A systematic review of appraisal tools for clinical practice guidelines: multiple similarities and one common deficit

Objective. To identify a critical appraisal tool for clinical practice guidelines that could serve as a basis for the development of an appraisal tool for clinical pathways. Design. Systematic review of the literature and personal contacts. Databases searched were: Medline, Embase, and Cinahl. Search terms were: practice guidelines, appraisal, and evaluation. The items of the identified appraisal tools were examined and thematically grouped into 10 guideline dimensions. Content analysis and scoring of these domains by the appraisal tools was evaluated. Results. Twenty-four different appraisal tools of practice guidelines were identified. None scored the evidence base of the clinical content of guidelines. Four tools scored all the guideline dimensions. The Cluzeau instrument is the only one of these four that has been validated. Of the three instruments based on the Cluzeau instrument, the AGREE instrument is the only validated instrument that uses a numerical scale. Conclusions. Being a simplified version of the Cluzeau instrument, the AGREE instrument has the most potential to serve as a basis for the development of an appraisal tool for clinical pathways. However, important limitations will have to be dealt with when developing such a tool.