颈腰椎慢性筋骨病损临床实践指南和专家共识的方法学质量评价  

Methodological evaluation of the quality of clinical practice guidelines and expert consensus for cervical and lumbar chronic muscle and bone diseases

作　　者：李正言[1,2] 许昌策 陆洁航 石金玉 王玉鹏 葛海雅 杜国庆 靳英辉[4] 詹红生 Zheng-Yan LI;Chang-Ce XU;Jie-Hang LU;Jin-Yu SHI;Yu-Peng WANG;Hai-Ya GE;Guo-Qing DU;Ying-Hui JIN;Hong-Sheng ZHAN(Shi's Center of Orthopedics and Traumatology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Institute of Traumatology&Orthopedics,Shanghai Academy of Traditional Chinese Medicine,Shanghai 201203,China;Management of Competitive Sports Training Center in Shanghai,Shanghai 201713,China;Center for Evidence-Based and Translational Medicine,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]上海中医药大学附属曙光医院石氏伤科医学中心,上海201203 [2]上海市中医药研究院骨伤科研究所,上海201203 [3]上海市竞技体育训练管理中心,上海201713 [4]武汉大学中南医院循证与转化医学中心,武汉430071

出　　处：《医学新知》2023年第3期209-219,共11页New Medicine

基　　金：国家自然科学基金面上项目(81973871、82074466);中华中医药学会团体标准化项目(20210805-BZCACM);上海市慢性筋骨病临床医学研究中心项目(20MC1920600);上海申康医院发展中心临床三年行动计划资助(SHDC2020CR1051B);上海市科学技术委员会重点项目(16401970102)。

摘　　要：目的 评价国内外颈腰椎慢性筋骨病损相关的临床实践指南和专家共识的方法学质量。方法 检索中国知网、维普、万方、中国生物医学文献数据库、PubMed、国际指南网、英国国家卫生与临床优化研究所、国际指南中心网,收集有关颈腰椎慢性筋骨病损相关的临床实践指南和专家共识。检索时限为建库至2022年7月31日。2名研究者按照纳入排除标准独立筛选指南并提取相关信息,4名研究者使用AGREE II评价工具对指南进行质量评价,并采用组内相关系数(ICC)评价其一致性。结果 本研究共纳入23篇临床实践指南和专家共识,其中21篇为临床实践指南,2为篇专家共识。AGREE II 6个领域得分率中位数和四分位间距分别为:范围和目的 84.72%(69.44%,88.89%)、参与人员59.72%(38.89%,75.00%)、严谨性71.88%(45.83%,81.77%)、清晰性81.94%(73.61%,87.50%)、应用性56.25%(30.21%,65.63%)、独立性79.17%(30.25%,85.42%)。总体评价一致性ICC为0.769。结论 现有证据表明国内颈腰椎慢性筋骨病损相关临床指南较国外总体质量相对一般,需对临床问题构建、证据检索和综合,以及患者价值与意愿和利益声明方面进一步完善,并建议基于此构建以中医证据为主体的中医骨伤疾病相关临床指南。Objective To evaluate the methodological quality of clinical practice guidelines and expert consensus for cervical and lumbar chronic muscle and bone injury.Methods China National Knowledge Network,VIP,Wanfang,China Biomedical Literature Database,PubMed,International Guidelines Network,National Institute for Health and Clinical Excellence,International Guidelines Center Network were searched to collect clinical practice guidelines and expert consensus related to cervical and lumbar chronic muscle and bone diseases.The search period is from the establishment of the databases to July 31,2022.The guidelines were independently screened by two researchers according to inclusion and exclusion criteria and relevant information was extracted.The AGREE II evaluation tool was used by four reseachers to evaluate the guidelines'quality,and the intra-group correlation coefficient(ICC)was used to evaluate their consistency.Results A total of 23 clinical practice guidelines and expert consensus were included in this study,of which 21 were clinical practice guidelines and 2 were expert consensus.The median and interquartile spacing of score rates for the six fields of AGREE II were:range and purpose 84.72%(69.44%,88.89%),participants 59.72%(38.89%,75.00%),rigor 71.88%(45.83%,81.77%),clarity 81.94%(73.61%,87.50%),application 56.25%(30.21%,65.63%),independence 79.17%(30.25%,85.42%).The overall evaluation consistency ICC was 0.769.Conclusions The existing evidence shows that the overall quality of domestic clinical guidelines related to cervical and lumbar chronic muscle and bone injury is relatively general compared with that of foreign countries,so it is necessary to further improve the construction of clinical problems,evidence retrieval and synthesis,as well as the value and willingness of patients and interest statement,and it is suggested to construct clinical guidelines for bone injury diseases based on the evidence of traditional Chinese medicine.

关 键 词：慢性筋骨病损 临床实践指南 专家共识 AGREE II工具 质量评价 

分 类 号：R681.5[医药卫生—骨科学]