Article Text

OP0294 The Quality of Eular Management Recommendations: A Review Ten Years after Publication of Standardised Operating Procedures
  1. A.N. Bourn1,2,
  2. P.G. Conaghan3,
  3. N.K. Arden4,5,
  4. C. Cooper4,5,
  5. M. Dougados6,
  6. C.J. Edwards2,4,5
  1. 1Department of Rheumatology, Yeovil District Hospital, Yeovil
  2. 2Department of Rheumatology, University Hospital Southampton, Southampton
  3. 3Division of Musculoskeletal Disease, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds
  4. 4MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton
  5. 5Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
  6. 6Rheumatology B Department, Cochin Hospital, René Descartes University, Paris, France


Objectives A decade after the publication of the EULAR standardised operating procedures for the production of management recommendations, we assessed the quality of existing EULAR management recommendations according to the latest Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument [1,2].

Methods The EULAR standardised operating procedures for the “elaboration, evaluation, dissemination, and implementation of recommendations” published in 2004 has been used to provide a formal structure to ensure the quality of EULAR endorsed recommendations.

We assessed the 26 EULAR recommendations for management published to date using the AGREE II tool. The AGREE II instrument was developed to provide a standardised structure for guidelines in development in order to improve consistency in quality, and provide a framework to assess the quality of published guidelines across 6 domains using 23 specific questions. The domains cover the scope and purpose; the extent of stakeholder involvement; rigour of the methodology and development process; clarity of presentation of the guideline; consideration of applicability, including barriers and facilitators to guideline implication and resource implications; and editorial independence.

Results Overall the EULAR recommendations reviewed have been performed to a high standard. The mean and range scores for each domain and overall scores are given in table 1. This highlights strengths in the areas of scope and purpose, rigour of development and clarity of presentation of the guidelines. The scores also show areas for development in future recommendations, with potential to improve stakeholder involvement, such as the inclusion of patient representatives in the guideline development group, and applicability of the recommendations, including resource implications and provision of an implementation algorithm or audit tool. Improvements in quality have continued over recent years with patient representation in 4 of 13 (30.7%) recommendations published 2000-2009 but 6 of 13 (61.5%) published 2010-2013.

Conclusions In the last 10 years the overall quality of recommendations was good with standards improving over the decade. However, this review process has also identified potential areas for improvement especially in patient representation and provision of implementation tools.


  1. Dougados M, Betteridge N, Burmester GR, et al. EULAR standardised operating procedures for the elaboration, evaluation, dissemination, and implementation of recommendations endorsed by the EULAR standing committees. Ann Rheum Dis 2004;63:1172–6.

  2. Brouwers M, Kho ME, Browman GP, et al for the AGREE Next Steps Consortium. AGREE II: Advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J. 2010;182:E839-842.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.1160

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