A comparison of clinical practice guideline appraisal instruments

Objective: To identify and compare clinical practice guideline appraisal in struments. Methods: Appraisal instruments, defined as instruments intended to be used for guideline evaluation, were identified by searching MEDLINE (1966-99) us ing the Medical Subject Heading (MeSH) practice guidelines, reviewing bibli ographies of the retrieved articles, and contacting authors of guideline ap praisal instruments. Two reviewers independently examined the questions/sta tements from all the instruments and thematically grouped them. The 44 grou pings were collapsed into 10 guideline attributes. Using the items, two rev iewers independently undertook a content analysis of the instruments. Results: Fifteen instruments were identified, and two were excluded because they were not focused on evaluation. All instruments were developed after 1992 and contained 8 to 142 questions/statements. Of the 44 items used for the content analysis, the number of items covered by each instrument ranged from 6 to 34. Only the instrument by Cluzeau and colleagues included at le ast one item for each of the 10 attributes, and it addressed 28 of the 44 i tems. This instrument and that of Shaneyfelt et al. are the only instrument s that have so far been validated. Conclusions: A comprehensive, concise, and valid instrument could help user s systematically judge the quality and utility of clinical practice guideli nes. The current instruments vary widely in length and comprehensiveness. T here is insufficient evidence to support the exclusive use of any one instr ument, although the Cluzeau instrument has received the greatest evaluation . More research is required on the reliability and validity of existing gui deline appraisal instruments before any one instrument can become widely ad opted.