TY - JOUR
T1 - Clinical practice guidelines for the management of patients with cleft lip and palate
T2 - A systematic quality appraisal using the appraisal of guidelines for research and Evaluation II instrument
AU - Yver, Christina M.
AU - Chorath, Kevin T.
AU - Connolly, John
AU - Shah, Mitali
AU - Majmudar, Tanmay
AU - Moreira, Alvaro G.
AU - Rajasekaran, Karthik
N1 - Funding Information:
AM reports a grant from the Parker B. Francis Foundation and a research grant from 2R25-HL126140, outside the submitted work.
Publisher Copyright:
Copyright © 2021 by Mutaz B. Habal, MD.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Patients with cleft lip and/or palate require complex and longitudinal care by a multidisciplinary cleft team. Unfortunately, delivery of cleft care is often fragmented, and care practices can vary significantly. Multiple clinical practice guidelines (CPGs) have been proposed to provide a standardized framework for cleft care delivery. As CPGs have gained popularity, there has been increasing demand to maintain the quality of existing guidelines. A comprehensive search of EMBASE, MEDLINE via PubMed, Scopus, Cochrane and grey literature sources published from January 1, 1990 to December 31, 2020 was conducted to identify CPGs for the care of cleft patients. The Appraisal of Guidelines for Research and Evaluation, 2nd edition II tool was used to assess the quality of selected CPGs. Intraclass coefficients were calculated to assess agreement among appraisers. Eleven guidelines were identified for study inclusion. One guideline was classified as ‘‘high’’ quality by Appraisal of Guidelines for Research and Evaluation II criteria, and the remaining guidelines were classified as ‘‘average’’ or ‘‘low’’ quality. The ‘‘Clarity of Presentation’’ domain achieved the highest mean score (76.9% ± 11.7%) across CPGs, whereas the ‘‘Rigor of Development’’ domain scored the lowest (35.6% ± 21.2%). Intraclass coefficients analysis reflected very good inter-rater reliability across all domains (0.853 – 0.987). These findings highlight significant variability in the quality of existing CPGs for the global management of patients with cleft lip and/or palate. The ‘‘Rigor of Development’’ domain reflects the greatest opportunity for improvement. Given these findings, future guidelines may prioritize incorporating a systematic review of existing evidence into recommendations.
AB - Patients with cleft lip and/or palate require complex and longitudinal care by a multidisciplinary cleft team. Unfortunately, delivery of cleft care is often fragmented, and care practices can vary significantly. Multiple clinical practice guidelines (CPGs) have been proposed to provide a standardized framework for cleft care delivery. As CPGs have gained popularity, there has been increasing demand to maintain the quality of existing guidelines. A comprehensive search of EMBASE, MEDLINE via PubMed, Scopus, Cochrane and grey literature sources published from January 1, 1990 to December 31, 2020 was conducted to identify CPGs for the care of cleft patients. The Appraisal of Guidelines for Research and Evaluation, 2nd edition II tool was used to assess the quality of selected CPGs. Intraclass coefficients were calculated to assess agreement among appraisers. Eleven guidelines were identified for study inclusion. One guideline was classified as ‘‘high’’ quality by Appraisal of Guidelines for Research and Evaluation II criteria, and the remaining guidelines were classified as ‘‘average’’ or ‘‘low’’ quality. The ‘‘Clarity of Presentation’’ domain achieved the highest mean score (76.9% ± 11.7%) across CPGs, whereas the ‘‘Rigor of Development’’ domain scored the lowest (35.6% ± 21.2%). Intraclass coefficients analysis reflected very good inter-rater reliability across all domains (0.853 – 0.987). These findings highlight significant variability in the quality of existing CPGs for the global management of patients with cleft lip and/or palate. The ‘‘Rigor of Development’’ domain reflects the greatest opportunity for improvement. Given these findings, future guidelines may prioritize incorporating a systematic review of existing evidence into recommendations.
KW - Cleft lip
KW - Cleft palate
KW - Clinical guidelines
KW - Orofacial cleft
KW - Recommendations
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U2 - 10.1097/SCS.0000000000008155
DO - 10.1097/SCS.0000000000008155
M3 - Article
C2 - 34545056
AN - SCOPUS:85126143985
SN - 1049-2275
VL - 33
SP - 449
EP - 452
JO - Journal of Craniofacial Surgery
JF - Journal of Craniofacial Surgery
IS - 2
ER -