The Clinical Evidence Extraction And Appraisement Of Headache Disorder For Traditional Chinese Medicine Guideline

ObjectiveTo critically collect,analyze and appraise the methodological quality of clinical practice guidelines for headache disorders over the world.Based on this results,we extracted and screened the key clinical questions in order to development systematic reviews.And then,to transform the results from evaluating the outcomes into the sources and support for development clinical practice guidelines.MethodsWe systematically searched in the PubMed,EMBASE,Web of Science,CBM,CNKI,VIP and WANFANG database;guideline-related databases:Guideline-International Network(GIN),National Guideline Clearinghouse(NGC),and Medlive databases.And we also searched the records of organizations with the authority for guideline development,grey literatures and guidelines published as monographs as complementary.The publishing date was limited from 1996 to June 2015.AGREE ? was applied to appraised the methodological quality of including guidelines.And systematic review was employed to analyze the credibility of its outcomes.Results1.Methodological quality of headache guidelines:23 guidelines were included.The overall consistency of the 4 appraisers was considered to be good(interclass correlation coefficient,0.84;95%confidence interval[CI],0.82-0.86).The mean(standard deviation)scores of scope and purpose,stakeholder involvement,rigor of development,clarity of presentation,applicability,and editorial independence were 52.11%(18.0%),39.5%(17.1%),33.4%(21.0%),49.8%(21.9%),23.8%(19.3%),and 24.2%(23.7%),respectively.Only 2 guidelines yielded the outcome of"Recommended",12 guidelines yielded a "Recommended with modification" result,and 9 guidelines indicated a "Not recommended"outcome.2.Systematic review:a total of 615 patients from 8 studies were included.The result shows that the effective rate of tongqiao huoxue decoction is better than flunarizine RR = 1.22,95%CI(1.13,1-32),P<0.001;the scores of headache intensity between tongqiao huoxue decoction and NSAIDs is no statistical significance RR =-0.01,95%CI(-1.89,1.87),P = 0.99.Conclusion1.The overall quality of TCM headache guidelines in China was lower than headache guidelines overseas.Guideline developers should carefully consider the 3 domains,including rigor of development,applicability,and editorial independence.2.In systematic review:Tongqiao huoxue decoction is significantly better than flunarizine in the effective rate of treating primary headache.There were some defects that existed in the original researches published in China would lessen the credibility of systematic reviews,including multiple diagnostic criteria,small sample size,poor methodological quality.And the syndrome differentiation of TCM increased the difficulty of standardization of clinical trials.3.As the TCM guideline developers began to apply evidence-based methods in developing guidelines,the numbers of evidence-based guidelines gradually increased.Evidence-based guidelines are becoming mainstream in developing guidelines,but still needed to consider problematic details,including socio-economic factors,management conflicts of interest,environment to implement and appraisement,preference and values of patients.The TCM guideline developers should screen high quality clinical trials for decision-making,consensus and recommendation.