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Critical Appraisal Issues


Appraisal of Guidelines for Research & Evaluation AGREE

Appraisal of Guidelines for Research & Evaluation


This solution will cover the chronic non-malignant pain management guideline generally, and only Migraine and chronic Headache.

Scope and Purpose:

1.      The overall objective(s) of the guidelines is (are) specifically described

Agreement Level (3);

·        Page 3 section 1.2 Paragraph 2

·        Page 5 section 1.5

Objective: To provide an evidence based resource for managing chronic non mal. Pain.

N.B.:    Specific objective for patients not specified although understandable.

2.      The clinical question(s) covered by the guidelines is(are) specifically described

Agreement Level (3);

Although not mentioned in a clear question form, one can find answers to questions easily in tables.

3.      The patient to whom the guidelines is meant to apply are specifically described

Agreement Level (4);

·        Page 9 section 1.12 Paragraph 2

·        Page 28 (Chronic headache) section 5.1 Paragraph 2

·                    Page 31 (Migraine) section 5.2

Stakeholder Involvement:

4.      The guidelines development group includes individuals from all the relevant professional groups

Agreement Level (4);

·        Page 34 section 1.2 Paragraph 4 + 6

In addition the task force conducted a survey before developing the recommendations, in order to assess the needs (page 12).

5.      The patient's views and preferences have been sought

Agreement Level (2);

·        Page 10 section 1.14.2

6.      The target user of the guidelines are clearly defined

Agreement Level (3);

·        Page 7 section 1.9 paragraph 3

Which clinicians? Could have been more clearly defined?

7.      The guidelines have been piloted among target users

Agreement Level (2);

·        Page 6 section 1.7

Although the guidelines were sent to physicians from various departments both in Canada and internationally, this was done for their comments and not clearly for pretesting the guideline (Piloting).

Rigor of Development:

8.      Systematic methods were used to search for evidence

Agreement Level (4);

·        Page 4, section 1.3

·        Page 9, section 1.12

·        Page 18, section 3.21 paragraph 3,2,2

·        Page 25, section 4.2.1

Methods and databases were clearly stated.

* Validation of included references was clearly described.

9.      The criteria for selecting the evidence are clearly described

Agreement Level (4);

·        Page 18, section 3.2.1

·        Page 25, section (whole chapter 4)

10.  The methods used for formulating the recommendation are clearly described

Agreement Level (3);

Description of methods on how the recommendation was formulated was detailed (including the previous survey page 12 and agreements of validation of literature), but no clear description on overall method of consensus technique.

11.  The health benefits, side effects and risk have been considered in formulating the recommendation

Agreement Level (3);

·        Page 5, section 1.6

·        Page 8, section 1.11

Mentioned briefly with a reference to refer to

·        Agreement level (2-3); Chronic Headache: Page 29, Paragraph 1

o       No details on cost and side effects of specific drugs.

·        Agreement level (4); Migraine: Page 32, section 6.3

Detailed side effects: Pages 63 – 64 tables 9-10 but cost: not detailed.

12.  There is an explicit link between the recommendation and the supporting evidence

Agreement level (3);

Chronic headache:        Page 62, table 8

Migraine:          Pages 32-33.

No link to specific list of references for each recommendation.

13.  The guidelines have been externally reviewed by experts prior to its publication

Agreement level (3);

·        Page 6, section 1.7

No patient representatives were included

No clear description of methodology of review, rather seamed as a general feedback request.

14.  A procedure for updating the guidelines is provided

Agreement level (4);

·        Page 7, Paragraph 1

Clarity and Presentation:

15.  The recommendations are specific and unambiguous

Agreement level (3);

·        Page 62-64, tables 8, 9, 10.

Chronic headache:        Page 30, conclusion

Migraine:          Pages 32,33

16.  The different options for management of condition are clearly presented

Agreement level (4);

·        Pages 9-10, section 1.13

Chronic headache:        Pages 29-30, 62, table 8

Migraine:          Pages 32-33, 63-64, tables 9, 10

17.  Key recommendations are easily identifiable

Agreement level (4);

18.  The guideline is supported with tools of application

Agreement level (4);

Refer to short reference guide. Table, contract, pain scale (although not uniform).


19.  The potential organizational barriers in applying the recommendations have been discussed

Agreement level (2);

·        Page 11

Not mentioned generally for chronic headache and migraine.

20.  The potential cost implications of applying the recommendations have been considered

Agreement level (2);

Not clearly considered, but refer to reference guide,

Page 11: drugs not covered by drug formulary.

21.  The guideline presents key review criteria for monitoring and/or audit purposes

Agreement level (1);

(e.g. Audit form containing number of ER visits for patients treated on basis of this guidelines)

Editorial Independence

22.  The guideline is editorially independent from the funding body

Agreement level (4);

·        Page 3, Paragraph 6

23.  Conflicts of interest of guideline development members have been recorded

Agreement level (2);

No clear statement that there are no conflicts of interest.

Further Comments:

Overall Assessment:

Recommend, but check other guidelines covering areas missing here.


Appraisal of Guidelines for Research & Evaluation AGREE