Abstract
Objective This study aimed to investigate the methodological quality of clinical guidelines (CGs) for integrated Chinese and Western medicine (ICWM) to inform clinical practice and guideline development. Methods We searched PubMed, EMBASE, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Data, VIP, five guideline databases, and four online book malls to identify ICWM CGs published up to January 11, 2019. Four independent appraisers assessed the quality of CGs using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument and evaluated six specific concerns for ICWM. The standardized scores were calculated for the individual AGREE II domains. Results Sixty-two ICWM CGs were included. The median standardized scores in the six domains of AGREE II were 65% in scope and purpose, 46% in clarity of presentation, 26% in applicability, 24% in stakeholder involvement, 15% in rigor of development, and 0% in editorial independence. The quality of ICWM CGs was significantly associated with the publication year (higher quality for CGs published after 2014) and the development method (higher quality for evidence-based CGs). Only one ICWM CG obtained a direct recommendation for use, and 14 could be recommended for use after modifications. The intra-appraiser consistency of the AGREE II appraisal was good (mean intraclass correlation coefficient range, 0.813–0.998). ICWM CGs also lacked a systematic search of ancient traditional Chinese medicine (TCM) classics (40.3%), conversion of TCM recommendations from ancient Chinese to the vernacular (14.5%), a discussion of interactions between TCM and Western medicine (27.4%), and rankings of different ICWM choices (0%). Conclusions Although an improvement after 2014 occurred, the current 64 ICWM CGs are generally of poor methodological quality. Only 15 ICWM CGs can be recommended for use directly or with modifications. As the key distinctions from Western/Chinese medicine CGs, the ICWM-specific recommendations are also insufficient for the ICWM CGs, especially for interactions between TCM and Western medicine and rankings of different ICWM choices. Study Registration. This study has been registered at PROSPERO (no. CRD42018095767).
Highlights
Western medicine has become the mainstay of the health care system in China, traditional Chinese medicine (TCM), an ancient medical approach with 3000 years of history, is still widely practiced [1, 2]
Study Design. is is a survey of currently available Integrated Chinese and Western medicine (ICWM) clinical guidelines (CGs) published before January 11, 2019, using the AGREE Appraisal of Guidelines for Research and (II) instrument. e study protocol is registered at PROSPERO
Using the publication year of a previous study assessing the quality of ICWM CGs as a time node, we found that CG quality in five domains was better for those published after 2014 than those published during 2014 or before. is subgroup difference should be associated with the better quality of evidence-based CGs; most (93.3%) evidence-based CGs included in the study were published after 2014
Summary
Western medicine has become the mainstay of the health care system in China, traditional Chinese medicine (TCM), an ancient medical approach with 3000 years of history, is still widely practiced [1, 2]. TCM is fundamentally different from Western medicine in both theory and practice. Due to the limitation of professional education, few healthcare practitioners master both Western medicine and TCM, and this is associated with ineffective application of ICWM and may increase costs and safety concerns [8]. Most Western medicine practitioners do not understand TCM theory, such as syndrome differentiation, and the properties, compatibility, and contraindications of Chinese herbs [5]. TCM practitioners lack evidence-based concepts and knowledge to make clinical decisions in Western medicine practice. TCM practitioners lack evidence-based concepts and knowledge to make clinical decisions in Western medicine practice. ey may be afraid that Western medicine is not sufficiently effective or safe and abandon this treatment approach, which creates a risk of delaying treatment and missing the optimal time to treat a condition
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