title: Raising the quality of rheumatology management recommendations: lessons from the EULAR process 10 years after provision of standard operating procedures.
abstract: OBJECTIVE
  To increase understanding of how to raise the quality of rheumatology guidelines by reviewing European League Against Rheumatism (EULAR) management recommendations, using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, 10 years after publication of the EULAR standardized operating procedures (SOP) for the production of recommendations. It was hoped that this work could help inform improvements in guideline development by other societies and organizations.
  
  
  METHODS
  The SOP were published in 2004 to ensure the quality of EULAR-endorsed recommendations. We reviewed 27 published EULAR recommendations for management using the AGREE II tool. This provides a framework to assess the quality of guidelines across six broad domains using 23 specific questions.
  
  
  RESULTS
  Overall the EULAR recommendations reviewed have been performed to a high standard. There are particular strengths in the methodology and presentation of the guidelines; however, the results indicate areas for development in future recommendations: in particular, stakeholder involvement and applicability of the recommendations. Improvements in quality were evident in recent years, with patient representation in 9 of 15 (60.0%) recommendations published 2010-14 compared with 4 of 12 (33.3%) published 2000-09.
  
  
  CONCLUSIONS
  In the last 10 years the overall quality of recommendations was good, with standards improving over the decade following publication of the SOP. However, this review process has identified potential areas for improvement, especially in patient representation and provision of implementation tools. The lessons from this work can be applied to the development of rheumatology guidelines by other societies and organizations.
authors.affiliation: NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK, Department of Rheumatology, Yeovil District Hospital, Yeovil.
authors.forename: Alexandra N
authors.initials: AN
authors.lastname: Colebatch-Bourn
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds.
authors.forename: Philip G
authors.initials: PG
authors.lastname: Conaghan
authors.affiliation: Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK and.
authors.forename: Nigel K
authors.initials: NK
authors.lastname: Arden
authors.affiliation: Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK and.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Department of Rheumatology, Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, EULAR Centre of Excellence; INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.affiliation: NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK, Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK and cedwards@soton.ac.uk.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Edwards
mesh_terms: D019468:Disease Management; D005060:Europe; D019317:Evidence-Based Medicine; D006801:Humans; D007391:International Cooperation; D010358:Patient Participation; D017410:Practice Guidelines as Topic / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000628:therapy*
keywords: clinical practice guideline; health care quality assessment; rheumatology