Recent Advance in Clinical Practice Guideline Development Methodology

Association between Conflicts of Interest Disclosure and Quality of Clinical Practice Guidelines in Japan: A Meta-Epidemiological Study

Accurate disclosure of financial conflicts of interest (COI) among clinical practice guideline (CPG) developers is critical to ensure the quality of CPGs. However, there is limited evidence on the impact of underreporting COIs on the quality of CPGs. This study aimed to examine the proportion of underreported COI disclosures in the development of Japanese CPGs and to estimate the association between underreported COIs and CPG quality using the Appraisal of Guidelines for Research & Evaluation (AGREE) II. Twenty-three Japanese CPGs published in 2019 and their 1114 developers were included in the study. The results show that underreporting of COIs occurred in 52% of the included CPGs and 8% of all CPG developers. Underreporting COI disclosures was negatively associated with low-quality CPG (Odds ratio [OR], 0.57; 95% confidence interval [CI]: 0.11, 3.04). On the other hand, CPGs that had more than 13% of CPG developers with voting rights on recommendation decisions and underreporting of COI disclosures were positively associated with low quality (OR, 1.78; 95% CI: 0.25, 12.45). For individual CPG developers with voting rights for recommendation decisions, the presence of a COI was positively associated with low quality (OR, 1.11; 95% CI: 0.71, 1.75). This study demonstrates that the involvement and underreporting of COIs did not seriously distort the CPG development process. However, the COI-related factors of CPG developers with voting rights for recommendation decisions may be associated with low CPG quality.

RoBANS 2: A Revised Risk of Bias Assessment Tool for Nonrandomized Studies of Interventions

Assessment of the risk of bias is an essential component of any systematic review. This is true for both nonrandomized studies and randomized trials, which are the main study designs of systematic reviews. The Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) was developed in 2013 and has gained wide usage as a risk-of-bias assessment tool for nonrandomized studies. Four risk-of-bias assessment experts revised it by reviewing existing assessment tools and user surveys. The main modifications included additional domains of selection and detection bias susceptible to nonrandomized studies of interventions, a more detailed consideration of the comparability of participants, and more reliable and valid outcome measurements. A psychometric assessment of the revised RoBANS (RoBANS 2) revealed acceptable inter-rater reliability (weighted kappa, 0.25 to 0.49) and construct validity in which intervention effects of studies with an unclear or high risk of bias were overestimated. The RoBANS 2 has acceptable feasibility, fair-to-moderate reliability, and construct validity. It provides a comprehensive framework for allowing authors to assess and understand the plausible risk of bias in nonrandomized studies of interventions.