LAUSR

OBJECTIVE To evaluate the quality of rehabilitation Clinical Practice Guidelines (CPGs), specifically with respect to their applicability. DATA SOURCES Medline, Embase, Web of Science, CINAHL, PsycINFO, the Cochrane Library Databases were searched for papers published in 2017-2019 that had applied the Appraisal of Guidelines for Research & Evaluation II (AGREE II) CPG quality assessment tool to rehabilitation CPGs. STUDY SELECTION 449 de-duplicated abstracts were independently screened by two authors, resulting in 47 articles. Independent screening of 47 full texts by two authors resulted in a final selection of 40 papers appraising 544 CPGs. DATA EXTRACTION Data were extracted by one author using a pretested Excel form and checked by a second. Key data on the review papers included: purpose, methods used for finding and appraising CPGs, appraising them using AGREE II, and observations and conclusions on CPG quality, specifically applicability. Key data on each CPG included: the 6 AGREE II domain scores and/or 23 item scores, as well as two global evaluations. DATA SYNTHESIS The mean AGREE II Domain scores for the 544 CPGs (all on a 0-100 scale) were Scope and purpose: 72; Stakeholder involvement 53; Rigor of development: 56; Clarity of presentation: 71; Applicability 34 and Editorial independence: 50. Only 36% of CPGs were recommended without modification. The 40 authors generally stated that all or most of the CPGs they appraised were poor or mediocre, especially with respect to Applicability. They only infrequently pointed out what information, going beyond that specified in AGREE II, would enhance applicability. CONCLUSIONS CPGs in principle are an ideal means to move knowledge obtained from clinical research into practice. Our review of reviews of rehabilitation CPGs shows that they commonly have deficits, especially where it comes to applicability. Much work needs to be done by guideline developers to make it easier for the average rehabilitation organization and clinician to implement CPGs in daily practice.