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A methodologic assessment of lymphedema clinical practice guidelines.
Matthew Tan1, Safa Salim1, Mostafa Beshr1
1Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom.
Summary
No current lymphedema clinical practice guidelines (CPGs) meet quality standards for clinical use. Future CPG development requires improved methodologic rigor, particularly in the rigor of development, to ensure reliable patient care guidance.
Area of Science:
- Medical Guidelines
- Clinical Practice
- Lymphedema Management
Background:
- Lymphedema clinical practice guidelines (CPGs) are crucial for healthcare professionals.
- Assessing the methodologic quality of existing CPGs is essential for selecting reliable guidance.
- Identifying areas for improvement can enhance future CPG development.
Purpose of the Study:
- To evaluate the methodologic quality of current lymphedema CPGs.
- To aid healthcare professionals in choosing high-quality, accessible lymphedema guidance.
- To pinpoint deficiencies in current CPGs for future enhancement.
Main Methods:
- A systematic search of MEDLINE, Embase, and CPG databases was conducted up to January 31, 2020.
- Six full-text, evidence-based lymphedema CPGs were included after applying exclusion criteria.
- The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument was used to assess CPG quality by two independent reviewers.
Main Results:
- Only six lymphedema CPGs met the inclusion criteria.
- No CPG achieved the ≥80% quality threshold, with the highest scoring 79.2%.
- Significant methodologic heterogeneity was observed, with poor performance in development rigor (domains 5 and 6).
Conclusions:
- Current lymphedema CPGs are not adequate for clinical practice based on the defined quality threshold.
- All reviewed CPGs require improvements in methodologic quality, especially in the rigor of development.
- Utilizing tools like AGREE II can guide the development of higher-quality future CPGs for complex conditions like lymphedema.
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