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Original Research: Education, Research, and Quality Improvement |

A Critical Review of the Quality of Cough Clinical Practice Guidelines

Mei Jiang, PhD; Wei-jie Guan, PhD; Zhang-fu Fang, PhD; Yan-qing Xie, PhD; Jia-xing Xie, PhD; Hao Chen, MD; Dang Wei, MD; Ke-fang Lai, MD; Nan-shan Zhong, MD
Author and Funding Information

Drs Jiang and Guan contributed equally to the study.

FUNDING/SUPPORT: This work was supported by the National Natural Science Foundation of China [Grant No. 81402772].

aState Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

bThe Second Clinical College, Nanjing University of Chinese Medicine, Nanjing, China

cEvidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China

CORRESPONDENCE TO: Ke-fang Lai, MD, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, Guangdong, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(4):777-788. doi:10.1016/j.chest.2016.04.028
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Background  Clinical practice guidelines (CPGs) have been developed to provide health-care practitioners with the best possible evidence, but the quality of these CPGs varies greatly.

Objective  The goal of this study was to systematically evaluate the quality of cough CPGs and identify gaps limiting evidence-based practice.

Methods  Systematic searches were conducted to identify cough CPGs in guideline databases, developers’ Websites, and Medline. Four reviewers independently evaluated eligible guidelines by using the Appraisal of Guidelines for Research and Evaluation II assessment tool. Agreement among reviewers was measured by using the intraclass correlation coefficient. The number of recommendations, strength of recommendation, and levels of evidence were determined.

Results  Fifteen cough CPGs were identified. An overall high degree of agreement among reviewers was observed (intraclass correlation coefficient, 0.82 [95% CI, 0.79-0.85]). The quality ranged from good to acceptable in the scope and purpose (mean, 72%; range, 54%-93%) and clarity and presentation (mean, 68%; range, 50%-90%) domains but not in stakeholder involvement (mean, 36%; range, 18%-90%), rigor of development (mean, 36%; range, 9%-93%), applicability (mean, 23%; range, 9%-83%), and editorial independence domains (mean, 24%; range, 0-96%). Seven guidelines (46.7%) were considered “strongly recommended” or “recommended with modifications” for clinical practice. More than 70% of recommendations were based on nonrandomized studies (Level C, 30.4%) and expert opinion (Level D, 41.3%).

Conclusions  The quality of cough CPGs is variable, and recommendations are largely based on low-quality evidence. There is significant room for improvement to develop high-quality guidelines, which urgently warrants first-class research to minimize the vital gaps in the evidence for formulation of cough CPGs.

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