OBJECTIVES:

Healthcare practice demand informed decision making. Practice advancement needs scientific development of clinical guidelines. The research team is involved in the development of clinical practice guidelines, and it was essential to appraise guidelines to observe patterns of quality.

METHODS:

The Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument evaluates the process of practice guideline development and the quality of reporting. The AGREE II is both valid and reliable and comprises 23 items organized into the original 6 quality domains. We appraised 4 mainstream clinical guidelines (2 cardiovascular and 2 kidney, all published in 2017) to observe patterns of quality among 6 domains of AGREE II instrument. Three experts performed the appraisal to reach on consensus scores.

RESULTS:

Though there are no clear thresholds for acceptable quality of guidelines as per AGREE score, generally a score above 70% is considered of good quality as described by the AGREE II manual. In our appraisal the Domain 1: Scope and Purpose scored 94% (SD ± 7) and Domain 4: Clarity of Presentation scored 99% (SD ± 3). Domain 2: Stakeholder Involvement 76% (SD ± 29) and Domain 3: Rigor of Development 76% (SD ± 20) were fairly good quality with considerable variation among guidelines. Domain 5: Applicability 57 (SD ± 11) and Domain 6: Editorial Independence 36 (SD ± 43) were scored relatively lower.

CONCLUSIONS:

Appraising a group of popular clinical guidelines gave an insight of challenges faced by time-tested guidelines. Though the rigor of development and clarity of presentation were taken care, it was difficult to communicate applicability. As information was insufficient and presence of just 1 item in Domain 6: editorial independence, we feel we could not derive a conclusion on it.