Adaptation of the 2015 American College of Rheumatology treatment guideline for rheumatoid arthritis for the Eastern Mediterranean Region: an exemplar of the GRADE Adolopment

Health and Quality of Life Outcomes

Research

Andrea Darzi¹  Manale Harfouche¹  Elie A. Akl²  Imad Uthman³  Wissam Hazer⁴  Holger J. Schünemann⁵  Peter Tugwell⁶  Bassel Elzorkany⁷  Khalid A. Alnaqbi⁸  Mohammed A. Omair⁹  Humeira Badsha^1,10  Nelly Ziade^1,11  Mohammed Hamoudeh^1,12  Basel Masri^1,13  Jasvinder A. Singh^1,14  Farida Al Balushi^1,15  Robin Christiansen^1,16  Hussein Halabi^1,17  Thurayya Arayssi^1,18  Samar Alemadi^1,18 

[1] AUB GRADE Center, Clinical Research Institute, American University of Beirut, PO Box 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon;AUB GRADE Center, Clinical Research Institute, American University of Beirut, PO Box 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon;Department of Health Research Methods, Evidence, and Impact (HE&I), McMaster University, Hamilton, ON, Canada;Department of Internal Medicine, American University of Beirut, PO Box 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon;American University of Beirut, Beirut, Lebanon;Aspetar, Doha, Qatar;Department of Medicine, McMaster University, Hamilton, ON, Canada;Department of Health Research Methods, Evidence, and Impact (HE&I), McMaster University, Hamilton, ON, Canada;Department of Medicine, University of Ottawa, Ottawa, Canada;Department of Rheumatology, Cairo University, Giza, Egypt;Department of Rheumatology, Medical Institute, Al Ain Hospital, Al Ain, United Arab Emirates;Division of Rheumatology, Department of Medicine, King Saud University, Riyadh, Saudi Arabia;Dr. Humeira Badsha Medical Center, Rheumatologist City Hospital, Rheumatologist Neurospinal Hospital, Dubai, United Arab Emirates;Faculty of Medicine, Univeristé Saint Joseph, Beirut, Lebanon;Hamad Medical Corporation, Doha, Qatar;Jordan Hospital, Amman, Jordan;Medicine Service and Center for Surgical Medical Acute care Research and Transitions, VA Medical Center, 510, 20th Street South, FOT 805B, Birmingham, AL, USA;Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, 1720 Second Ave. South, 35294-0022, Birmingham, AL, USA;Ministry of Health, Muscat Governorate, Oman;Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark;Rheumatology Division, Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia;Weill Cornell Medicine-Qatar- Department of Internal Medicine, Doha, Qatar;

关键词: Practice guideline;    Adaptation;    GRADE;    Evidence-based medicine;    Eastern Mediterranean Region;    Rheumatoid arthritis;    Conflicts of interest;   

DOI  :  10.1186/s12955-017-0754-1

 received in 2017-03-07, accepted in 2017-09-07,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIt has been hypothesized that adaptation of health practice guidelines to the local setting is expected to improve their uptake and implementation while cutting on required resources. We recently adapted the published American College of Rheumatology (ACR) Rheumatoid Arthritis (RA) treatment guideline to the Eastern Mediterranean Region (EMR). The objective of this paper is to describe the process used for the adaptation of the 2015 ACR guideline on the treatment of RA for the EMR.MethodsWe used the GRADE-Adolopment methodology for the guideline adaptation process. We describe in detail how adolopment enhanced the efficiency of the following steps of the guideline adaptation process: (1) groups and roles, (2) selecting guideline topics, (3) identifying and training guideline panelists, (4) prioritizing questions and outcomes, (5) identifying, updating or conducting systematic reviews, (6) preparing GRADE evidence tables and EtD frameworks, (7) formulating and grading strength of recommendations, (8) using the GRADEpro-GDT software.ResultsThe adolopment process took 6 months from January to June 2016 with a project coordinator dedicating 40% of her time, and the two co-chairs dedicating 5% and 10% of their times respectively. In addition, a research assistant worked 60% of her time over the last 3 months of the project. We held our face-to-face panel meeting in Qatar. Our literature update included five newly published trials. The certainty of the evidence of three of the eight recommendations changed: one from moderate to very low and two from low to very low. The factors that justified a very low certainty of the evidence in the three recommendations were: serious risk of bias and very serious imprecision. The strength of five of the recommendations changed from strong to conditional. The factors that justified the conditional strength of these 5 recommendations were: cost (n = 5 [100%]), impact on health equities (n = 4 [80%]), the balance of benefits and harms (n = 1 [20%]) and acceptability (n = 1 [20%]).ConclusionThis project confirmed the feasibility of GRADE-Adolopment. It also highlighted the value of collaboration with the organization that had originally developed the treatment guideline. We discuss the implications for both guideline adaptation and future research to advance the field.

【 授权许可】

CC BY   
© The Author(s). 2017