title: A Systematic Critical Appraisal of Clinical Practice Guidelines in Juvenile Idiopathic Arthritis Using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) Instrument.
abstract: OBJECTIVE
  The objectives of this review are to: 1) appraise the methodological quality of clinical practice guidelines (CPGs) in juvenile idiopathic arthritis (JIA) providing pharmacological and/or non-pharmacological intervention recommendations, and 2) summarize the recommendations provided by the included CPGs and compare them where possible.
  
  
  METHODS
  A systematic search was performed. Three trained appraisers independently evaluated the methodological quality of the CPGs using a validated and reliable instrument, the Appraisal of Guidelines in Research and Evaluation II. Six domains were considered: 1) score and purpose; 2) stakeholder involvement; 3) rigor of development; 4) clarity of presentation; 5) applicability; and 6) editorial independence. The domains consist of a total of 23 items each scored on a 7-point scale. High quality CPGs were identified if they had a domain score above 60% in rigor of development, and two other domains.
  
  
  RESULTS
  Of the three included CPGs, the Royal Australian College of General Practitioners (RACGP) and American College of Rheumatology (ACR) CPGs were considered to be of high quality, but the German Society for Pediatric Rheumatology was of lower quality. Domains one to four had high domain scores across the guidelines (mean (standard deviation)): 72.76 (13.80); 66.67 (9.81); 64.67 (7.77); and 87.00 (9.64), respectively. Lower scores were obtained for applicability (14.00 (5.57)) and editorial independence (43.44 (7.02)). Recommendations varied across CPGs due to differences in context, target audience (general practitioners, rheumatologists, and other multidisciplinary healthcare professionals) and patients' disease presentations. Despite this variability, progression of pharmacological treatment did not conflict between CPGs. Recommendations for non-pharmacological interventions were vague and the interventions considered varied between CPGs.
  
  
  CONCLUSIONS
  Overall, recommendations were based on a paucity of evidence and weak study designs. Further research is needed on interventions in JIA, as well as higher quality CPGs to facilitate implementation of the best evidence-based recommendations in clinical practice.
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Christine A M
authors.initials: CA
authors.lastname: Smith
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Karine
authors.initials: K
authors.lastname: Toupin-April
authors.affiliation: Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Jutai
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Ciarán M
authors.initials: CM
authors.lastname: Duffy
authors.affiliation: Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Prinon
authors.initials: P
authors.lastname: Rahman
authors.affiliation: École de Santé Publique, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Cavallo
authors.affiliation: School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Lucie
authors.initials: L
authors.lastname: Brosseau
mesh_terms: D001171:Arthritis, Juvenile / Q000175:diagnosis*; D002648:Child; D006287:Health Planning Guidelines; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards