Clinical practice guidelines for neurogenic bladder management following SCI: Robust or not?
Overall, clinical practice guidelines (CPGs) for the management of neurogenic bladder following spinal cord injury (SCI) are robust in stating their scope and in presenting recommendations clearly, but only three CPGs have domain scores >70 percent in terms of methodological rigor, reports a study.
The investigators performed a comprehensive search of PubMed, Web of Science, Health Systems Evidence, Cochrane, Cinahl and Epistomonikos, as well as 12 CPG portals. Inclusion criteria were as follows: English language, includes recommendations for managing neurogenic bladder in adults, all phases of care, and published 2011 onwards in peer-reviewed journal or CPG portal.
Key characteristics, including years covered by CPG searching and number of neurogenic bladder recommendations, were extracted from eligible CPGs. The AGREE II instrument was used for quality appraisal and the intraclass correlation coefficient for assessment of appraiser agreement.
A total of 4,028 citations and eight relevant CPGs were identified. There were 304 recommendations contained collectively in the CPGs, with more than half (n=160) pertaining to assessment, surgery or education. Older CPGs had the most surgery recommendations, while more recent ones focused on conservative therapy.
There was good methodological quality across CPGs, particularly in the domains of ‘clarity of presentation’ (mean domain score, 84 percent), ‘scope and purpose’ (72 percent) and ‘editorial independence’ (68 percent).
On the other hand, shortcomings were noted in the domains of ‘rigor of development’ (52 percent), ‘stakeholder involvement’ (42 percent) and ‘applicability’ (33 percent).
“Future CPGs should also focus on providing implementation, audit resources and incorporating patient perspectives,” the investigators said.