A methodological assessment of diabetic foot syndrome clinical practice guidelines

Abstract

Objectives: Diabetic foot syndrome (DFS) contributes to significant morbidity in diabetic patients. Diagnostic and therapeutic approaches to DFS may be summarised in clinical practice guidelines (CPGs) to aid clinical practice but may only benefit patients if the CPG is of high quality. This study determines the methodological quality of DFS CPGs using a validated assessment tool to identify CPGs adequate for use in clinical practice. Methods: Medline, EMBASE and CPG databases were searched to 31st May 2019. Reference lists were also searched. Full text English evidence-based DFS CPGs were included. CPGs based on expert consensus, guideline summaries or only available if purchased were excluded. Four reviewers independently assessed methodological quality using Appraisal of Guidelines for Research and Evaluation II instrument. An overall guideline assessment scaled score of ≥80% was considered of adequate quality to recommend use. Results: 16 CPGs were identified. Good inter-reviewer reliability (ICC 0.985, 95% CI 0.980-0.989) was achieved. Poor scores were noted in domains 2 (stakeholder involvement), 5 (applicability), and 6 (editorial independence). Significant methodological heterogeneity was observed in all domains with the most noted in domain 6 (mean scaled score 43.2±32.1%). Four CPGs achieved overall assessment scores of ≥80%. Conclusion: Four CPGs were considered adequate for clinical practice based on methodological quality. However, elements of methodological quality were still lacking, and all CPGs showed areas for improvement, potentially through increased multidisciplinary team involvement and trial application of recommendations. Methodological rigour may be improved using structured approaches with validated CPG creation tools in the future. Future work should also assess recommendation accuracy using available validated assessment tools.