Current knowledge on the adaptation of clinical practice guidelines: a scoping review
Bibliographic record
Abstract
BACKGROUND: The adaptation of clinical practice guidelines (CPGs) is increasingly used to efficiently develop contextualised recommendations for local, regional and national settings. However, adaptation approaches lack standardisation, and their application remains unclear. OBJECTIVE: To identify existing literature on CPG adaptation approaches, synthesise and analyse the definitions, rationales, key steps and their applications. METHODS: We conducted a scoping review and identified studies through (1) database searches in MEDLINE and EMBASE (October 2024); (2) forward citation searches (January 2024); (3) manual searches; and (4) expert recommendations. We included documents describing adaptation approaches that allow reproducibility or adapted guidelines reflecting their application, without language restriction. We analysed data using descriptive and content analysis, with visualisations using Tableau. RESULTS: We identified 49 adaptation approaches (2000-2024) and 151 applications (2007-2024). 28 approaches originated from high-income countries (57.1%), primarily aimed at improving guideline development efficiency. We categorised these approaches into methodological frameworks (n=16, 32.7%), medical association frameworks (n=7, 14.3%), organisational handbooks (n=12, 24.5%), national or regional approaches (n=13, 26.5%) and one topic-specific methodology. From the key adaptation steps of the identified approaches, we found that 'judging quality of evidence' and 'establishing guideline group processes' were the least addressed. Approximately 20% of applications modified the original approaches during the adaptation process. ADAPTE (n=50, 33.1%) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-ADOLOPMENT (n=41, 27.2%) are the most commonly used adaptation approaches. Also, over half of the identified applications were adapted at the evidence level (n=88, 58.3%) and completed the process within 12 months (range: 2-36 months). CONCLUSIONS: 49 adaptation approaches were identified, with a recent surge in interest and utilisation. Although adaptation can save time and resources, substantial variations among existing approaches and their applications remain. These findings highlight the need for comprehensive guidance to support standardisation and optimise the quality of the adaptation process.
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | Metaresearch Domain: Methods · Genre: Review About the Canadian research system: no · About a Canadian topic: no | Systematic review | low |
| gpt | Metaresearch Domain: Methods · Genre: Review About the Canadian research system: no · About a Canadian topic: no | Systematic review | low |
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 | 0.031 | 0.655 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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, unvalidatedLabeled directly by 2 models reading the full record.
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".