title: Quality of tuberculosis guidelines: urgent need for improvement.
abstract: METHODS
  Clinical practice guidelines have been developed for many disorders, but their quality varies greatly and does not always reach an acceptable standard. No evaluation of clinical practice guidelines on tuberculosis (TB) has been carried out to date.
  
  
  OBJECTIVE
  To identify and assess the quality of TB guidelines.
  
  
  METHODS
  We systematically searched documents published from January 1998 to May 2008 in Medline and the Turning Research into Practice (TRIP) database and in clearing houses and on websites of scientific societies. Three appraisers evaluated each guideline using the AGREE (Appraisal of Guidelines, Research and Evaluation) instrument. A standardised score was calculated separately for each of the six domains.
  
  
  RESULTS
  A total of 36 guidelines for TB were identified, and after appraisal good overall agreement was observed among the three evaluators. Results revealed that quality was acceptable in two domains but had serious shortcomings in the other four. A slight improvement in quality was observed in documents published in 2005 or later. After global assessment, 18 documents were considered 'recommended with provisos' and only two documents 'strongly recommended' for use in clinical practice.
  
  
  CONCLUSIONS
  The methodological quality of TB guidelines was disappointingly low. All guideline developers should adhere to instruments such as AGREE to produce documents of optimal quality.
authors.affiliation: Preventive Medicine and Healthcare Quality Service, Department of Public Health, History of Science and Gynaecology, Hospital Universitari Sant Joan d'Alacant, Universidad Miguel Hernandez, Alicante, Spain. carmen.gallardo@alu.umh.es
authors.forename: C R
authors.initials: CR
authors.lastname: Gallardo
authors.forename: D
authors.initials: D
authors.lastname: Rigau
authors.forename: A
authors.initials: A
authors.lastname: Irfan
authors.forename: A
authors.initials: A
authors.lastname: Ferrer
authors.forename: J A
authors.initials: JA
authors.lastname: Caylà
authors.forename: X
authors.initials: X
authors.lastname: Bonfill
authors.forename: P
authors.initials: P
authors.lastname: Alonso-Coello
authors.forename: P
authors.initials: P
authors.lastname: Alonso-Coelho
mesh_terms: D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000639:trends*; D014376:Tuberculosis / Q000628:therapy*