Appraisal of clinical practice guidelines for the management of attention deficit hyperactivity disorder (ADHD) using the AGREE II Instrument: A systematic review

RESEARCH ARTICLE Appraisal of clinical practice guidelines for the management of attention deficit hyperactivity disorder (ADHD) using the AGREE II Instrument: A systematic review Yasser Sami Amer ID1,2,3,4*, Haya Faisal Al-Joudi5, Jeremy L. Varnham ID6,7, Fahad A. Bashiri8, Muddathir Hamad Hamad8, Saleh M. Al Salehi9, Hadeel Fakhri Daghash10, Turki Homod Albatti6,11, on behalf of The Saudi ADHD Society¶ a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Amer YS, Al-Joudi HF, Varnham JL, Bashiri FA, Hamad MH, Al Salehi SM, et al. (2019) Appraisal of clinical practice guidelines for the management of attention deficit hyperactivity disorder (ADHD) using the AGREE II Instrument: A systematic review. PLoS ONE 14(7): e0219239. https://doi.org/10.1371/journal.pone.0219239 1 CPG Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia, 2 Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia, 3 Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia, 4 Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt, 5 Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, 6 Saudi ADHD Society, Riyadh, Saudi Arabia, 7 School of Psychology, University of East London, London, United Kingdom, 8 Division of Neurology, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia, 9 Child Development Center, King Abdullah Bin Abdulaziz University Hospital, Princess Noura Bint AbdulRahman University, Riyadh, Saudi Arabia, 10 Ada’a Program, Assistant Deputyship for Hospital Services, Ministry of Health, Riyadh, Saudi Arabia, 11 Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia ¶ Membership of the Saudi ADHD Society is provided in the Acknowledgments * Abstract Editor: Pan Lin, South-Central University for Nationalities, CHINA Received: July 21, 2018 Accepted: June 19, 2019 Published: July 5, 2019 Copyright: © 2019 Amer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This work was supported by Saudi ADHD Society. URL: https://adhd.org.sa/. This is part of a comprehensive project for adaptation of National CPG for ADHD sponsored by the Saudi ADHD Society. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Background and objective High quality evidence-based clinical practice guidelines (CPGs) have a major impact on the appropriate diagnosis and management and positive outcomes. The evidence-based healthcare for patients with attention deficit hyperactive disorder (ADHD) is challenging. The objective of this study was to appraise the quality of published CPGs for ADHD. Methods A systematic review was conducted for ADHD CPGs using CPG databases, DynaMed, PubMed, and Google Scholar. The quality of each included CPG was appraised by three independent appraisers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Results Six CPGs were critically reviewed. The AGREE II standardized domain scores revealed variation between the quality of these CPGs with the National Institute of Health and Care Excellence (NICE), University of Michigan Health System, and American Academy of PLOS ONE | https://doi.org/10.1371/journal.pone.0219239 July 5, 2019 1 / 15 Quality of guidelines for attention deficit hyperactivity disorder Competing interests: The authors have declared that no competing interests exist. Pediatrics CPGs as the top three. Overall, the recommendations for management of ADHD were similar in these CPGs. Conclusions Reporting of CPG development is often poorly documented. Guideline development groups should aim to follow the AGREE II criteria to improve the standards and quality of CPGs. The NICE CPG showed the best quality. Embedding the AGREE II appraisal of CPGs in the training and education of healthcare providers is recommended. The protocol for this study was published in PROSPERO (International prospective register of systematic reviews). Link: http://www.crd.york.ac.uk/PROSPERO/display_record. php?ID=CRD42017078712 and is additionally available from protocols.io. Link: https://dx. doi.org/10.17504/protocols.io.q27dyhn. Introduction Attention deficit hyperactivity disorder [1,2] or Attention-Deficit/ Hyperactivity Disorder [3,4] (ADHD), is a chronic neurodevelopmental disorder characterized by developmentally inappropriate levels of hyperactivity-impulsivity and/or inattention [1–9]. ADHD is clinically and genetically heterogeneous with multiple possible etiologies and frequent neuropsychiatric comorbidities [10,11]. ADHD is highly prevalent in 5–6% of children and in 3.8–4.4% of adults [12]. Clinical practice guidelines (CPGs) summarize the best available evidence and provide guidance for healthcare providers during their daily practice. CPGs can support the knowledge-to-action cycle effectively if they were developed using a systematic and rigorous methodology. Published evidence has revealed that CPGs can improve patient outcomes, patient experience, and quality and safety in healthcare [13]. In 2011, the Health and Medicine Division (HMD) of the American National Academies, formerly the Institute of Medicine (IOM), published its eight criteria of trustworthy CPGs, Clinical Practice Guidelines We Can Trust [14]. Since then, many sets of standards or criteria for high quality CPGs have been published or updated, including the Guidelines International Network’s [15], the GIN-McMaster Checklist [16], and the AGREE II Reporting Checklist [17], based upon the AGREE II Instrument’s 23 criteria. These standards have helped in shaping the development process and methodologies of CPGs worldwide [18]. Two systematic reviews of CPG appraisal tools have included a total of 64 tools [19,20]; these revealed that the AGREE II Instrument was the only tool that had a validated scoring system, as well as already being widely adopted. It has proven to become the international gold standard for quality assessment and development of CPGs, being cited more than 746 times between 2013–2018 [21]. A brief review of literature on the utilization of AGREE II for ADHD CPGs revealed two uses: One was restricted to psychopharmacological management of ADHD [22], and the other was conducted as part of a Master’s thesis in Pediatrics at Alexandria University [23]. (...truncated)