Assessment of the Quality of Methodological Rigour and Reporting of Clinical Practice Guidelines for the Management of Allergic Rhinitis – QUGAR study

Background: To assess the methodological rigour and transparency of reporting in clinical practice guidelines for the management of allergic rhinitis (AR). Methods: We systematically searched MEDLINE, TRIP database (including the National Guidelines Clearinghouse) and professional society websites for guidelines about the management of AR published after the year 2000. We assumed that older guidelines would no longer influence current clinical practice. If the guideline was updated after 2000 we assessed the most recent version. We included all guidelines published in English and endorsed by an international or national government agency or professional group, irrespective of country of origin or publication status. Two reviewers independently screened search results using predefined eligibility criteria and assessed the rigour of development and reporting of included guidelines using the AGREE II instrument (www.agreetrust.org). Results: Our search revealed 432 records of which 34 full text articles were assessed for eligibility. Nine documents fulfilled our criteria – 3 international and 6 national guidelines from Japan, Singapore, South Africa, UK and the USA. Overall methodological rigour and reporting of guidelines about the management of AR was variable – from fulfilling most AGREE II criteria to almost none. There was no association between the methodological rigour and time of publication or the target scope of the guideline (national vs. international). Across all guidelines the most rigorously reported domain was “clarity of presentation” (median score 53%), mainly due to fair presentation of different management options (item 16), followed by “scope and purpose” (median score 42%). The least rigorously addressed was “applicability” domain with median score of 2% across all guidelines. Median scores for domains “stakeholder involvement”, “rigour of development” and editorial independence” were 17%, 15% and 25%, respectively. The ARIA guidelines (2010 update) achieved the highest scores in 5 out of 6 domains and the lowest score on any domain was 60%. Conclusions: Guideline users should be aware of the variability in quality of development and reporting of guidelines for the management of AR. They should choose higher quality guidelines to inform their practice. For many guidelines there is much room for improvement, in particular in the domains of applicability and implementation.