基于RIGHT康复临床实践指南报告质量研究

doi:10.3969/j.issn.1006-9771.2020.02.006

Abstract

Abstract:

Objective To evaluate the quality of reporting of clinical practice guidelines of rehabilitation.Methods A comprehensive retrieve was performed in electronic databases of PubMed, EMBASE, CNKI, China Biology Medicine disc, Wanfang data, etc., from January 1, 2017 to January 11, 2020. Supplementary searches had been done on relevant websites. Two researchers reviewed literatures and assessed the reporting quality independently by using Reporting Items for Practice Guidelines in Healthcare (RIGHT), and any disagreements needed to be discussed in a consensus meeting.Results A total of 16 guidelines were included, with an average reporting rate of (44.8±27.9)%. Among the seven domains of RIGHT, basic information was reported the highest (57.3%), and evidence (31.3%) and other information (31.3%) was the lowest. The reporting rate was less as the guidelines published in China than in foreign contries (OR = 0.80, 95%CI 0.56-1.16), in original version than in update version (OR = 0.79, 95%CI 0.54-1.16); and higher as developed by various societies or associations than developed by non-societies or associations (OR = 1.15, 95%CI 0.82-1.61), however, no statistically significant difference was found in above comparisons.Conclusion Current clinical practice guidelines of rehabilitation reported with low quality. It is proposed that future guideline developers should report guidelines after RIGHT statements, including key information and content, in order to improve the quality of reporting guidelines.

Key words: rehabilitation medicine, clinical practice guidelines, Reporting Items for Practice Guidelines in Healthcare, quality of reporting

CLC Number:

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.

Figures/Tables 7

指南题目	发表年份	健康问题	国内/ 国外	发表类型	发布机构	指南类型
2016 SOSORT Guidelines: Orthopaedic and Rehabilitation Treatment of Idiopathic Scoliosis during Growth^[16]	2018	肌肉骨骼系统和结缔组织疾病	国外	杂志	学会/协会	更新版
A Clinical Practice Guideline for the Management of Patients with Acute Spinal Cord Injury: Recommendations on the Type and Timing of Rehabilitation ^[17]	2017	肌肉骨骼系统和结缔组织疾病	国外	杂志	非学会/协会	初始版
Australian and New Zealand Pulmonary Rehabilitation Guidelines ^[18]	2017	呼吸系统疾病	国外	杂志	学会/协会	初始版
Clinical Practice Guideline for Cardiac Rehabilitation in Korea: Recommendations for Cardiac Rehabilitation and Secondary Prevention after Acute Coronary Syndrome^[19]	2019	循环系统疾病	国外	杂志	非学会/协会	初始版
Clinical Practice Guidelines for addressing the Rehabilitation Needs of Elderly in the Indian context ^[20]	2018	老年病	国外	杂志	非学会/协会	初始版
Canadian Stroke Best Practice Recommendations: Telestroke Best Practice Guidelines Update 2017^[21]	2017	神经系统疾病	国外	杂志	非学会/协会	更新版
General Guidelines in the Rehabilitation Process for Return to Training after A Sports Injury^[22]	2017	损伤、中毒和外因的某些其他后果	国外	杂志	非学会/协会	初始版
Rehabilitation of the Laryngectomised Patient. Recommendations of the Spanish Society of Otolaryngology and Head and Neck Surgery^[23]	2019	肿瘤	国外	杂志	学会/协会	初始版
Sexual Rehabilitation After Treatment for Prostate Cancer Part 2: Recommendations from the Fourth International Consultation for Sexual Medicine (ICSM 2015) ^[24]	2017	泌尿生殖系统疾病	国外	杂志	非学会/协会	初始版
Stroke in Childhood Clinical Guideline for Diagnosis, Management and Rehabilitation ^[25]	2017	神经系统疾病	国外	网页	非学会/协会	更新版
Vision Rehabilitation Preferred Practice Pattern^[26]	2017	眼和附器疾病	国外	杂志	学会/协会	初始版
骨质疏松症康复指南^[27,28]	2019	肌肉骨骼系统和结缔组织疾病	国内	杂志	学会/协会	初始版
脑卒中水中运动治疗中国循证临床实践指南(2019版) ^[29]	2019	神经系统疾病	国内	杂志	学会/协会	初始版
物理技术辅助脑卒中康复的临床指南^[30]	2019	神经系统疾病	国内	杂志	学会/协会	初始版
中国骨肌疾病体外冲击波疗法指南(2019年版)^[31]	2019	肌肉骨骼系统和结缔组织疾病	国内	杂志	学会/协会	更新版
中国脑卒中早期康复治疗指南^[32]	2017	神经系统疾病	国内	杂志	学会/协会	初始版

RIGHT条目内容		报告	未报告
领域一:基本信息
1a	能够通过题目判断为指南,即题目中应该出现类似“指南”或“推荐意见”的字眼	15(93.8)	1(6.3)
1b	描述指南的发表年份	6(37.5)	10(62.5)
1c	描述指南的分类,即筛查、诊断、治疗、管理、预防或其他	14(87.5)	2(12.5)
2	对指南推荐意见进行汇总呈现	5(31.3)	11(68.8)
3	为避免混淆,应对指南中出现的新术语或重要术语进行定义;如果涉及缩略语,应该将其列出并给出对应的全称	2(12.5)	14(87.5)
4	确定至少一位通讯指南制订者或作者,以便联系和反馈	13(81.3)	3(18.8)
领域二:背景
5	描述问题的基本流行病学,比如患病率、发病率、病死率和疾病负担(包括经济负担)	11(68.8)	5(31.3)
6	应描述指南的总目标和具体要达到的目的	12(75.0)	4(25.0)
7a	应描述指南拟实施的主要目标人群	13(81.3)	3(18.8)
7b	应描述指南拟实施的需特别考虑的亚组人群	1(6.3)	15(93.8)
8a	应描述指南的主要使用者(如初级保健提供者、临床专家、公共卫生专家、项目经理或政策制订者)以及指南的其他潜在用户	10(62.5)	6(37.5)
8b	应描述指南针对的具体环境,比如初级卫生保健机构、中低收入国家或住院部门(机构)	3(18.8)	13(81.3)
9a	应描述参与指南制订的所有贡献者及其角色和责任(如指导小组、指南专家组、外审人员、系统评价小组和方法学家)	2(12.5)	14(87.5)
9b	应罗列参与指南制订的所有个人,提供其职称、职务、工作单位等信息	16(100.0)	0(0.0)
领域三:证据
10a	应描述指南推荐意见所基于的关键问题,建议以PICO(人群、干预、对照和结局指标)格式呈现	3(18.8)	13(81.3)
10b	应描述结局遴选和分类的方法	1(6.3)	15(93.8)
11a	应描述该指南基于的系统评价是专门新制作的,还是使用现有已发表的	2(12.5)	14(87.5)
11b	如果指南制订者使用现有已发表的系统评价,应给出参考文献并描述是如何检索和评价的(提供检索策略、筛选条目以及对系统评价的偏倚风险评估),同时报告是否对其进行了更新	8(50.0)	8(50.0)
12	应描述对证据体的质量评价方法或条目	11(68.8)	5(31.3)
领域四:推荐意见
13a	应提供清晰、准确且可实施的推荐意见。拟推荐的干预措施,以及实施干预措施的具体环境,从而让使用者具有可操作性	11(68.8)	5(31.3)
13b	如果证据显示在重要的亚组人群中,某些影响推荐意见的因素存在重大差异,特别是亚组之间的利弊平衡,应单独提供针对这些人群的推荐意见	6(37.5)	10(62.5)
13c	应描述推荐意见的强度以及支持该推荐的证据质量	10(62.5)	6(37.5)
14a	应描述在形成推荐意见时,是否考虑了目标人群的价值观和偏好。如果考虑,请描述确定和收集这些患者价值观和偏好的方法。如果未考虑,需要给出原因	8(50.0)	8(50.0)
14b	应描述在形成推荐意见时,是否考虑了成本和资源利用。如果考虑,请描述具体的方法(如成本效果分析)并总结结果;如果未考虑,请给出原因	8(50.0)	8(50.0)
14c	应描述在形成推荐意见时,是否还考虑了公平性、可行性和可接受性等其他因素	2(12.5)	14(87.5)
15	应描述决策过程和方法,特别是形成推荐意见的方法	7(43.8)	9(56.3)
领域五:评审和质量保证
16	应描述指南制订后是否对其进行独立评审,如果是,请描述具体的评审过程以及评审意见的考虑和处理过程	9(56.3)	7(43.8)
17	应描述指南是否经过了质量控制程序,如果是,则描述其过程	2(12.5)	14(87.5)
领域六:资助与利益冲突声明和管理
18a	应描述指南制订各个阶段的资金资来源情况	10(62.5)	6(37.5)
18b	如适用,也应描述后期在推荐意见的传播和实施过程中的作用	1(6.3)	15(93.8)
19a	应描述指南制订相关的利益冲突的类型	9(56.3)	7(43.8)
19b	应描述对利益冲突的评价和管理方法以及指南用户如何获取这些声明	5(31.3)	11(68.8)
领域七:其他方面
20	应描述在哪里可获取到指南、相应附件及其他相关文件	6(37.5)	10(62.5)
21	应描述当前实践与研究证据之间的差异,和(或)提供对未来研究的建议证据的不足,或者对未来研究的提示	7(43.8)	9(56.3)
22	应描述指南制订过程中的所有局限性(比如制订小组不是多学科团队,或未考虑患者的价值观和偏好)及其对推荐意见有效性可能产生的影响	2(12.5)	14(87.5)

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RIGHT条目	国内	国外	OR(95%CI)
1a	100%	91%	1.57(0.05, 45.37)
1b	60%	27%	4.00(0.43, 37.11)
1c	60%	100%	0.06(0.00, 1.59)
2	20%	36%	0.44(0.04, 5.40)
3	0%	18%	0.35(0.01, 8.58)
4	60%	91%	0.15(0.01, 2.29)
5	80%	64%	2.29(0.19, 28.19)
6	80%	73%	1.50(0.12, 19.44)
7a	60%	91%	0.15(0.01, 2.29)
7b	0%	9%	0.64(0.02, 18.37)
8a	60%	64%	0.86(0.10, 7.51)
8b	40%	9%	6.67(0.44, 101.73)
9a	0%	18%	0.35(0.01, 8.58)
9b	100%	100%	0.00(0.00, 0.00)
10a	20%	18%	1.13(0.08, 16.31)
10b	20%	0%	7.67(0.26, 225.42)
11a	20%	9%	2.50(0.12, 50.44)
11b	40%	55%	0.56(0.07, 4.76)
12	80%	64%	2.29(0.19, 28.19)
13a	40%	82%	0.15(0.01, 1.56)
13b	60%	27%	4.00(0.43, 37.11)
13c	80%	55%	3.33(0.28, 40.29)
14a	40%	55%	0.56(0.07, 4.76)
14b	40%	55%	0.56(0.07, 4.76)
14c	0%	18%	0.35(0.01, 8.58)
15	40%	45%	0.80(0.09, 6.85)
16	60%	55%	1.25(0.15, 10.70)
17	0%	18%	0.35(0.01, 8.58)
18a	40%	73%	0.25(0.03, 2.32)
18b	20%	0%	7.67(0.26, 225.42)
19a	60%	55%	1.25(0.15, 10.70)
19b	0%	45%	0.11(0.01, 2.41)
20	20%	45%	0.30(0.03, 3.63)
21	40%	45%	0.80(0.09, 6.85)
22	0%	18%	0.35(0.01, 8.58)
整体报告率	41%	46%	0.80(0.56, 1.16)

RIGHT条目	初始版	更新版	OR(95%CI)
1a	92%	100%	0.85(0.03, 25.05)
1b	25%	75%	0.11(0.01, 1.52)
1c	92%	75%	3.67(0.17, 77.55)
2	33%	25%	1.50(0.12, 19.44)
3	0%	50%	0.04(0.00, 1.11)
4	83%	75%	1.67(0.11, 25.43)
5	75%	50%	3.00(0.29, 31.63)
6	75%	75%	1.00(0.07, 13.64)
7a	75%	100%	0.30(0.01, 7.17)
7b	8%	0%	1.17(0.04, 34.52)
8a	58%	75%	0.47(0.04, 5.90)
8b	17%	25%	0.60(0.04, 9.16)
9a	17%	0%	2.14(0.09, 54.22)
9b	100%	100%	0.00(0.00, 0.00)
10a	17%	25%	0.60(0.04, 9.16)
10b	8%	0%	1.17(0.04, 34.52)
11a	17%	0%	2.14(0.09, 54.22)
11b	33%	100%	0.06(0.00, 1.36)
12	67%	75%	0.67(0.05, 8.64)
13a	67%	75%	0.67(0.05, 8.64)
13b	42%	25%	2.14(0.17, 27.10)
13c	58%	75%	0.47(0.04, 5.90)
14a	50%	50%	1.00(0.10, 9.61)
14b	50%	50%	1.00(0.10, 9.61)
14c	17%	0%	2.14(0.09, 54.22)
15	33%	75%	0.17(0.01, 2.16)
16	50%	75%	0.33(0.03, 4.19)
17	8%	25%	0.27(0.01, 5.77)
18a	58%	75%	0.47(0.04, 5.90)
18b	8%	0%	1.17(0.04, 34.52)
19a	75%	0%	24.43(1.03, 580.63)^a
19b	25%	50%	0.33(0.03, 3.52)
20	33%	50%	0.50(0.05, 4.98)
21	42%	50%	0.71(0.07, 6.92)
22	8%	25%	0.27(0.01, 5.77)
整体报告率	43%	49%	0.79(0.54, 1.16)

RIGHT条目	学会/协会	非学会/协会	OR(95%CI)
1a	89%	100%	0.38(0.01, 10.74)
1b	44%	29%	2.00(0.24, 16.36)
1c	78%	100%	0.20(0.01, 4.91)
2	22%	43%	0.38(0.04, 3.34)
3	11%	14%	0.75(0.04, 14.58)
4	78%	86%	0.58(0.04, 8.15)
5	89%	43%	10.67(0.82, 138.22)
6	67%	86%	0.33(0.03, 4.19)
7a	78%	86%	0.58(0.04, 8.15)
7b	11%	0%	2.65(0.09, 75.29)
8a	78%	43%	4.67(0.53, 40.89)
8b	22%	14%	1.71(0.12, 23.94)
9a	11%	14%	0.75(0.04, 14.58)
9b	100%	100%	0.00(0.00, 0.00)
10a	22%	14%	1.71(0.12, 23.94)
10b	11%	0%	2.65(0.09, 75.29)
11a	22%	0%	5.00(0.20, 122.74)
11b	56%	43%	1.67(0.23, 12.22)
12	78%	57%	2.63(0.30, 23.00)
13a	67%	71%	0.80(0.09, 6.85)
13b	44%	29%	2.00(0.24, 16.36)
13c	78%	43%	4.67(0.53, 40.89)
14a	56%	43%	1.67(0.23, 12.22)
14b	44%	57%	0.60(0.08, 4.40)
14c	11%	14%	0.75(0.04, 14.58)
15	44%	43%	1.07(0.15, 7.82)
16	67%	43%	2.67(0.35, 20.51)
17	11%	14%	0.75(0.04, 14.58)
18a	56%	71%	0.50(0.06, 4.09)
18b	11%	0%	2.65(0.09, 75.29)
19a	56%	57%	0.94(0.13, 6.88)
19b	22%	43%	0.38(0.04, 3.34)
20	44%	29%	2.00(0.24, 16.36)
21	44%	43%	1.07(0.15, 7.82)
22	0%	29%	0.12(0.01, 2.88)
整体报告率	46%	43%	1.15(0.82, 1.61)

Report Quality of Clinical Practice Guidelines of Rehabilitation Based on RIGHT

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