title: Improvement evident but still necessary in clinical practice guideline quality: a systematic review.
abstract: To review the quality of clinical practice guidelines (CPGs) from a wide range of health care topics and report any changes seen since 1992.
  
  
  
  A literature search in MEDLINE, EMBASE, Web of Science Core Collection, and BIOSIS was conducted in London, Ontario, Canada. Publications were screened to identify those assessing the quality of CPGs using the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument. Data were gathered regarding year of publication, institution type, health topic, country of origin, domain scores, and final recommendation.
  
  
  
  Twenty-five studies met the inclusion criteria. AGREE II scores from 415 individual CPGs published between 1992 and 2014 were obtained. Domain scores increased significantly over time, and the proportion of guidelines being recommended based on AGREE II assessment was significantly greater after 2010. Domain scores in Applicability and Editorial independence had no significant effect on a CPG's final recommendation, whereas other domains had a significant effect. Finally, international development groups produced CPGs with significantly higher scores.
  
  
  
  This review found a steady improvement in CPG quality over time. This is particularly evident in guidelines published after 2010. However, certain domains that are integral to the methodological quality of CPGs remain unsatisfactorily low.
authors: Department of Medicine, Schulich School of Medicine & Dentistry, Western University, Clinical Skills Building, London, Ontario N6A 5C1, Canada. Electronic address: jarmstrong2018@meds.uwo.ca.
authors: James Jacob
authors: JJ
authors: Armstrong
authors: Department of Medicine, Schulich School of Medicine & Dentistry, Western University, Clinical Skills Building, London, Ontario N6A 5C1, Canada.
authors: Alexander M
authors: AM
authors: Goldfarb
authors: Department of Medicine, Schulich School of Medicine & Dentistry, Western University, Clinical Skills Building, London, Ontario N6A 5C1, Canada.
authors: Ryan S
authors: RS
authors: Instrum
authors: Monsignor Roney Ambulatory Care Center, 930 Richmond Street, London, Ontario N6A 3J4, Canada; Hand and Upper Limb Center Clinical Research Lab, McMaster University School of Rehabilitation Science, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada.
authors: Joy C
authors: JC
authors: MacDermid
mesh_terms: D002985:Clinical Protocols / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011364:Professional Practice / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*
keywords: AGREE; Appraisal; Clinical; Guidelines; Policy; Quality