Rigorous Development does not Ensure that Guidelines are Acceptable to a Panel of Knowledgeable Providers

• Published in: Journal of general internal medicine : JGIM 2008-01, Vol.23 (1), p.37-44
• Main Authors: Nuckols, Teryl K., Lim, Yee-Wei, Wynn, Barbara O., Mattke, Soeren, MacLean, Catherine H., Harber, Philip, Brook, Robert H., Wallace, Peggy, Garland, Rena H., Asch, Steven
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Biological and medical sciences; California; Consensus; Delphi Technique; Evidence-Based Medicine; General aspects; Guideline Adherence - statistics & numerical data; Guidelines; Health care delivery; Health participants; Humans; Internal Medicine; Medical sciences; Medicine; Medicine & Public Health; Miscellaneous; Musculoskeletal Diseases - diagnosis; Occupational Diseases - diagnosis; Original; Original Article; Physicians; Practice Guidelines as Topic - standards; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality Control
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-007-0440-9

BACKGROUND Rigorous guideline development methods are designed to produce recommendations that are relevant to common clinical situations and consistent with evidence and expert understanding, thereby promoting guidelines’ acceptability to providers. No studies have examined whether this technical quality consistently leads to acceptability. OBJECTIVE To examine the clinical acceptability of guidelines having excellent technical quality. DESIGN AND MEASUREMENTS We selected guidelines covering several musculoskeletal disorders and meeting 5 basic technical quality criteria, then used the widely accepted AGREE Instrument to evaluate technical quality. Adapting an established modified Delphi method, we assembled a multidisciplinary panel of providers recommended by their specialty societies as leaders in the field. Panelists rated acceptability, including “perceived comprehensiveness” (perceived relevance to common clinical situations) and “perceived validity” (consistency with their understanding of existing evidence and opinions), for ten common condition/therapy pairs pertaining to Surgery, physical therapy, and chiropractic manipulation for lumbar spine, shoulder, and carpal tunnel disorders. RESULTS Five guidelines met selection criteria. Their AGREE scores were generally high indicating excellent technical quality. However, panelists found 4 guidelines to be only moderately comprehensive and valid, and a fifth guideline to be invalid overall. Of the topics covered by each guideline, panelists rated 50% to 69% as “comprehensive” and 6% to 50% as “valid”. CONCLUSION Despite very rigorous development methods compared with guidelines assessed in prior studies, experts felt that these guidelines omitted common clinical situations and contained much content of uncertain validity. Guideline acceptability should be independently and formally evaluated before dissemination.