NHMRC Glaucoma Guidelines - ANZGIG

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NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 2 – Methods Grading the evidence The NHMRC Body of Evidence matrix (Table 2.1) was used to determine the evidence base and consistency of evidence, the clinical impact, its applicability and generalisability. Matrix use for the evidence statements Using Table 2.1, each evidence statement in this guideline is underpinned with a specific matrix that refers to the evidence supporting that evidence statement (see Table 2.2). Each evidence statement matrix was provided in Chapter 1. Each evidence statement matrix was reported in its five distinct levels to guide health care providers regarding the complexity of the evidence and its clinical application. Table 2.1: NHMRC Body of Evidence matrix (2009) A B C D Component Excellent Good Satisfactory Poor Evidence base 1 One or more level I studies with a low risk of bias or several level II studies with low risk of bias One or two level ii studies with low risk of bias or a sr/multiple level iii studies with low risk of bias One or two level iii studies with low risk of bias, or level i or ii studies with moderate risk of bias Level iv studies, or level i to iii studies/srs with high risk of bias Consistency 2 All studies consistent Most studies consistent and inconsistencies may be explained Some inconsistency reflecting genuine uncertainty around clinical question Evidence is inconsistent Clinical impact Very large Substantial Moderate Slight or restricted Generalisability Population/s studied in body of evidence are the same as the target population for the guideline Population/s studied in the body of evidence are similar to the target population for the guideline Population/s studied in body of evidence differ to target population for guideline but it is clinically sensible to apply this evidence to target population 3 Population/s studied in body of evidence differ to target population and hard to judge whether it is sensible to generalise to target population Applicability Directly applicable to Australian healthcare context Applicable to Australian healthcare context with few caveats Probably applicable to Australian healthcare context with some caveats Not applicable to Australian healthcare context SR = Systematic review; several = more than two studies 1 Level of evidence determined from the NHMRC evidence hierarchy 2 If there is only one study, rank this component as ‘not applicable’ 3 For example, results in adults that are clinically sensible to apply to children OR psychosocial outcomes for one cancer that may be applicable to patients with another cancer National Health and Medical Research Council 29
NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 2 – Methods Table 2.2: Exemplar Body of Evidence matrix Evidence base Consistency Clinical impact Generalisability Applicability A A A A A Guideline development Recommendations were formed through steps outlined by the Australian National Health and Medical Research Council (NHMRC 1999, 2000a,b, 2005) 1 . This approach recognises that high quality guideline development requires examination of the relevant literature using five evidence dimensions (hierarchy, methodological quality, significance, effect size, and applicability). Throughout the glaucoma guideline development process, the drafts of guideline text and recommendations were circulated for consultation within the Working Committee. There were some instances where there was a lack of relevant research related to a clinical question. The NHMRC hierarchy does not recognise expert or clinical opinion as a formal hierarchy of evidence level; however in the absence of formal scientific evidence, it is accepted international practice that consensus recommendations be provided (Canadian Health Services Research Foundation 2005; Jones & Hunter 1995; Murphy, Black, Camping et al 1998). Therefore in this situation, the Working Committee provided evidence statements based on consensus opinion and supported by specific references as appropriate. In addition, the Working Committee and key health care providers provided clinical insights into referral processes, nomenclature and evidence interpretation. The Working Committee and key health care providers’ input is clearly identified as Communications and Points of Note throughout this guideline. The recommendations were developed by the Working Committee and were derived from the evidence statements in the relevant chapter. The 14 recommendations were considered to be the key messages for health practitioners. The Working Committee also developed good practice points which were also derived from the evidence statements. References AGREE Collaboration (2003): Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Available at: http://www.agreecollaboration.org/instrument/ Canadian Health Services Research Foundation (2005): Conceptualising and combining evidence for health system guidance. Available at: http://chsrf.ca/other_documents/evidence_e.php Jones J, Hunter D (1995): Consensus methods for medical and health services research. British Medical Journal; 311: 376-380. Murphy MK, Black NA, Lamping DL, McKee CM, Sanderson CBF, Askham J, Marteau T (1998): Consensus Development Methods, and their use in clinical guideline development. Health Technology Assessment; 2(3). 1 The current NHMRC hierarchy of evidence is currently completing public consultation however it is available for guideline developers to use. 30 National Health and Medical Research Council
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NHMRC Glaucoma Guidelines - ANZGIG

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