全球阻塞性睡眠呼吸暂停指南质量评价

doi:10.3969/j.issn.1674-8115.2024.02.010

上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (2): 237-249.doi: 10.3969/j.issn.1674-8115.2024.02.010

• 论著 · 循证医学 • 上一篇

全球阻塞性睡眠呼吸暂停指南质量评价

高怡青(), 彭裕, 许华俊, 易红良, 关建, 殷善开()

上海交通大学医学院附属第六人民医院耳鼻咽喉头颈外科，上海市睡眠呼吸障碍疾病重点实验室，上海 200233

收稿日期:2023-07-14 接受日期:2023-12-21 出版日期:2024-02-28 发布日期:2024-03-25
通讯作者: 殷善开 E-mail:karoliney@sjtu.edu.cn;skyin@sjtu.edu.cn
作者简介:高怡青（1998—），女，博士生；电子信箱：karoliney@sjtu.edu.cn。
基金资助:
科技创新2030—“脑科学与类脑研究”重大项目(2021ZD0201900);上海市科学技术委员会科技创新行动计划(18DZ2260200);上海申康医院发展中心促进市级医院临床技能与临床创新三年行动计划(SHDC2020CR2044B)

Quality assessment of global obstructive sleep apnea guidelines

GAO Yiqing(), PENG Yu, XU Huajun, YI Hongliang, GUAN Jian, YIN Shankai()

Department of Otolaryngology Head and Neck Surgery, Shanghai Sixth People′s Hospital, Shanghai Jiao Tong University; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China

Received:2023-07-14 Accepted:2023-12-21 Online:2024-02-28 Published:2024-03-25
Contact: YIN Shankai E-mail:karoliney@sjtu.edu.cn;skyin@sjtu.edu.cn
Supported by:
STI2030?Major Projects from National Key R&D Program of China(2021ZD0201900);Technology Innovation Action Plan of Shanghai Municipal Commission of Science and Technology(18DZ2260200);Three?Year Action Plan of Promoting Clinical Skills and Clinical Innovation of Municipal Hospitals of Shanghai Hospital Development Center(SHDC2020CR2044B)

摘要/Abstract

摘要：

目的·对全球范围内已发表的阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）临床实践指南进行质量评价。方法·检索PubMed、Embase、中国知网、万方数据知识服务平台、中国生物医学文献数据库、梅斯医学、The Cochrane Library、医脉通、美国预防服务工作组网站、英国国家卫生与临床优化研究所网站、新西兰指南工作组网站、苏格兰校际指南网络、国际指南协作网等中的OSA相关指南，检索时间限定为建库至2022年12月。由2名研究人员独立筛选文献和提取信息，采用指南研究和评估工具Ⅱ（Appraisal of Guidelines for Research and Evaluation Ⅱ，AGREE Ⅱ）和国际实践指南报告标准（Reporting Items for Practice Guidelines in Healthcare，RIGHT）对纳入的指南进行质量评价，并按不同指南发布地区进行亚组分析；评价者间一致性采用组内相关系数（intra-class correlation coefficient，ICC）进行检验。对所有纳入指南进行全文阅读，汇总其提出的临床问题。结果·共纳入35篇OSA相关指南。评价者ICC为0.975，显示评价者间一致性较好。AGREE Ⅱ的评价结果显示：纳入指南的平均整体质量分值为（63.60±16.45）%，最低为23.40%，最高为91.67%；6个领域中严谨性［（56.07±25.89）%］和应用性［（53.57±15.52）%］得分较低。RIGHT的评价结果显示，纳入指南的平均总报告率为（67.84±20.03）%，最低为14.29%，最高为94.29%，其中平均报告率较低的领域为评审和质量保证［（31.40±45.51）%］、资金资助和利益冲突声明与管理［（56.43±33.95）%］和其他方面［（56.19±36.85）%］。亚组分析表明，亚洲地区的指南在AGREE Ⅱ的严谨性及整体的质量得分显著低于美洲和欧洲地区的指南（均P<0.05），在RIGHT的证据和其他方面2个领域的报告率也均显著低于美洲和欧洲地区的指南（P<0.05）。纳入的35部指南主要关注了OSA的筛查诊断、治疗及疾病管理3个方面42个临床问题。结论·目前全球OSA指南质量差异较大，各个地区的指南在严谨性、应用性、评审和质量保证、资金资助和利益冲突声明与管理等方面都有待加强，尤其是亚洲地区的指南。

关键词: 阻塞性睡眠呼吸暂停, 临床实践指南, 质量评价, 系统综述

Abstract:

Objective ·To evaluate the quality of clinical practice guidelines of obstructive sleep apnea (OSA) published worldwide. Methods ·The guidelines of OSA were retrieved in PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, SinoMed, MedSci, The Cochrane Library, and the websites such as Medlive, U. S. Preventive Services Task Force (USPSTF), National Institute for Health and Care Excellence (NICE), New Zealand Guidelines Group (NZGG), Scottish Intercollegiate Guidelines Network (SIGN), and Guidelines International Network (GIN) from establishment to December 2022. Two reviewers screened the literature and extracted the main information independently, using the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) and Reporting Items for Practice Guidelines in Healthcare (RIGHT) to evaluate the quality of the included OSA guidelines. Subgroup analysis was performed according to the publication regions of guidelines. The inter-evaluator consistency test was also performed and the results were expressed as the intra-class correlation coefficient (ICC). All the included guidelines were read entirely and the clinical questions they raised were summarized. Results ·A total of 35 OSA guidelines were included. The ICC value of 0.975 showed a good inter-evaluator agreement. The results of AGREE Ⅱ showed that the average score of all guidelines was (63.60±16.45)%, with a minimum of 23.40% and a maximum of 91.67%. In the six domains, the scores of "Rigor of development" [(56.07±25.89)%] and "Applicability" [(53.57±15.52)%] were relative low. The average reporting rate of RIGHT of all the included guidelines was (67.84±20.03)%, with a minimum of 14.29% and a maximum of 94.29%, and the three domains with the lowest reporting rates were "Review and quality assurance" [(31.40±45.51)%], "Funding and conflict of interest declaration and management" [(56.43±33.95)%] and "Other aspects" [(56.19±36.85)%]. Subgroup analysis showed that guidelines in Asian had a lower score in "Rigor of development" and a lower overall score of AGREE Ⅱ than the guidelines in America and Europe (both P<0.05), and the reporting rates in the domains of "Evidence" and "Other information" of RIGHT of the Asian guidelines were also lower than those in the guidelines in America and Europe (P<0.05). These guidelines focused on 42 clinical questions which were classified to 3 aspects, i.e. screening and diagnosis, treatment and long-term management of OSA. Conclusion ·The quality of current global OSA guidelines varies a lot, and they need to be strengthened in terms of rigor of development, applicability, review and quality assurance, funding and conflict of interest declaration and management, especially those in Asia.

Key words: obstructive sleep apnea (OSA), clinical practice guideline, quality assessment, systematic review

中图分类号:

R762

高怡青, 彭裕, 许华俊, 易红良, 关建, 殷善开. 全球阻塞性睡眠呼吸暂停指南质量评价[J]. 上海交通大学学报（医学版）, 2024, 44(2): 237-249.

GAO Yiqing, PENG Yu, XU Huajun, YI Hongliang, GUAN Jian, YIN Shankai. Quality assessment of global obstructive sleep apnea guidelines[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(2): 237-249.

图/表 6

参考文献 46

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Guideline	Grading system	Evidence level	Grade of recommendation
AASM2006^[10]	AASM	Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ	Standard, Guideline, Option
AASM2008^[12]	AASM	Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ	Standard, Guideline, Option
AASM2009^[13]	AASM	1, 2, 3	Standard, Guideline, Option
CTS2011^[41]	OCEBM	A, B, C, D	1(1a, 1b, 1c), 2(2a, 2b, 2c), 3(3a, 3b, 3c), 4, 5
ACP2013^[14]	GRADE	High, Moderate, Low	Strong, Weak
ACP2014^[15]	GRADE	High, Moderate, Low	Strong, Weak
INOSA2015^[39]	AAP	A, B, C, D, X	Strong recommendation, Recommendation, Option, No recommendation
AASM-AADSM2015^[17]	GRADE	High, Moderate, Low, Very low	Standard, Guideline, Option
DG-HNO-KHC2016^[37]	OCEBM	A, B, C, D	A, B, C, D
SASM2016^[18]	GRADE	High, Moderate, Low, Very low	Strong, Weak
AASM2017^[19]	GRADE	High, Moderate, Low, Very low	Strong, Weak
ASMBS017^[20]	OCEBM	High, Moderate, Low, Very low	Strong, Weak
SASM2018^[22]	GRADE	High, Moderate, Low, Very low	Strong, Weak, No recommendation
CMDA2018^[32]	GRADE	High, Moderate, Low, Very low	Strongly recommended, Weakly recommended, Weakly against, Strongly against
ATS2018^[23]	GRADE	High, Moderate, Low, Very low	Strong, Conditional
AASM2019^[24]	GRADE	High, Moderate, Low, Very low	Strong, Conditional
VA-DoD2020^[25]	GRADE	Unreported	Strong, Weak
JRS2021^[42]	MINDS	A-Strong, B-Moderate, C-Weak, D-Very weak	Strong, Weak, No recommendation
AASM-2021^[27]	GRADE	High, Moderate, Low, Very low	Strong, Conditional
ERS2021^[44]	GRADE	High, Moderate, Low, Very low	Strong, Conditional
USPSTF2022^[28]	USPSTF	High, Moderate, Low	A, B, C, D, I
GSDSM2022^[38]	AWMF	1, 2, 3, 4	A, B, C, D
SFORL2022^[34]	GRADE	1, 2, 3, 4	A, B, C

Guideline	Grading system	Evidence level	Grade of recommendation
AASM2006^[10]	AASM	Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ	Standard, Guideline, Option
AASM2008^[12]	AASM	Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ	Standard, Guideline, Option
AASM2009^[13]	AASM	1, 2, 3	Standard, Guideline, Option
CTS2011^[41]	OCEBM	A, B, C, D	1(1a, 1b, 1c), 2(2a, 2b, 2c), 3(3a, 3b, 3c), 4, 5
ACP2013^[14]	GRADE	High, Moderate, Low	Strong, Weak
ACP2014^[15]	GRADE	High, Moderate, Low	Strong, Weak
INOSA2015^[39]	AAP	A, B, C, D, X	Strong recommendation, Recommendation, Option, No recommendation
AASM-AADSM2015^[17]	GRADE	High, Moderate, Low, Very low	Standard, Guideline, Option
DG-HNO-KHC2016^[37]	OCEBM	A, B, C, D	A, B, C, D
SASM2016^[18]	GRADE	High, Moderate, Low, Very low	Strong, Weak
AASM2017^[19]	GRADE	High, Moderate, Low, Very low	Strong, Weak
ASMBS017^[20]	OCEBM	High, Moderate, Low, Very low	Strong, Weak
SASM2018^[22]	GRADE	High, Moderate, Low, Very low	Strong, Weak, No recommendation
CMDA2018^[32]	GRADE	High, Moderate, Low, Very low	Strongly recommended, Weakly recommended, Weakly against, Strongly against
ATS2018^[23]	GRADE	High, Moderate, Low, Very low	Strong, Conditional
AASM2019^[24]	GRADE	High, Moderate, Low, Very low	Strong, Conditional
VA-DoD2020^[25]	GRADE	Unreported	Strong, Weak
JRS2021^[42]	MINDS	A-Strong, B-Moderate, C-Weak, D-Very weak	Strong, Weak, No recommendation
AASM-2021^[27]	GRADE	High, Moderate, Low, Very low	Strong, Conditional
ERS2021^[44]	GRADE	High, Moderate, Low, Very low	Strong, Conditional
USPSTF2022^[28]	USPSTF	High, Moderate, Low	A, B, C, D, I
GSDSM2022^[38]	AWMF	1, 2, 3, 4	A, B, C, D
SFORL2022^[34]	GRADE	1, 2, 3, 4	A, B, C

Guideline	Domain						Total score/%	Recommended level
Guideline	Scope and purpose/%	Stakeholder involvement/%	Rigor of development/%	Clarity of presentation/%	Applicability/%	Editorial independence/%	Total score/%	Recommended level
Mean score (x±s)	79.68±20.38	60.71±22.87	56.07±25.89	75.63±15.61	53.57±15.52	68.52±23.25	63.60±16.45	‒
AASM2006^[10]	61.11	25.00	47.92	77.78	33.33	55.00	49.36	C
AASM2007^[11]	91.67	63.89	56.25	66.67	39.58	73.33	63.14	A
AASM2008^[12]	100.00	44.44	64.58	72.22	37.50	80.00	66.03	A
AASM2009^[13]	61.11	41.67	54.17	66.67	66.67	80.00	61.86	A
CSOHNS 2009^[29]	33.33	0	10.42	63.89	33.33	20.00	23.40	D
CTS2011^[41]	100.00	44.44	48.96	66.67	64.58	75.00	63.78	A
CMA-CTS2012^[30]	44.44	11.11	6.25	66.67	54.17	30.00	30.13	D
ACP2013^[14]	100.00	44.44	60.42	97.22	39.58	90.00	69.87	A
ACP2014^[15]	100.00	50.00	64.58	97.22	64.58	90.00	75.64	A
ASA2014^[16]	66.67	58.33	80.21	72.22	14.58	53.33	59.94	B
INOSA2015^[39]	44.44	50.00	38.54	72.22	54.17	80.00	54.81	B
AASM-AADSM2015^[17]	100.00	75.00	89.58	94.44	47.92	100.00	85.26	A
CMA2015^[31]	55.56	41.67	7.29	63.89	43.75	30.00	33.33	C
DG-HNO-KHC2016^[37]	50.00	38.89	65.63	72.22	37.50	80.00	59.94	B
SASM2016^[18]	100.00	61.11	75.00	97.22	62.50	100.00	81.73	A
AASM2017^[19]	100.00	58.33	75.00	86.11	70.83	76.67	76.92	A
ASMBS017^[20]	94.44	69.44	75.00	100.00	54.17	66.67	74.68	A
AASM-2017^[21]	66.67	66.67	15.63	38.89	54.17	60.00	44.55	B
SASM2018^[22]	100.00	55.56	75.00	72.22	43.75	90.00	73.40	A
CMDA2018^[32]	75.00	66.67	41.67	72.22	31.25	35.00	49.04	B
ATS2018^[23]	100.00	97.22	81.25	94.44	68.75	60.00	80.77	A
CMA-2018^[33]	58.33	55.56	9.38	66.67	52.08	55.00	42.31	C
AASM2019^[24]	72.22	83.33	67.71	88.89	68.75	60.00	71.15	A
VA-DoD2020^[25]	77.78	77.78	65.63	72.22	72.92	66.67	70.51	A
NICE2021^[43]	100.00	58.33	31.25	100.00	62.50	43.33	57.37	C
RRSDI2021^[40]	88.89	63.89	16.67	63.89	64.58	50.00	49.68	A
JRS2021^[42]	100.00	100.00	86.46	75.00	68.75	100.00	88.14	A
AASM2021^[26]	63.89	66.67	25.00	58.33	50.00	75.00	51.60	B
AASM-2021^[27]	69.44	100.00	79.17	58.33	64.58	88.33	77.56	A
ERS2021^[44]	100.00	100.00	85.42	83.33	87.50	100.00	91.67	A
GSDSM2022^[38]	66.67	75.00	72.92	38.89	70.83	80.00	69.55	A
SFORL2022^[34]	75.00	58.33	75.00	83.33	39.58	85.00	70.51	A
USPSTF2022^[28]	88.89	83.33	75.00	80.56	54.17	100.00	79.81	A
SPLF2010^[35]	100.00	66.67	57.29	72.22	37.50	30.00	56.73	B
SPLF2014^[36]	83.33	72.22	82.29	94.44	64.58	40.00	71.79	A

Guideline	Domain						Total score/%	Recommended level
Guideline	Scope and purpose/%	Stakeholder involvement/%	Rigor of development/%	Clarity of presentation/%	Applicability/%	Editorial independence/%	Total score/%	Recommended level
Mean score (x±s)	79.68±20.38	60.71±22.87	56.07±25.89	75.63±15.61	53.57±15.52	68.52±23.25	63.60±16.45	‒
AASM2006^[10]	61.11	25.00	47.92	77.78	33.33	55.00	49.36	C
AASM2007^[11]	91.67	63.89	56.25	66.67	39.58	73.33	63.14	A
AASM2008^[12]	100.00	44.44	64.58	72.22	37.50	80.00	66.03	A
AASM2009^[13]	61.11	41.67	54.17	66.67	66.67	80.00	61.86	A
CSOHNS 2009^[29]	33.33	0	10.42	63.89	33.33	20.00	23.40	D
CTS2011^[41]	100.00	44.44	48.96	66.67	64.58	75.00	63.78	A
CMA-CTS2012^[30]	44.44	11.11	6.25	66.67	54.17	30.00	30.13	D
ACP2013^[14]	100.00	44.44	60.42	97.22	39.58	90.00	69.87	A
ACP2014^[15]	100.00	50.00	64.58	97.22	64.58	90.00	75.64	A
ASA2014^[16]	66.67	58.33	80.21	72.22	14.58	53.33	59.94	B
INOSA2015^[39]	44.44	50.00	38.54	72.22	54.17	80.00	54.81	B
AASM-AADSM2015^[17]	100.00	75.00	89.58	94.44	47.92	100.00	85.26	A
CMA2015^[31]	55.56	41.67	7.29	63.89	43.75	30.00	33.33	C
DG-HNO-KHC2016^[37]	50.00	38.89	65.63	72.22	37.50	80.00	59.94	B
SASM2016^[18]	100.00	61.11	75.00	97.22	62.50	100.00	81.73	A
AASM2017^[19]	100.00	58.33	75.00	86.11	70.83	76.67	76.92	A
ASMBS017^[20]	94.44	69.44	75.00	100.00	54.17	66.67	74.68	A
AASM-2017^[21]	66.67	66.67	15.63	38.89	54.17	60.00	44.55	B
SASM2018^[22]	100.00	55.56	75.00	72.22	43.75	90.00	73.40	A
CMDA2018^[32]	75.00	66.67	41.67	72.22	31.25	35.00	49.04	B
ATS2018^[23]	100.00	97.22	81.25	94.44	68.75	60.00	80.77	A
CMA-2018^[33]	58.33	55.56	9.38	66.67	52.08	55.00	42.31	C
AASM2019^[24]	72.22	83.33	67.71	88.89	68.75	60.00	71.15	A
VA-DoD2020^[25]	77.78	77.78	65.63	72.22	72.92	66.67	70.51	A
NICE2021^[43]	100.00	58.33	31.25	100.00	62.50	43.33	57.37	C
RRSDI2021^[40]	88.89	63.89	16.67	63.89	64.58	50.00	49.68	A
JRS2021^[42]	100.00	100.00	86.46	75.00	68.75	100.00	88.14	A
AASM2021^[26]	63.89	66.67	25.00	58.33	50.00	75.00	51.60	B
AASM-2021^[27]	69.44	100.00	79.17	58.33	64.58	88.33	77.56	A
ERS2021^[44]	100.00	100.00	85.42	83.33	87.50	100.00	91.67	A
GSDSM2022^[38]	66.67	75.00	72.92	38.89	70.83	80.00	69.55	A
SFORL2022^[34]	75.00	58.33	75.00	83.33	39.58	85.00	70.51	A
USPSTF2022^[28]	88.89	83.33	75.00	80.56	54.17	100.00	79.81	A
SPLF2010^[35]	100.00	66.67	57.29	72.22	37.50	30.00	56.73	B
SPLF2014^[36]	83.33	72.22	82.29	94.44	64.58	40.00	71.79	A

Guideline	Section							Total reporting rate/%	General level
Guideline	Basic information/%	Background/%	Evidence/ %	Recommendations/%	Review and quality assurance/%	Funding and declaration and management of interests/%	Other information/%	Total reporting rate/%	General level
Mean reporting rate (x±s)	73.81±16.81	85.36± 18.56	60.60±31.99	69.80± 27.23	31.40± 45.51	56.43± 33.95	56.19±36.85	67.84±20.03	‒
AASM2006^[10]	50.00	87.50	60.00	85.71	0	25.00	100.00	65.71	Moderate
AASM2007^[11]	66.67	87.50	60.00	71.43	50.00	50.00	33.33	65.71	Moderate
AASM2008^[12]	83.33	87.50	60.00	57.14	0	50.00	33.33	62.86	Moderate
AASM2009^[13]	83.33	87.50	60.00	57.14	0	50.00	33.33	62.86	Moderate
CSOHNS2009^[29]	50.00	12.50	0	14.29	0	0	0	14.29	Low
CTS2011^[41]	83.33	75.00	100.00	71.43	0	100.00	66.67	77.14	High
CMA-CTS2012^[30]	83.33	62.50	0	28.57	0	0	0	34.29	Low
ACP2013^[14]	83.33	100.00	80.00	85.71	0	100.00	66.67	82.86	High
ACP2014^[15]	83.33	100.00	100.00	85.71	0	50.00	33.33	77.14	High
ASA2014^[16]	66.67	62.50	60.00	57.14	100.00	50.00	66.67	62.86	Moderate
INOSA2015^[39]	66.67	100.00	60.00	42.86	0	50.00	33.33	60.00	Moderate
AASM-AADSM2015^[17]	100.00	87.50	80.00	100.00	100.00	50.00	100.00	88.57	High
CMA2015^[31]	66.67	100.00	0	28.57	0	0	33.33	42.86	Moderate
DG-HNO-KHC2016^[37]	83.33	50.00	60.00	28.57	0	50.00	66.67	51.43	Moderate
SASM2016^[18]	83.33	100.00	80.00	100.00	0	75.00	100.00	85.71	High
AASM2017^[19]	83.33	100.00	100.00	100.00	0	75.00	100.00	88.57	High
ASMBS017^[20]	83.33	100.00	80.00	85.71	0	100.00	100.00	85.71	High
AASM-2017^[21]	66.67	87.50	0	57.14	0	75.00	0	51.43	Moderate
SASM2018^[22]	83.33	87.50	80.00	71.43	0	75.00	66.67	74.29	High
CMDA2018^[32]	66.67	87.50	60.00	42.86	0	0	0	48.57	Moderate
ATS2018^[23]	83.33	87.50	100.00	85.71	100.00	50.00	66.67	82.86	High
CMA-2018^[33]	83.33	62.50	0	14.29	0	25.00	0	34.29	Low
AASM2019^[24]	83.33	87.50	80.00	100.00	50.00	50.00	33.33	77.14	High
VA-DoD2020^[25]	100.00	100.00	80.00	85.71	0	75.00	66.67	82.86	High
NICE2021^[43]	16.67	62.50	40.00	57.14	0	0	33.33	37.14	Low
RRSDI2021^[40]	66.67	87.50	0	57.14	100.00	100.00	66.67	65.71	Moderate
JRS2021^[42]	66.67	100.00	80.00	100.00	100.00	100.00	33.33	85.71	High
AASM2021^[26]	83.33	87.50	40.00	85.71	0	50.00	100.00	71.43	High
AASM-2021^[27]	83.33	87.50	60.00	100.00	100.00	100.00	100.00	88.57	High
ERS2021^[44]	66.67	100.00	100.00	100.00	100.00	100.00	100.00	94.29	High
GSDSM2022^[38]	83.33	87.50	80.00	85.71	100.00	75.00	33.33	80.00	High
SFORL2022^[34]	66.67	100.00	60.00	85.71	100.00	75.00	100.00	82.86	High
USPSTF2022^[28]	83.33	100.00	80.00	85.71	0	100.00	100.00	85.71	High
SPLF2010^[35]	33.33	75.00	60.00	28.57	0	0	0	37.14	Low
SPLF2014^[36]	66.67	100.00	80.00	100.00	100.00	50.00	100.00	85.71	High

全球阻塞性睡眠呼吸暂停指南质量评价

Quality assessment of global obstructive sleep apnea guidelines

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Metrics

Evaluation	MD (95%CI)
Evaluation	American Region vs European Region	P value	American Region vs Asian Region	P value	European Region vs Asian Region	P value
AGREE Ⅱ
Scope and Purpose	0.04 (-0.12‒0.19)	0.637	0.23 (0.07‒0.39)	0.005	0.20 (-0.05‒0.44)	0.104
Stakeholder involvement	-0.04 (-0.21‒0.14)	0.660	0.15 (-0.05‒0.35)	0.142	0.18 (-0.11‒0.48)	0.203
Rigour of development	-0.03 (-0.20‒0.13)	0.688	0.37 (0.13‒0.61)	0.000	0.40 (0.13‒0.67)	0.007
Clarity of presentation	0.00 (-0.16‒0.16)	0.986	0.10 (0.02‒0.18)	0.021	0.10 (-0.09‒0.28)	0.252
Applicability	-0.03 (-0.18‒0.11)	0.632	0.03 (-0.09‒0.16)	0.591	0.07 (-0.12‒0.25)	0.435
Editorial independence	0.12 (-0.14‒0.37)	0.319	0.27 (0.10‒0.44)	0.003	0.15 (-0.15‒0.46)	0.295
Total Score	0.01 (-0.10‒0.11)	0.898	0.23 (0.10‒0.35)	0.010	0.22 (0.03‒0.41)	0.026
RIGHT
Basic information	0.21 (-0.02‒0.45)	0.068	0.12 (0.02‒0.22)	0.015	-0.09 (-0.33‒0.14)	0.395
Background	0.08 (-0.11‒0.27)	0.356	0.13 (-0.12‒0.39)	0.245	0.06 (-0.24‒0.35)	0.686
Evidence	0.03 (-0.17‒0.24)	0.735	0.47 (0.17‒0.77)	0.006	0.44 (0.12‒0.75)	0.011
Recommendations	0.12 (-0.17‒0.41)	0.361	0.40 (0.23‒0.57)	0.000	0.28 (-0.05‒0.61)	0.087
Review and quality assurance	-0.32 (-0.72‒0.08)	0.113	0.00 (-0.37‒0.37)	1.000	0.32 (-0.23‒0.88)	0.234
Funding and declaration and management of interests	0.18 (-0.07‒0.42)	0.159	0.33 (-0.04‒0.71)	0.077	0.16 (-0.31‒0.62)	0.480
Other information	0.06 (-0.24‒0.37)	0.669	0.47 (0.22‒0.73)	0.001	0.41 (0.04‒0.78)	0.032
Total reporting rate	0.09 (-0.13‒0.31)	0.373	0.28 (0.09‒0.47)	0.009	0.19 (-0.07‒0.45)	0.142

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