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Protein, malnutrition and wasting disorders

Critical appraisal of papers reporting recommendation on sarcopenia using the AGREE II tool: a EuroAIM initiative

Abstract

Background/objectives

The growing interest of medical community about sarcopenia resulted in the production of several clinical practice guidelines (CPGs), with an unavoidable variability in terms of the overall quality of those publications. Our aim is to evaluate the quality of CPGs on sarcopenia using the AGREE II instrument.

Subjects/methods

We performed an online literature search for sarcopenia CPGs using different databases. Four independent reviewers evaluated the quality of CPGs using the AGREE II instrument. To classify the quality of each guideline, we defined specific thresholds of final score: high-quality if five or more domains scored >60%; average-quality if three or four domains scored >60%; low-quality if ≤2 domains scored >60%.

Results

Our literature search yielded 315 articles, and after applying exclusion criteria our final analysis included 19 CPGs. The overall quality of CPGs was remarkable, as 13/19 (68.4%) were considered of “high-quality” CPGs, with more than four domains reached a score higher than 60%. “Scope and Purpose” and “Clarity of Presentations” had the best domain results (78.4% and 73.8%, respectively), while the two domains with the lowest scores were “Rigor of Development” and “Applicability” (61.5% and 58.7%, respectively). Interobserver variability ranged between moderate (0.624) and fair (0.275).

Conclusions

Our study showed that the overall quality of CPGs about sarcopenia was noteworthy, as more than two-third of paper obtained a “high-quality” score. The domain “applicability” had the lowest score, suggesting that emphasis should be put on possible strategies for helping other doctors to implement guideline recommendations in clinical practice.

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Fig. 1: Overview of the study flowchart.

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Acknowledgements

This work has been conducted within the framework of the EuroAIM, research platform of the European Institute for Biomedical Research (http://www.eibir.org/scientific-activities/joint-initiatives/euroaim/). This study was supported by the Italian Ministry of Health (Ricerca Corrente).

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All authors contributed to meet the ICMJE Recommendations for authorship, having provided: 1. Substantial contributions to the conception and design (CM, DA), acquisition (IV), or analysis and interpretation of data (LP, SG, JV, VC). 2. Drafting the paper (CM, DA) or revising it critically for important intellectual content (CM, LMS). 3. Final approval of the version to be published (all authors). 4. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Carmelo Messina.

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Messina, C., Vitale, J.A., Pedone, L. et al. Critical appraisal of papers reporting recommendation on sarcopenia using the AGREE II tool: a EuroAIM initiative. Eur J Clin Nutr 74, 1164–1172 (2020). https://doi.org/10.1038/s41430-020-0638-z

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