title: Tools for assessing the content of guidelines are needed to enable their effective use--a systematic comparison.
abstract: BACKGROUND
  To ensure that clinical practice guidelines (CPGs) form a sound basis for decision-making in health care, it is necessary to be able to reliably assess and ensure their quality. This results in the need to assess the content of guidelines systematically, particularly with regard to the validity of their recommendations.The aim of the present analysis was to determine the suitability and applicability of frequently used assessment tools for evidence syntheses with regard to the assessment of guideline content.
  
  
  METHODS
  We conducted a systematic comparison and analysis of established tools for the assessment of evidence syntheses (guidelines, systematic reviews, health technology assessments). The tools analyzed were: ADAPTE, AGREE II, AMSTAR, GLIA and the INAHTA checklist. We analyzed methodological steps related to the assessment of the reliability and validity of guideline recommendations. Data were extracted and analyzed by two persons independently of one another.
  
  
  RESULTS
  Widely used tools for the methodological assessment of evidence syntheses are not suitable for a comprehensive content-related assessment. They remain mostly at the level of assessment of the documentation of processes. Some tools assess selected content-related aspects, but operationalization is either unspecific or lacking.
  
  
  CONCLUSIONS
  None of the tools analyzed enables the structured and comprehensive assessment of the content of guideline recommendations with special regard to their reliability and validity. All tools contribute towards the judicious use of evidence syntheses by supporting their systematic development or assessment. However, further progress is needed, particularly with regard to the assessment of content quality. This includes comprehensive operationalization and documentation of the assessment process to ensure reliability and validity, and therefore to enable the effective use of trustworthy guidelines in the health care system.
authors.affiliation: Department Evidence-based Health Services Research, Faculty of Health, Department of Medicine, Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str, 200, Building 38, 51109 Cologne, Germany. michaela.eikermann@uni-wh.de.
authors.forename: Michaela
authors.initials: M
authors.lastname: Eikermann
authors.forename: Nicole
authors.initials: N
authors.lastname: Holzmann
authors.forename: Ulrich
authors.initials: U
authors.lastname: Siering
authors.forename: Alric
authors.initials: A
authors.lastname: Rüther
mesh_terms: D020811:Biomedical Technology / Q000379:methods; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D017410:Practice Guidelines as Topic; D011786:Quality Control; D011787:Quality of Health Care / Q000592:standards*; D015203:Reproducibility of Results; D012107:Research Design / Q000706:statistics & numerical data*