Reliability and validity of the AGREE instrument used by physical therapists in assessment of clinical practice guidelines.
BACKGROUND
The AGREE instrument has been validated for evaluating Clinical Practice Guidelines (CPG) pertaining to medical care. This study evaluated the reliability and validity of physical therapists using the AGREE to assess quality of CPGs relevant to physical therapy practice.


METHODS
A total of 69 physical therapists participated and were classified as generalists, specialist or researchers. Pairs of appraisers within each category evaluated independently, a set of 6 CPG selected at random from a pool of 55 CPGs.


RESULTS
Reliability between pairs of appraisers indicated low to high reliability depending on the domain and number of appraisers (0.17-0.81 for single appraiser; 0.30-0.96 when score averaged across a pair of appraisers). The highest reliability was achieved for Rigour of Development, which exceeded ICC> 0.79, if scores from pairs of appraisers were pooled. Adding more than 3 appraisers did not consistently improve reliability. Appraiser type did not determine reliability scores. End-users, including study participants and a separate sample of 102 physical therapy students, found the AGREE useful to guide critical appraisal. The construct validity of the AGREE was supported in that expected differences on Rigour of Development domains were observed between expert panels versus those with no/uncertain expertise (differences of 10-21% p = 0.09-0.001). Factor analysis with varimax rotation, produced a 4-factor solution that was similar, although not in exact agreement with the AGREE Domains. Validity was also supported by the correlation observed (Kendall-tao = 0.69) between Overall Assessment and the Rigour of Development domain.


CONCLUSIONS
These findings suggest that the AGREE instrument is reliable and valid when used by physiotherapists to assess the quality of CPG pertaining to physical therapy health services.
MacDermid
Joy C
JC
School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. macderj@mcmaster.ca
Brooks
Dina
D
Solway
Sherra
S
Switzer-McIntyre
Sharon
S
Brosseau
Lucie
L
Graham
Ian D
ID
D002309:Cardiology; D032921:Consensus; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D009462:Neurology; D009985:Orthopedics; D026761:Physical Therapy Specialty / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011785:Quality Assurance, Health Care
J Health Serv Res Policy. 2000 Apr;5(2):76-82
10947551
Int J Qual Health Care. 1999 Feb;11(1):21-8
10411286
Int J Technol Assess Health Care. 2000 Autumn;16(4):1039-49
11187086
CMAJ. 2001 Jan 23;164(2):191-9
11332311
Qual Saf Health Care. 2003 Feb;12(1):18-23
12571340
Int J Qual Health Care. 2003 Feb;15(1):31-45
12630799
Int J Technol Assess Health Care. 2003 Winter;19(1):148-57
12701947
J Eval Clin Pract. 2003 May;9(2):195-202
12787183
Lancet. 2003 Oct 11;362(9391):1225-30
14568747
J Can Dent Assoc. 2004 May;70(5):301
15132811
J Clin Oncol. 2004 May 15;22(10):2000-7
15143093
Arch Intern Med. 1990 Sep;150(9):1811-8
2203320
Br Med Bull. 1995 Oct;51(4):927-40
8556300
Annu Rev Public Health. 1996;17:511-38
8724238
Int J Technol Assess Health Care. 2000 Autumn;16(4):1024-38
11155826