ORIGINAL RESEARCH; QUALITY ASSESSMENT AND COMPARATIVE ANALYSIS ON THE RECOMMENDATIONS OF CURRENT GUIDELINES ON SCREENING AND DIAGNOSIS OF PERIPHERAL ARTERIAL DISEASE; A SYSTEMATIC REVIEW
Authors: Uyagu O , Ofoegbu C , Ikhidero J , Chukwuka E , Enwere O , Ogierhiakhi O , Adelosoye A. 
Published: February 2022

Introduction

Peripheral Artery Disease (PAD) is a major atherosclerotic disease, and there are several clinical practice guidelines available for it. The paucity of strong evidence is known to give room for variations in recommendations across guidelines with attendant confusion amongst clinicians in clinical practice. This study aims to conduct a quality assessment and comparative analysis on PAD screening and diagnostic recommendations in the management of PAD.

Methods

We conducted a systematic review of CPGs’ written after 2010 and on or before 2020. An exhaustive search was conducted through the major medical databases and websites of specialist international organisations of interest and using our inclusion criteria, the appropriate guidelines were extracted. The AGREE-II instrument was used for quality assessment, while the recommendations across screening and diagnosis were extracted and then comparatively analysed.

Results

We found nine guidelines that fit our criteria. The guidelines had the lowest scores across the applicability and stakeholder involvement domains. The highest scores were recorded in the Clarity of presentation, Scope and purpose and Editorial independence in order of decreasing magnitude. Also, the trend was the guideline quality scores improved over time. The guidelines were unanimous in offering to screen to ‘high-risk ‘patients, although there were some discrepancies in the appropriate age range and unavailability of strong evidence across the guidelines backing this recommendation. The guidelines also showed harmony in adopting the Ankle-Brachial index as the initial diagnostic investigation of choice. However, concerning further diagnostic investigations and imaging, we found several discrepancies among the recommendations in the absence of strong evidence.

Conclusion

Though the quality of the guidelines is shown to be improving over time, they display poor scores in the stakeholder involvement and applicability domains, which could be influencing low interest in research that can improve screening and diagnostic recommendations.

STRENGHTS AND LIMITATIONS

-

This review, unlike previous studies, focused on Peripheral Arterial Diseases(PAD) guidelines written after 2010 and reflects a synthesis of the current state of guideline quality and the most recent recommendations in PAD management regarding screening and diagnosis.

-

Complex data has been aggregated, comparatively assessed using thematic analysis and the results presented in concise and straightforward forms using texts, charts and tables to satisfy the needs of all kinds of readers alike from the medical research community to the patients and public reader.

-

By utilising rigorous systematic review methodology and a mixed qualitative and quantitative approach to the data analysis, this study has revealed the current areas of strengths and weaknesses of the quality of the PAD guidelines, which is inadvertently related to the reason behind the persisting absence of high-level evidence in screening and diagnostic recommendations.

-

Qualitative analyses are inherently challenging to process, especially when dealing with clinical practise guidelines (CPGs’) that contain large amounts of information; as such, the process was cumbersome and time-consuming with the inevitable loss of data during the thematic classification process.

-

During the literature search, the search strategies were executed exclusively in English Language labouring under the auspices that the major PAD CPG’s will have an English language translation, so it is possible that some guidelines written within the study timeframe were not captured due to this limitation.

Registration

Registrated in PROSPERO; ID; CRD42020219176