A Systematic Critical Appraisal of Non-Pharmacological Management of Rheumatoid Arthritis with Appraisal of Guidelines for Research and Evaluation II
A Systematic Critical Appraisal of Non-Pharmacological Management of Rheumatoid Arthritis with Appraisal of Guidelines for Research and Evaluation II
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DOI：
10.1371/journal.pone.0095369
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发表时间：
2014-05-19
期刊：
影响因子：
3.7
通讯作者：
Mc Ewan, Jessica
中科院分区：
文献类型：
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作者：
Brosseau, Lucie;Rahman, Prinon;Mc Ewan, Jessica
临床实践指南（CPG）已经制定，以总结有关类风湿关节炎（RA）管理的证据，并促进消费者，卫生专业人员，卫生管理人员和政策制定者对循证知识的吸收。本综述的目的是使用标准化和经验证的工具-研究和评价指南评估（AGREE II）工具评估CPGS对RA非药物管理的质量，并总结这些CPGS的关键建议。系统检索了2001年至2013年的科学文献数据库，共识别出13个RA CPG。只有少数AGREE II领域得到了CPGS的有效处理。在13个中央政策组中，有10个有效地解决了范围和目的问题，11个中央政策组中有利益攸关方参与，6个中央政策组中有制定的严谨性问题，9个中央政策组中有清晰度/表述问题，1个中央政策组中有编辑独立性问题，没有一个中央政策组中有适用性问题。根据7分AGREE II评分系统，纳入的CPG的总体质量为4.8 +/- 1.04。患者教育/自我管理、有氧运动、动态和伸展运动是高质量CPG对RA非药物管理的普遍推荐。一般临床管理建议在高质量CPG中趋于相似。非药物管理干预措施在一半以上的选定CPG中得到了表面上的解决。CPG创建者在制定指南时应使用AGREE II标准。为了最终提高关节炎患者的生活质量，需要向用户实施创新和有效的CPG方法。此外，很难在强烈推荐、推荐和弱推荐之间建立联系，因为在被评估的CPG之间的推荐强度之间没有共识。
Clinical practice guidelines (CPGs) have been developed to summarize evidence about the management of rheumatoid arthritis (RA) and facilitate the uptake of evidence-based knowledge by consumers, health professionals, health administrators and policy makers. The objectives of this review was to assess the quality of CPGS on non-pharmacological management of RA with a standardized and validated instrument - the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool and summarize the key recommendations from these CPGs. Scientific literature databases from 2001 to 2013 were systematically searched and a total of 13 CPGs for RA was identified. Only a minority of AGREE II domains were effectively addressed by the CPGS. Scope and purpose was effectively addressed in 10 out of 13 CPGs, stakeholder involvement in 11 CPGs, rigor of development in 6 CPGs, clarity/presentation in 9 CPGs, editorial independence in 1 CPGs, and applicability in none of the CPGs. The overall quality of the included CPGs according to the 7-point AGREE II scoring system was 4.8 +/- 1.04. Patient education/self-management, aerobic, dynamic and stretching exercises were the commonly recommended for the non-pharmacological management of RA by the high-quality CPGs. The general clinical management recommendations tended to be similar among high-quality CPGs. Non-pharmacological management interventions were superficially addressed in more than half of the selected CPGs. CPGs creators should use the AGREE II criteria when developing guidelines. Innovative and effective methods of CPGs implementation to users are needed to ultimately enhance the quality of life of arthritic individuals. In addition, it was difficult to establish between strongly recommended, recommended and weakly recommended, as there is no consensus between the strength of the recommendations between the appraised CPGs.