Adaptation of the 2015 American College of Rheumatology treatment guideline for rheumatoid arthritis for the Eastern Mediterranean Region

An exemplar of the GRADE Adolopment

Andrea Darzi, Harfouche Manale, Thurayya Arayssi, Samar Alemadi, Khaled A. Alnaqbi, Humeira Badsha, Farida Al Balushi, Bassel Elzorkany, Hussein Halabi, Mohammed Hamoudeh, Wissam Hazer, Basel Masri, Mohammed A. Omair, Imad Uthman, Nelly Ziade, Jasvinder A. Singh, Robin Christiansen, Peter Tugwell, Holger J. Schünemann, Elie A. Akl

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: It has been hypothesized that adaptation of health practice guidelines to the local setting is expected to improve their uptake and implementation while cutting on required resources. We recently adapted the published American College of Rheumatology (ACR) Rheumatoid Arthritis (RA) treatment guideline to the Eastern Mediterranean Region (EMR). The objective of this paper is to describe the process used for the adaptation of the 2015 ACR guideline on the treatment of RA for the EMR. Methods: We used the GRADE-Adolopment methodology for the guideline adaptation process. We describe in detail how adolopment enhanced the efficiency of the following steps of the guideline adaptation process: (1) groups and roles, (2) selecting guideline topics, (3) identifying and training guideline panelists, (4) prioritizing questions and outcomes, (5) identifying, updating or conducting systematic reviews, (6) preparing GRADE evidence tables and EtD frameworks, (7) formulating and grading strength of recommendations, (8) using the GRADEpro-GDT software. Results: The adolopment process took 6 months from January to June 2016 with a project coordinator dedicating 40% of her time, and the two co-chairs dedicating 5% and 10% of their times respectively. In addition, a research assistant worked 60% of her time over the last 3 months of the project. We held our face-to-face panel meeting in Qatar. Our literature update included five newly published trials. The certainty of the evidence of three of the eight recommendations changed: one from moderate to very low and two from low to very low. The factors that justified a very low certainty of the evidence in the three recommendations were: serious risk of bias and very serious imprecision. The strength of five of the recommendations changed from strong to conditional. The factors that justified the conditional strength of these 5 recommendations were: cost (n = 5 [100%]), impact on health equities (n = 4 [80%]), the balance of benefits and harms (n = 1 [20%]) and acceptability (n = 1 [20%]). Conclusion: This project confirmed the feasibility of GRADE-Adolopment. It also highlighted the value of collaboration with the organization that had originally developed the treatment guideline. We discuss the implications for both guideline adaptation and future research to advance the field.

Original languageEnglish
Article number183
JournalHealth and Quality of Life Outcomes
Volume15
Issue number1
DOIs
Publication statusPublished - 21 Sep 2017

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Mediterranean Region
Rheumatoid Arthritis
Guidelines
Qatar
Group Processes
Rheumatology
Practice Guidelines
Software
Organizations
Costs and Cost Analysis
Health

Keywords

  • Adaptation
  • Conflicts of interest
  • Eastern Mediterranean Region
  • Evidence-based medicine
  • GRADE
  • Practice guideline
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Adaptation of the 2015 American College of Rheumatology treatment guideline for rheumatoid arthritis for the Eastern Mediterranean Region : An exemplar of the GRADE Adolopment. / Darzi, Andrea; Manale, Harfouche; Arayssi, Thurayya; Alemadi, Samar; Alnaqbi, Khaled A.; Badsha, Humeira; Al Balushi, Farida; Elzorkany, Bassel; Halabi, Hussein; Hamoudeh, Mohammed; Hazer, Wissam; Masri, Basel; Omair, Mohammed A.; Uthman, Imad; Ziade, Nelly; Singh, Jasvinder A.; Christiansen, Robin; Tugwell, Peter; Schünemann, Holger J.; Akl, Elie A.

In: Health and Quality of Life Outcomes, Vol. 15, No. 1, 183, 21.09.2017.

Research output: Contribution to journalArticle

Darzi, A, Manale, H, Arayssi, T, Alemadi, S, Alnaqbi, KA, Badsha, H, Al Balushi, F, Elzorkany, B, Halabi, H, Hamoudeh, M, Hazer, W, Masri, B, Omair, MA, Uthman, I, Ziade, N, Singh, JA, Christiansen, R, Tugwell, P, Schünemann, HJ & Akl, EA 2017, 'Adaptation of the 2015 American College of Rheumatology treatment guideline for rheumatoid arthritis for the Eastern Mediterranean Region: An exemplar of the GRADE Adolopment', Health and Quality of Life Outcomes, vol. 15, no. 1, 183. https://doi.org/10.1186/s12955-017-0754-1
Darzi, Andrea ; Manale, Harfouche ; Arayssi, Thurayya ; Alemadi, Samar ; Alnaqbi, Khaled A. ; Badsha, Humeira ; Al Balushi, Farida ; Elzorkany, Bassel ; Halabi, Hussein ; Hamoudeh, Mohammed ; Hazer, Wissam ; Masri, Basel ; Omair, Mohammed A. ; Uthman, Imad ; Ziade, Nelly ; Singh, Jasvinder A. ; Christiansen, Robin ; Tugwell, Peter ; Schünemann, Holger J. ; Akl, Elie A. / Adaptation of the 2015 American College of Rheumatology treatment guideline for rheumatoid arthritis for the Eastern Mediterranean Region : An exemplar of the GRADE Adolopment. In: Health and Quality of Life Outcomes. 2017 ; Vol. 15, No. 1.
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T1 - Adaptation of the 2015 American College of Rheumatology treatment guideline for rheumatoid arthritis for the Eastern Mediterranean Region

T2 - An exemplar of the GRADE Adolopment

AU - Darzi, Andrea

AU - Manale, Harfouche

AU - Arayssi, Thurayya

AU - Alemadi, Samar

AU - Alnaqbi, Khaled A.

AU - Badsha, Humeira

AU - Al Balushi, Farida

AU - Elzorkany, Bassel

AU - Halabi, Hussein

AU - Hamoudeh, Mohammed

AU - Hazer, Wissam

AU - Masri, Basel

AU - Omair, Mohammed A.

AU - Uthman, Imad

AU - Ziade, Nelly

AU - Singh, Jasvinder A.

AU - Christiansen, Robin

AU - Tugwell, Peter

AU - Schünemann, Holger J.

AU - Akl, Elie A.

PY - 2017/9/21

Y1 - 2017/9/21

N2 - Background: It has been hypothesized that adaptation of health practice guidelines to the local setting is expected to improve their uptake and implementation while cutting on required resources. We recently adapted the published American College of Rheumatology (ACR) Rheumatoid Arthritis (RA) treatment guideline to the Eastern Mediterranean Region (EMR). The objective of this paper is to describe the process used for the adaptation of the 2015 ACR guideline on the treatment of RA for the EMR. Methods: We used the GRADE-Adolopment methodology for the guideline adaptation process. We describe in detail how adolopment enhanced the efficiency of the following steps of the guideline adaptation process: (1) groups and roles, (2) selecting guideline topics, (3) identifying and training guideline panelists, (4) prioritizing questions and outcomes, (5) identifying, updating or conducting systematic reviews, (6) preparing GRADE evidence tables and EtD frameworks, (7) formulating and grading strength of recommendations, (8) using the GRADEpro-GDT software. Results: The adolopment process took 6 months from January to June 2016 with a project coordinator dedicating 40% of her time, and the two co-chairs dedicating 5% and 10% of their times respectively. In addition, a research assistant worked 60% of her time over the last 3 months of the project. We held our face-to-face panel meeting in Qatar. Our literature update included five newly published trials. The certainty of the evidence of three of the eight recommendations changed: one from moderate to very low and two from low to very low. The factors that justified a very low certainty of the evidence in the three recommendations were: serious risk of bias and very serious imprecision. The strength of five of the recommendations changed from strong to conditional. The factors that justified the conditional strength of these 5 recommendations were: cost (n = 5 [100%]), impact on health equities (n = 4 [80%]), the balance of benefits and harms (n = 1 [20%]) and acceptability (n = 1 [20%]). Conclusion: This project confirmed the feasibility of GRADE-Adolopment. It also highlighted the value of collaboration with the organization that had originally developed the treatment guideline. We discuss the implications for both guideline adaptation and future research to advance the field.

AB - Background: It has been hypothesized that adaptation of health practice guidelines to the local setting is expected to improve their uptake and implementation while cutting on required resources. We recently adapted the published American College of Rheumatology (ACR) Rheumatoid Arthritis (RA) treatment guideline to the Eastern Mediterranean Region (EMR). The objective of this paper is to describe the process used for the adaptation of the 2015 ACR guideline on the treatment of RA for the EMR. Methods: We used the GRADE-Adolopment methodology for the guideline adaptation process. We describe in detail how adolopment enhanced the efficiency of the following steps of the guideline adaptation process: (1) groups and roles, (2) selecting guideline topics, (3) identifying and training guideline panelists, (4) prioritizing questions and outcomes, (5) identifying, updating or conducting systematic reviews, (6) preparing GRADE evidence tables and EtD frameworks, (7) formulating and grading strength of recommendations, (8) using the GRADEpro-GDT software. Results: The adolopment process took 6 months from January to June 2016 with a project coordinator dedicating 40% of her time, and the two co-chairs dedicating 5% and 10% of their times respectively. In addition, a research assistant worked 60% of her time over the last 3 months of the project. We held our face-to-face panel meeting in Qatar. Our literature update included five newly published trials. The certainty of the evidence of three of the eight recommendations changed: one from moderate to very low and two from low to very low. The factors that justified a very low certainty of the evidence in the three recommendations were: serious risk of bias and very serious imprecision. The strength of five of the recommendations changed from strong to conditional. The factors that justified the conditional strength of these 5 recommendations were: cost (n = 5 [100%]), impact on health equities (n = 4 [80%]), the balance of benefits and harms (n = 1 [20%]) and acceptability (n = 1 [20%]). Conclusion: This project confirmed the feasibility of GRADE-Adolopment. It also highlighted the value of collaboration with the organization that had originally developed the treatment guideline. We discuss the implications for both guideline adaptation and future research to advance the field.

KW - Adaptation

KW - Conflicts of interest

KW - Eastern Mediterranean Region

KW - Evidence-based medicine

KW - GRADE

KW - Practice guideline

KW - Rheumatoid arthritis

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