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ABSTRACT
Background: We established a program of research to improve the development, reporting and evaluation of practice guidelines. We assessed the construct validity of the items and user's manual in the β version of the AGREE II.
Methods: We designed guideline excerpts reflecting high- and low-quality guideline content for 21 of the 23 items in the tool. We designed two study packages so that one low-quality and one high-quality version of each item were randomly assigned to each package. We randomly assigned 30 participants to one of the two packages. Participants reviewed and rated the guideline content according to the instructions of the user's manual and completed a survey assessing the manual.
Results: In all cases, content designed to be of high quality was rated higher than low-quality content; in 18 of 21 cases, the differences were significant (p < 0.05). The manual was rated by participants as appropriate, easy to use, and helpful in differentiating guidelines of varying quality, with all scores above the mid-point of the seven-point scale. Considerable feedback was offered on how the items and manual of the β-AGREE II could be improved.
Interpretation: The validity of the items was established and the user's manual was rated as highly useful by users. We used these results and those of our study presented in part 1 to modify the items and user's manual. We recommend AGREE II (available at www.agreetrust.org) as the revised standard for guideline development, reporting and evaluation.
For clinical practice guidelines to achieve their full potential as tools to assist in clinical, policy-related and system-level decisions,1-3 they need to be of high quality and developed using rigorous methods.4 Thus, strategies are required to facilitate the development and reporting of guidelines and tools able to distinguish guidelines of varying quality. The AGREE Collaboration (Appraisal of Guidelines, Research and Evaluation) was the first to create a generic tool to assess the process of guideline development and reporting,5,6 and it quickly became the standard for guideline evaluation.7
As with any new assessment tool, ongoing development of the instrument was required to improve its measurement properties and advance the guideline enterprise. The AGREE Next Steps Consortium undertook a program of research to achieve these goals and create the next version of the...