title: Strategies to assess the validity of recommendations: a study protocol.
abstract: BACKGROUND
  Clinical practice guidelines (CPGs) become quickly outdated and require a periodic reassessment of evidence research to maintain their validity. However, there is little research about this topic. Our project will provide evidence for some of the most pressing questions in this field: 1) what is the average time for recommendations to become out of date?; 2) what is the comparative performance of two restricted search strategies to evaluate the need to update recommendations?; and 3) what is the feasibility of a more regular monitoring and updating strategy compared to usual practice?. In this protocol we will focus on questions one and two.
  
  
  METHODS
  The CPG Development Programme of the Spanish Ministry of Health developed 14 CPGs between 2008 and 2009. We will stratify guidelines by topic and by publication year, and include one CPG by strata.We will develop a strategy to assess the validity of CPG recommendations, which includes a baseline survey of clinical experts, an update of the original exhaustive literature searches, the identification of key references (reference that trigger a potential recommendation update), and the assessment of the potential changes in each recommendation.We will run two alternative search strategies to efficiently identify important new evidence: 1) PLUS search based in McMaster Premium LiteratUre Service (PLUS) database; and 2) a Restrictive Search (ReSe) based on the least number of MeSH terms and free text words needed to locate all the references of each original recommendation.We will perform a survival analysis of recommendations using the Kaplan-Meier method and we will use the log-rank test to analyse differences between survival curves according to the topic, the purpose, the strength of recommendations and the turnover. We will retrieve key references from the exhaustive search and evaluate their presence in the PLUS and ReSe search results.
  
  
  CONCLUSIONS
  Our project, using a highly structured and transparent methodology, will provide guidance of when recommendations are likely to be at risk of being out of date. We will also assess two novel restrictive search strategies which could reduce the workload without compromising rigour when CPGs developers check for the need of updating.
authors: Iberoamerican Cochrane Centre- Biomedical Research Institute Sant Pau IIB Sant Pau, Barcelona, Spain. laura.martinez.garcia@cochrane.es
authors: Laura
authors: L
authors: Martínez García
authors: Andrea Juliana
authors: AJ
authors: Sanabria
authors: Ignacio
authors: I
authors: Araya
authors: Jennifer
authors: J
authors: Lawson
authors: R Brian
authors: RB
authors: Haynes
authors: David
authors: D
authors: Rigau
authors: Ivan
authors: I
authors: Solà
authors: Petra
authors: P
authors: Díaz Del Campo
authors: Maria Dolors
authors: MD
authors: Estrada
authors: Itziar
authors: I
authors: Etxeandia-Ikobaltzeta
authors: Elvira
authors: E
authors: García Álvarez
authors: Javier
authors: J
authors: Gracia
authors: Anna
authors: A
authors: Kotzeva
authors: Arturo
authors: A
authors: Louro-González
authors: Flavia
authors: F
authors: Salcedo-Fernandez
authors: Maria Mar
authors: MM
authors: Trujillo-Martín
authors: Pablo
authors: P
authors: Alonso-Coello
mesh_terms: D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D006801:Humans; D016247:Information Storage and Retrieval; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D012196:Review Literature as Topic; D013997:Time Factors; D057170:Translational Research, Biomedical
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