title: A critical appraisal of the North American Spine Society guidelines with the Appraisal of Guidelines for Research and Evaluation II instrument.
abstract: BACKGROUND
  The North American Spine Society (NASS) publishes clinical guidelines that are taken into consideration worldwide by clinicians who have a special interest in spinal surgery. The Appraisal of Guidelines for Research and Evaluation (AGREE) II is the second version of the original AGREE instrument to assess the quality of guidelines in terms of development process. This appraisal aims to evaluate each individual NASS guideline using AGREE II tool to demonstrate its methodologic robust and weakness.
  
  
  OBJECTIVE
  To evaluate the quality of the clinical practice guidelines published by the NASS.
  
  
  METHODS
  Four appraisers used the AGREE II guideline evaluation instrument to evaluate the NASS guidelines.
  
  
  METHODS
  All six guidelines available on the NASS web site as of July 1, 2014 were evaluated. Four reviewers independently assessed these guidelines using the AGREE II instrument. The instrument standardizes the quantitative assessment of quality for a guideline's development process across six domains that include: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. Additionally, each reviewer rated the overall quality of the guidelines.
  
  
  RESULTS
  Overall results for the AGREE II domains across all six guidelines were: scope and purpose (median score, 94.4%), stakeholder involvement (median score, 56.9%), rigor of development (median score, 91.7%), clarity of presentation (median score, 94.4%), applicability (median score, 60.9%), and editorial independence (median score, 71.9%).
  
  
  CONCLUSIONS
  Our study showed that the quality of the NASS guidelines needs some improvement. There is a critical need for broader stakeholder involvement including patient representatives and health economists. Consideration of resource implications and monitoring process and standardization of how recommendations are implemented need to be improved. Studies analyzing facilitators and barriers would be helpful for future NASS guidelines.
authors.affiliation: Department of Neurosurgery, Yenimahalle Education and Research Hospital, 2026.Cd, 06370, Batikent, Ankara, Turkey. Electronic address: mesutemreyaman@hotmail.com.
authors.forename: Mesut Emre
authors.initials: ME
authors.lastname: Yaman
authors.affiliation: Department of Urology, Memorial Hospital, 1422.Sokak No:4, 06520 Çankaya, Ankara, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Gudeloglu
authors.affiliation: Department of Neurosurgery, Corum Education and Research Hospital, Çamlık Cad.No:2, Corum, Turkey.
authors.forename: Salim
authors.initials: S
authors.lastname: Senturk
authors.affiliation: Department of Cardiovascular Surgery, Ankara University School of Medicine, 06590, Cebeci, Ankara, Turkey.
authors.forename: Nur Dikmen
authors.initials: ND
authors.lastname: Yaman
authors.affiliation: Department of Orthopaedics, Yenimahalle Education and Research Hospital, 2026.Cd, 06370, Batikent, Ankara, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Tolunay
authors.affiliation: Department of Neurosurgery, Yenimahalle Education and Research Hospital, 2026.Cd, 06370, Batikent, Ankara, Turkey.
authors.forename: Yasar
authors.initials: Y
authors.lastname: Ozturk
authors.affiliation: Department of Orthopaedics, Yenimahalle Education and Research Hospital, 2026.Cd, 06370, Batikent, Ankara, Turkey.
authors.forename: Arslan Kağan
authors.initials: AK
authors.lastname: Arslan
mesh_terms: D006801:Humans; D019637:Orthopedic Procedures / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012107:Research Design / Q000592:standards; D012955:Societies, Medical / Q000592:standards*; D013131:Spine / Q000601:surgery; D014481:United States
keywords: AGREE; Appraisal; Clinical guidelines; North American Spine Society; Quality; Spine surgery