South African clinical practice guidelines quality measured with complex and rapid appraisal instruments.
BACKGROUND
Critically appraising the quality of clinical practice guidelines (CPGs) is an essential element of evidence implementation. Critical appraisal considers the quality of CPG construction and reporting processes, and the credibility of the body of evidence underpinning recommendations. To date, the focus on CPG critical appraisal has come from researchers and evaluators, using complex appraisal instruments. Rapid critical appraisal is a relatively new approach for CPGs, which targets busy end-users such as service managers and clinicians. This paper compares the findings of two critical appraisal instruments: a rapid instrument (iCAHE) and a complex instrument (AGREE II). They were applied independently to 16 purposively-sampled, heterogeneous South African CPGs, written for eleven primary health care conditions/health areas. Overall scores, and scores in the two instruments' common domains Scope and Purpose, Stakeholder involvement, Underlying evidence/Rigour of Development, Clarity), were compared using Pearson r correlations and intraclass correlation coefficients. CPGs with differences of 10 % or greater between scores were identified and reasons sought for such differences. The time taken to apply the instruments was recorded.


RESULTS
Both instruments identified the generally poor quality of the included CPGs, particularly in Rigour of Development. Correlation and agreement between instrument scores was moderate, and there were no overall significant score differences. Large differences in scores for some CPGs could be explained by differences in instrument construction and focus, and CPG construction. The iCAHE instrument was demonstrably quicker to use than the AGREE II instrument.


CONCLUSIONS
Either instrument could be used with confidence to assess the quality of CPGs. The choice of appraisal instrument depends on the needs and time of end-users. Having an alternative (rapid) critical appraisal tool will potentially encourage busy end-users to identify and use good quality CPGs to inform practice decisions.
International Centre for Allied Health Evidence (iCAHE), University of South Australia, City East Campus, P4-18 North Terrace, Adelaide, 5000, Australia. Karen.Grimmer@unisa.edu.au.|Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa. Karen.Grimmer@unisa.edu.au.
Karen
K
Grimmer
European and Developing Countries Clinical Trial Partnership (EDCTP), Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa.|South African Cochrane Centre (SACC), South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa.
Shingai
S
Machingaidze
Centre for Evidence-Based Health Care (CEBHC), Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.|Center for Health Research and Movement Science, University of Santo Tomas, Espana, 1018, Manila, Philippines.
Janine
J
Dizon
European and Developing Countries Clinical Trial Partnership (EDCTP), Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa.
Tamara
T
Kredo
Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.|South African Cochrane Centre (SACC), South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa.
Quinette
Q
Louw
Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.|Centre for Evidence-Based Health Care (CEBHC), Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.
Taryn
T
Young
D002985:Clinical Protocols / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011786:Quality Control; D013019:South Africa; D011795:Surveys and Questionnaires; D017749:Total Quality Management / Q000379:methods / Q000706:statistics & numerical data
AGREE II; CPG quality; Clinical practice guidelines (CPGs); Complex appraisal tool; Primary health care; Rapid appraisal tool, iCAHE checklist; Reporting standards; South Africa