Coloured or Irlen lenses for reading difficulties - Part 3: Appraise | Evidence Based Practice in Optometry EBP Australia UNSW

Step:

3 Appraise

Duration:

20 minutes

Level:

The clinical practice guidelines and secondary sources found require appraisal to determine how believable the conclusions are.

However developed and published appraisal tools are lacking for secondary sources, unlike primary sources.

The National Health and Medical Research Council clinical practice guideline portal reports 4 criteria for which practice guidelines, policy statements and other summaries can be appraised:

The clinical practice guideline contains statements that include recommendations, strategies, or information that assists health care practitioners and patients make decisions about appropriate health care for specific clinical circumstances.The NHMRC does not (except in the case of NHMRC approved guidelines) evaluate the accuracy of the reasoning contained in or the conclusions reached by the guideline.

The clinical practice guideline was produced under the auspices of medical specialty associations; relevant professional societies, public or private health organisations, non-government agencies or government agencies at the federal or state level for current use within Australia. A clinical practice guideline developed and issued by an individual not officially sponsored or supported by one of the above types of organisations does not meet the inclusion criteria.

Corroborating documentation can be produced that a systematic literature search and review of existing scientific evidence published in peer reviewed journals was performed during the guideline development. A guideline is not excluded if corroborating documentation can be produced detailing specific gaps in scientific evidence for some of the guideline's recommendations.
The NHMRC confirms that a systematic literature search was conducted by the Guideline developer, however the NHMRC has not (except in the case of NHMRC approved guidelines):

evaluated the accuracy of the information contained in the guidelines;

evaluated the accuracy of the information contained in the corroborating documentation; or

evaluated whether the corroborating documentation cited by the guideline in fact supports the statements or recommendations contained within the guideline.

The full text guideline is available upon request in print or electronic format, in the English language. The guideline is current and the most recent version produced. Documented evidence can be produced or verified that the guideline was developed, reviewed, or revised within the last five years.

This is just one example of how such sources could be appraised.

Body Tabs

Treatment

As an example, the American Academy of Pediatrics (2011) published guideline will be appraised:

Criteria	Met?	Specify page and paragraph
Contains recommendations for use by health care practitioners and patients to inform decision making.	Yes	Page e848 columns 2 and 3.
Guideline produced by a health, professional organisation (not an individual).	Yes - American Academy of Pediatrics, American Academy of Ophthalmology, American Academy of Pediatric Ophthalmology and Strabismus, and American Association of Certified Orthoptists	Page e818, column 2
Documentation that a systematic search was utilised in development.	No – no search details were reported. It is unclear whether all sources were considered in the literature review or if there was bias. References are used in text to support claims.
Full text guideline is available upon request in print or electronic format.	Yes – click here
Documented evidence reviewed is developed or revised to include evidence from the last 5 years.	Published in 2011, revised from original in 2009. Most recent research discussed was published in 2010.

Overall the Joint Statement met the majority of the criteria - it is recent, is produced by reputed organisations and is available on the internet. The main issue is that a systematic search for the literature was not reported. Inclusion and exclusion of studies was also not reported. Even though in-text referencing is used to suport claims, it is unclear whether all the possible studies on the topic were included in the review or if there was any bias in searching, selecting or referencing studies in the statement.

The Joint Statement concluded that:

"Visual problems do not cause dyslexia. Scientific evidence does not support the efficacy of eye exercises, behavioral/perceptual vision therapy, training glasses, or special tinted filters or lenses in improving the long-term educational performance in these complex pediatric neurocognitive conditions. Recommendations for multidisciplinary evaluation and management must be based on evidence of proven effectiveness demonstrated by objective scientific methodology.^{106,112,239,270,276}It is important that any therapy for learning disabilities be scientifically established to be valid before it can be recommended for treatment.¹⁰⁶Because vision therapy is not evidence based, it cannot be advocated." (page e849, column 2, paragraph 2)

Resource contributed by: Elizabeth Murray and Isabelle Jalbert
Affiliation: University of NSW
Web-site:
E-mail: i.jalbert[at]unsw.edu.au
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on Thu, 12/19/2013 - 18:16 elizabeth.murra...

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