Using the Appraisal of Guidelines for Research and Evaluation II to Assess Clinical Practice Guidelines

Abstract

In a 2007 column that I wrote with MaryJo Vetter (Levin & Vetter, 2007), we took readers through the process of assessing a clinical practice guideline (CPG) for dementia using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. At the time, we had to print/develop our own appraisal tool and calculate scores for each domain by hand. Although this process required a lot of work on the part of evaluators and several hours for workshops on how to use this critical appraisal tool, all those who participated in workshops with me on how to assess CPG's with this tool found this method of guideline assessment relevant and useful. I find it difficult to believe that it has been 6 years since that column. Fortunately for us, the AGREE Trust (http://www.agreetrust.org/) developed AGREE II. Not only has the Rigour of Development domain been enhanced, but the entire process of guideline evaluation can now also be conducted online. This column will focus on these exceptional and useful refinements and is coauthored by a mentee of mine, Lorraine Ferrara, who has worked with me side by side to introduce the AGREE II and the process of guideline evaluation to our clinical colleagues at the Visiting Nurse Service of New York (VNSNY). Before proceeding with the practical hints for using this amazing new tool, I wish to share with you how the tool has been refined. First, the 4-point Likerttype scale on the original tool has been replaced with a 7-point scale. Next, modifications, additions, and deletions have been made to approximately half of the original core items. One major change is the addition of NEW Item 9: strengths and limitations of the body of evidence are clearly described (The AGREE Next Steps Consortium, 2009, p. 2). The last change is that the new AGREE II tool includes a newly restructured user's manual. The manual is part of the complete AGREE tool document and includes information and guidance for completing each of the items. PRACTICAL HINTS First, go to the AGREE Trust Web site http://www.agreetrust.org/. Next, create a user ID and password for yourself by clicking on Register here (see Figure 1, number 1). There is no charge for this. (That in itself is amazing in this day and age.) Next, download the AGREE II PDF (Figure 1, number 2). Before reading the AGREE II, you may want to familiarize yourself with the tool first by viewing the AGREE II Overview Tutorial, an avatar-guided tutorial that takes approximately 10 minutes to complete. The tutorial provides an overview of the AGREE II and how to use this tool. …