A quality appraisal of clinical practice guidelines for herpes zoster and postherpetic neuralgia using the AGREE II instrument

Abstract

Background: This study systematically assesses the methodological quality of both Western and traditional medicine clinical practice guidelines (CPGs) for herpes zoster (HZ) and postherpetic neuralgia (PHN) using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument. Methods: A systematic search was conducted up to January 10, 2025 to identify CPGs for HZ or PHN, regardless of whether they were based on Western or traditional medicine. All CPGs addressing diagnosis, evaluation, treatment, prevention, and management were included. Two evaluators independently screened the records and extracted the data. The quality of the CPGs was independently assessed by 5 evaluators using the AGREE II instrument. The intraclass correlation coefficient (ICC) was calculated to assess inter-rater reliability. Results: Eleven CPGs were included, consisting of ten from Western medicine and 1 from traditional medicine. The AGREE II domain scores were as follows: The “Clarity of Presentation” domain received the highest score (76.2%), whereas “Editorial Independence,” “Stakeholder Involvement,” and “Applicability” scored below 30%, with “Applicability” receiving the lowest score (10.9%). Inter-rater reliability was excellent, with ICCs for the AGREE II domains ranging from 0.927 to 0.990. Four CPGs were rated as Moderate quality (Recommended with modifications), and 6 CPGs were of Low quality (Not recommended). Among the Western medicine CPGs, JASP 2021 was the only 1 rated as High quality (Recommended), whereas CACMS 2013, the only traditional medicine CPG, was rated as Low quality (Not recommended). Conclusion: The findings reveal considerable variability in quality, with overall low-to-moderate quality observed in the guidelines for HZ and PHN. These results highlight the need to address the domains with consistently low scores identified by the AGREE II instrument by adopting a multidisciplinary approach, strengthening applicability, and ensuring rigor in the development process to improve guideline quality.