Guidelines on neurostimulation for chronic pain: a compliance appraisal of reporting standards

The field of neuromodulation has experienced substantial growth, accompanied by an increase in clinical practice guidelines aimed at supporting evidence-based practice. However, adherence to reporting standards remains critical in the development of a comprehensive and transparent clinical practice guideline. This study evaluated the reporting quality of guidelines on neurostimulation for chronic pain by assessing compliance with the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist and the Appraisal of Guidelines for Research and Evaluation (AGREE) checklist and explored predictors of reporting quality.

A search strategy was conducted from database inception to April 17, 2024 to identify guideline articles on neurostimulation treatment (spinal cord stimulation, dorsal root ganglion stimulation, peripheral nerve stimulation) for chronic pain. Primary outcomes included the percentage of completed RIGHT and AGREE checklist items. Secondary outcomes included the identification of under-reported checklist items, predictors of reporting quality, and agreement between the two checklists.

A total of 24 guideline articles were included, with a mean percentage of completed items being 55.12%±12.68% for the RIGHT checklist and 52.16%±10.51% for the AGREE checklist. Items that were most frequently under-reported (<25% completion) included themes of population-specific considerations, cost/resource implications, guideline limitations, recommendation development process, magnitude of benefit versus magnitude of harm, and statement of competing interests and how they were managed. Secondary analysis revealed no significant associations between RIGHT/AGREE reporting quality and journal impact factor, year of publication, number of authors, or guideline themes. There was good inter-checklist agreement between the RIGHT and AGREE checklists (intraclass correlation coefficient 0.76, 95% CI 0.44 to 0.90), suggesting overlapping but distinct evaluation criteria.

Current guidelines of neurostimulation for chronic pain exhibit significant variability in reporting items, with notable deficiencies in the description of key methodological areas. While adherence to established checklists such as RIGHT and AGREE remains poor and inconsistent, these tools provide a critical framework for enhancing comprehensiveness, transparency, and methodological rigor in future guideline development.