Objective: To identify and compare clinical practice
guideline appraisal instruments.
Methods: Appraisal instruments,
defined as instruments intended to be used for guideline evaluation,
were identified by searching MEDLINE (1966–99) using the Medical
Subject Heading (MeSH) practice guidelines, reviewing bibliographies
of the retrieved articles, and contacting authors of guideline
appraisal instruments. Two reviewers independently examined the
questions/statements from all the instruments and thematically
grouped them. The 44 groupings were collapsed into 10 guideline
attributes. Using the items, two reviewers independently undertook a
content analysis of the instruments.
Results: Fifteen instruments were identified, and two were excluded
because they were not focused on evaluation. All instruments were
developed after 1992 and contained 8 to 142
questions/statements. Of the 44 items used for the content analysis,
the number of items covered by each instrument ranged from 6 to 34.
Only the instrument by Cluzeau and colleagues
included at least one item for each of the 10 attributes, and
it addressed 28 of the 44 items. This instrument and that of Shaneyfelt
et al. are the only instruments that have so far been validated.
Conclusions: A comprehensive, concise, and valid instrument could help
users systematically judge the quality and utility of clinical
practice guidelines. The current instruments vary widely in
length and comprehensiveness. There is insufficient evidence
to support the exclusive use of any one instrument, although the
Cluzeau instrument has received the greatest evaluation. More
research is required on the reliability and validity of existing
guideline appraisal instruments before any one instrument can become
widely adopted.
