Biomedical
Methodological quality of guidelines for management of Lyme neuroborreliosis
Peer Reviewed
Abstract
Background; Many aspects of clinical management of Lyme neuroborreliosis are subject to intense debates. Guidelines show considerable variability in their recommendations, leading to divergent treatment regimes. The most pronounced differences in recommendations exist between guidelines from scientific societies and from patient advocacy groups. Assessment of the methodological quality of these contradictory guideline recommendations can be helpful for healthcare professionals. Methods; Systematic searches were conducted in MEDLINE and databases of four international and national guideline organizations for guidelines on Lyme neuroborreliosis published from 1999–2014. Characteristics (e.g., year of publication, sponsoring organization) and key recommendations were extracted from each guideline. Two independent reviewers assessed the methodological quality of each guideline according to the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. AGREE II scores from guidelines developed by scientific societies and from patient advocacy groups were compared across domains. Results; We identified eight eligible guidelines of which n = 6 were developed by scientific societies and n = 2 by patient advocacy groups. Agreement on AGREE II scores was good (Cohen’s weighted kappa = 0.87, 95 % CI 0.83–0.92). Three guidelines, all from scientific societies, had an overall quality score of ≥ 50 %. Two of them were recommended for use according to the AGREE II criteria. Across all guidelines, the AGREE II domain with the highest scores was “Clarity of Presentation” (65, SD 19 %); all other domains had scores < 50 % with the domain “Applicability” having the lowest scores (4, SD 4 %). Guidelines developed by scientific societies had statistically significantly higher scores regarding clarity of presentation than guidelines from patient advocacy groups (p = 0.0151). No statistically significant differences were found in other domains. Conclusions; Current guidelines on Lyme neuroborreliosis vary in methodological quality and content. Health care providers and patients need to be aware of this variability in quality when choosing recommendations for their treatment decisions regarding Lyme neuroborreliosis. No statement can be given on quality of content and validity of recommendations, as these issues are not subject to assessment with the AGREE II tool and are prone to individual interpretation of the available evidence by the corresponding guideline panels. To enhance guideline quality, guideline panels should put more emphasis on linking recommendations to the available evidence, transparency in reporting how evidence was searched for and evaluated, and the implementation of recommendations into clinical practice.
Key Questions about Lyme Neuroborreliosis Management Guidelines
The article "Methodological quality of guidelines for management of Lyme neuroborreliosis" evaluates the quality of existing guidelines for managing Lyme neuroborreliosis (LNB). The study found significant variability in the methodological quality and content of these guidelines, with some lacking transparency in evidence evaluation and implementation strategies. The authors emphasize the need for healthcare providers and patients to be aware of this variability when making treatment decisions.
What is Lyme neuroborreliosis, and why is it important to assess the quality of its management guidelines?
Lyme neuroborreliosis is a neurological manifestation of Lyme disease, a tick-borne illness caused by the bacterium Borrelia burgdorferi. Assessing the quality of its management guidelines is crucial because inconsistent or low-quality guidelines can lead to varied treatment approaches, potentially affecting patient outcomes.
How was the methodological quality of the guidelines assessed?
The authors utilized the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate the methodological quality of each guideline. This tool assesses guidelines across several domains, including scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence.
What were the findings regarding the quality of the guidelines?
The study identified eight eligible guidelines, with six developed by scientific societies and two by patient advocacy groups. Three guidelines had an overall quality score of ≥ 50%, and two were recommended for use according to the AGREE II criteria. The domain with the highest scores was "Clarity of Presentation," while other domains, particularly "Applicability," had lower scores.
What recommendations do the authors make to improve the quality of LNB management guidelines?
The authors recommend that guideline panels focus on linking recommendations to available evidence, ensuring transparency in how evidence is searched for and evaluated, and developing strategies for implementing recommendations into clinical practice.
By addressing these questions, the article highlights the variability in the quality of LNB management guidelines and underscores the importance of evidence-based, transparent, and implementable recommendations to improve patient care.
