Abstract
Constipation is one of the most frequent complaints in health establishments, affecting approximately 20% of the world population. The key to the successful management of this disorder is its early identification and immediate treatment with nondrug measures as the main therapeutic alternative. While clinical guidelines are informative documents that include recommendations aimed at optimizing patient care, this study aims to evaluate the quality of these documents available in the management of this condition. This study evaluated clinical guidelines available in databases, scientific societies and class councils, which had as their theme the management of constipation. The methodology used to evaluate the quality of these documents was the application of the AGREE II instrument. Kappa test of agreement between evaluators was applied to corroborate uniformity in application of the AGREE II instrument. Of the eleven documents analyzed, only three presented the criteria for recommendation proposed for use in clinical practice, with a general average of quality indexes ranging from 93 to 72%. One guideline was recommended with modifications in its structure, with a general average of quality indexes of 44%. The mean overall score among the analyzed documents was 49.01%. Methodological care and expression of information in a concise and clear way, both of the content and methodology employed, result in documents of great quality, however, no aspects were present in most of the guidelines analyzed. Furthermore, it is observed that there are still points that should be improved.
Highlights
Constipation is one of the most frequent health establishments, affecting approximately 20% worldwide.(Antunes et al., 2019; Garcia et al, 2016) In general, the prevalence ranges from 2 to 27% according to locality, population group and type of survey used for diagnosis, making its real prevalence difficult to determine.(Antunes et al, 2019; Silva & Sabino Pinho, 2016)It affects up to 30% of children and represents approximately 3 to 5% of all visits to pediatricians, in addition to a quarter of referrals to pediatric gastroenterology.(DynaMed [Internet]
In a broad sense, are informative documents that include recommendations aimed at optimizing the healthcare provided to the patient.(Ministério da Saúde, 2016) Evidence-based clinical guidelines are made based on a systematic review of scientific evidence and on the evaluation of the benefits and harms of different options in health care.(Ministério da Saúde, 2016) In addition to presenting quality information based on the best available scientific evidence, the guidelines should be accessible by healthcare professionals
Considering all the aspects demonstrated above on the panorama of constipation in the world and the usefulness of clinical guidelines in the use of health care, this study aims to evaluate the quality of these available documents through the analysis of the format of construction of these tools and the level of scientific evidence present in them
Summary
Constipation is one of the most frequent health establishments, affecting approximately 20% worldwide.(Antunes et al., 2019; Garcia et al, 2016) In general, the prevalence ranges from 2 to 27% according to locality, population group and type of survey used for diagnosis, making its real prevalence difficult to determine.(Antunes et al, 2019; Silva & Sabino Pinho, 2016)It affects up to 30% of children and represents approximately 3 to 5% of all visits to pediatricians, in addition to a quarter of referrals to pediatric gastroenterology.(DynaMed [Internet]. In addition to being among the initial conducts, they are the main steps to prevent constipation.(American College of Gastroenterology Chronic Constipation Task Force, 2005; Rao & Sharma, n.d.; World. Gastroenterology Organisation, 2010) Parallel to this, pharmacological treatment participates in therapy as a support in the control of symptoms.(American College of Gastroenterology Chronic Constipation Task Force, 2005; Rao & Sharma, n.d.; World Gastroenterology Organisation, 2010). In a broad sense, are informative documents that include recommendations aimed at optimizing the healthcare provided to the patient.(Ministério da Saúde, 2016) Evidence-based clinical guidelines are made based on a systematic review of scientific evidence and on the evaluation of the benefits and harms of different options in health care.(Ministério da Saúde, 2016) In addition to presenting quality information based on the best available scientific evidence, the guidelines should be accessible by healthcare professionals. Due to the large volume of information and variability in the quality of scientific information generated in the health area, there is a need to develop a synthesis that facilitates access to this knowledge and enables recommendations based on results from multiple sources, providing scientific support for decision making.(Ministério da Saúde, 2016)
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