AGREE II: advancing guideline development, reporting and evaluation in health care
Open accessAbstract
Clinical practice guidelines, which are systematically developed statements aimed at helping people make clinical, policy-related and system-related decisions,[1][1],[2][2] frequently vary widely in quality.[3][3],[4][4] A strategy was needed to differentiate among guidelines and ensure that those
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Evidence synthesis methods followed best practice.
“Evidence synthesis methods are outlined in the full guideline and followed best practice (9, 13, 14)”
From Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome (2023) · cites this paper as [9]
Domain 3: Rigour of development (page not supplied) sets out criteria for sound evidence-related methods, including systematic searching, clear selection criteria, and describing the evidence’s strengths and limitations. It does not assess the citing guideline or establish that its evidence synthesis methods followed those criteria. (LLM, conf=0.84)
Experimental — accuracy not yet measuredEvidence synthesis methods followed best practice.
“Evidence synthesis methods are outlined in the full guideline and followed best practice 9,13,14”
From Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome (2023) · cites this paper as [9]
Domain 3, “Rigour of development” (page not available), identifies systematic evidence searches, clearly described selection criteria, and assessment of the evidence’s strengths and limitations as aspects of guideline rigour. It does not assess the citing guideline or establish that its evidence synthesis methods followed those practices. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe text and recommendations were verified according to the AGREE II instrument.
“The text and recommendations were then verified according to the AGREE II instrument [21].”
From 2018 European Thyroid Association (ETA) Guidelines on the Diagnosis and Management of Central Hypothyroidism (2018) · cites this paper as [21]
The project followed the updated European League Against Rheumatism standardised operating procedure and used the Appraisal of Guidelines for Research & Evaluation II tool.
“We followed the updated European League Against Rheumatism (EULAR) standardised operating procedure5 and used the Appraisal of Guidelines for Research & Evaluation II tool.6”
From EULAR recommendations for the management of antiphospholipid syndrome in adults (2019) · cites this paper as [6]
Processes aligned with all elements of the AGREEII tool for quality guideline assessment, with extensive evidence synthesis and meta-analysis.
“Processes aligned with all elements of the AGREEII tool for quality guideline assessment, 9 with extensive evidence synthesis and meta-analysis.”
From Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome (2023) · cites this paper as [9]
Processes aligned with all elements of the AGREE-II tool for quality guideline assessment, with extensive evidence synthesis and meta-analysis.
“Processes aligned with all elements of the AGREE-II tool for quality guideline assessment (9), with extensive evidence synthesis and meta-analysis.”
From Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome (2023) · cites this paper as [9]
Systematic literature searches were performed based on AGREE II criteria.
“Systematic literature searches were performed (based on AGREE II criteria21) to answer the following question: in high-quality clinical studies performed in adults, what effects do probiotics have on lower GI symptoms/problems that are typically managed in primary care?”
From Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice - an evidence-based international guide (2013) · cites this paper as [21]
Guideline quality can be assessed and quantified using the AGREE system across six domains.
“Guideline quality can be assessed and quantified using the AGREE system (Appraisal of Guidelines, Research and Evaluation), where a guideline is assessed across six domains [6].”
From European guidelines for personality disorders: past, present and future (2019) · cites this paper as [6]
The AGREE manual recommends at least 2 appraisers and preferably 4 in order to achieve a reliable rating.
“the AGREE manual [6] recommends at least 2 appraisers and preferably 4 in order to achieve a reliable rating”
From European guidelines for personality disorders: past, present and future (2019) · cites this paper as [6]
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“A practicing family physician, nurse practitioner and pharmacist (who were not members of the Deprescribing project) provided a clinical review of each guideline using the AGREE II Global Rating Scale [33] to guide their evaluation in rating the scope and purpose of the guideline, stakeholder involvement, rigour of de…”
MethodInfluentialBritish Association of Dermatologists guidelines for the management of people with vitiligo 2021
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Hassapidou, M., Vlassopoulos, A., Kalliostra, M., Govers, E., Mulrooney, H., Ells, L., Salas, X. R., Muscogiuri, G., Darleska, T. H., Busetto, L., et al. (2023) · Obesity Facts · doi:10.1159/000528083 · Cited by 121 · see citing works
Schildmann, E., & Schildmann, J. (2014) · Journal of Palliative Medicine · doi:10.1089/jpm.2013.0511 · Cited by 120 · see citing works
Tools to support evidence-informed public health decision making
Yost, J., Dobbins, M., Traynor, R., DeCorby, K., Workentine, S., & Greco, L. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-728 · Cited by 116 · see citing works
Rytter, H. M., Graff, H. J., Henriksen, H. K., Aaen, N., Hartvigsen, J., Hoegh, M., Nisted, I., Næss-Schmidt, E. T., Pedersen, L. L., Schytz, H. W., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.32221 · Cited by 107 · see citing works
Management of Depression in Patients With Cancer: A Clinical Practice Guideline
Li, M., Kennedy, E. B., Byrne, N., Gérin-Lajoie, C., Katz, M. R., Keshavarz, H., Sellick, S., & Green, E. (2016) · Journal of Oncology Practice · doi:10.1200/jop.2016.011072 · Cited by 96 · see citing works
Møller, G., Andersen, H. K., & Snorgaard, O. (2017) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.116.139626 · Cited by 93 · see citing works
Management of acne: Canadian clinical practice guideline
Asai, Y., Baibergenova, A., Dutil, M., Humphrey, S., Hull, P., Lynde, C., Poulin, Y., Shear, N. H., Tan, J., Toole, J., et al. (2016) · Canadian Medical Association Journal · doi:10.1503/cmaj.140665 · Cited by 95 · see citing works
Morgan-Bathke, M., Raynor, H. A., Baxter, S. D., Halliday, T. M., Lynch, A., Malik, N., Garay, J. L., & Rozga, M. (2023) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2022.11.014 · Cited by 85 · see citing works
Optimizing the language and format of guidelines to improve guideline uptake
Gupta, S., Rai, N., Bhattacharrya, O., Cheng, A. Y. Y., Connelly, K. A., Boulet, L.-P., Kaplan, A., Brouwers, M. C., & Kastner, M. (2016) · Canadian Medical Association Journal · doi:10.1503/cmaj.151102 · Cited by 82 · see citing works
Self-citationPharmacological Augmentation in Unipolar Depression: A Guide to the Guidelines
Taylor, R. W., Marwood, L., Oprea, E., DeAngel, V., Mather, S., Valentini, B., Zahn, R., Young, A. H., & Cleare, A. J. (2020) · International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyaa033 · Cited by 76 · see citing works
Risks and benefits of web-based patient narratives: systematic review
Drewniak, D., Glässel, A., Hodel, M., & Biller-Andorno, N. (2020) · Journal of Medical Internet Research · doi:10.2196/15772 · Cited by 70 · see citing works
Canadian Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder
Wood, E., Bright, J., Hsu, K., Goel, N., Ross, J. W. G., Hanson, A., Teed, R., Poulin, G., Denning, B., Corace, K., et al. (2023) · Canadian Medical Association Journal · doi:10.1503/cmaj.230715 · Cited by 74 · see citing works
Pharmacotherapy for obesity management in adults: 2025 clinical practice guideline update
Pedersen, S. D., Manjoo, P., Dash, S., Jain, A., Pearce, N., & Poddar, M. (2025) · Canadian Medical Association Journal · doi:10.1503/cmaj.250502 · Cited by 78 · see citing works
Quality of clinical practice guidelines in delirium: a systematic appraisal
Bush, S. H., Marchington, K. L., Agar, M., Davis, D. H. J., Sikora, L., & Tsang, T. W. Y. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-013809 · Cited by 59 · see citing works
Shrubsole, K., Worrall, L., Power, E., & O’Connor, D. A. (2017) · Aphasiology · doi:10.1080/02687038.2016.1143083 · Cited by 58 · see citing works
Sørensen, A., Juhl Jørgensen, K., & Munkholm, K. (2022) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253211067656 · Cited by 52 · see citing works
Quality of reporting of surveys in critical care journals: A methodologic review*
Duffett, M., Burns, K. E., Adhikari, N. K., Arnold, D. M., Lauzier, F., Kho, M. E., Meade, M. O., Hayani, O., Koo, K., Choong, K., et al. (2012) · Critical Care Medicine · doi:10.1097/ccm.0b013e318232d6c6 · Cited by 49 · see citing works
Self-citationMensah, G. P., ten Ham‐Baloyi, W., van Rooyen, D. (. M. )., & Jardien‐Baboo, S. (2020) · Nursing Open · doi:10.1002/nop2.324 · Cited by 47 · see citing works
Clinical practice guidelines for irritable bowel syndrome in Korea, 2017 revised edition
Song, K. H., Jung, H.-K., Kim, H. J., Koo, H. S., Kwon, Y. H., Shin, H. D., Lim, H. C., Shin, J. E., Kim, S. E., Cho, D. H., et al. (2018) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm17145 · Cited by 47 · see citing works
“Details are available in the AGREE II user manual.(14) The K AGREE II quality evaluation tool, a Korean-language evaluation tool developed by the Steering Committee for Clinical Practice Guidelines and Korean Medical Guidelines Information Center, was used to develop the candidate seed guidelines (http://www.”
MethodCeresoli, M., Coccolini, F., Biffl, W. L., Sartelli, M., Ansaloni, L., Moore, E. E., Di Saverio, S., Kluger, Y., & Catena, F. (2020) · World Journal of Emergency Surgery · doi:10.1186/s13017-020-00318-z · Cited by 41 · see citing works
Ng, J. Y., Nazir, Z., & Nault, H. (2020) · BMC Complementary Medicine and Therapies · doi:10.1186/s12906-020-03085-1 · Cited by 39 · see citing works
Akl, E. A., Morgan, R. L., Rooney, A. A., Beverly, B., Katikireddi, S. V., Agarwal, A., Alper, B. S., Alva-Diaz, C., Amato, L., Ansari, M. T., et al. (2021) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2020.09.037 · Cited by 34 · see citing works
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A methodological review of the quality of reporting of surveys in transfusion medicine
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Gabriel, F. C., Stein, A. T., de Melo, D. O., Henrique Fontes-Mota, G. C., dos Santos, I. B., de Oliveira, A. F., Fráguas, R., & Ribeiro, E. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-051918 · Cited by 15 · see citing works
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- Authors
- Brouwers, M. C., Kho, M. E., Browman, G. P., Burgers, J. S., Cluzeau, F., Feder, G., Fervers, B., Graham, I. D., Grimshaw, J., Hanna, S. E., Littlejohns, P., Makarski, J., Zitzelsberger, L., & for the AGREE Next Steps Consortium
- Affiliations
- McMaster University (CA)
- Lyon 1 Université (FR)
- BC Cancer Agency (CA)
- Radboud University Medical Center (NL)
- St George's, University of London (GB)
- Canadian Institutes of Health Research (CA)
- Ottawa Hospital (CA)
- Canadian Partnership Against Cancer (CA)
- ORCID
- Venue
- Canadian Medical Association Journal
- Publisher
- CMA Impact Inc.
- Published
- 2010-07-05
- Volume
- 182
- Issue
- 18
- Pages
- E839-E842
- ISSN
- 0820-3946 (ISSN-L)
- 1488-2329
- PMC
- PMC3001530
- OpenAlex
- W2129688566
- Semantic Scholar
- b5f74e1feb184f314eeb7ffa1762bf439dd2161d
- Cited by
- 3,790
- References
- 17
- Citations by year
- 2026: 349 · 2025: 375 · 2024: 358 · 2023: 303 · 2022: 362 · 2021: 364 · 2020: 319 · 2019: 244 · 2018: 229 · 2017: 202 · 2016: 187 · 2015: 160 · 2014: 134 · 2013: 97 · 2012: 67
- FWCI
- 63.31
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Canadian Medical Association Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Social Sciences › Sociology and Political Science › Delphi Technique in Research
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Keywords
- AGREE II, guideline quality assessment, guideline evaluation, guideline development, health care guidelines
- MeSH terms
- Delivery of Health Care, Humans, Manuals as Topic, Program Development, Practice Guidelines as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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