Guideline Development Process Research Articles

Institutionalising guideline development in a new universal healthcare system: a study in Cyprus

Abstract Issue Guideline development is a lengthy and diligent process that involves the assessment and interpretation of evidence by a committee. Whilst the implementation of high quality healthcare guidelines ensures consistency and quality in healthcare delivery, many countries worldwide, including Cyprus, lack the capacity and resources to develop de novo guidelines. Description of the problem Guidelines developed by internationally recognised organisations, such as NICE, are a valuable resource for countries like Cyprus. The collaboration between NICE and the newly established healthcare system in Cyprus introduced a process for guideline institutionalisation, taking advantage of existing human resources and building guideline development capability in Cyprus. Results This process involved recruiting local professionals to form a guideline secretariat. The secretariat, supported by NICE, is responsible for overseeing the guideline development process including technical expert committee (TEC) recruitment and stakeholder consultation. The TEC contextualise an existing NICE guidelines to reflect local considerations. NICE provides quality assurance to ensure changes are contextual in nature and consistent with the underpinning evidence. Despite initial challenges, getting stakeholder buy-in and engaging healthcare professionals in the TEC, one contextualised guideline has been produced and two others are at the final stage. Lessons Guideline contextualisation is an efficient and sustainable way of building guideline development capability to institutionalize guidelines in settings with limited capacity. Key messages • De-novo guideline development is time consuming and demanding and many countries require an alternative process for producing locally relevant guidelines, capitalising on existing resources. • Support by an established organisation ensures quality, is less resource intensive, and builds capability for the sustainability of the process.

Protocol: Assessing the impact of interest-holder engagement on guideline development: A systematic review.

This is the protocol for a Campbell systematic review. The objectives are as follows. The objective of this review is to identify and synthesize empirical research on the impacts of interest-holder engagement on the guideline development process and content. Our research questions are as follows: (1) What are the empirical examples of impact on the process in health guideline development across any of the 18 steps of the GIN-McMaster checklist? (2) What are the empirical examples of impact on the content in health guideline development across any of the 18 steps of the GIN-McMaster checklist?

Understanding the Politics of Food Regulation and Public Health: An Analysis of Codex Standard-Setting Processes on Food Labelling

Background: The importance of the international food regulatory system to global health, is often overlooked. There are calls to reform this system to promote healthy and sustainable food systems centred on the Codex Alimentarius Commission (Codex), the United Nation’s (UN’s) standard-setting body. Yet this presents a significant political challenge, given Codex has historically prioritized food safety risks over wider harms to public health, and is dominated by powerful food exporting nations and industry groups with a primary interest in trade expansion. To better understand this challenge, we examine who participates and contests Codex standards, using the development of the new Guidelines on Front-of-pack Nutrition Labelling (FOPNL) as a case study. Methods: The study involved: (i) collecting Codex Committee on Food Labelling (CCFL) documents (2016-2023); (ii) identification, categorization, and enumeration of actors involved in the development of the Guidelines; and (iii) guided by a constructivist framework, analysis of how actors framed and contested key provisions of the Guidelines. Results: Country representation was skewed towards high-income (47.9%). Member state delegations were dominated by non-health ministries (59.8%) and industry actors (16.1%). Industry actors comprised the large majority of observers (84.2%) and civil society actors representing public health interests the least (12.2%). Commercial actors used frames supporting positive FOPNL messages (eg, low in salt) opposing negative ones (eg, "high-in" sugar warnings) and called for product exemptions (eg, sports foods and baby foods). Public health actors used frames supporting simplified FOPNL to reduce consumer confusion, that hold up public health goals, and prevent inappropriate marketing. Conclusion: Participation in the Guidelines development process suggests stronger preferences for trade facilitation and commerce over public health. Ambitions to reform the international food regulatory system may require an examination of who participates and how to address this asymmetrical representation of interests. These results suggest the need to greatly strengthen public health representation at Codex.

The Egyptian 24-h movement guidelines for children and adolescents: an integration of physical activity, sedentary behaviour, sleep and eating habits—by the Egyptian Academy of Bone and Muscle health

BackgroundThe objectives of this work were as follows: (1) to develop holistic recommendations for physical activity, sleep, sedentary behaviours and eating habits adapted to children and adolescent life stage (5–17 years) and targeting optimal metabolic cycle and achieving energy balance; (2) to provide evidence-based information that can be used by the government, policy makers, healthcare professionals, community, schools as well as families to endorse active, healthy, living in apparently healthy children and youth aged 5–17 years, and as a base for monitoring the activities, particularly the physical ones, on the people level. The Egyptian Academy of Bone and Muscle Health followed an established guideline development process to create the Egyptian 24-h movement clinical guideline for children and adolescents. Online databases (PubMed, Embase and Cochrane Library) were searched for relevant peer-reviewed studies that met the a priori inclusion criteria.ResultsA total of 41 studies met the inclusion criteria. Leveraging evidence from the review of the literature led to the development of 11 key questions covering 8 domains. Fifteen statements focus on the overall identified targets through integration of the movement activities and eating behaviour. Results revealed a major change in the previous basic understandings as it shifts away from segregated into integrated movement behaviour and dietary habit paradigm. Based on this, the final guideline was developed providing evidence-based recommendations for a “Healthy 24-h day”, for Egyptian children and adolescents.ConclusionThe 24-h composition of movement behaviours has principal implications for health at all ages. The developed guideline provides an up-to-date evidence-based recommendation towards a holistic approach for favourable daily life activities and adopts a feasible perspective by outlining these activities within a 24-h period. In addition, eating and dietary elements have been included to complete the energy cycle. Children and adolescents who meet the 24-h movement guidelines generally report more favourable health indicators than those who do not.

Quality evaluation of French guidelines in primary care infectious disease: An AGREE II assessment.

Antibiotic prescription, its nature and its duration are a very common decision-making situation in primary care practice. Clinical practice guidelines (CPGs) are regularly emitted by various organisations on this topic. Our goal is to run a quality appraisal of the current French guidelines, for the most common primary care infectious pathologies. We collected all primary care CPGs that are currently prevailing in France through a systematic review of the french website Antibioclic®. For each of these guidelines, a quality assessment was run by 3 independent reviewers, by means of the Appraisal of Guidelines for REsearch & Evaluation II instrument. The main outcome was a 'reliability score', defined as the sum of the scores in domains 'rigour of development' and 'editorial independence'. To be considered 'reliable', the CPG had to reach a 60% threshold in these two domains. Secondary outcomes were as follows: global quality score of CPGs, number and ratio of CPGs for which a systematic review has been conducted during its conception. Over the 43 CPGs that have been assessed, none reached the 60%-threshold as to the reliability score. Only one CPG (2.33%) gets an over-60% quality assessment in the domain of rigour of development (D3), whereas three CPGs (6.98%) reach this threshold in the domain of editorial independence (D6). One CPG (2.33%) met the quality threshold of 60% as to overall assessment. Rigour of development and editorial independence are the domains that obtained the lowest average score, respectively, 11% and 21%. Overall assessment received an average score of 29%. A systematic review of the literature was mentioned for 10 CPGs (23.26%). There is a lack of quality in the development process of the current French guidelines in primary care infectiology. This process should be reconsidered, with higher insistence as to its quality.

Consensus-Based Guidelines for Communicating a Misdiagnosis of Multiple Sclerosis to Reduce Psychological Distress.

Multiple sclerosis (MS) misdiagnosis is common, and when discovered, frequently leads to substantial disruption to patients' lives and anxiety for clinicians. Our objective was to develop expert consensus-based guidelines about how to communicate a misdiagnosis of MS to a patient, to reduce the potential for both psychological distress and litigation. A modified Delphi method using a systematic literature review on doctor and patient experiences of the MS diagnosis communication was used to populate items for a first-round questionnaire. Our Delphi panel represented three perspectives (clinicians, people with MS, and published experts in health communication), and we recruited 18 panelists in total (6 per perspective). Consensus was defined a priori as 75% of panelists giving an item the same rating. A feedback round was undertaken with six external reviewers, naïve to the guideline development process, and the panelists. Items were reviewed by the study team and synthesized to create the finalized guidelines. Consensus was reached for 45 items rated as "very important" and presented in the feedback round. The study team synthesized the 45 items to 27 items. Ten items related specifically to the communication of the MS misdiagnosis and 17 items to generic guidelines highlighted as important in the MS misdiagnosis appointment. Seven recommendations form the guidelines presented here. Seven consensus-based recommendations offer guidance to practising neurologists in their communication with patients in a situation that has the potential to be highly distressing, for both clinician and patient.

Management of Stage III Non-Small Cell Lung Cancer: ASCO Rapid Recommendation Update.

ASCO Rapid Recommendation Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options. Guidelines and updates are not intended to substitute for independent professional judgment of the treating provider and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix 1 and Appendix 2, online only).

Navigating Complexities: Vitamin D, Skin Pigmentation, and Race.

Vitamin D plays a critical role in many physiological functions, including calcium metabolism and musculoskeletal health. This commentary aims to explore the intricate relationships among skin complexion, race, and 25-hydroxyvitamin D (25[OH]D) levels, focusing on challenges the Endocrine Society encountered during clinical practice guideline development. Given that increased melanin content reduces 25(OH)D production in the skin in response to UV light, the guideline development panel addressed the potential role for 25(OH)D screening in individuals with dark skin complexion. The panel discovered that no randomized clinical trials have directly assessed vitamin D related patient-important outcomes based on participants' skin pigmentation, although race and ethnicity often served as presumed proxies for skin pigmentation in the literature. In their deliberations, guideline panel members and selected Endocrine Society leaders underscored the critical need to distinguish between skin pigmentation as a biological variable and race and ethnicity as socially determined constructs. This differentiation is vital to maximize scientific rigor and, thus, the validity of resulting recommendations. Lessons learned from the guideline development process emphasize the necessity of clarity when incorporating race and ethnicity into clinical guidelines. Such clarity is an essential step toward improving health outcomes and ensuring equitable healthcare practices.

Behaviours of farmed saltwater crocodiles (Crocodylus porosus) housed individually or in groups.

Saltwater crocodiles (Crocodylus porosus) are farmed in Australia primarily for their skins and meat. Commercially, they are raised in group pens as hatchlings and grower crocodiles and then moved to unitised (individual) pens for the final finishing stage when they are several years old. They will exhibit aggressive behaviour towards each other in captivity. Unitised pens can prevent animal injury and teeth marks on the skins but may result in other social restrictions. Research into behavioural housing preferences could assist the industry and inform the process of guideline development for optimal crocodile management and welfare. This study assessed the impacts of two housing systems, unitised or group pens, in 20 commercial finishing crocodiles through measuring behavioural profiles of individuals from video recordings, including housing preference when given a choice. Both pens included water and an above-water shelf, but the crocodiles in unitised pens could also access underneath the shelf. A threat perception test was applied to assess anxiety when housed individually or in groups. However, it was difficult to apply a standardised stimulus to all animals that reliably elicited a behavioural response. Further work would be needed to validate this test for commercial reptiles as the outcomes were not robust. The behavioural observation results showed clear differences in where the crocodiles spent their time across the day and in their activity levels between the pen types. However, interpretation of this variation was confounded by the physical and social differences between the pen types given the inconsistency in shelf access. Behaviours exhibited also differed given there were social opportunities in the group pens where individuals were observed engaged in both aggressive and non-aggressive contact interactions. In the free choice environment, crocodiles spent similar amounts of time in both unitised and group pens, suggesting there were features of both pen types that were attractive to the animals. However, skins were damaged from teeth marks highlighting the physical and economical risks of group housing. Further work could validate behavioural tests to quantify affective state impacts in different housing environments and whether social interactions do provide benefits for improving crocodile welfare.

Applying the WHO-INTEGRATE evidence-to-decision framework in the development of WHO guidelines on parenting interventions: step-by-step process and lessons learnt

BackgroundDevelopment of guidelines for public health, health system, and health policy interventions demands complex systems thinking to understand direct and indirect effects of interventions within dynamic systems. The WHO-INTEGRATE framework, an evidence-to-decision framework rooted in the norms and values of the World Health Organization (WHO), provides a structured method to assess complexities in guidelines systematically, such as the balance of an intervention’s health benefits and harms and their human rights and socio-cultural acceptability. This paper provides a worked example of the application of the WHO-INTEGRATE framework in developing the WHO guidelines on parenting interventions to prevent child maltreatment, and shares reflective insights regarding the value added, challenges encountered, and lessons learnt.MethodsThe methodological approach comprised describing the intended step-by-step application of the WHO-INTEGRATE framework and gaining reflective insights from introspective sessions within the core team guiding the development of the WHO guidelines on parenting interventions and a methodological workshop.ResultsThe WHO-INTEGRATE framework was used throughout the guideline development process. It facilitated reflective deliberation across a broad range of decision criteria and system-level aspects in the following steps: (1) scoping the guideline and defining stakeholder engagement, (2) prioritising WHO-INTEGRATE sub-criteria and guideline outcomes, (3) using research evidence to inform WHO-INTEGRATE criteria, and (4) developing and presenting recommendations informed by WHO-INTEGRATE criteria. Despite the value added, challenges, such as substantial time investment required, broad scope of prioritised sub-criteria, integration across diverse criteria, and sources of evidence and translation of insights into concise formats, were encountered.ConclusionsApplication of the WHO-INTEGRATE framework was crucial in the integration of effectiveness evidence with insights into implementation and broader implications of parenting interventions, extending beyond health benefits and harms considerations and fostering a whole-of-society-perspective. The evidence reviews for prioritised WHO-INTEGRATE sub-criteria were instrumental in guiding guideline development group discussions, informing recommendations and clarifying uncertainties. This experience offers important lessons for future guideline panels and guideline methodologists using the WHO-INTEGRATE framework.

Clinical Practice Guideline Development in Pediatric Emergency Medicine Departments Across the United States: A Cross-sectional Study.

This cross-sectional study aimed to assess the process of clinical practice guideline (CPG) development in pediatric emergency medicine departments (PEDs) across the United States, with a focus on identifying areas for improvement to enhance the quality of CPGs. An electronic survey was distributed to PEDs with pediatric emergency medicine fellowship programs. Respondents were asked about their CPG development processes (ie, guideline committee composition, consideration of conflicts of interest, grading recommendations, guideline training opportunities) based on the Appraisal of Guidelines, Research, and Evaluation (AGREE II) tool as well as implementation and monitoring. Univariate analysis was used to assess associations between the number of AGREE II elements adhered to and annual patient volume. Of the 84 PEDs surveyed, 44 (52.4%) responded, representing institutions from 28 states. Most PEDs (97.7%, n = 43) reported developing their own guidelines, citing the need to improve care quality and standardize patient care as primary reasons. Although most guideline committees included multidisciplinary team members (74.4%, n = 32), routine patient involvement in committees was rare (11.6%, n = 5), and barriers such as time and resource constraints hindered their inclusion. Formal training for committee members in guideline development was uncommon (18.6%, n = 8). There was an association between higher annual patient volume and the number of AGREE II elements adhered to (P = 0.03). Few PEDs considered potential conflicts of interest among committee members (13.6%, n = 6). Over half of surveyed PEDs (54.5%, n = 24) lacked a systematic approach to grading recommendations. Educational materials and workshops were the most common guideline implementation strategies. Our findings highlight need for improvement in the CPG development process in PEDs. Including patients in committees, providing formal training for committee members, and adopting a rigorous approach to grading recommendations are crucial steps toward enhancing guideline quality. Emphasizing these improvements has the potential to improve the quality of CPGs for pediatric emergency care.

The quality of guidelines on the pancreatic perioperative enhanced recovery after surgery: a systematic quality appraisal using AGREE II instrument.

To evaluate the quality of guidelines on the pancreatic perioperative enhanced recovery after surgery both domestically and internationally, providing reference and reference for clinical practice. Systemically retrieved in the guideline websites, professional association websites and databases, such as up to date, BMJ Best Practice, PubMed, Embase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wan Fang Data, China Science and Technology Journal Database(VIP), China Biology Medicine disc (CBMdisc), Medlive, Guidelines International Network(GIN), National Guideline Clearinghouse(NGC), National Institute for Health and Care Excellence(NICE), Registered Nurses Association of Ontario(RNAO), Scottish Intercollegiate Guidelines Network(SIGN), Joanna Briggs Institute Library(JBI), including guidelines and expert consensus on enhanced postsurgical recovery in pancreatic surgery published as of December 20, 2023. The Appraisal of Guidelines for Research and Evaluation II(AGREE II) tool was applied to evaluate the quality of the guidelines by four assessors. This study included seven guidelines, all of which were rated as Grade B in terms of quality, with ICC coefficients ranging from 0.752 to 0.884, indicating a high level of consistency. When formulating guidelines in the future, it is recommended to use AGREE II as a reference, emphasizing the standardization of the guideline development process and methods, fully considering patients' values and preferences, focusing on the applicability of the guidelines, and striving to create high-quality evidence-based recommendations.

World Federation of Acupuncture-Moxibustion Societies (WFAS) Clinical Practice Guideline on Acupuncture and Moxibustion: Migraine recommendation summaries: 世界针灸学会联合会《针灸临床实践指南:偏头痛》推荐意见概述

Clinical Practice Guideline on Acupuncture and Moxibustion: Migraine (WFAS 007.9-2023) is a clinical practice guideline officially released by the World Federation of Acupuncture-Moxibustion Societies (WFAS) on October 9, 2023, and is the first international guideline on the treatment of migraine with acupuncture. This international standard was developed under the guidance of rigorous evidence-based methodology, and it contains guideline purpose, scope, applicable population, applicable settings, overview of acupuncture for migraine, guideline development process and recommendations. For promoting the understanding and application of this guideline, this article summarizes a total of 18 recommendations in order to assist clinical decisions for migraine with acupuncture.

The development of the Egyptian 24-h movement guidelines for adults aged 50 years and older: an integration of sleep, sedentary behavior, and physical activity by the Egyptian Academy of Bone and Muscle Health

BackgroundWith the vision of healthy aging, the Egyptian Academy of Bone and Muscle Health followed an established guideline development process to create the Egyptian 24-h movement clinical guideline for adults aged 50 years and older adults. This guideline highlights the significance of movement behaviors across the whole 24-h day. Online databases (PubMed, Embase, and Cochrane Library) were searched for relevant peer-reviewed studies that met the a priori inclusion criteria.ResultsA total of 53 studies met the inclusion criteria. Leveraging evidence from the review of the literature led to the development of 27 statements answering the 5 key questions. Results revealed a major change in the previous basic understandings as it shifts away from focussing on a sole movement behavior to the combination of all the movement behaviors. Based on this, the final guideline was developed providing evidence-based recommendations for a “Healthy 24-Hour Day”, comprising a mix of light-intensity and moderate-to-vigorous-intensity physical activity, sleep, and sedentary behavior.ConclusionThe developed guidelines are meant to help in the decision-making process and are intended for use by adults and older both nationally and internationally; also, for endorsement by the policy-makers. Dissemination and implementation efforts would impact positively on both health professionals and researchers and would also be useful to interested members of the public sector.

Evidence, what’s in a name? Some methodological remarks on the Grading of Recommendations Assessment, Development, and Evaluation approach for guideline development

The GRADE approach was developed to provide a standardized approach to guideline development. GRADE has increased the transparency of the different steps in the guideline development process. However, GRADE should not be seen as the magic bullet that removes all uncertainty and resolves all debates in the scientific community. This is especially true in the context of rare disease such as hemophilia when a guideline is based on low-quality evidence.

Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer-Cyclin-Dependent Kinase 4 and 6 Inhibitors: ASCO Guideline Rapid Recommendation Update.

ASCO Rapid Recommendation Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options. Guidelines and updates are not intended to substitute for independent professional judgment of the treating provider and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix 1 and Appendix 2, online only).

Update of the World Health Organization's Mental Health Gap Action Programme Guideline for Psychoses (Including Schizophrenia).

The World Health Organization's (WHOs) Mental Health Gap Action Programme (mhGAP) aims to improve healthcare for mental, neurological, and substance use disorders in nonspecialized settings, with a focus on low- and middle-income countries (LMICs). mhGAP includes guidelines for the treatment of psychoses (including schizophrenia), which were recently updated in 2023. The complexity of the WHO guideline update process and the updated recommendations on psychoses are presented. The WHO guideline development process is outlined as well as the evidence appraisal and the translation of the evidence into recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The guideline update process includes a review of the literature, a compilation of systematic reviews, and extracting data related to critical and important outcomes. The updated recommendations and the justifying evidence are discussed. The WHO mhGAP guidelines for psychoses are adapted to LMICs, and consist of 13 recommendations in 2023, whereof 5 were updated, and 1 recommendation was newly developed. Background information on how these recommendations were obtained, and significant changes since the previous guideline update in 2015 are provided. Unlike other guidelines, the WHO must consider various countries, contextual factors, and the WHO Model Lists of Essential Medicines when developing its guidelines. A transformation of the WHO guideline for psychoses into a living guideline would ensure always up-to-date recommendations and facilitate shared decision-making.

Protocol for the development of a consensus practice guideline To address clinical and regulatory barriers to buprenorphine dispensing in community pharmacy

BackgroundLess than half of community pharmacies in the United States stock buprenorphine products indicated for the treatment of opioid use disorder. This lack of access to buprenorphine in community pharmacies is a significant barrier to care. To address this issue, this protocol outlines a comprehensive approach to develop a practice guideline aimed at improving access to safe and effective opioid use disorder treatment in community pharmacies.MethodsThe guideline development process will proceed in three phases, following a technique closely aligned with the Institute of Medicine’s guidance on guideline development. The first phase will involve conducting qualitative interviews with pharmacists in three states to identify their beliefs toward buprenorphine dispensing. As limitations on buprenorphine supply are related to constraints at all levels of the drug supply and regulatory system, the second phase, we will recruit representatives from regulatory agencies, pharmacy organizations, the Drug Enforcement Administration, pharmaceutical wholesalers as well as addiction medicine physicians and psychiatric pharmacists to develop consensus recommendations through a modified Delphi design. This will be followed by a public comment period and external expert review of the recommendations led by the National Association of Boards of Pharmacy. Finally, in the third phase, a national, mixed media dissemination campaign will be led by the National Community Pharmacists Association (NCPA) to convey recommendations to practicing pharmacists.DiscussionThe guideline development process aims to incorporate the perspectives of multiple stakeholders and emphasize the importance of addressing the regulatory and pharmacy-specific aspects of care in addition to clinical evidence and guidance. The development of this guideline will provide targeted, multidisciplinary guidance for pharmacists, improving access to safe and effective opioid use disorder treatment in the community setting.PreregistrationThis protocol was registered with the Open Science Framework in March of 2023. Registration may be found at: https://doi.org/10.17605/OSF.IO/6S9DY.

Endocrine and Targeted Therapy for Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer-Capivasertib-Fulvestrant: ASCO Rapid Recommendation Update.

ASCO Rapid Recommendation Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options. Guidelines and updates are not intended to substitute for independent professional judgment of the treating provider and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix 1 and Appendix 2, online only).

A narrative review of global and national physical activity and sedentary behaviour guidelines development processes - The GUidelines Standards (GUS) project

BackgroundClinical and public health guidelines serve to direct clinical practice and policy, based on the best available evidence. The World Health Organization (WHO) and national health bodies of many countries have released physical activity and sedentary behaviour guidelines. Despite significant overlap in the body of evidence reviewed, the guidelines differ across jurisdictions. This study aimed to review the processes used to develop global and national physical activity and sedentary behaviour guidelines and examine the extent to which they conform with a recommended methodological standard for the development of guidelines. MethodsWe extracted data on nine sets of guidelines from seven jurisdictions (WHO, Australia, Canada, Japan, the Netherlands, United Kingdom, and United States). We rated each set of guidelines as high, medium, or low quality on criteria related to the rigour of the development process. ResultsWe observed variation in the quality of guidelines development processes across jurisdictions and across different criteria. Guidelines received the strongest overall ratings for criteria on clearly describing the evidence selected and stating an explicit link between the recommendations and the supporting evidence. Guidelines received the weakest overall ratings for criteria related to clearly describing the methods used to formulate the recommendations and reporting external review by experts prior to publication. Evaluated against the selected criteria, the strongest processes were undertaken by the WHO and Canada. ConclusionsReaching agreement on acceptable guideline development processes, as well as the inclusion and appraisal procedures of different types of evidence, would help to strengthen and align future guidelines.