The quality of clinical practice guidelines for fiberoptic endoscopic evaluation of swallowing: A systematic review

Abstract

BACKGROUND: Clinical practice guidelines (CPGs) can act as a bridge between clinical research and everyday practice. CPGs have been generated to inform Fiberoptic Endoscopic Evaluation of Swallowing (FEES), but their quality is unclear. OBJECTIVE: This study aims to systematically evaluate the quality of FEES CPGs to identify their suitability for use in clinical practice. METHODS: A systematic review of the literature was conducted. A comprehensive search of four academic databases (Medline, Embase, CINAHL, Web of Science) and other sources was completed. Three independent researchers used the Appraisal of Guidelines for Research and Evaluation-II (AGREE-II) instrument to appraise the quality of included CPGs. CPGs were rated over 23 items across six domains. Intraclass correlation coefficients established agreement across raters. RESULTS: Four FEES CPGs were included. Individual CPG scores ranged from 0% to 89% across AGREE-II domains. Median domain scores were “Scope and Purpose” 66%; “Stakeholder Involvement” 47%; “Rigour of Development” 29%; “Clarity of Presentation” 60%; “Applicability” 13% and “Editorial Independence” 0%. None of the CPGs included sufficient detail regarding their development methodology and supporting evidence. No CPG was recommended to guide practice in their current state. Only 1 CPG was recommended for use, upon appropriate modifications. CONCLUSION: CPGs are highly influential tools that play a vital role in guiding clinical practice. Study findings highlight a scarcity of high-quality FEES CPGs to inform dysphagia practice. Superior FEES CPGs are required to ensure individuals with dysphagia are benefiting from high-quality research emerging internationally.