Artikel
Potential Impacts of Grading vs. Not Grading Literature
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Veröffentlicht: | 10. Juli 2012 |
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Gliederung
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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.