Coronavirus (1458) Which actionable statements qualify as good practice statements In Covid-19 guidelines?

26 April, 2022

'Good practice statements (GPS) (ie, actionable statements about interventions that would do substantially more good than harm or vice versa) do not qualify for rating the certainty of evidence, but are important statements in guidelines. The GRADE Working Group developed five criteria to assess the appropriateness of issuing a GPS.'

The authors found that GPS for COVID-19 are 'characterised by unclear designation and development processes, and methodological weaknesses'. Citation and abstract below.

CITATION: Dewidar O, Lotfi T, Langendam M, et al. Which actionable statements qualify as good practice statements In Covid-19 guidelines? A systematic appraisal. BMJ Evidence-Based Medicine Published Online First: 15 April 2022. doi: 10.1136/bmjebm-2021-111866

OBJECTIVES: To evaluate the development and quality of actionable statements that qualify as good practice statements (GPS) reported in COVID-19 guidelines.

DESIGN AND SETTING: Systematic review...

MAIN OUTCOME MEASURES: We used GRADE Working Group criteria for assessing the appropriateness of issuing a GPS...

RESULTS: 253 guidelines from 44 professional societies issued 3726 actionable statements. We classified 2375 (64%) as GPS; of which 27 (1%) were labelled as GPS by guideline developers. 5 (19%) were labelled as GPS by their authors but did not meet GPS criteria. Of the 2375 GPS, 85% were clear and actionable; 59% provided a rationale necessitating the message for healthcare practice, 24% reported the net positive consequences from implementing the GPS. Systematic collection of evidence was deemed impractical for 13% of the GPS, and 39% explained the chain of indirect evidence supporting GPS development. 173/2375 (7.3%) statements explicitly satisfied all five criteria. The guidelines' overall quality was poor regardless of the appropriateness of GPS development and labelling.

CONCLUSIONS: Statements that qualify as GPS are common in COVID-19 guidelines but are characterised by unclear designation and development processes, and methodological weaknesses.

COMMENT (NPW): It would be interesting to see a similar analysis of GPS about other diseases. I have not had a chance to review the paper in depth, but it appears to have implications for all GPS.

Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org