Evaluation of Selected Pres­sure Ulcer Management International Guidelines (AGREE II Tool)

Authors: S. Saibertová 1;  A. Pokorná 1;  S. Vasmanská 1;  P. Búřilová 1;  N. Müllerová 2;  L. Fiedlerová 2;  D. Svobodová 3;  P. Camprová 3;  G. Šmelková 3;  L. Kubátová 4
Authors‘ workplace: Katedra ošetřovatelství, LF MU, Brno 1;  LF UK a FN Plzeň 2;  1. LF UK a VFN v Praze 3;  ÚVN – VFN Praha 4
Published in: Cesk Slov Neurol N 2016; 79/112(Supplementum1): 40-44
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2016S40


The aim of this study was to analyse methodological quality of selected clinical guidelines for the management of pressure ulcers with the use of AGREE II tool.

Material and methods:
Descriptive study with qualitative research methodology. The evaluated clinical guidelines were identified and selected through a literature search and according to suggestions from international scientific societies focused on wound management. In total, four pairs of assessors evaluated methodological quality of four international clinical guidelines using the AGREE II tool (the Appraisal of Guidelines for REsearch & Evaluation). Six domains of quality were evaluated: Scope and Purpose, Stakeholder Involvement, Rigour of Development, Clarity of Presentation, Applicability, Editorial Independence.

The selected clinical guidelines had relatively high methodological quality and all of them were suggested for use in clinical practice by the assessors after some minor corrections with respect to the Czech clinical practice. All of the evaluated guidelines had the highest score in the Scope and Purpose domain (more than 80%). There were rather substential differences in other domains. The lowest score was in the following domains : Applicability Rigour of Development and Editorial Independence.

Methodological quality of all selected and evaluated clinical guidelines for the management of pressure ulcer was quite high except the Editorial Independence and Rigour of Development domains. Evaluation of clinical guidelines with the use of AGRE II was conducted as part of a process of adaptation of clinical guidelines for the Czech healthcare settings. Overall methodological quality was the highest for the Prevention and Treatment of Pressure Ulcers : Quick Reference Guide (85.71%).

Key words:
clinical guidelines – management of pressure ulcer – methodological quality –AGREE II tool

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


1. Field MJ, Lohr KN. Guidelines for Clinical Practice. From Development to Use. Washington (DC): National Academies Press (US) 1992. [online]. Available from URL: http:/ / www.ncbi.nlm.nih.gov/ books/ NBK234503.

2. Woolf SH, Grol R, Hutchinson A, et al. Potential benefits, limitations, and harms of clinical guidelines. BMJ 1999;318:527– 30.

3. Woolf SH, Grol R, Hutchinson A, et al. An international overview. In Eccles MP, Grimshaw JM, eds. Clinical practice guidelines. Oxford: Radclif­fe Medical Press Ltd 2000.

4. Siebenhofer A, Semlitsch T, Sier­ing U, et al. Validation and reliability of a guideline appraisal mini-checklist for daily practice use. BMC Medical Research Methodology 2016;16:39. doi: 10.1186/ s12874-016-0139-x.

5. AGREE Col­laboration. Development and validation of an international appraisal instrument for as­ses­s­ing the quality of clinical practice guidelines: the AGREE project. Qual Saf Health Care 2003;12(1):18– 23.

6. Pokorná A. Problematika prevence dekubitů s ohledem na soudobé poznatky a závěry empirických studií. Hojení Ran 2013;4:7– 11.

7. Brouwers MC, Kho, ME, Browman, GP, et al. The Global Rat­ing Scale complements the AGREE II in advanc­ing the quality of practice guidelines. J Clin Epidemiol 2012;65(5):526– 34. doi: 10.1016/ j.jclinepi.2011.10.008.

8. Fehring, RJ. Methods to validate nurs­ing dia­gnoses. Heart Lung 1987,16(6):625– 9.

9. Levin, R. Who Are the Experts? A Com­mentary on Nurs­ing Dia­gnosis Validation Studies. Nurs Dia­gn 2001,12(1):29– 32.

10. Líčeník R, Kurfürst P, Ivanová K. AGREE II: Nástroj pro hodnocení doporučených postupů pro výzkum a evaluaci. Olomouc: Univerzita Palackého v Olomouci 2013.

11. Jo HS, Kim DI, Oh MK. National Priority Sett­ing of Clinical Practice Guidelines Development for Chronic Dis-ease Management. J Korean Med Sci 2015; 30(12):1733– 42.doi: 10.3346/ jkms.2015.30.12.1733.

12. National Pres­sure Ulcer Advisory Panel, EuropeanPres­sure Ulcer Advisory Panel and Pan Pacific. Pres­sure Injury Al­liance. Prevention and Treatment of Pres­sure Ulcers: Quick Reference Guide. Haesler E, ed.Cambridge Media: Osborne Park, Australia 2014. [online]. Available from URL:http:/ / international-pres­sure-ulcer-guidelines.myshopify.com.

13. Sabharwal S, Patel NK, Gauher S, et al. High methodologic quality but poor applicability: as­ses­sment of the AAOS guidelines us­ing the AGREE II instrument. Clin Orthop Relat Res 2014;472(6):1982– 8. doi: 10.1007/ s11999-014-3530-0.

14. Parisi P, Vanacore N, Belcastro V, et al. Clinical guidelines in pediatric headache: evaluation of quality us­ing the AGREE II instrument. J Headache Pain 2014;1(15):57. doi: 10.1186/ 1129-2377-15-57.

15. Smith CA, Toupin-April K, Jutai JW, et al. A Systematic Critical Appraisal of Clinical Practice Guidelines in Juvenile Idiopathic Arthritis Us­ing the Appraisal of Guidelines for Research and Evaluation II (AGREE II) Instrument. PLoS One 2015;10(9):e0137180. doi: 10.1371/ journal.pone.0137180.

16. Pres­sure ulcers: prevention and management, NICE guidelines 2014. [online]. Available from URL: http:/ / www.rcpch.ac.uk/ system/ files/ protected/ page/ NICE%20CG%20Pres­sure%20ulcers%20(prevention%20and%20management)%20PUBLISHED_2.pdf.

17. A SELF-HELP GUIDE, Pres­sure Ulcers, Prevention and Treatment 2010. [online]. Available from URL: http:/ / dmsystems.com/ pdf/ PUSelfHelpGuide.pdf.

18. Prevention and Treatment of Pres­sure Ulcers: Quick Reference Guide 2014. [online]. Available from URL: http:/ / www.npuap.org/ wp-content/ uploads/ 2014/ 08/ Updated-10-16-14-Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-16Oct2014.pdf.

19. National best practice and evidence based guidelines for wound management 2009. [online]. Available from URL: http:/ / www.lenus.ie/ hse/ bitstream/ 10147/ 92646/ 1/ HSE+Wound+Management.pdf.

Paediatric neurology Neurosurgery Neurology
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account