- 1Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
- 2Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada. anna.gagliardi@uhnresearch.ca.
Abstract
BACKGROUND:
Complementary and alternative
medicine (CAM) use is often not disclosed by patients, and can be
unfamiliar to health care professionals. This may lead to underuse of
beneficial CAM therapies, and overuse of other CAM therapies with little
proven benefit or known contraindications. No prior research has
thoroughly evaluated the credibility of knowledge-based resources. The
purpose of this research was to assess the quantity and quality of CAM
guidelines.
METHODS:
A
systematic review was conducted to identify CAM guidelines. MEDLINE,
EMBASE and CINAHL were searched in January 2016 from 2003 to 2015. The
National Guideline Clearinghouse, National Center for Complementary and
Integrative Health web site, and two CAM journals were also searched.
Eligible guidelines published in English language by non-profit agencies
on herbal medicine, acupuncture, or spinal manipulation for adults with
any condition were assessed with the Appraisal of Guidelines, Research
and Evaluation II (AGREE II) instrument.
RESULTS:
From
3,126 unique search results, 17 guidelines (two herbal medicine, three
acupuncture, four spinal manipulation, eight mixed CAM therapies)
published in 2003 or later and relevant to several clinical conditions
were eligible. Scaled domain percentages from highest to lowest were
clarity of presentation (85.3 %), scope and purpose (83.3 %), rigour of
development (61.2 %), editorial independence (60.1 %), stakeholder
involvement (52.0 %) and applicability (20.7 %). Quality varied within
and across guidelines. None of the 17 guidelines were recommended by
both appraisers; 14 were recommended as Yes or Yes with modifications.
CONCLUSIONS:
Guidelines
that scored well could be used by patients and health care
professionals as the basis for discussion about the use of these CAM
therapies. In future updates, guidelines that achieved variable or lower
scores could be improved according to specifications in the AGREE II
instrument, and with insight from a large number of resources that are
available to support guideline development and implementation. Future
research should identify CAM therapies other than those reviewed here
for which guidelines are available. Research is also needed on the
safety and effectiveness of CAM therapies.
KEYWORDS:
AGREE II; Clinical practice guideline; Complementary and alternative medicine; Integrative medicine; Systematic review