Appraising the quality of clinical practice guidelines in traditional Chinese medicine using AGREE II instrument: A systematic review

Objectives: The aim of this study was to investigate the quality of clinical practice guidelines (CPGs) of traditional Chinese medicine (TCM) published in journals and books using AGREE II instrument for further enhancing TCM CPG development. Methods: A systematic search of relevant guideline websites and literature databases (including Chinese Guideline Clearinghouse, PubMed Wanfang Data Knowledge Service Platform, VIP Online Publishing Platform, China National Knowledge Infrastructure and SinoMed) was undertaken from inception to December, 2015 to identify and select CPGs related to TCM. Four independent reviewers assessed the eligible TCM CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Their degree of agreement was evaluated by intra-class correlation coefficient (ICC). Results: From 2380 citations, 115 TCM CPGs were included. The mean scores for each AGREE II domain were as follows: (i) scope and purpose (mean +/- SD=41.1 +/- 19.6); (ii) stakeholder involvement (mean +/- SD=37.6 +/- 15.1); (iii) rigour of development (mean +/- SD=20.1 +/- 10.9); (iv) clarity and presentation (mean +/- SD=33.3 +/- 15.4); (v) applicability (mean +/- SD=10.5 +/- 4.5) and (vi) editorial independence (mean +/- SD=11.4 +/- 7.6). Only 10% (n=12) TCM CPGs were rated as "recommended". The ICC values for TCM CPGs appraisal using the AGREE II ranged from 0.76 to 0.93. Conclusions: The quality of TCM CPGs has remained suboptimal according to AGREE II instrument evaluation. The use of AGREE II in the development process ensures that these considerations are incorporated, and more efforts must be made to improve the quality of TCM CPGs. Therefore, an evidence-based method should be used, and reporting the full texts according to AGREE II checklists for the further TCM CPGs development to ensure the translation of evidence into practice.