁶,YANG Nan^2,^3,^4,⁵,YU Xuan^3,⁴,ZHANG Jing-yi^2,^3,^4,^5,⁶,MA Yan-fang^2,^3,^4,⁵,WANG Jian-jian^2,^3,^4,^5,⁶,ZHANG Xian-zhuo¹,SHI Xiu-e^7,⁸,CHEN Yao-long^2,^3,^4,⁵(),YANG Ke-hu^1,^2,^3,^4,⁵()

1. the First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu 730000, China
2. Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, China
3. WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, Gansu 730000, China
4. Chinese GRADE Center, Lanzhou University, Lanzhou, Gansu 730000, China
5. Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu 730000, China
6. School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
7. Rehabilitation Center Hospital of Gansu, Lanzhou, Gansu 730000, China
8. Gansu Evidence-based Rehabilitation Medical Research Center, Lanzhou, Gansu 730000, China

Received:2020-02-10 Revised:2020-02-13 Published:2020-02-25 Online:2020-03-19
Contact: CHEN Yao-long,YANG Ke-hu E-mail:chenyaolong@vip.163.com;kehuyangebm2006@126.com
Supported by:
Gansu Major Project of the National Social Science Fund(19ZDA142);Key Laboratory of Evidence-based Medicine and Clinical Translation Innovation Fund(CXJJ2019002)

Abstract

Abstract:

Objective To analyze the results of Grading of Recommendations Assessment, Development and Evaluation (GRADE) for clinical practice guidelines of rehabilitation.Methods Clinical practice guidelines of rehabilitation were systematically retrieved from PubMed, EMBASE, CNKI, China Biology Medicine disc, Wanfang database and the guideline-related websites until January 11, 2020. Two researchers independently screened guidelines using Grading of Recommendations Assessment, Development and Evaluation (GRADE), and extracted and analyzed the results.Results A total of 83 clinical practice guidelines of rehabilitation were included, in which 46 (55.4%) applied grading systems. Only four (4.8%) guidelines applied GRADE, including 44 recommendations, in which 39 guidelines (88.6%) had quality of evidence. Among the evidences citied in the recommendations, low quality evidences were the most (34.1%); among the recommendations, weak recommendations were more (56.8%). The quality of strong recommendation supporting evidence was higher than that of weak recommendation (χ² = 8.218, P < 0.05). Conclusion The application of the GRADE grading system in clinical practice guidelines of rehabilitation remains to be improved. It is proposed for guideline makers to further implement the methodology of guidelines and GRADE to improve the reliability and applicability of the clinical practice guidelines of rehabilitation more effectively.

Key words: rehabilitation medicine, clinical guidelines, Grading of Recommendations Assessment,Development and Evaluation, quality of evidence, strength of recommendation

CLC Number:

ZHOU Qi,WANG Ling,YANG Nan,YU Xuan,ZHANG Jing-yi,MA Yan-fang,WANG Jian-jian,ZHANG Xian-zhuo,SHI Xiu-e,CHEN Yao-long,YANG Ke-hu. Quality of Evidence and Strength of Recommendations of Clinical Practice Guidelines of Rehabilitation Based on GRADE[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(2): 156-160.

Figures/Tables 4

References 28

[1]	GRADE Working Group. Grading quality of evidence and strength of recommendations[J]. BMJ, 2004, 328(7454):1490-1494. doi: 10.1136/bmj.328.7454.1490
[2]	Brouwers M C, Kho M E, Browman G P, et al. AGREE II: advancing guideline development, reporting, and evaluation in health care[J]. Can Med Assoc J, 2010, 182(18):E839-E842. doi: 10.1503/cmaj.090449
[3]	Chen Y, Yang K, Marusic A, et al. A reporting tool for practice guidelines in Healthcare: the RIGHT statement[J]. Ann Intern Med, 2017, 166(2):128-132. doi: 10.7326/M16-1565
[4]	杨克虎, 陈耀龙. 写在循证医学诞生20周年[J]. 中国循证儿科杂志, 2011, 6(3):7-10.
[5]	杨克虎. 循证社会科学的产生、发展与未来[J]. 图书与情报, 2018(3):1-10.
[6]	Chen Y, Wang C, Shang H, et al. Clinical practice guidelines in China[J]. BMJ, 2018, 360:j5158.
[7]	GRADE Working Group [EB/OL]. [2020-01-11]. http://www.gradeworkinggroup.org.
[8]	邱卓英. 《国际功能、残疾和健康分类》研究总论[J]. 中国康复理论与实践, 2003, 9(1):2-5.
[9]	袁涛, 王忠太. 骨质疏松症康复指南(上)[J]. 中国康复医学杂志, 2019, 34(11):1265-1272.
[10]	Alison J A, McKeough Z J, Johnston K, et al. Australian and New Zealand pulmonary rehabilitation guidelines[J]. Respirology, 2017, 22(4):800-819.
[11]	Fehlings M G, Tetreault L A, Aarabi B, et al. A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the type and timing of rehabilitation[J]. Global Spine J, 2017, 7(3):231S-238S. doi: 10.1177/2192568217701910
[12]	Alison J A, Franssen F M E. Optimizing health in chronic lung diseases: what did we learn from the experts in pulmonary rehabilitation?[J]. Respirology, 2019, 24(9):916-917. doi: 10.1111/resp.v24.9
[13]	The periodic health examination. Canadian task force on the periodic health examination[J]. Can Med Assoc J, 1979, 121(9):1193-1254.
[14]	陈耀龙, 李幼平, 杜亮, 等. 医学研究中证据分级和推荐强度的演进[J]. 中国循证医学杂志, 2008, 8(2):127-133.
[15]	Guyatt G H, Oxman A D, Vist G E, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations[J]. BMJ, 2008, 336(7650):924-926. doi: 10.1136/bmj.39489.470347.AD
[16]	World Health Organization. WHO Handbook for Guideline Development [M/OL]. 2nd ed. [2020-01-11]. http://apps.who.int/medicinedocs/en/m/abstract/Js22083en/.
[17]	邱卓英, 郭键勋, 李伦, 等. 世界卫生组织康复指南《健康服务体系中的康复》:背景、理论架构与方法、主要内容和实施[J]. 中国康复理论与实践, 2020, 26(1):16-20.
[18]	王行环. 循证临床实践指南的研发与评价[M]. 北京: 中国协和医科大学出版社, 2016: 21-57.
[19]	Andrews J C, Schünemann H J, Oxman A D, et al. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation's direction and strength[J]. J Clin Epidemiol, 2013, 66(7):726-735. doi: 10.1016/j.jclinepi.2013.02.003
[20]	Balshem H, Helfand M, Schunemann H J, et al. GRADE guidelines: 3. Rating the quality of evidence[J]. J Clin Epidemiol, 2011, 64(4):401-406. doi: 10.1016/j.jclinepi.2010.07.015 pmid: 21208779
[21]	Guyatt G H, Oxman A D, Sultan S, et al. GRADE guidelines: 9. Rating up the quality of evidence[J]. J Clin Epidemiol, 2011, 64(12):1311-1316. doi: 10.1016/j.jclinepi.2011.06.004
[22]	世界卫生组织. 健康服务体系中的康复[J]. 邱卓英,郭键勋,李伦,译. 中国康复理论与实践, 2020, 26(1):1-14.
[23]	李安巧, 邱卓英, 吴弦光, 等, 译. 康复2030:国际康复发展状况与行动呼吁[J]. 中国康复理论与实践, 2017, 23(4):379.
[24]	杨克虎, 陈耀龙, 李幼平, 等. 中国能否应对指南挑战?[J]. 中国循证医学杂志, 2013, 13(6):621-623.
[25]	杨克虎, 李秀霞, 拜争刚. 循证社会科学研究方法[M]. 兰州: 兰州大学出版社, 2018.
[26]	IOM. Clinical Practice Guidelines We Can Trust [M]. Washington D. C.: The National Academies Press, 2011.
[27]	陈耀龙, 马艳芳, 周奇, 等. 谁应该参与临床实践指南的制订?[J]. 协和医学杂志, 2019, 10(5):524-530.
[28]	陈耀龙, 杨克虎. 正确理解、制订和使用临床实践指南[J]. 协和医学杂志, 2018, 9(4):367-373.

证据质量	具体描述	表达符号
高	非常有把握观察值接近真实值	A
中	对观察值有中等把握:观察值有可能接近真实值,但也有可能差别很大	B
低	对观察值的把握有限:观察值可能与真实值有很大差别	C
极低	对观察值几乎没有把握:观察值与真实值可能有极大差别	D

推荐强度	具体描述	表达符号
强	明确显示干预措施利大于弊或弊大于利	1
弱	利弊不确定或无论质量高低的证据均显示利弊相当	2

分级	高	中	低	极低	合计
强	4(9.1)	3(6.8)	5(11.4)	2(4.5)	14(31.8)
弱	0	9(20.5)	10(22.7)	6(13.6)	25(56.8)
合计	4(9.1)	12(27.3)	15(34.1)	8(18.2)	39(88.6)

Quality of Evidence and Strength of Recommendations of Clinical Practice Guidelines of Rehabilitation Based on GRADE

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 4

References 28

Related Articles 15

Metrics

Comments

Recommended 0

[1]	LIU Xiaoxie, CHU Hongling, LIU Mei, GUO Aixin, WANG Siyuan, ZENG Fanshuo, JIANG Shan, XIE Yuxiao, ZHOU Mouwang. Scientific, transparent and applicable rankings of Chinese guidelines and consensus of rehabilitation medicine published in medical journals in 2022 [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(12): 1365-1376.
[2]	LIU Xinrong,XU Guangxu,LI Lin,WANG Yu,LI Xu,ZHAO Ruoxin,LIU Yuanbiao,GU Yuhui,YAO Jie,ZHANG Min,WANG Lijuan. Development of rehabilitation medical resources in Jiangsu during Thirteenth Five-year Plan [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(4): 407-414.
[3]	ZHANG Yuanmingfei,YANG Yanyan,ZHANG Na,LIU Jingyu,LIU Xiaoxie,ZHANG Zhiliang,ZHOU Mouwang. 2021 National Report on Rehabilitation Medicine Services, Quality and Safety in Medical Care System [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(12): 1365-1379.
[4]	Shi-cai WU. Research on Ethical Connotation and Its Practice of Rehabilitation Medicine [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(2): 125-130.
[5]	Li-jun MENG,Shi-cai WU. Implementation of Ethical Principles to Promote Development of Rehabilitation Services [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(2): 237-242.
[6]	SHI Xiu-e, WANG Bin-xiong, FANG Ya-qiong, ZHANG Yan, CHEN Zhao-quan, WANG Bo, WANG Man-xia, ZHANG Ting, HUANG Chao-rong, PEI Hong-bo. Comprehensive Evaluation of Rehabilitation Medical Service Quality in Tertiary General Hospitals in Gansu, China [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(1): 117-124.
[7]	WANG Ling,LU Shu-ya,LUO Xu-fei,YU Xuan,LÜ Meng,ZHANG Xian-zhuo,SHI Xiu-e,CHEN Yao-long,YANG Ke-hu. Clinical Practice Guidelines of Rehabilitation: Composition of Expert Group and Situation of Conflict of Interest [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(2): 150-155.
[8]	WANG Zi-jun,WANG Ling,YU Xuan,ZHOU Qi,SHI Qian-ling,ZHAO Si-ya,XUN Yang-qin,ZHANG Xian-zhuo,YANG Nan,SHI Xiu-e,CHEN Yao-long,YANG Ke-hu. Report Quality of Clinical Practice Guidelines of Rehabilitation Based on RIGHT [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(2): 161-169.
[9]	JIANG Shan,WANG Ying,WANG Hui. Development of Occupational Therapy for Chinese Aging Population: Opportunities and Challenges [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(2): 237-241.
[10]	DU Xiao-xia, SONG Lu-ping, LI Jian-jun. Investigation of Key Teacher Training for Rehabilitation Residents Standardized Training [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2019, 25(1): 116-118.
[11]	SANG De-chun. Rehabilitation Medicine Education for Bachelor Degree [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2017, 23(7): 865-868.
[12]	ZHANG Hao, WANG Xiao-yan, ZHANG Ting-ting, ZHANG Xin, CHI Qian-qian, ZHANG Xiao-nian. Analysis of Standardized Resident Training Graduation Exam in Rehabilitation Medicine in Beijing during 2011 to 2016　 [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2017, 23(4): 494-496.
[13]	ZHOU Nan, GONG Ling-yun, WU Shi-bin. Construction and Practice of Regional Three Grade Rehabilitation Medical Service System [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2017, 23(3): 370-372.
[14]	WU Shi-cai. Promotion of Higher Education of Rehabilitation in China [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2017, 23(2): 131-135.
[15]	LEI Mai, YANG Jian-rong, TAN Wei, HU Cai-you, JIANG Wen-yu, LIN Wei, QIN Li-zhen, YANG Qing-cheng, WU Min. Investigation for Department of Rehabilitation Medicine in Guangxi, China [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2016, 22(9): 1110-1113.