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 to analyze the consistency of their recommendations.
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 Action of the Cooperation between Science and Technology European framework and every member of the International Parkinson and Movement Disorders Society with special interest in dystonia.
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 and stakeholder involvement was 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.
The quality of appraised guidelines was low. It is necessary to improve the quality of
guidelines on
dystonia, and the applied terminology of
dystonia also needs to be standardized.