Evaluation of the quality of published SCI clinical practice guidelines using the AGREE II instrument: Results from Can-SCIP expert panel

Figures & data

Table 1 SCI Clinical Practice Guidelines selected for inclusion.

Guideline Name	Abbreviation	Year	Phase of Care	Topic Area(s) Covered	Country of Origin
Spinal Cord Injury (2009) Evidence-Based Nutrition Practice Guideline^Citation14	NUTR	2009	Cross-Continuum	Nutrition	United States
Sexuality and Reproductive Health in Adults with SCI^Citation15	CSCM	2010	Rehab/Community	Sexuality	United States
Home Mechanical Ventilation: A Canadian Thoracic Society CPG^Citation16	CTS	2011	Community	Respiratory	Canada
Evidence-Based Guideline Update: Intraoperative Spinal Monitoring with Somatosensory and Transcranial Electrical Motor Evoked Potentials^Citation17	NUWER	2011	Acute Care	Surgical Monitoring	United States
Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease^Citation18	NICE	2012	Cross-Continuum	Bladder	United Kingdom
Canadian BPG for the Prevention and Management of Pressure Ulcers in People with SCI: A Resource Handbook for Clinicians^Citation19	PU-ONF	2013	Cross-Continuum	Skin	Canada
Clinical Guideline for Standing in Adults Following Spinal Cord Injury^Citation20	CGFS	2013	Rehab/Community	Standing Therapy	United Kingdom & Ireland
Development of Clinical Guidelines for the Prescription of a Seated Wheelchair or Mobility Scooter for People with TBI or SCI^Citation21	OTA	2013	Cross-Continuum	Wheelchair/ Mobility Device	Australia
Management of Acute Combination Fractures of the Atlas and Axis in Adults^Citation22	ATL-ATX	2013	Acute	Surgical Management	United States
Initial Closed Reduction of Cervical Spinal Fracture-Dislocation Injuries^Citation23	CNS-FXDIS	2013	Acute	Fracture Treatment	United States
Deep Venous Thrombosis and Thromboembolism in Patients with Cervical SCI^Citation24	CNS-DVT	2013	Cross-Continuum	Venous Thrombo-Embolism (VTE)	United States
Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries: 2013 Update^Citation25	CNS	2013	Acute	Medical/Surgical Management	United States
Pressure Ulcer Prevention and Treatment Following SCI, 2nd edition^Citation26	PU-PVA	2014	Cross-Continuum	Skin/Nutrition	United States
The Prevention and Management of Pressure Ulcers in Primary and Secondary Care^Citation27	NICE PU	2014	Community	Skin	United Kingdom
Prevention and Treatment of Pressure Ulcers: Individuals with Spinal Cord Injury^Citation27	NPUAP	2014	Cross-Continuum	Skin	United States
Prevention of Venous Thromboembolism in Individuals with SCI^Citation28	CSCM	2016	Cross-Continuum	VTE	United States
The CanPain SCI CPG for Rehab Management of Neuropathic Pain after SCI: Recommendations Treatment^Citation29	CANPAIN TREAT	2016	Cross Continuum	Pain	Canada
The CanPain SCI CPG for Rehab Management of Neuropathic Pain after SCI: Screening and Diagnosis Recommendations^Citation30	CANPAIN DIAG	2016	Cross-Continuum	Pain	Canada
The CanPain SCI CPG for Rehab Management of Neuropathic Pain after SCI: Recommendations for Model Systems of Care^Citation31	CANPAIN SYS CARE	2016	Cross-Continuum	Pain	Canada
Provincial Guidelines for Spinal Cord Assessment^Citation32	CCO	2016	Cross-Continuum	Medical	Canada
Spinal injury: Assessment and Initial Management^Citation12	NICE	2016	Acute	Medical/Surgical	United Kingdom
A Review and Update on the Guidelines for the Acute Management of Cervical SCI – Part II^Citation33	REVIEW PAR	2016	Acute	Medical/Surgical	United States
Evidence-based Scientific Exercise Guidelines for Adults with SCI: An Update and a New Guideline^Citation34	GINIS	2017	Rehab/Community	Exercise	Canada & United Kingdom
CPG for the Management of Patients With Acute SCI and Central Cord Syndrome: Recommendations on the Timing (≤24 h Versus >24 h) of Decompressive Surgery^Citation35	DECOM	2017	Acute	Surgical	International
CPG for the Management of Patients With Acute SCI: Recommendations on the Use of Methylprednisolone Sodium Succinate^Citation36	MSS	2017	Acute	Medical Management	International
CPG for the Management of Patients With Acute SCI: Recommendations on the Type and Timing of Anticoagulant Thromboprophylaxis^Citation37	ANTICOAG	2017	Acute	VTE	International
CPG for the Management of Patients With Acute SCI: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction^Citation38	MRI	2017	Acute	Diagnostic Imaging	International
CPG for the Management of Patients With Acute SCI: Recommendations on the Type and Timing of Rehabilitation^Citation39	TIME	2017	Cross-Continuum	Rehabilitation	International
Rehabilitation in Health Systems^Citation40	WHO	2017	Cross-Continuum	Rehabilitation	International
International Perspectives on SCI^Citation41	WHO INT	2013	Cross-Continuum	Rehabilitation	International
Urodynamics in Patients with SCI: A Clinical Review and Best Practice Paper^Citation42	URO	2017	Cross-Continuum	Urinary Tract	International
Guidelines for the Rehabilitation of Patients with Metastatic Spinal Cord Compression^Citation43	MSCC	2017	Acute	Surgical/Medical Decompression	United Kingdom
Norwegian Guidelines for the Prehospital Management of Adult Trauma Patients with Potential Spinal Injury^Citation44	NOR	2017	Pre-Hospital	Spinal Immobilization	Norway
Wounds Canada Best Practice Recommendations^Citation45	WOUNDCAN	2017	Cross-Continuum	Skin Care	Canada
Neuropathic Pain in Adults: Pharmacological Management in Non-Specialist Settings (CG173)^Citation46	PALRM	2018	Community	Pain	United Kingdom
Identification and Management of Cardiometabolic Risk after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers^Citation10	NASH	2018	Cross-Continuum	Cardiometabolic Diabetes	United States
Diagnosis, Management and Surveillance Neurogenic Lower Urinary Tract Dysfunction^Citation47	CUA	2019	Cross-Continuum	Urinary Tract	Canada
Bone Mineral Density Testing in Spinal Cord Injury: The 2019 ISCD Official Positions^Citation48	BMD	2019	Cross-Continuum	Bone Health	International
Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions: Preventing the Highs and Lows^Citation49	PVA AD	2020	Cross-Continuum	Autonomic Dysreflexia	United States
Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers^Citation50	PVA BOWEL	2020	Cross-Continuum	Bowel	United States
Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers^Citation51	PVA EWB	2020	Cross-Continuum	Mental Health & Substance Use Disorders	United States

Figure 1 PRISMA study flow diagram.

Table 2 Standardized domain scores (%).

Domains	Domain 1 – Scope & Purpose	Domain 2 – Stakeholder Involvement	Domain 3 – Rigour of Development	Domain 4 – Clarity of Presentation	Domain 5 – Applicability	Domain 6 – Editorial Independence
ANTICOAG 2017	91.11	88.89	80.00	95.56	71.67	81.67
ATLAS AXIS 2013	75.00	45.83	60.94	79.17	42.71	68.75
BMD 2019	94.44	77.78	86.81	96.30	87.50	61.11
CANPAIN DIAG 2016	81.94	65.28	78.13	77.78	65.63	79.17
CANPAIN SYS CARE 2016	84.44	64.44	64.58	80.00	56.67	61.67
CANPAIN TREAT 2016	89.81	7.80	76.63	94.44	53.47	72.22
CCO 2016	70.83	51.39	61.98	68.06	54.17	64.58
CGFS 2013	77.78	72.22	79.69	79.17	50.00	56.25
CNS 2013	86.11	38.89	38.54	70.83	17.71	85.42
CNS-DVT 2013	59.72	23.61	44.27	84.72	21.88	50.00
CNS-FXDIS 2013	80.56	69.44	71.35	87.50	61.46	85.42
CSCM 2010	91.67	69.44	84.90	90.28	35.42	56.25
CSCM 2016	81.94	66.67	84.90	98.61	35.42	87.50
CTS 2011	95.56	75.56	90.42	93.33	76.67	100.00
CUA 2019	88.89	83.33	66.67	94.44	59.72	83.33
DECOM 2017	83.33	72.22	81.25	86.11	68.75	66.67
MSCC 2017	90.28	70.83	55.73	30.56	38.54	68.75
GINIS 2017	100.00	98.61	96.88	93.06	87.50	89.58
MRI 2017	84.72	84.72	92.71	97.22	70.83	85.42
MSS 2017	84.72	70.83	87.76	87.50	64.06	83.33
NASH 2018	91.11	88.89	80.00	95.56	71.67	81.67
NICE 2012	75.00	45.83	60.94	79.17	42.71	68.75
NICE 2016	81.94	65.28	78.13	77.78	65.63	79.17
NICE PU 2014	84.44	64.44	64.58	80.00	56.67	61.67
NOR 2017	89.81	7.80	76.63	94.44	53.47	72.22
NPUAP 2014	87.50	81.94	82.81	94.44	68.75	97.92
NUTR 2009	70.83	51.39	61.98	68.06	54.17	64.58
NUWER 2011	77.78	72.22	79.69	79.17	50.00	56.25
OTA 2013	86.11	38.89	38.54	70.83	17.71	85.42
PALRM 2018	59.72	23.61	44.27	84.72	21.88	50.00
PU-ONF 2013	80.56	69.44	71.35	87.50	61.46	85.42
PU-PVA 2014	91.67	69.44	84.90	90.28	35.42	56.25
REVIEW PAR 2016	81.94	66.67	84.90	98.61	35.42	87.50
TIME 2017	95.56	75.56	90.42	93.33	76.67	100.00
URO 2017	88.89	83.33	66.67	94.44	59.72	83.33
WHO 2017	83.33	72.22	81.25	86.11	68.75	66.67
WHO INT 2013	90.28	70.83	55.73	30.56	38.54	68.75
WOUNDCAN 2017	100.00	98.61	96.88	93.06	87.5	89.58
PVA BOWEL 2020	100.00	66.67	85.58	100.00	79.17	91.7
PVA AD 2020	100.00	83.33	79.17	100.00	54.17	83.33
PVA EWB 2020	88.89	72.22	81.25	94.44	58.33	91.67
Median	86.11	69.44	79.17	87.50	56.67	79.17
Mean	85.32	65.03	73.90	84.81	55.55	75.83

Table 3 Appraiser agreement.

Domain	Scope & Purpose	Stakeholder Involvement	Rigour of Development	Clarity of Presentation	Applicability	Editorial Independence
ICC	0.93	0.87	0.91	0.81	0.80	0.74

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