Systematic reviews of clinical practice guidelines: a methodological guide

  • Type :#article
  • Date read: 2023-05-11
  • Bibtex: @johnston2019
  • Bibliography: Johnston, A., Kelly, S. E., Hsieh, S.-C., Skidmore, B., & Wells, G. A. (2019). Systematic reviews of clinical practice guidelines: A methodological guide. Journal of Clinical Epidemiology, 108, 64–76.

Example citation

My notes

  • For the PERMANENS review, perhaps we should consider doing either a systematic review of clinical guidelines or a practitioner review. I think it will be hard to combine them. A practitioner review is one piece of a recommendation, but reviewing clinical guidelines synthesises those recommendations.
  • PICAR statement
    • Doing a standard literature search may not give your everything since some clinical practice guidelines are published on other websites than peer-reviewed journals

Example PICAR statement

  • Assess CPG quality. There is a tool called AGREE II that seems like standard in the field
  • Some things to consider when designing your review (table 2 in article):
    • Language
    • Year of publication
    • Region of origin (one country, global, high-income countries?)
    • Publishing body
    • Scope
    • Inclusion screening and data extraction
    • Methodological quality

Synthesizing guideline recommendations

  • Which are the key features of the recommendations that should be extracted and analyzed?
    • levels of evidence is a common one.

Case example


Objectives Systematic reviews (SRs) of clinical practice guidelines (CPGs) are unique knowledge syntheses that require tailored approaches to, and greater subjectivity in, design and execution compared with other SRs in clinical epidemiology. We provide review authors structured direction on how to design and conduct methodologically rigorous SRs of CPGs. Study Design and Setting A guidance paper outlining suggested methodology for conducting all stages of an SR of CPGs. We present concrete examples of approaches used by published reviews, including a case exemplar demonstrating how this methodology was applied to our own SR of CPGs. Results Review context and the unique characteristics of CPGs as research syntheses or clinical guidance statements must be considered in all aspects of review design and conduct. Researchers should develop a “PICAR” statement to help form and focus on the research question(s) and eligibility criteria, assess CPG quality using a validated appraisal tool, and extract, analyze, and summarize data in a way that is cogent and transparent. Conclusion SRs of CPGs can be used to systematically identify, assess, and summarize the current state of guidance on a clinical topic. These types of reviews often require methodological tailoring to ensure that their objectives and timelines are effectively and efficiently addressed; however, they should all meet the criteria for an SR, follow a rigorous methodological approach, and adhere to transparent reporting practices. PDF: johnston_2019_systematic_reviews_of_clinical_practice_guidelines_-_a_methodological_guide.pdf