What Determines the Quality of Rehabilitation Clinical Practice Guidelines?: An Overview Study.

The study relied on published reviews, and many reviews did not clearly report how they used AGREE II procedures, so ratings may not have been applied consistently. The definition of rehabilitation was broad, and the reviews often gave minimal information about whether the guidelines actually covered rehabilitation practices or services. Analyses were based on subsets: 33 reviews provided overall quality ratings for 384 CPGs, and 24 reviews provided recommendation data for 280 CPGs. AGREE II item scoring can be subjective, and the manual gives little guidance for intermediate scores or for combining raters' overall assessments. The analysis did not independently verify the evidence base behind guideline recommendations; a high rigor score may reflect reported methods rather than properly assessed evidence. The search may have missed reviews that did not use AGREE II terms in titles or abstracts. Variation between reviews could not be explained by topic area, rater severity, or other available factors.

The authors reported no conflicts of interest, and no conflicts were reported by individuals in control of the content.

Do not treat a high AGREE II score as proof that a guideline is clinically sound. The paper says AGREE II scores should not be treated as the last word, and a high rating is not a guarantee that recommendations are based on all relevant evidence properly assessed.