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Abstract：
OBJECTIVE: The purpose of this study was to systematically evaluate the methodological quality of massage-related clinical practice guidelines (CPGs)/consensus on massage using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument and to summarize the current status of recommendations in the CPGs.
METHODS: The Chinese National Knowledge Infrastructure (CNKI), WanFang Data, China Science and Technology Journal Database (VIP), China Biology Medicine disc (CBM), PubMed, Embase, and guideline websites (such as the Chinese Medical Ace Base, the China Association of Chinese Medicine, the World Health Organization, Guideline International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network) were searched from inception to October 31, 2022. In addition, the reference lists of relevant studies were reviewed to identify domestic and overseas massage CPGs/consensus. The search terms adopted a combination of subject words and free words, mainly including traditional Chinese medicine, complementary therapies, Tuina, massage, manipulation, chiropractic/osteopathic, spinal, acupressure, guideline, and consensus. Two researchers independently completed the eligible records and extracted the data. Before the formal research, calibrations were performed twice on AGREE II, and all reviewers completed the pilot test three times until they understood and reached an agreement on the assessment items. Three researchers appraised the methodological quality of the included guidelines using the AGREE II instrument and calculated the overall intraclass correlation coefficient (ICC) of agreement.
RESULTS: The evaluation results showed that among the 49 eligible CPGs/consensus, 4 (8.2%) CPGs/consensus were considered \"recommended\", 15 (30.6%) CPGs/consensus were considered \"recommended with modifications\", and 30 (61.2%) CPGs/consensus were considered \"not recommended\", while the consensus was considered \"not recommended\". Generally, the scores in the six domains of the guidelines were all higher than the consensus. Evaluation results for the overall quality of 36 CPGs showed that 4 (11%) were \"good quality\", 15 (42%) were \"sufficient quality\" and 17 (47%) were \"lower quality\". The AGREE II quality scores of domains ranged from 0.30 to 0.75 ([ICC = 0.993, 95% CI (0.992, 0.995)]). The domain of scope and purpose (domain 1), with a median score of 0.75 (0.52~0.91), performed best in the guidelines with AGREE II, and stakeholder involvement (domain 2) [median 0.39 (0.31~0.56)] and application (domain 5) [median 0.30 (0.17~0.47] obtained lower scores. The consensus score of domain 1 was better at 26.0 (21.6~44.8), followed by rigor of development (domain 3) with a score of 18.0 (10.0~28.9). A total of 119 massage-related recommendations were extracted from 49 guidelines/consensuses, including \"in favor\" (102, 85.7%), \"against\" (9, 7.6%), and \"did not make recommendations\" (8, 6.7%).
CONCLUSIONS: The overall quality of the included guidelines was low, and most of the guidelines were not \"recommended\". In future guideline updates, the existing evidence should be used, the professional composition of members of the expert group should be enriched, and patients\' values and preferences should be fully considered. It is necessary to clearly propose recognizable recommendations and strengthen the rigor and standardization of guideline formulation. Thus, clear standard guidelines can be formulated to better guide clinical practice.
METHODS: The Chinese National Knowledge Infrastructure (CNKI), WanFang Data, China Science and Technology Journal Database (VIP), China Biology Medicine disc (CBM), PubMed, Embase, and guideline websites (such as the Chinese Medical Ace Base, the China Association of Chinese Medicine, the World Health Organization, Guideline International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network) were searched from inception to October 31, 2022. In addition, the reference lists of relevant studies were reviewed to identify domestic and overseas massage CPGs/consensus. The search terms adopted a combination of subject words and free words, mainly including traditional Chinese medicine, complementary therapies, Tuina, massage, manipulation, chiropractic/osteopathic, spinal, acupressure, guideline, and consensus. Two researchers independently completed the eligible records and extracted the data. Before the formal research, calibrations were performed twice on AGREE II, and all reviewers completed the pilot test three times until they understood and reached an agreement on the assessment items. Three researchers appraised the methodological quality of the included guidelines using the AGREE II instrument and calculated the overall intraclass correlation coefficient (ICC) of agreement.
RESULTS: The evaluation results showed that among the 49 eligible CPGs/consensus, 4 (8.2%) CPGs/consensus were considered \"recommended\", 15 (30.6%) CPGs/consensus were considered \"recommended with modifications\", and 30 (61.2%) CPGs/consensus were considered \"not recommended\", while the consensus was considered \"not recommended\". Generally, the scores in the six domains of the guidelines were all higher than the consensus. Evaluation results for the overall quality of 36 CPGs showed that 4 (11%) were \"good quality\", 15 (42%) were \"sufficient quality\" and 17 (47%) were \"lower quality\". The AGREE II quality scores of domains ranged from 0.30 to 0.75 ([ICC = 0.993, 95% CI (0.992, 0.995)]). The domain of scope and purpose (domain 1), with a median score of 0.75 (0.52~0.91), performed best in the guidelines with AGREE II, and stakeholder involvement (domain 2) [median 0.39 (0.31~0.56)] and application (domain 5) [median 0.30 (0.17~0.47] obtained lower scores. The consensus score of domain 1 was better at 26.0 (21.6~44.8), followed by rigor of development (domain 3) with a score of 18.0 (10.0~28.9). A total of 119 massage-related recommendations were extracted from 49 guidelines/consensuses, including \"in favor\" (102, 85.7%), \"against\" (9, 7.6%), and \"did not make recommendations\" (8, 6.7%).
CONCLUSIONS: The overall quality of the included guidelines was low, and most of the guidelines were not \"recommended\". In future guideline updates, the existing evidence should be used, the professional composition of members of the expert group should be enriched, and patients\' values and preferences should be fully considered. It is necessary to clearly propose recognizable recommendations and strengthen the rigor and standardization of guideline formulation. Thus, clear standard guidelines can be formulated to better guide clinical practice.
摘要：
目的：本研究的目的是使用指南研究与评估（AGREEII）工具系统地评估与按摩相关的临床实践指南（CPGs）/共识的方法学质量，并总结CPGs中建议的现状。
方法：中国国家知识基础设施(CNKI)，万方数据,中国科技期刊数据库(VIP),中国生物医学光盘（CBM），PubMed,Embase,和指南网站(如中国医学王牌基地，中国中医药协会,世界卫生组织,国际网络准则，国家健康与护理卓越研究所，苏格兰校际指南网络）从开始到2022年10月31日进行了搜索。此外,回顾了相关研究的参考清单，以确定国内外按摩CPG/共识。搜索词采用了主题词和自由词的组合，主要包括中药,补充疗法,推拿,按摩,操纵,整脊/整骨疗法，脊柱,穴位按摩,指导方针，和共识。两名研究人员独立完成了符合条件的记录并提取了数据。在正式研究之前,在AGREEII上进行了两次校准，所有评审人员三次完成试点测试，直到他们理解并就评估项目达成一致。三名研究人员使用AGREEII仪器评估了纳入指南的方法学质量，并计算了协议的总体组内相关系数（ICC）。
结果：评估结果显示，在49个合格的CPG/共识中，4个（8.2%）CPG/共识被认为是“推荐”，15(30.6%)CPG/共识被认为是“建议修改”，30个(61.2%)CPG/共识被认为“不推荐”，而共识被认为是“不建议”。一般来说,指南的六个领域的得分均高于共识。对36个CPGs的总体质量评估结果表明，有4个（11％）为“良好质量”，15人（42%）“质量足够”，17人（47%）“质量较低”。领域的AGREEII质量评分范围为0.30至0.75([ICC=0.993,95%CI(0.992,0.995)])。范围和目的域（域1），中位数为0.75（0.52~0.91），在AGREEII指南中表现最好，利益相关者参与（领域2）[中位数0.39（0.31〜0.56）]和应用（领域5）[中位数0.30（0.17〜0.47）获得了较低的分数。域1的一致得分为26.0(21.6~44.8)，其次是严格的发展（领域3），得分18.0（10.0〜28.9）。从49条指引/共识中,共抽取119条按摩相关建议,包括“赞成”(102，85.7%)，“反对”（9.7.6%），和“没有提出建议”（8，6.7%）。
结论：纳入指南的总体质量较低，大多数指南都不是“推荐”。在未来的指南更新中，应该利用现有的证据，丰富专家组成员的专业组成，应充分考虑患者的价值观和偏好。有必要提出可识别的建议，并加强指南制定的严谨性和标准化。因此，可制定明确的标准指南,更好地指导临床实践。
方法：中国国家知识基础设施(CNKI)，万方数据,中国科技期刊数据库(VIP),中国生物医学光盘（CBM），PubMed,Embase,和指南网站(如中国医学王牌基地，中国中医药协会,世界卫生组织,国际网络准则，国家健康与护理卓越研究所，苏格兰校际指南网络）从开始到2022年10月31日进行了搜索。此外,回顾了相关研究的参考清单，以确定国内外按摩CPG/共识。搜索词采用了主题词和自由词的组合，主要包括中药,补充疗法,推拿,按摩,操纵,整脊/整骨疗法，脊柱,穴位按摩,指导方针，和共识。两名研究人员独立完成了符合条件的记录并提取了数据。在正式研究之前,在AGREEII上进行了两次校准，所有评审人员三次完成试点测试，直到他们理解并就评估项目达成一致。三名研究人员使用AGREEII仪器评估了纳入指南的方法学质量，并计算了协议的总体组内相关系数（ICC）。
结果：评估结果显示，在49个合格的CPG/共识中，4个（8.2%）CPG/共识被认为是“推荐”，15(30.6%)CPG/共识被认为是“建议修改”，30个(61.2%)CPG/共识被认为“不推荐”，而共识被认为是“不建议”。一般来说,指南的六个领域的得分均高于共识。对36个CPGs的总体质量评估结果表明，有4个（11％）为“良好质量”，15人（42%）“质量足够”，17人（47%）“质量较低”。领域的AGREEII质量评分范围为0.30至0.75([ICC=0.993,95%CI(0.992,0.995)])。范围和目的域（域1），中位数为0.75（0.52~0.91），在AGREEII指南中表现最好，利益相关者参与（领域2）[中位数0.39（0.31〜0.56）]和应用（领域5）[中位数0.30（0.17〜0.47）获得了较低的分数。域1的一致得分为26.0(21.6~44.8)，其次是严格的发展（领域3），得分18.0（10.0〜28.9）。从49条指引/共识中,共抽取119条按摩相关建议,包括“赞成”(102，85.7%)，“反对”（9.7.6%），和“没有提出建议”（8，6.7%）。
结论：纳入指南的总体质量较低，大多数指南都不是“推荐”。在未来的指南更新中，应该利用现有的证据，丰富专家组成员的专业组成，应充分考虑患者的价值观和偏好。有必要提出可识别的建议，并加强指南制定的严谨性和标准化。因此，可制定明确的标准指南,更好地指导临床实践。
