Assessment of CPGs using the AGREE II Instrument
The AGREE II Instrument (www.agreetrust.org) consists of 23 items
organized in 6 domains: scope and purpose, stakeholder involvement,
rigor of development, clarity of presentation, applicability, and
editorial independence.12 Each item is scored on a 1-7
Likert scale. The AGREE II evaluation was guided by utilizing its online
version; “My AGREE PLUS” that supports having a CPG “appraisal
group” for each CPG that compiles and calculates the items’ ratings
into domain ratings, and comments.12 The four AGREE II
appraisers hold the relevant clinical expertise in obstetrics and
gynecology (YS, AA), internal medicine and hematology (GE, MA), in
addition to an expert CPG methodologist (YA). At the outset, the CPG
methodologist conducted capacity building sessions for the reviewers
through hands-on sessions in the concepts, evidence-based CPGs’
standards, and using the AGREE II instrument. Each reviewer scored
his/her assigned CPGs. Each one of the included CPGs was critically
appraised by all of the five reviewers. All appraisers reviewed the full
CPG documents including any updates plus any relevant supplementary
information or links to online webpages related to the CPG methods or
CPG implementation tools. For each item, AGREE appraisers were asked to
record the justifications for their scores in the ‘Comment’ section.
Wide discrepancies between the assessors’ scores were resolved by asking
those who had provided outlying scores to re-assess after discussion
with the entire group. The standardized AGREE domain scores or ratings
(%) were automatically calculated by online My AGREE PLUS. We agreed
upon a cut-off point of 70% for each AGREE standardized domain score or
rating. After the appraisal, more weight was emphasized on the scores of
domains 3 and 5 to facilitate the filtration and final evaluation of the
reporting quality of eligible CPGs. Similar cut-off values were
reported.13,14 In addition to the classification of
the six AGREE II domains, the evidence-base of the included CPGs, their
references sections, were screened for systematic reviews or
meta-analyses specifically Cochrane reviews. We utilized the PRISMA
statement flow diagram and checklist’ in the reporting our
review.15-17 There was no patient nor public
involvement in this review.