Evaluation of the Quality of Guidelines for Myasthenia Gravis with the AGREE II Instrument

Background: Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners in making decisions about appropriate healthcare in specific clinical circumstances. The methodological quality of CPGs for myasthenia gravis (MG) are unclear. Objective: To critically evaluate the methodological quality of CPGs for MG using AGREE II instrument. Method: A systematical search strategy on PubMed, EMBASE, DynaMed, the National Guideline Clearinghouse (NGC) and the Chinese Biomedical Literature database (CBM) was performed on September 20th 2013. All guidelines related to MG were evaluated with AGREE II. The software used for analysis was SPSS 17.0. Results: A total of 15 CPGs for MG met the inclusion criteria (12 CPGs in English, 3 CPGs in Chinese). The overall agreement among reviews was moderate or high (ICC > 0.70). The mean scores (mean +/- SD) for al six domains were presented as follows: scope and purpose (60.93% +/- 16.62%), stakeholder involvement (40.93% +/- 20.04%), rigor of development (37.22% +/- 30.46%), clarity of presentation (64.26% +/- 16.36%), applicability (28.19% +/- 20.56%) and editorial independence (27.78% +/- 28.28%). Compared with non-evidence-based CPGs, evidence-based CPGs had statistically significant higher quality scores for all AGREE II domains (P < 0.05). All domain scores appear slightly higher for CPGs published after AGREE II instrument development and validation (P < 0.05). The quality scores of CPGs developed by NGC/AAN were higher than the quality scores of CPGs developed by other organizations for all domains. The difference was statistically significant for all domains with the exception of clarity of presentation (P = 0.07). Conclusions: The qualities of CPGs on MG were generally acceptable with several flaws. The AGREE II instrument should be adopted by guideline developers, particularly in China.