Quality and Scope of Published International Guidelines for Multiple Sclerosis Care: AGREE II Appraisal

Abstract

Background

There is no comprehensive clinical practice guideline (CPG) for multiple sclerosis (MS) rehabilitation and symptom management. This study aimed to identify and appraise the quality and scope of topics covered by existing international CPGs to inform development of a future comprehensive guideline.

Methods

Electronic databases and grey literature were systematically searched for existing CPGs for MS. Identified guidelines were screened independently by 3 authors for inclusion criteria. Included guidelines were each appraised by 4 reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. The AGREE-II comprises 23 items organized into 6 domains assessing the quality and reporting of CPGs. Mean AGREE ratings and ranges were calculated for each quality domain. The intra class correlation coefficient (ICC) assessed inter-rater reliability. Individual recommendations were organized into broad topics.

Results

15 CPGs published between 1998 and 2020 met the inclusion criteria. These derived from USA (n = 8), UK (n = 3), Canada (n = 2), and Europe (n = 2). Standardized scores (and range) of quality ratings for the six domains were: 1. Scope and purpose = 83.2% (range 53.7 −100%); 2. Stakeholder involvement = 64.2% (range 31.9–100%); 3. Rigour of development = 55.7% (range 12–93.8%); 4. Clarity of presentation = 79.6% (range 56.9–100%); 5. Applicability = 34.9% (range 13.9–78.1%); and 6. Editorial independence = 60% (range 0–100%). The highest scoring domains were for Scope and purpose and Clarity of presentation. Applicability was the lowest scoring domain with 12/15 guidelines scoring low in this domain. There was moderate to excellent inter-rater reliability (0.60–0.96 across the 6 domains). Recommendations from the CPGs covered spasticity, fatigue, bowel, bladder, pregnancy, physical activity, cognition, mood, and/or multi-disciplinary care topics.

Conclusion

Existing CPGs have well-defined objectives and target populations, yet clinical applicability and rigour of development is lower. A comprehensive up-to-date MS clinical practice guideline that provides implementation support is urgently needed.