Quality and reporting of guidelines on the diagnosis and management of dystonia

Background The quality of clinical practice guidelines on dystonia has not yet been assessed. Our aim was to appraise the methodological quality of guidelines worldwide and analyze the consistency of their recommendations. Methods We searched for clinical practice guidelines on dystonia diagnosis/treatment in the National Guideline Clearinghouse, PubMed, National Institute for Health and Care Excellence, Guidelines International Network and Web of Science databases. We also searched for guidelines on homepages of international neurological societies. We asked for guidelines from every Management Committee member of the BM1101 COST Action and every member of the International Parkinson and Movement Disorders Society with special interest in dystonia. Results Fifteen guidelines were evaluated. Among guidelines on treatment, only one from the American Academy of Neurology could be considered as high quality. Among guidelines on diagnosis and therapy, the guideline from the European Federation of Neurological Societies was recommended by the appraisers. Clinical applicability and reports of editorial independence were the greatest shortcomings. The rigor of development was poor, stakeholder involvement were also incomplete in most guidelines. Discrepancies among recommendations may result from the weight given to consensus statements and expert opinions due to the lack of evidence, as well as inaccuracy of disease classification. Conclusions The quality of appraised guidelines was low. It is necessary to improve the quality of guidelines on dystonia; the applied terminology of dystonia also needs to be standardized. This article is protected by copyright. All rights reserved.