Corp et al. conducted an important study to synthesize the evidence from European guidelines on neck and lower back pain to identify appropriate recommendations (Corp et al., 2021). The Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) was used to critically appraise these guidelines (Corp et al., 2021). Although AGREE II is a concise and widely used tool in the appraisal of the methodological quality of guidelines, it has some major limitations, which should be considered by the abovementioned authors and health providers (Liu et al., 2021). First, AGREE II only targets the reporting of the methodological quality of guidelines, which is not sufficient for ensuring that the recommendations are of optimal quality. Thus, a recently released tool, AGREE-Recommendation EXcellence (AGREE-REX), has been designed to assess whether guideline recommendations are clinically credible, trustworthy and implementable, which is more appropriate for Corp et al. to use to identify appropriate recommendations (Brouwers et al., 2020). AGREE II itself, however, cannot solve inconsistency in recommendations. Second, the current version of AGREE II does not provide a clear cut-off to distinguish between high- and low-quality domains or overall quality. Most AGREE II users personally apply a cut-off, like that applied by Corp et al. (Corp et al., 2021; Hoffmann-Eßer et al., 2018; Liu et al., 2021). However, as different standards have been applied in different studies, health providers may be confused when choosing a guideline with sufficient quality. We suggest specifying a universal cut-off in future versions of AGREE. Finally, the appraisal of guidelines using AGREE II highly relies on the personal judgement of reviewers (Liu et al., 2021). The decision to assign a score does not need to follow specific rules. AGREE II users should be cautious in conducting training before assessments. Additionally, quality control, like reviewers’ agreement and reassessment, is necessary. The development of high-quality guidelines is a systematic and complex procedure. To improve the development, reporting and application of better guidelines with appropriate recommendations, several tools have been introduced considering the concepts of evidence-based medicine, for example, a system for rating evidence or the quality instruments used during guideline development: Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) and the Oxford Levels of Evidence (Bennett et al., 2019); guideline reporting checklist: Reporting Items for practice Guidelines in HealThcare (RIGHT) and AGREE checklist (Yao et al., 2020); and appraisal of guidelines and its’ recommendations’ quality: AGREE II and AGREE-REX. The appropriate use of these tools may be helpful. We suggest that health providers, methodologists, policymakers and educators closely adhere to the new versions of well-developed tools.

公司等。进行了一项重要研究，以综合欧洲关于颈部和腰部疼痛的指南的证据，以确定适当的建议（Corp 等，  2021 年）。研究和评估指南评估工具 II (AGREE II) 用于对这些指南进行批判性评估 (Corp et al.,  2021 )。尽管 AGREE II 是评估指南方法学质量的简洁且广泛使用的工具，但它也有一些主要的局限性，上述作者和卫生服务提供者应考虑到这些问题（Liu et al.,  2021）。首先，AGREE II 仅针对指南方法学质量的报告，这不足以确保建议具有最佳质量。因此，最近发布的工具 AGREE-Recommendation EXcellence (AGREE-REX) 旨在评估指南建议在临床上是否可信、可信和可实施，这更适合 Corp 等人。用于确定适当的建议（Brouwers 等人，  2020 年）。但是，AGREE II 本身无法解决建议中的不一致问题。其次，当前版本的 AGREE II 没有提供明确的界限来区分高质量和低质量域或整体质量。大多数 AGREE II 用户个人应用了一个截止值，就像 Corp 等人应用的那样。（Corp 等人，  2021; Hoffmann-Eßer 等人，  2018 年；Liu 等人，  2021 年）。然而，由于不同的研究采用了不同的标准，卫生提供者在选择具有足够质量的指南时可能会感到困惑。我们建议在未来版本的 AGREE 中指定一个通用的截止点。最后，使用 AGREE II 对指南的评估高度依赖于审稿人的个人判断（Liu et al.,  2021）。分配分数的决定不需要遵循特定规则。AGREE II 用户在评估前进行培训时应谨慎。此外，质量控制，如审稿人的同意和重新评估，也是必要的。高质量指南的制定是一个系统而复杂的过程。为了改进具有适当建议的更好指南的制定、报告和应用，考虑到循证医学的概念，引入了几种工具，例如，用于对证据进行评级的系统或指南制定过​​程中使用的质量工具：推荐等级、评估、开发和评估 (GRADE) 和牛津证据级别（Bennett 等，  2019); 指南报告清单：《健康护理指南》（RIGHT）和同意清单（Yao et al., 2020）的报告项目 ；和评估指南及其建议的质量：AGREE II 和 AGREE-REX。适当使用这些工具可能会有所帮助。我们建议卫生提供者、方法论者、政策制定者和教育者密切关注新版本的完善工具。