gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

Potential Impacts of Grading vs. Not Grading Literature

Meeting Abstract

  • K. Hegmann - Rocky Mtn. Center for Occupational & Environmental Health, University of Utah, Salt Lake City, USA
  • C. Wolfkiel - American College of Occupational and Environmental Medicine, Chicago, IL, USA
  • J. Harris - Kaiser Permanente, San Francisco, USA
  • M. Thiese - Rocky Mtn. Center for Occupational & Environmental Health, University of Utah, Salt Lake City, USA
  • M. Hughes - Rocky Mtn. Center for Occupational & Environmental Health, University of Utah, Salt Lake City, USA
  • J. Biggs - Rocky Mtn. Center for Occupational & Environmental Health, University of Utah, Salt Lake City, USA
  • U. Ott - Rocky Mtn. Center for Occupational & Environmental Health, University of Utah, Salt Lake City, USA
  • J. Ording - American College of Occupational and Environmental Medicine, Chicago, IL, USA

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP057

DOI: 10.3205/12gin169, URN: urn:nbn:de:0183-12gin1699

Published: July 10, 2012

© 2012 Hegmann et al.
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Outline

Text

Background: Some have argued that critical appraisal ('grading') of the literature is unnecessary to support practice guidelines. However, critical appraisal is required for the American College of Occupational and Environmental Medicine's (ACOEM) Evidence-based Practice Guidelines.

Objective: To assess potential guidance results depending on critical appraisal of evidence.

Methods: ACOEM Low Back Pain guidelines were reviewed to determine whether the literature was heterogeneous, and the appraised strength of evidence. An assessment was made whether guidance might differ if evidence had not been appraised. Methods and recommendations were then compared across international guidelines for LBP to confirm these findings.

Results: ACOEM Guidelines 3rd Edition contains at least 162 distinct treatment recommendations for LBP (some of which are compound). These are derived from systematic reviews including 906 references. Time cost for grading of evidence is doubled (approximately 20min vs. 10min/article). There are several areas where guidance may differ if literature was not appraised. Among these are: NSAIDs for sciatica, Transcutaneous Electric Nerve Stimulation (TENS), stretching exercises and manipulation for some indications. For areas with low quality evidence, there was nevertheless convergence of recommendations among guidelines that used well-structured processes.

Discussion: Guidance may differ if critical appraisal is performed. Differences in guidance are most likely with either substantially conflicting evidence and/or low magnitudes of efficacy.

Implications for guideline developers/users: Critical appraisal of evidence is time-consuming. It may result in different guidance compared with not appraising evidence, but may be limited to areas with relatively low magnitudes of efficacy and/or conflicting evidence.