Orig Post BJSM | Re-Post 8/13/15
Abstract
Aim In recent years, considerable effort has been devoted to the development and revisions to an internati
onal consensus statement on concussion in sport (ICSCS). The aim of this studywas to obtain expert views on the methodological rigour and transparency with which the 2008 ICSCS was developed, as aprecursor to the development of the 2012 update.
Methods Delegates registered for the 2012 fourth International Conference on Concussion in Sport, selected local concussion researchers not involved in any prior international consensus meetings, and all authors of the 2008 ICSCS published paper were invited to assess the methodological rigour and transparency with which the 2008 ICSCS was developed. The online Appraisal of Guidelines for Research and Evaluation (AGREE) II assessment tool, with six quality domains, was used and domain scores were expressed as a percentage of the maximum possible score for that domain.
Results 18 appraisers completed the online AGREE II assessment. Ten appraisers said they would recommend the 2008 ICSCS for use (without modification) and seven said they would recommend its use with some modification. The ‘scope and purpose’ and ‘clarity of presentation’ were rated highest, both scoring 78%. The lowest scoring domain was ‘applicability’ with a score of 55%.
Conclusions The quality of the ICSCS is important because it is used to guide return-to-play decisions and the management of sport-related concussions. This appraisal of the 2008 ICSCS suggests that a greater focus is needed on the actual implementation of future ICSCS and the relationship between implementation and desired health outcomes.
Introduction
The dose will vary based on effectiveness and toleration, sildenafil 50mg tablets the dose may be increased to a maximum recommended dose of 100 mg or decreased to 25 mg. The man no longer has to get embarrassed in front of the navigate to this pharmacy store buy levitra love of his life. So parents and teens bit the bullet and paid personal corporations viagra online consultation to show youngsters a way to drive. Some people tadalafil without rx http://deeprootsmag.org/2012/10/12/de-paris-tout-pour-lamour/ are more sensitive to salt and should lower their intake even more. Sports concussion is a growing public health concern in most collision sports, particularly the football codes. Together with the need for evidence-based assessment and management strategies for sport-related concussion, this has resulted in a number of major international consensus statements for concussion in sport (ICSCS) being developed and widely disseminated.1–4 One of the key international initiatives has been the formation of the ‘Concussion in Sport’ (CIS) group, which consists of worldwide experts working in the field of sports concussion.
Since 2001, in conjunction with several leading sports organisations including the International Ice Hockey Federation, International Olympic Committee, Fédération Internationale de Football Association and the International Rugby Board, the CIS group has held conferences to revise and update key aspects of sports concussion knowledge. These conferences have resulted in consensus statements on key definitions, assessment and management strategies for sports concussion. The CIS group has moved from providing only position and agreement statements to using a recognised methodology to obtain consensus at its conferences leading to the publication of international consensus statements. In addition, the conferences prior to this study have led to the development of evaluation tools, the Sports Concussion Assessment Tool (SCAT) and SCAT2 aimed at improving and standardising the sideline evaluation of sports-related concussion. The concussion statements and concussion evaluation tools are freely available and have been ‘developed for use by doctors, therapists, health professionals, coaches and other people involved in the care of injured athletes, whether at the recreational, elite or professional level’.3
The international statements on sports concussion have been widely cited in the research literature5 and their recommendations have been used to guide diagnosis and treatment of sports concussion around the world. Given the intended impact of these statements on sports medicine practice, it is vital that a rigorous methodology be used to develop them to ensure that their recommendations are sound. Until now, the quality of the various ICSCS in terms of the methodological rigour and transparency with which they were developed has not been independently assessed.
Defining the quality of guidelines and consensus statements can be complicated and previous studies have shown that the quality of development of clinical guidelines is variable.6–8 The Institute of Medicine defines clinical guidelines as ‘systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances’.9 In principle, a ‘good’ clinical guideline acts as a link between clinical research and its translation into practice, leading to improved health outcomes. One of the key assumptions behind clinical guidelines is that the greater the strength of the evidence used, the higher the quality of the guideline and the greater potential for use in actual healthcare practice. Governments, professional associations and healthcare organisations have often developed guidelines based on the consensus of expert groups. Several limitations of consensus/expert guidelines/statements have previously been identified10: they may not consider all of the published evidence available; the quality of the evidence may not be considered rigorously; there may be a lack of transparency in how recommendations are derived; and the recommendations generated may not be reproducible by other expert groups. Because clinical guidelines can vary in quality, it is important to assess the methods used to develop practice guidelines in order to be confident of the resulting recommendations.
One tool for assessing guideline quality, the Appraisal of Guidelines for Research and Evaluation (AGREE),11 was developed by a collaboration between academics and healthcare practitioners in an attempt to coordinate guideline development internationally. The most recent version, AGREE II,12 ,13 is a valid, reliable and internationally recognised tool that assesses the methodological rigour and transparency with which a practice guideline is developed. Several studies have used AGREE II to assess the quality of practice guidelines,7 ,14 ,15 inform practice guideline development and to guide what specific information should be reported in practice guidelines.15 ,16
This paper reports the findings of an evaluation conducted in 2012 using AGREE II of the development of the 2008 ICSCS. It was intended that this assessment would help to identify the independently rated methodological strengths in the development of the 2008 ICSCS to inform the development of the planned 2012 Zurich ICSCS.