Systematic Appraisal of the American College of Rheumatology Clinical Practice Guidelines

Objective Because the American College of Rheumatology ( ACR ) practice guidelines affect the United States' and international treatment practice, we used the Appraisal of Guidelines for Research and Evaluation ( AGREE ) II instrument to characterize the quality of the guidelines and to identify potential areas for improvement. Methods Using the six quality domains in the AGREE II online tool, four reviewers assessed the practice guidelines available at the ACR website and the immediately previous version to summarize the domain scores for each guideline and examine trends over time. Results As of April 2016, the ACR website listed nine guidelines, four with immediate previous versions. Based on AGREE II , the minimum and maximum for each domain (with higher being better) of the current guidelines were 78‐99 for Scope and Purpose, 57‐99 for Stakeholder Involvement, 87‐ 96 for Rigor of the Methodology, 83‐99 for Clarity of Presentation, 49‐78 for Applicability, 69‐85 for Editorial Independence, and 71‐96 overall. Over time, although the average domain quality of the guidelines improved for all, the Applicability and Editorial Independence domains had the least amount of improvement. For the four guidelines with previous versions, the mean ( SD ) absolute improvements for each domain were 18 (±11) for Scope and Purpose, 13 (±8) for Stakeholder Involvement, 38 (±22) for Rigor of the Methodology, 25 (±15) for Clarity of Presentation, 22 (±12) for Applicability, 24 (±17) for Editorial Independence, and 31 (±5) overall. Conclusion Based on the AGREE II instrument, the ACR guidelines have achieved high quality over the past 16 years. The Applicability and Editorial Independence domains have the greatest potential for future improvement.