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Critical Appraisal of Research Articles: Clinical Practice Guidelines

What is a Clinical Practice Guideline?

A clinical practice guideline is a systematically developed statement designed to help health care professionals make decisions about appropriate health care for specific clinical circumstances.

Guidelines attempt to do this by:

  • Describing a range of generally accepted approaches for the diagnosis, management, or prevention of specific diseases or conditions.

  • Defining practices that meet the needs of most patients in most circumstances.

Clinical Practice Guidelines

Find Clinical Practice Guidelines:

1. Go to ClinicalKey and limit the search to "Guidelines".

2.  When searching MEDLINE, click on "Additional Limits", and limit by publication type (Practice Guideline).

Questions to Ask

Scope and Purpose

  • Are the overall objectives of the guideline specifically described?
  • Is the clinical question(s) covered by the guideline specifically described?
  • Are the patients to whom the guideline is meant to apply specifically described?

Stakeholder Involvement

  • Does the guideline development group include individuals from all of the relevant professional groups?
  • Have the patients' views and preferences been sought?
  • Have the target users of the guideline been clearly defined?
  • Has the guideline been piloted among target users?

Rigour of Development

  • Were systematic methods used to search for evidence?
  • Is the criteria for selecting the evidence clearly described?
  • Were the methods used for formulating the recommendations clearly described?
  • Were the health benefits, side effects, and risks considered in formulating the recommendations?
  • Is there an explicit link between the recommendations and the supporting evidence?
  • Has the guideline been externally reviewed by experts prior to its publication?
  • Is a procedure for updating the guideline provided?

Clarity and Presentation

  • Are the recommendations specific and unambiguous?
  • Are different options for management of the condition clearly presented?
  • Are key recommendations clearly identifiable?
  • Is the guideline supported with tools for application?


  • Have the potential organization barriers in applying the recommendation been discussed?
  • Have the potential cost implications of applying the recommendations been considered?
  • Does the guideline present key review criteria for monitoring and/or auditing purposes?

Editorial Independence

  • Is the guideline editorially independent from the funding body?
  • Have conflicts of interest of guideline development members been recorded?

Appraisal of Clinical Practice Guidelines

The AGREE (Appraisal of Guidelines for Research & Evaluation) Instrument is a tool that assesses the methodological rigour and transparency in which a guideline is developed and it is used internationally.

The purpose of the AGREE Instrument is to provide a framework for assessing the quality of clinical practice guidelines.

 The AGREE Instrument is designed to assess guidelines developed by local, regional, national, or international groups or affiliated government organizations.  These include:

  1. New guidelines
  2. Existing guidelines
  3. Updates of existing guidelines

PDF of the latest AGREE Instrument