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.