Open access Original research Reporting specifications regarding epilepsy … · Wangfi etal Open 20199e029589 doi101136bmjopen2019029589 1 Open access Reporting specifications regarding

1Wang Z, et al. BMJ Open 2019;9:e029589. doi:10.1136/bmjopen-2019-029589

Open access

Reporting specifications regarding epilepsy practice guidelines based on the RIGHT reporting checklist: an analysis

Zhijie Wang,1,2 Yu Zhang,1 Wei Guo,3 Xiaoyang Mio Hu,2 Xiao Gao,4 Liming Lu1

To cite: Wang Z, Zhang Y, Guo W, et al. Reporting specifications regarding epilepsy practice guidelines based on the RIGHT reporting checklist: an analysis. BMJ Open 2019;9:e029589. doi:10.1136/bmjopen-2019-029589

► Prepublication history for this paper is available online. To view these files, please visit the journal online (http:// dx. doi. org/ 10. 1136/ bmjopen- 2019- 029589).

ZW and YZ contributed equally.

Received 02 February 2019Revised 02 August 2019Accepted 23 September 2019

For numbered affiliations see end of article.

Correspondence toProfessor Xiao Gao; gaoxiaohlj@ 163. com

Dr Liming Lu; lulimingleon@ 126. com

Original research

© Author(s) (or their employer(s)) 2019. Re- use permitted under CC BY- NC. No commercial re- use. See rights and permissions. Published by BMJ.

AbstrACtObjective Clinical guidelines are designed to optimise patient care and provide efficient approaches for therapy. Epilepsy is a chronic brain disorder that continues to experience a considerable treatment gap due to non- standard recommendations. We assessed the reporting quality of clinical practice guidelines on epilepsy over the past 5 years to generate a reporting specification for this study.setting Seven databases were searched in May 2018 focusing on the period from 2013 to 2018. These included Medline, EMBASE, PubMed, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, Wanfang and Chinese Science and Technology Journal Database (VIP). Reporting quality of epilepsy guidelines was assessed by two independent authors using the Reporting Items for practice Guidelines in HealThcare (RIGHT) approach. Spearman’s correlation was used to assess inter- rater reliability.Participants Participants with epilepsy or seizure, not limited by age, gender, course of disease or cause of epilepsy, were included.Interventions There were no limitations with regard to intervention.Primary and secondary outcome measures The outcome was the ability of the RIGHT tool to measure reporting quality.results Twelve relevant guidelines were included in this study. The reporting quality was not high in any of the included guidelines. The highest reporting quality included a ‘yes’ proportion of 77.1%, whereas the worst included a corresponding proportion of 37.1%. Overall evaluation results showed that 16.7% of the included guidelines were of high quality, 75% were of medium quality and 8.3% were of low quality. The correlation between the two estimators was credible (ρ>0.7).Conclusions Appraisal of these guidelines using the RIGHT tool revealed that the quality of reporting varied among guidelines. Items that exhibited low quality in most included guidelines were healthcare questions, rationale/explanation for recommendations, quality assurance, funding source(s) and role(s) of the funder, and limitations of the guideline. Thus, these aspects should receive greater attention in future guideline reporting.

IntrOduCtIOnEpilepsy is a chronic, repeating, relapsing neurological brain disorder with high inci-dence and mortality rates, and the disorder can affect any individual irrespective of age, region and ethnicity.1 2 According to WHO in 2014, there are approximately 50 million patients with epilepsy worldwide, with the disease morbidity rate being 4‰−7‰. Compared with adults, children and adoles-cents have a higher prevalence but a lower mortality rate. An earlier study reported that mortality from the disorder was up to 3% in American children, but more than 30% in American adults.3 Although the disorder can be controlled in most patients by appro-priate therapy, some (especially those living in developing countries) are not able to receive appropriate treatment for reasons such as poor income, cognitive deficiencies and healthcare costs. In China, for example, the treatment gap is approximately 63%, implying that about four million patients do not receive the recommended treatment for epilepsy.4

strengths and limitations of this study

► To the best of our knowledge, no studies have assessed the quality of epilepsy guidelines us-ing the Reporting Items for practice Guidelines in HealThcare (RIGHT) checklist.

► The included guidelines were measured using the RIGHT tool, produced by the Practice Guidelines in Healthcare Group, a component of WHO.

► Twelve relevant guidelines, involving six regions, were included in this study.

► The study showed insufficient reporting quality in some areas.

► This study indicates that greater attention is needed with regard to healthcare questions, rationale/expla-nation for recommendations, quality assurance, and funding source(s) and role(s) of the funder in future guidelines reporting.

on October 1, 2020 by guest. P

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2 Wang Z, et al. BMJ Open 2019;9:e029589. doi:10.1136/bmjopen-2019-029589

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Clinical guidelines based on high- quality systematic review evidence assessed the benefits and limitations of alternative care options for facilitating optimised patient care and effective therapy approaches.5 With increasing worldwide attention to epilepsy, a growing body of clin-ical guidelines are available. However, these guidelines are not standardised, varying in terms of the respective country’s definition of epilepsy. Although clinical guide-lines allow for standardising and improving the quality of clinical practice, questions on guideline development and reporting remain unanswered.6 7 Ineffective treat-ment methods for epilepsy persist because of unclear pathogenesis and lack of quality, standardised clinical guidelines. An instructive clinical guideline should be based on high- quality evidence- based systematic reviews and reporting. However, the reporting quality of clinical guidelines seems low,8 and the currently used tools do not accurately address quality assessment and reporting in a single statement. There are two reporting checklists avail-able for clinical guidelines: one is the Appraisal of Guide-lines, Research and Evaluation instrument (AGREE) and another is the Reporting Items for practice Guidelines in HealThcare (RIGHT). AGREE, developed by a small group, was produced for use in both quality assessment and reporting, although it was limited to items derived from the tool itself (rather than other assessments).9 To construct a specific clinical guideline and fill the gap in current assessment approaches, Chen and colleagues10 from the WHO established the RIGHT tool.

In this review, we analyse the reporting quality of epilepsy practice guidelines based on the RIGHT tool. This will help identify insufficient reporting section to better guide clinical control of epilepsy.

MethOdsstudy designThis study comprised a review of epilepsy clinical practice guidelines (CPG) using the RIGHT tool.

review protocolThis study was performed in accordance with the guide-lines of the Preferred Reporting Items for Systematic Reviews and Meta- Analyses.11

eligibility criteriaTypes of guidelinesGuidelines that focused on preventive and/or thera-peutic intervention in epilepsy were included, whereas those solely describing epidemiology, training, research methods or legal issues regarding epilepsy were excluded. Furthermore, summarised organisational guidelines, comments or correspondence studies were excluded.

Types of participants and public involvementThere were no patients involved in this study. In this study, we focused on guidelines and not participants them-selves, which needs no ‘Patient and Public Involvement’.

In those included guidelines, participants with epilepsy or seizure, regardless of age, gender, course of disease or cause of epilepsy (eg, caused by pregnancy or trauma), were included.

Types of interventionsThere were no limitations with regard to interventions. Drug therapies and non- drug therapies recommended in the guidelines were included.

Literature searchGuidelines meeting the eligibility criteria were searched in English and Chinese using a computer program to avoid subjective interpretation. Seven databases, Medline, EMBASE, PubMed, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, Wanfang and Chinese Science and Tech-nology Journal Database (VIP), were searched for articles published from January 2013 to December 2018. The search strategy used the terms ‘epilepsy’ or ‘seizure’ (‘癫痫’) AND ‘guideline’ or ‘guidance’ or ‘recommendation’ or ‘consensus’ or ‘policy’ (‘指南’ or ‘专家共识’). We also searched Medline, a publicly available repository of guide-lines in China (http:// guide. medlive. cn), using keyword searches based on the eligibility criterion of ‘epilepsy’ (‘癫痫’). Concomitantly, the National Guideline Clear-inghouse (http://www. guideline. gov), National Insti-tute for Health and Care Excellence (http://www. nice. org. uk), International League Against Epilepsy (ILAE) (http://www. ilae. org) and WHO (http://www. who. int) were searched using the terms ‘epilepsy’ or ‘seizure’ AND ‘guideline’. Two authors (ZW and YZ) screened the titles and abstracts independently to standardise screening, and selection differences, if any, were resolved through discussion. Full texts were screened to confirm eligibility.

data extractionThe following information was extracted from each guideline: title of the guideline, region(s) of guideline development, year of publication, source of publication, organisation(s) responsible for the guideline, number of authors, target population, funding, guideline focus and whether it was an update of a previous edition. Other information pertaining to guideline format included basic information, background, evidence, recommenda-tions, review and quality assurance, funding, declaration and management of interests, and other information (eg, suggestions for further research and limitations of the guideline).

Assessment of the quality of reportingThe RIGHT tool is a checklist that can be used to assess the reporting quality of CPG, and aids in understanding and implementation of clinical guidelines, serves as a standard for guideline reporting in peer reviews (ie, for reviewers and journal editors), and assists developers in guideline reporting.10 The RIGHT tool consists of seven sections: basic information (items 1–4), background (items 5–9), evidence (items 10–12), recommendation (items 13–15),



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Figure 1 PRISMA flow diagram for this study. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta- Analyses; RIGHT, Reporting Items for practice Guidelines in HealThcare.

review and quality assurance (items 16–17), funding and declaration and management of interests (items 18–19), and other information (items 20–22). Assessment was performed by two authors (ZW and YZ); ‘yes’ indicated full reporting of necessary information, whereas ‘no’ indi-cated partial or no reporting. We defined reporting to be of high quality if the ‘yes’ responses were >70%, medium quality if they were 40%–70% and low quality if they were 0.7 indicated good inter- rater reli-ability). If opinions differed, a third author (LL) made a final decision. The percentage of fully reported items was expressed to assess reporting quality of guidelines.

data analysis and investigation of heterogeneityData were analysed using SPSS V.19.0 and Microsoft Excel (Microsoft, Redmond, Washington, USA). The descrip-tive results are shown in tables. Inter- rater reliability was calculated for each domain of the RIGHT instrument using intraclass correlation coefficient with a ρ value.

resuLtsOf the total 938 potentially relevant articles identified, 883 were excluded after title and abstract screening. The remaining 55 were retrieved and full texts were read,

resulting in 12 guidelines that met the inclusion criteria (figure 1).

Guideline characteristicsThe characteristics of the included guidelines12–23 are detailed in table 1. Of the included guidelines, one16 produced by the ILAE was an international guideline, one20 established by the ILAE- Commission on European Affairs focused on women and girls with epilepsy in Europe, one19 was published for neonatal seizure in Australia, two were published in the USA (one15 focused on vagus nerve stimulation and the other17 focused on convulsive status epilepticus), two were published in the UK (one14 was published in Scotland not focused on epilepsy in pregnancy and the other18 placed emphasis on epilepsy in pregnancy all over the UK), and four were published in China (three12 21 22 were produced in mainland China and one14 was produced in Hong Kong). One22 guide-line referred to treatments involving traditional Chinese medicine (TCM), but was limited to a summary of this approach; another was a guideline established for TCM clinical diagnosis and treatment of paediatric patients, including a detailed description of TCM treatments for children with epilepsy; and one23 guideline focused on presurgical epilepsy work- up. The correlation between the



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Tab

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Table 2 Assessment Spearman’s correlation (ρ) of every item

Items CriteriaNumber of ‘yes’ %

Spearman’s correlation (ρ)

Basic information

1 Title/subtitle 12 100 0.90

2 Executive summary 12 100 0.90

3 Abbreviations and acronyms

12 100 0.87

4 Corresponding developer

10 83.3 0.84

Background

5 Brief description of the health problem(s)

10 83.3 0.86

6 Aim(s) of the guideline and specific objectives

10 83.3 0.84

7 Target population(s) 9 75 0.81

8 End users and settings 3 25 0.81

9 Guideline development groups

5 41.7 0.78

Evidence

10 Healthcare questions 0 0 0.82

11 Systematic reviews 11 91.6 0.73

12 Assessment of the certainty of the body of evidence

6 50 0.71

Recommendations

13 Recommendations 6 50 0.76

14 Rationale/explanation for recommendations

0 0 0.77

15 Evidence to decision processes

2 16.7 0.72

Review and quality assurance

16 External review 6 50 0.88

17 Quality assurance 1 8.3 0.97

Funding and declaration and management of interests

18 Funding source(s) and role(s) of the funder

2 16.7 0.91

19 Declaration and management of interests

4 33.3 0.82

Other information

20 Access 10 83.3 0.87

21 Suggestions for further research

4 33.3 0.82

22 Limitations of the guideline

1 8.3 0.93

two estimators is shown in table 2, and the ρ of each item was >0.7, indicating the robustness of this study results.

Quality of reporting evaluation by rIGhtThe quality of guideline reporting was evaluated using the RIGHT tool; notably, most included guidelines did not show high reporting quality (table 3). We assessed each

item in strict accordance with the standard and calculated the percentage of fully reported items. The best reporting quality achieved a score of 77.1%,18 whereas the worst achieved a score of 37.1%.21 Overall evaluation results showed that 16.7% of included guidelines were of high quality, 75% were of medium quality and 8.3% were of low quality (figure 2).

basic informationIn general, all included guidelines showed sufficient reporting of basic information. Only two12 14 did not report any corresponding developers or authors, whereas others fully reported the title, executive summary, abbre-viations and corresponding information.

backgroundBackground was not adequately reported in any of the included guidelines; notably, two16 22 did not describe the epidemiology of epilepsy, two19 22 did not clearly describe the aim of the guidelines, three12 18 21 had no subgroups, one19 did not explicitly describe the intended primary and potential users, two13 21 did not describe the specific roles of authors who contributed to guideline develop-ment, and four12 15 16 21 did not list the identity informa-tion of authors. Furthermore, only two12 13 guidelines were intended to focus on low- income regions.

evidenceReporting of evidence was inadequate. Although most included guidelines stated that they were developed based on randomised controlled trials or meta- analyses, none included regular reporting of population, intervention, comparator and outcome. Four guidelines13 14 21 23 did not indicate the manner in which outcomes were selected, and it was unclear whether those guidelines were the first version or an updated version.21 Five16–19 22 included guidelines assessed evidence in accordance with the Grading of Recommendations Assessment, Development and Evaluation approach.

recommendationClear and actionable recommendations were provided in all guidelines; however, four12 19–21 did not clearly indi-cate the strength of each recommendation, only one22 considered feedback from children with epilepsy and their parents (ie, through follow- up and online survey), two16 22 emphasised that guideline development groups had made decisions through repeated discussions, and only two guidelines18 23 included equity when formulating its recommendations.

review and quality assuranceSix guidelines12 14 18–20 22 had been peer- reviewed, and only one16 had undergone quality assurance process.

Funding and declaration and management of interestsThree guidelines12 14 21 did not describe the funding sources, whereas two15 16 precisely declared that the stakeholder did not participate in the development of



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Tab

le 3

Q

ualit

y of

rep

ortin

g ev

alua

tion

by

RIG

HT

(eac

h ite

m)

Sec

tio

n/to

pic

Num

ber

Item

Ass

essm

ent

1213

1415

1617

1819

2021

2223

Bas

ic in

form

atio

n

Title

/sub

title

1aId

entif

y th

e re

por

t as

a g

uid

elin

e,

that

is, w

ith ‘g

uid

elin

e(s)

’ or

‘rec

omm

end

atio

n(s)

’ in

the

title

.

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

1bD

escr

ibe

the

year

of p

ublic

atio

n of

th

e gu

idel

ine.

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

1cD

escr

ibe

the

focu

s of

the

gu

idel

ine,

suc

h as

scr

eeni

ng,

dia

gnos

is, t

reat

men

t m

anag

emen

t,

pre

vent

ion

or o

ther

s.

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Exe

cutiv

e su

mm

ary

2P

rovi

de

a su

mm

ary

of t

he

reco

mm

end

atio

ns c

onta

ined

in t

he

guid

elin

e.

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Ab

bre

viat

ions

and

ac

rony

ms

3D

efine

new

or

key

term

s, a

nd

pro

vid

e a

list

of a

bb

revi

atio

ns a

nd

acro

nym

s if

app

licab

le.

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Cor

resp

ond

ing

dev

elop

er4

Iden

tify

at le

ast

one

corr

esp

ond

ing

dev

elop

er o

r au

thor

who

can

be

cont

acte

d a

bou

t th

e gu

idel

ine.

No

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Bac

kgro

und

Brie

f des

crip

tion

of t

he h

ealth

p

rob

lem

(s)

5D

escr

ibe

the

bas

ic e

pid

emio

logy

of

the

pro

ble

m, s

uch

as t

he

pre

vale

nce/

inci

den

ce, m

orb

idity

, m

orta

lity

and

bur

den

(inc

lud

ing

finan

cial

) res

ultin

g fr

om t

he

pro

ble

m.

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

No

Yes

Aim

(s) o

f the

gu

idel

ine

and

sp

ecifi

c ob

ject

ives

6D

escr

ibe

the

aim

(s) o

f the

gu

idel

ine

and

sp

ecifi

c ob

ject

ives

, su

ch a

s im

pro

vem

ents

in h

ealth

in

dic

ator

s (e

g, m

orta

lity

and

d

isea

se p

reva

lenc

e), q

ualit

y of

life

or

cos

t sa

ving

.

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

No

Yes

Targ

et p

opul

atio

n(s)

7aD

escr

ibe

the

prim

ary

pop

ulat

ion(

s) t

hat

is a

ffect

ed b

y th

e re

com

men

dat

ion(

s) in

the

gu

idel

ine.

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

7bD

escr

ibe

any

sub

grou

ps

that

are

gi

ven

spec

ial c

onsi

der

atio

n in

the

gu

idel

ine.

Yes

No

Yes

Yes

Yes

Yes

No

Yes

Yes

No

Yes

Yes

Con

tinue

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Num

ber

Item

Ass

essm

ent

1213

1415

1617

1819

2021

2223

End

use

rs a

nd

sett

ings

8aD

escr

ibe

the

inte

nded

prim

ary

user

s of

the

gui

del

ine

(suc

h as

prim

ary

care

pro

vid

ers,

cl

inic

al s

pec

ialis

ts, p

ublic

hea

lth

pra

ctiti

oner

s, p

rogr

amm

e m

anag

ers

and

pol

icym

aker

s)

and

oth

er p

oten

tial u

sers

of t

he

guid

elin

e.

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

8bD

escr

ibe

the

sett

ing(

s) fo

r w

hich

th

e gu

idel

ine

is in

tend

ed, s

uch

as p

rimar

y ca

re, l

ow- i

ncom

e an

d m

idd

le- i

ncom

e co

untr

ies,

or

inp

atie

nt fa

cilit

ies.

Yes

Yes

No

No

No

No

No

No

No

No

No

Yes

Gui

del

ine

dev

elop

men

t gr

oup

s

9aD

escr

ibe

how

all

cont

ribut

ors

to t

he g

uid

elin

e d

evel

opm

ent

wer

e se

lect

ed a

nd t

heir

role

s an

d r

esp

onsi

bili

ties

(eg,

ste

erin

g gr

oup

, gui

del

ine

pan

el, e

xter

nal

revi

ewer

s, s

yste

mat

ic r

evie

w t

eam

an

d m

etho

dol

ogis

ts).

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

9bLi

st a

ll in

div

idua

ls in

volv

ed in

d

evel

opin

g th

e gu

idel

ine,

incl

udin

g th

eir

title

, rol

e(s)

and

inst

itutio

nal

affil

iatio

n(s)

.

No

Yes

Yes

No

No

Yes

Yes

Yes

Yes

No

Yes

No

Evi

den

ce

Hea

lthca

re

que

stio

ns10

aS

tate

the

key

que

stio

ns t

hat

wer

e th

e b

asis

for

the

reco

mm

end

atio

ns

in P

ICO

(pop

ulat

ion,

inte

rven

tion,

co

mp

arat

or a

nd o

utco

me)

or

othe

r fo

rmat

as

app

rop

riate

.

No

No

No

No

No

No

No

No

No

No

No

No

10b

Ind

icat

e ho

w t

he o

utco

mes

wer

e se

lect

ed a

nd s

orte

d.

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

No

Tab

le 3

C

ontin

ued

Con

tinue

d



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Num

ber

Item

Ass

essm

ent

1213

1415

1617

1819

2021

2223

Sys

tem

atic

rev

iew

s11

aIn

dic

ate

whe

ther

the

gui

del

ine

is

bas

ed o

n ne

w s

yste

mat

ic r

evie

ws

don

e sp

ecifi

cally

for

this

gui

del

ine

or w

heth

er e

xist

ing

syst

emat

ic

revi

ews

wer

e us

ed.

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

11b

If th

e gu

idel

ine

dev

elop

ers

used

ex

istin

g sy

stem

atic

rev

iew

s,

refe

renc

e th

ese

and

des

crib

e ho

w

thos

e re

view

s w

ere

iden

tified

and

as

sess

ed (p

rovi

de

the

sear

ch

stra

tegi

es a

nd t

he s

elec

tion

crite

ria, a

nd d

escr

ibe

how

the

ris

k of

bia

s w

as e

valu

ated

) and

w

heth

er t

hey

wer

e up

dat

ed.

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Ass

essm

ent

of t

he

cert

aint

y of

the

b

ody

of e

vid

ence

12D

escr

ibe

the

app

roac

h us

ed t

o as

sess

the

cer

tain

ty o

f the

bod

y of

ev

iden

ce.

No

No

No

No

Yes

Yes

Yes

Yes

No

No

Yes

Yes

Rec

omm

end

atio

ns

Rec

omm

end

atio

ns13

aP

rovi

de

clea

r, p

reci

se a

nd

actio

nab

le r

ecom

men

dat

ions

.Ye

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

s

13b

Pre

sent

sep

arat

e re

com

men

dat

ions

for

imp

orta

nt

sub

grou

ps

if th

e ev

iden

ce

sugg

ests

tha

t th

ere

are

imp

orta

nt

diff

eren

ces

in fa

ctor

s in

fluen

cing

re

com

men

dat

ions

, par

ticul

arly

the

b

alan

ce o

f ben

efits

and

har

ms

acro

ss s

ubgr

oup

s.

Yes

No

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

13c

Ind

icat

e th

e st

reng

th o

f re

com

men

dat

ions

and

the

ce

rtai

nty

of t

he s

upp

ortin

g ev

iden

ce.

No

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

Yes

Yes

Tab

le 3

C

ontin

ued

Con

tinue

d



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Num

ber

Item

Ass

essm

ent

1213

1415

1617

1819

2021

2223

Rat

iona

le/

exp

lana

tion

for

reco

mm

end

atio

ns

14a

Des

crib

e w

heth

er v

alue

s an

d p

refe

renc

es o

f the

tar

get

pop

ulat

ion(

s) w

ere

cons

ider

ed

in t

he fo

rmul

atio

n of

eac

h re

com

men

dat

ion.

If y

es, d

escr

ibe

the

app

roac

hes

and

met

hod

s us

ed

to e

licit

or id

entif

y th

ese

valu

es

and

pre

fere

nces

. If v

alue

s an

d

pre

fere

nces

wer

e no

t co

nsid

ered

, p

rovi

de

an e

xpla

natio

n.

No

No

No

No

No

No

No

No

No

No

Yes

Yes

14b

Des

crib

e w

heth

er c

ost

and

re

sour

ce im

plic

atio

ns w

ere

cons

ider

ed in

the

form

ulat

ion

of r

ecom

men

dat

ions

. If y

es,

des

crib

e th

e sp

ecifi

c ap

pro

ache

s an

d m

etho

ds

used

(suc

h as

co

st- e

ffect

iven

ess

anal

ysis

) and

su

mm

aris

e th

e re

sults

. If r

esou

rce

issu

es w

ere

not

cons

ider

ed,

pro

vid

e an

exp

lana

tion.

No

No

No

No

No

No

No

No

No

No

Yes

No

14c

Des

crib

e ot

her

fact

ors

take

n in

to

cons

ider

atio

n w

hen

form

ulat

ing

the

reco

mm

end

atio

ns, s

uch

as

equi

ty, f

easi

bili

ty a

nd a

ccep

tab

ility

.

No

No

No

No

No

No

Yes

No

No

No

No

Yes

Evi

den

ce t

o d

ecis

ion

pro

cess

es15

Des

crib

e th

e p

roce

sses

and

ap

pro

ache

s us

ed b

y th

e gu

idel

ine

dev

elop

men

t gr

oup

to

mak

e d

ecis

ions

, par

ticul

arly

the

fo

rmul

atio

n of

rec

omm

end

atio

ns

(suc

h as

how

con

sens

us w

as

defi

ned

and

ach

ieve

d a

nd w

heth

er

votin

g w

as u

sed

).

No

No

No

No

Yes

No

No

No

No

No

Yes

No

Rev

iew

and

qua

lity

assu

ranc

e

Ext

erna

l rev

iew

16In

dic

ate

whe

ther

the

dra

ft

guid

elin

e un

der

wen

t in

dep

end

ent

revi

ew a

nd, i

f so,

how

thi

s w

as

exec

uted

and

the

com

men

ts

cons

ider

ed a

nd a

dd

ress

ed.

Yes

No

Yes

No

No

No

Yes

Yes

Yes

No

Yes

No

Qua

lity

assu

ranc

e17

Ind

icat

e w

heth

er t

he g

uid

elin

e w

as

sub

ject

ed t

o a

qua

lity

assu

ranc

e p

roce

ss.

No

No

No

No

Yes

No

No

No

No

No

No

No

Fund

ing

and

dec

lara

tion

and

man

agem

ent

of in

tere

sts

Tab

le 3

C

ontin

ued

Con

tinue

d



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Num

ber

Item

Ass

essm

ent

1213

1415

1617

1819

2021

2223

Fund

ing

sour

ce(s

) an

d r

ole(

s) o

f the

fu

nder

18a

Des

crib

e th

e sp

ecifi

c so

urce

s of

fu

ndin

g fo

r al

l sta

ges

of g

uid

elin

e d

evel

opm

ent.

No

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

No

18b

Des

crib

e th

e ro

le o

f fun

der

(s) i

n th

e d

iffer

ent

stag

es o

f gui

del

ine

dev

elop

men

t an

d in

the

d

isse

min

atio

n an

d im

ple

men

tatio

n of

the

rec

omm

end

atio

ns.

No

No

No

Yes

Yes

No

No

No

No

No

No

No

Dec

lara

tion

and

m

anag

emen

t of

in

tere

sts

19a

Des

crib

e w

hat

typ

es o

f con

flict

s (fi

nanc

ial a

nd n

on- fi

nanc

ial)

wer

e re

leva

nt t

o gu

idel

ine

dev

elop

men

t.

No

No

No

Yes

No

Yes

Yes

No

Yes

No

Yes

Yes

19b

Des

crib

e ho

w c

onfli

cts

of in

tere

st

wer

e ev

alua

ted

and

man

aged

and

ho

w u

sers

of t

he g

uid

elin

e ca

n ac

cess

the

dec

lara

tions

.

No

No

No

Yes

No

No

Yes

No

Yes

No

Yes

No

Oth

er in

form

atio

n

Acc

ess

20D

escr

ibe

whe

re t

he g

uid

elin

e,

its a

pp

end

ices

and

oth

er r

elat

ed

doc

umen

ts c

an b

e ac

cess

ed.

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Sug

gest

ions

for

furt

her

rese

arch

21D

escr

ibe

the

gap

s in

the

evi

den

ce

and

/or

pro

vid

e su

gges

tions

for

futu

re r

esea

rch.

No

No

No

Yes

Yes

Yes

Yes

No

No

No

No

No

Lim

itatio

ns o

f the

gu

idel

ine

22D

escr

ibe

any

limita

tions

in t

he

guid

elin

e d

evel

opm

ent

pro

cess

(s

uch

as t

he d

evel

opm

ent

grou

ps

wer

e no

t m

ultid

isci

plin

ary

or

pat

ient

s’ v

alue

s an

d p

refe

renc

es

wer

e no

t so

ught

), an

d in

dic

ate

how

the

se li

mita

tions

mig

ht

have

affe

cted

the

val

idity

of t

he

reco

mm

end

atio

ns.

No

No

No

No

No

Yes

No

No

No

No

No

No

Per

cen

t of

‘yes

’*51

.448

.654

.368

.668

.668

.677

.154

.365

.737

.174

.365

.7

*'ye

s’ m

eans

full

rep

ortin

g of

the

info

rmat

ion

need

ed; ‘

no’ m

eans

par

tly o

r no

t re

por

ting.

RIG

HT,

Rep

ortin

g Ite

ms

for

pra

ctic

e G

uid

elin

es in

Hea

lThc

are.

Tab

le 3

C

ontin

ued



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Figure 2 Quality of reporting evaluation by RIGHT. (A) Reporting quality for each guideline. (B) Overall evaluation of reporting quality.

the guidelines at any stage. Four15 18 20 22 had detailed a description of the conflict of interest of the authors.

Other informationMost guidelines provided accession websites for the full guidelines and their appendices but two.12 13 Four guide-lines15–18 provided suggestions for further research; one17 presented some limitations of its use and suggested future guideline developers to avoid such limitations.

dIsCussIOnThis study identified 12 guidelines on epilepsy published in the past 5 years, including both Western medicine and TCM. Appraisal of these guidelines with the RIGHT tool revealed that the quality of reporting varied among guidelines. Some of the included guide-lines showed relatively higher quality and favourable overall recommendations; these could be used by healthcare providers and patients as the basis for discus-sion on management of epilepsy. However, considering individual differences among patients, each recom-mendation should be used with caution. Moreover, some items in these guidelines were of low quality (eg, healthcare- related questions, rationale/explanation for recommendations, quality assurance, funding source(s) and role(s) of the funder, and limitations of the guide-line); thus, these aspects should receive greater atten-tion in future guideline reporting.

Notable strengths of this study include its use of comprehensive systematic review to identify eligible clinical guidelines and its assessment of quality using the RIGHT tool, which is published by the WHO and is an internationally accepted standard for appraisal of guidelines. This study found that CPGs for epilepsy are wide- ranging and have been published in many regions in the past 5 years.

However, according to the appraisal of each item based on the RIGHT tool, all included guidelines were desig-nated as ‘recommended with provisions or modifications’ due to inadequate reporting quality. A previous research drew a conclusion of a heterogeneity in methodological quality and great gaps in topics of epilepsy guidelines as assessed by AGREE II tool.24 Although different tools were used to assess epilepsy guidelines, and both assess-ment tools as mentioned above focus on different aspects, similar findings were concluded in this study, showing that the included epilepsy guidelines are of poor reporting quality. The findings in the present study are consistent with the assessments of guidelines in multiple regions, as well as patients and clinical medicine interventions: the included guidelines did not adhere to established reporting quality standards, and further improvement in guideline development is needed. Although there were limitations in the included guidelines according to assessment via the RIGHT tool, only four of the included guidelines provided suggestions for future guideline developers to avoid such limitations in future work. The greatest limitation in the included guidelines was a lack of consideration of the requirements and recommenda-tions for patients and their relatives with regard to psycho-logical or economic burden. An ideal clinical guideline should enable improvement for patients and their disor-ders, thereby guiding clinical doctors and better serving the patients. Furthermore, few or the included guide-lines reported how stakeholders influenced the develop-ment of the guidelines, which suggests that the guidelines may exhibit low credibility, especially those targeting a specific treatment recommendation. Only one guideline focused on TCM interventions for epilepsy; reporting of this guideline was not of high quality and solely targeted children with epilepsy. It is well known that antiepileptic drugs perform irreversible harm to the liver and kidneys; epilepsy in 25.3% of adult patients and 13.4% of paediatric patients was reported to have led to intractable epilepsy due to antiepileptic resistance and long- term treatment.25 Thus, to reduce the adverse effects of antiepileptic drugs, TCM or other complementary alternative therapies should be recommended for use in clinical applications according to a systematic review. The findings of this study may serve as an alert for epilepsy guidelines development and reporting in the future as poor reporting quality of CPGs could mislead clinical care for patients with epilepsy.

LimitationsThere were some limitations to this study. The main limitation was that only papers published in English



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and Chinese were searched for this study, leading to some guidelines published in Japanese, Russian, French, Spanish, German, Italian or other languages being missed. Second, the inclusion of six regions limited the findings to those regions; however, the regions were chosen because they were expected to be representative. We consider epilepsy interventions and other healthcare practices to have a particular impact in the USA, Europe, UK and China, where higher morbidity is reported. Third, a robust series of eligibility criteria were formu-lated and tested before these guidelines were identified; however, some guidelines might be missed by computer-ised searches. Finally, the RIGHT tool has a broad range of assessment of individual guideline components for specialists across medical specialties and levels of seniority, which might have led to subjective estimation during the decision- making process. However, the correlation between the estimators suggested that the RIGHT tool overcomes this potential bias.

In future updates, guidelines that achieved higher quality of reporting and overall recommendations could be improved based on the RIGHT tool specifications, as well as with insight from a large number of resources that are available to support guideline development and implementation.26 27 Future research should iden-tify patients with epilepsy and interventions other than those reviewed here in a manner supported by sufficient evidence to facilitate guideline development.

COnCLusIOnsAppraisal of these guidelines using the RIGHT tool revealed that the quality of reporting varied among guide-lines. Items that exhibited low quality in most included guidelines were healthcare questions, rationale/expla-nation for recommendations, quality assurance, funding source(s) and role(s) of the funder, and limitations of the guideline. Thus, these aspects should receive greater attention in future guideline reporting.

Author affiliations1Medical College of Acupuncture and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China2Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK3Oncology Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China4Geriatric Ward, The Second Hospital Affiliated of Heilongjiang University of Chinese Medicine (Southern Branch), Harbin, China

Contributors ZW and YZ contributed equally to this work. This review was drafted by ZW and YZ, and revised by XG and LL. The search strategy was addressed by XMH and WG, and updated by ZW. ZW and XMH screened potential trials, extracted the data and completed the data synthesis independently. XG and LL arbitrated in cases of disagreement and ensured the absence of errors. All authors gave final approval for the version to be published. We confirm that we have read the journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Funding This study is supported by the International Program for Postgraduates, Guangzhou University of Chinese Medicine, and Construction of High Level University, Guangzhou University of Chinese Medicine.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

data availability statement All data relevant to the study are included in the article.

Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non- commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non- commercial. See: http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.

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Reporting specifications regarding epilepsy practice guidelines based on the RIGHT reporting checklist: an analysisAbstractIntroductionMethodsStudy designReview protocolEligibility criteriaTypes of guidelinesTypes of participants and public involvementTypes of interventions

Literature searchData extractionAssessment of the quality of reportingData analysis and investigation of heterogeneity

ResultsGuideline characteristicsQuality of reporting evaluation by RIGHTBasic informationBackgroundEvidenceRecommendationReview and quality assuranceFunding and declaration and management of interestsOther information

DiscussionLimitations

ConclusionsReferences

Documents

Open access Original research Reporting specifications regarding epilepsy … · Wangfi etal Open 20199e029589 doi101136bmjopen2019029589 1 Open access Reporting specifications regarding