Quality and Scope of Published International Guidelines for Multiple Sclerosis Care: AGREE II Appraisal
Bibliographic record
Abstract
BackgroundThere is no comprehensive clinical practice guideline (CPG) for multiple sclerosis (MS) rehabilitation and symptom management. This study aimed to identify and appraise the quality and scope of topics covered by existing international CPGs to inform development of a future comprehensive guideline.MethodsElectronic databases and grey literature were systematically searched for existing CPGs for MS. Identified guidelines were screened independently by 3 authors for inclusion criteria. Included guidelines were each appraised by 4 reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. The AGREE-II comprises 23 items organized into 6 domains assessing the quality and reporting of CPGs. Mean AGREE ratings and ranges were calculated for each quality domain. The intra class correlation coefficient (ICC) assessed inter-rater reliability. Individual recommendations were organized into broad topics.Results15 CPGs published between 1998 and 2020 met the inclusion criteria. These derived from USA (n = 8), UK (n = 3), Canada (n = 2), and Europe (n = 2). Standardized scores (and range) of quality ratings for the six domains were: 1. Scope and purpose = 83.2% (range 53.7 -100%); 2. Stakeholder involvement = 64.2% (range 31.9-100%); 3. Rigour of development = 55.7% (range 12-93.8%); 4. Clarity of presentation = 79.6% (range 56.9-100%); 5. Applicability = 34.9% (range 13.9-78.1%); and 6. Editorial independence = 60% (range 0-100%). The highest scoring domains were for Scope and purpose and Clarity of presentation. Applicability was the lowest scoring domain with 12/15 guidelines scoring low in this domain. There was moderate to excellent inter-rater reliability (0.60-0.96 across the 6 domains). Recommendations from the CPGs covered spasticity, fatigue, bowel, bladder, pregnancy, physical activity, cognition, mood, and/or multi-disciplinary care topics.ConclusionExisting CPGs have well-defined objectives and target populations, yet clinical applicability and rigour of development is lower. A comprehensive up-to-date MS clinical practice guideline that provides implementation support is urgently needed.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.132 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".