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Journal of Evaluation in Clinical Practice ISSN 1365-2753

Central Auditory Processing Disorder: a systematic search

and evaluation of clinical practice guidelines
Chyrisse Heine PhD1 and Robyn O’Halloran PhD2
1
Senior Lecturer, 2Lecturer, Discipline of Speech Pathology, Department of Community & Clinical Allied Health, School of Allied Health, College of
Science, Health and Engineering, La Trobe University, Bundoora, Vic, Australia

Keywords Abstract
clinical guidelines, evaluation, systematic
reviews Rationale, aims and objectives An increased interest in Central Auditory Processing
Disorder has seen the publication of several guidelines to help inform clinical practice. The
Correspondence aim of this study was to conduct a systematic search and critically evaluate published
Dr Chyrisse Heine guidelines to inform the ongoing development of evidence-based practice in this area.
Discipline of Speech Pathology Method A systematic search of the literature was conducted according to the Preferred
Department of Community & Clinical Allied Reporting Items for Systematic Reviews guidelines. Nominated guidelines were then
Health critiqued using the Appraisal of Guidelines and Research and Evaluation (AGREE II) tool.
College of Science, Health and Engineering, Results Five clinical practice guidelines in the area of Central Auditory Processing Dis-
School of Allied Health order were identified. The British Society of Audiology guideline achieved the highest
La Trobe University rating for scope and purpose, rigour of development and applicability and overall score.
Bundoora, Vic 3086 Conclusions The AGREE II tool is an effective way to critically evaluate the quality of
Australia methodological reporting of clinical practice guidelines in the area of Central Auditory
E-mail: c.heine@latrobe.edu.au Processing Disorder and provides direction for the ongoing development of these guide-
lines in the future.
Accepted for publication: 12 November 2015
Acronyms and Abbreviations: Central Auditory Processing (CAP); Central Auditory Pro-
doi:10.1111/jep.12494 cessing Disorder (CAPD); Clinical practice guideline (CPG); Preferred Reporting Items for
Systematic Reviews (PRISMA); Appraisal of Guidelines and Research and Evaluation
(AGREE II).

individuals with deficiency in any of these processes are clinically

Introduction
Central Auditory Processing (CAP) and Central Auditory Process-
ing Disorder (CAPD) have been described and debated in the
literature over many years. However, there is currently no univer-
sally accepted definition of CAP and CAPD and no consensus
regarding assessment, diagnosis or treatment of this disorder. This
may be partly explained by the notion that it is a disorder that
transgresses multiple professional disciplines including audiology,
speech pathology and psychology.
One of the most quoted definitions of CAP and CAPD is by the
American Speech and Hearing Association (ASHA) [1] who
define CAP as ‘the auditory mechanisms that underlie the follow-
ing abilities or skills: sound localization and lateralization; audi-
tory discrimination; auditory pattern recognition; temporal aspects
of audition, including temporal integration, temporal discrimina-
tion (e.g. temporal gap detection), temporal ordering, and temporal
masking; auditory performance in competing acoustic signals
(including dichotic listening); and auditory performance with
degraded acoustic signals’ (p2). According to this definition,
diagnosed as having CAPD [1].
CAPD may be apparent throughout the lifespan, however, it is
of particular interest in the school-aged population since it is
associated with language deficits, impaired literacy acquisition
and generally poor academic performance [2–4]. The difficulty
diagnosing CAPD is elucidated in a recent study by Dawes and
Bishop [4] who investigated whether there was a difference in the
learning profiles of children with CAPD (n = 25) and those with
dyslexia (n = 19). Results of this study found that 52% of children
with CAPD would also fit a diagnosis of dyslexia or specific
language impairment or both.
The debate regarding CAPD goes beyond the issues related to
diagnosis, and includes the use of terminology, differences
in attribution of site-of-lesion, underlying mechanisms and
co-morbidity [5]. This lack of consensus has been recently high-
lighted in the British Society of Audiology (BSA) ‘white paper’ [6].
In an attempt to provide guidance to clinicians, different profes-
sional bodies such as the American Academy of Audiology (AAA)
[7], the Canadian Interorganizational steering group for speech

988 Journal of Evaluation in Clinical Practice 21 (2015) 988–994 © 2015 John Wiley & Sons, Ltd.
C. Heine and R. O‘Halloran
language pathology and audiology [8] and the BSA [9,10] have
published position statements or practice guidelines on CAPD. The
recommendations in these positions statements and practice guide-
lines also vary and it remains unclear which statement or guideline
clinicians should use to inform clinical practice. For example, the
AAA [7] reported that CAPD ‘can be the result of a number of
different etiologies that involve deficits in the function of the central
auditory nervous system (CANS)’ (p3) and that the diagnosis of
CAPD ‘should be made by audiologists who have been properly
educated and trained in the area’ (p5). In contrast, the BSA [9]
concluded that CAPD is ‘closely associated with impaired top-
down, cognitive function. There is no evidence that it is produced by
a primary, sensory disability’(p6).
One reason for the variability in the recommendations of these
practice guidelines may be in how they were developed. Ideally,
clinical practice guidelines are ‘statements that include recommen-
dations intended to optimize patient care that are informed by a
systematic review of evidence and an assessment of the benefits
and harms of alternative care options’ [ [11], p1]. When clinical
practice guidelines are based on a systematic search of the research
evidence, they provide clinicians with a high level of synthesized
research evidence that enables them and their clients to make more
informed decisions about clinical care [12]. However, not all clini-
cal practice guidelines are of a high quality and different appraisal
tools have been developed over the years to discriminate high
quality guidelines from low quality ones [13]. In a systematic
review of these appraisal tools, Vlayen and colleagues [13] con-
cluded that the Appraisal of Guidelines and Research and Evalu-
ation (AGREE) instrument [14] should be used to appraise clinical
practice guidelines because it is the only tool that has been vali-
dated, is easy to use, has been internationally developed and was
therefore widely accepted [13]. Further revisions were made to the
AGREE instrument resulting in the publication of the AGREE II
tool in 2010 [15] which was updated again in 2013 (see http://
www.agreetrust.org/). Detailed information about the history of
the development of the AGREE tool, modifications to the AGREE
II tool, psychometric properties and translations can be found on
the AGREE website [16] and has been used to review the quality
of clinical practice guidelines across a wide range of topics includ-
ing the management of aphasia after stroke [17] acute pain in
paediatrics [18] and alcohol and drug misuse in adolescents [19].
The development of this valid, internationally accepted appraisal
tool provides the opportunity to evaluate the quality of current
clinical practice guidelines in the area of CAPD and provide direc-
tion for the ongoing development of research evidence in this area.
Thus, the aim of this study was to conduct a systematic search of
the literature for clinical practice guidelines related to the assess-
ment and management of CAPD and to critique these guidelines
using the AGREE II tool.
Methods and materials
Evidence acquisition
The literature identification and selection procedure was based on
the Preferred Reporting Items for Systematic Reviews [20]. Spe-
cifically, a systematic search of the literature was conducted in the
months from June 2013 until December 2013. Another search was
also conducted in October 2015 for any new CPGs (clinical practice
© 2015 John Wiley & Sons, Ltd.
CAPD: an evaluation of clinical practice guidelines
guidelines) that may have been published in 2014 or 2015. Search
terms were generated to include the concepts of population and
publication type. Population search terms included central auditory
processing disorder OR auditory processing disorder OR auditory
processing OR central auditory processing OR perceptual disor-
ders. The publication type search terms were practice guideline,
clinical guideline, clinical practice guideline, position statement or
systematic review. Eight databases were searched including
MEDLINE, Informit health, CINAHL, EMBASE, Cochrane
Library, PsycINFO, Health & Medical Complete (ProQuest) and
Web of Science. An internet search using Google Scholar was also
conducted. In addition, searches were made of the following six
association websites; American Speech and Hearing Association,
American Academy of Audiology, Royal College of Speech and
Language Therapists (UK), British Society of Audiology, Speech
Pathology Australia, Audiological Society of Australia and 10
guideline databases; National Health and Medical Research
Council of Australia Clinical Practice Guidelines Portal, Medical
Journal of Australia Clinical Guidelines, New Zealand Guideline
Group, National Institute for Health and Clinical Excellence (UK),
Scottish Intercollegiate Guidelines Network, International Guide-
line Library (Guidelines International Network), CMA Infobase:
Clinical Practice Guidelines (Canadian Medical Association),
National Guideline Clearinghouse (US) and Compendium of EBP
Guidelines & Systematic Reviews (ASHA)].
Inclusion criteria and selection process
Following a similar study conducted by Rohde and colleagues
[17], documents were included in this appraisal if they met the
following four criteria. These were that the document: (i) met the
definition of a CPG as defined by Field and Lohr [21]. That is, that
the document included ‘systematically developed statements to
assist practitioner and patient decisions about appropriate
healthcare for specific clinical circumstances (p2); (ii) addressed
the topic of assessment, diagnosis, prognosis or management of
CAP or CAPD in children and/or adults; (iii) related to audiology,
speech pathology or multidisciplinary practice in the area of
CAPD; and (iv) were published in or translated into English.
The authors and the research assistant are experienced in the
field of evidence-based practice and speech pathology. Addition-
ally, the first author and the research assistant are experienced in
the field of audiology. Following a discussion regarding search
terms, inclusion and exclusion criteria, the first author conducted
the initial search of the databases. The first author and research
assistant then independently screened the initial yield on the basis
of title and summary removing duplicates and any other docu-
ments that did not meet all four criteria described above. Then the
two authors independently read the full text of the remaining 10
documents and independently decided if they should be included
in the appraisal. Throughout the search history, disagreements
were resolved through consensus.
Appraisal using the AGREE II
The AGREE II [15] comprises 23 items that are categorized into
six separate domains. The six domains and the number of items
used to rate each domain are: Scope and purpose (3 items); Stake-
holder involvement (3 items); Rigour of development (8 items);
989
CAPD: an evaluation of clinical practice guidelines C. Heine and R. O‘Halloran

Clarity of presentation (3 items); Applicability (4 items); and Edi-

torial independence (2 items). Each of the 23 items addresses a Records identified through library database
searching, Google search, guideline
different aspect of guideline quality. In addition, the AGREE II
database and professional association
also includes two assessment items to rate the overall quality of the websites, (n = 126)
guideline and provide direction as to whether or not the guideline
is recommended for use [16]. To rate a clinical practice guideline
using the AGREE II, each reviewer independently reads the clini-
cal practice guideline and any relevant supplementary material and
then rates the guideline on each of the 23 items using the 7-point Records after duplicates removed
(n = 112)
Likert scale that ranges from 1 (strongly disagree) to 7 (strongly
agree). Where information in the clinical practice guideline was
unclear, the researchers contacted the guideline authors for further
information. Once each reviewer has independently rated the Screening by title and
guideline, the quality score for each domain is calculated. This is abstract Records excluded as:
determined by adding up all the reviewers’ scores on each item in (n = 112) not a CPG (n = 2), out of
scope (n = 99); not in
each domain and then calculating the quality domain score as a
English (n=1).
percentage of the maximum domain score possible. A fictional Total excluded
worked example of calculating the quality domain score of Scope (n = 102)
and Purpose is provided in Appendix A. Each quality domain score
is reported separately and is distinct from other domain scores
[14]. Finally, each reviewer considers how well the clinical prac-
tice guideline rated on each of the 23 items to make an overall
judgement on the quality of the clinical practice guideline again on
a 7-point scale from (1), lowest possible quality, to (7), highest Screening of full-text Full-text articles
articles excluded, not CPGs
possible quality, and states whether the clinical practice guideline
(n = 10) (n = 4)
is recommended for use, recommended for use with modifications
or not recommended.

Results
The literature search yielded 126 documents. A total of 14 docu-
ments were removed due to duplication. A further 102 articles
were excluded as they were not consistent with the definition of
clinical practice guideline (n = 2), not related to CAPD (n = 99) or
not published in or translated into English (n = 1). Both authors
reviewed the full text of the remaining 10 documents. A further
four documents were removed as they too were not consistent with
the definition of clinical practice guideline on close reading. The
six remaining documents that were included in this evaluation
were the (i) AAA Clinical Practice Guidelines [7]; (ii) American
Speech and Hearing Association (ASHA) (Central) Auditory Pro-
cessing Disorders technical report [1]; (iii) BSA, Position State-
ment Auditory Processing Disorder (APD) [9]; (iv) Canadian
guidelines on auditory processing disorder in children and adults:
Assessment and Intervention [8]; (v) Colorado Department of
Education, Auditory Processing Disorders: A team approach to
screening, assessment & intervention practices [22]; and (vi) the
BSA Practice Guidance. An overview of current management of
auditory processing disorder (APD) [10]. Details of the search
results are provided in Fig. 1.
How the six guidelines were rated by the two raters on each item
of the AGREE II is presented in Table 1 below. A summary of the
calculated quality domain scores of the five guidelines is presented
in Table 2.
As is evident from Table 2, the quality domain scores for stating
the Scope and Purpose of the guideline ranged from 50% (for the
BSA Position Guidance guideline) to below 20% (for the Colorado
and ASHA guidelines). Similarly, domain scores for Stakeholder
involvement ranged from 41.6% for the Canadian guideline to
Studies included in
review
(n = 6)
Figure 1 Flow chart illustrating the literature search and selection
process.
19.4% for the AAA guideline. In regards to Rigour of develop-
ment, there was a big gap between the two BSA guidelines (which
both received a score of around 45%) and the other guidelines
(Canadian, AAA, Colorado and ASHA) which all received a score
around 10–11%. Clarity of presentation scores ranged from a
score of 63.8% for the BSA Clinical Guidance guideline to a low
score of 19.4% for the Colorado guideline. In the domain of
Applicability, all guidelines scored under 30% with the British
Position Statement guideline scoring the highest (27.1%), fol-
lowed by the AAA guideline (with a score of 22.9%), the BSA
Clinical Guidance guideline scoring 20.8%, the Colorado and
Canadian guidelines equally scoring 12.5% and the ASHA guide-
line scoring the lowest value of 8.3%. Again, all guidelines
received a low score (under 10%) for Editorial independence with
the Colorado, AAA, ASHA and Canadian guidelines all receiving
a score of 8.3% and the British Clinical Guidance guideline receiv-
ing a score of 0% in this area. In general, guideline ratings in most
domains were low (with the highest rating in a domain around
63.8%), primarily due to poor methodological reporting.

990 © 2015 John Wiley & Sons, Ltd.

C. Heine and R. O‘Halloran CAPD: an evaluation of clinical practice guidelines

In terms of the overall quality of the guidelines, the BSA Posi-

Independence
tion Statement guideline was rated highest with a rating of 5 out of

23

1
1
1
1
1
1
1
1
1
1
1
1
Editorial 7. Strengths of the BSA Position Statement guideline included that
the objectives were well-described (item 1), development groups
22 were consulted (item 4), systematic methods were used to develop
3
1
3
1
2
1
3
1
3
1
1
1
the position statement (item 7), the strengths and limitations of the
guideline were clearly described (item 9) and specific recommen-
21

1
1
1
1
1
1
2
1
2
1
2
1
dations were provided (item 15). The second highest rated guide-
lines were the Canadian guideline and British Clinical Guidance
20

5
1
2
1
2
2
1
1
1
1
3
1
guideline, both receiving a quality rating of 4 out of 7. The Cana-
dian guideline was extensive and included a multidisciplinary
Applicability

19

approach to diagnosis and management. In particular, high ratings

5
1
2
1
6
7
3
1
4
2
5
3
were given to the following items: that the target users were clearly
18

defined (item 6), procedures for updating the guideline were pro-
3
2
3
1
1
1
3
2
2
1
2
1
vided (item 14) and that specific recommendations were provided
(item 15). The British Clinical Guidance guideline was clearly
17

3
1
1
1
2
3
2
1
2
1
5
5 written and included a reference to evidence-based practice. High
Presentation

ratings were obtained for specifically describing the overall objec-

16
Clarity of

3
3
3
2
5
6
6
5
4
2
6
6

tives of the guideline (item 1), clearly describing the criteria for the
evidence (item 8) and clearly presenting options for management
15

4
2
3
2
4
4
6
5
3
1
4
3

of the health issue (item 16). The remaining guidelines received a

quality rating score of 2 out of 7. These guidelines provided more
14

general descriptive information with little or no information on

2
1
2
2
3
4
3
5
2
1
3
5

how the guideline would be updated and little detail relating to

13

other disciplines involved in CAPD assessment and management.

1
1
1
1
1
1
1
3
1
1
4
4

Whilst none of the reviewed guidelines were recommended for

12

use in their current form, there were three guidelines that were
3
2
3
1
6
4
1
1
3
1
3
2

recommended for use with modification. These were the British

Society of Audiology (BSA), Position statement auditory process-
11

3
1
1
1
1
3
1
1
3
1
3
5

ing disorder (APD) [9], Canadian guidelines on auditory process-

Rigour of Development

ing disorder in children and adults: Assessment and Intervention

10

3
1
3
2
2
2
1
1
2
1
2
1

AAA, American Academy of Audiology; ASHA, American Speech and Hearing Association.

[8] and the British Society of Audiology (BSA) Practice Guidance.

An overview of current management of auditory processing dis-
9

1
1
2
1
7
5
2
1
2
1
3
4

order (APD) [10].

8

1
1
2
1
5
3
2
1
2
1
6
6

Discussion
7

3
1
2
1
7
6
2
1
3
1
4
4

This is the first study that we are aware of that systematically

searches and critiques clinical practice guidelines on CAPD.
6

2
3
3
5
3
3
7
5
4
3
4
6

Whilst the BSA Position Statement guideline received the highest

involvement
Stakeholder

overall rating on the AGREE II, this critique also highlighted areas
5

1
1
1
1
1
1
1
1
1
1
1
1

where the guideline could be improved. For example, whilst the

level of evidence supporting some BSA Position Statement guide-
4

3
3
3
2
5
5
4
3
4
4
5
3
Table 1 Item rating of each guideline by each rater

line recommendations are clearly stated, some recommendations

are made (such as the use of auditory training as a management
3

6
4
2
1
3
5
4
4
3
2
3
3

option) without reference to supporting levels of evidence.

Scope and

Furthermore, this guideline only briefly defined CAPD and did not
Purpose

2
1
2
1
2
2
1
1
1
2
3
4

transparently describe the stakeholders involved in the develop-

ment of the guideline. Therefore, this guideline was recommended
1

2
2
3
2
6
5
3
4
3
2
5
6

for use with modification. Suggested modifications include refer-

ence to the level of evidence for all management recommenda-
Domain

1
2
1
2
1
2
1
2
1
2
1
2
Rater
Rater
Rater
Rater
Rater
Rater
Rater
Rater
Rater
Rater
Rater
Rater

tions, inclusion of stakeholder information and providing a more

Item

comprehensive definition of CAPD.

The Canadian and British Clinical Guidance guidelines received
British Position

the second highest score for methodological quality and were also
British Clinical
Statement

recommended for use with modification. The Canadian guideline

Guidance
Guideline

Canadian

Colorado

was extensive, derived from the input of multiple societies reflect-

ASHA

ing a multidisciplinary approach, and included the management of

AAA

CAPD. However, it did not provide levels of evidence to support

© 2015 John Wiley & Sons, Ltd. 991

CAPD: an evaluation of clinical practice guidelines
Table 2 Clinical practice guideline domain scores on the AGREE II tool
Scope and Stakeholder Rigour of
Guideline Purpose Involvement Development
AAA 30.5% 19.4% 10.4%
ASHA 13.8% 25% 10.4%
British Position Statement 47.2% 33.3% 45.8%*
Canadian 30.5% 41.6%* 11.5%
Colorado 19.4% 30.5% 10.4%
British Clinical Guidance 50%* 38.8% 44.7%*
*Denotes highest rated guideline in the specific domain.
AAA, American Academy of Audiology; AGREE, Appraisal of Guidelines and Research and Evaluation; ASHA, American Speech and Hearing
Association.
the recommendations made and it did not include information on
how the guideline would be monitored and changed according to
developments in the research literature. The British Clinical Guid-
ance Guideline included a multidisciplinary approach with refer-
enced levels of evidence. Although this guideline was clearly
written and considered stakeholders, it was restricted in applica-
bility and did not clearly include the views of the funding body and
competing interests of members of the working party that devel-
oped the guideline. The three further guidelines (Colorado, ASHA
and AAA) were not recommended. Although the AAA guideline
does provide the level of evidence for each recommendation made
in the area of CAPD, it has only included audiologists as the
stakeholders with little consultation from other professional
groups who may be involved in the assessment and/ or manage-
ment of CAPD (item 5 on the AGREE II). Furthermore, whilst the
diagnostic process is extensively presented, the management of
CAPD is not covered in great detail, thus the supporting evidence
and recommendations in the management section is limited (items
8 and 9 on the AGREE II). It is unknown who comprised the
reference group and by whom this guideline was reviewed. There
is also no information available regarding recommendations and
how this guideline will be updated. The Colorado guidelines are
based on the ASHA (2005) guidelines and provide a comprehen-
sive but descriptive overview of tests, checklists and treatment
options for CAPD. This guideline has not been peer reviewed and
thus received a low rating on items 5, 13 and 23 on the AGREE II.
Much of the information contained in this guideline is, however, of
clinical value. Since none of the recommendations of this guide-
line are directly linked to research evidence, it is not possible to
judge the strength of the clinical recommendations provided in the
guideline. Similarly, the 2005 ASHA [1] position statement, based
on the 1996 publication by ASHA [23] is an important landmark
compilation of information regarding the clinical assessment and
management of CAPD. Even though it does not purport to be a
guideline, it was included in this review because it met the inclu-
sion criteria. As a position statement supplying technical support,
this document is the initial platform on which other documents
have been based and has allowed for fruitful discussion and further
research in the area of CAPD. A recognized limitation of this study
is that guidelines in languages other than English were not
included in this study.
The implication of the finding that most of the domains scored
below 50% suggests that there are many criteria considered impor-
992
C. Heine and R. O‘Halloran
Combined
Clarity of Editorial Overall
Presentation Applicability Independence Rating
27.7% 22.9% 8.3%* 2/7
33.3% 8.3% 8.3%* 2/7
50% 27.1%* 4.1% 5/7
52.7% 12.5% 8.3%* 4/7
19.4% 12.5% 8.3%* 2/7
63.8%* 20.3% 0% 4/7
tant in the AGREE II tool that are not included in the CPGs on
CAPD that are currently available. The AGREE II tool highlighted
some areas where all CPGs in CAPD could be improved. For
example, at present there is very little consultation with target
population groups (such as medical professionals, teachers, people
with CAPD and their families) to inform the development of
CPGs. Inclusion of a wide array of stakeholders can add to the
credibility of the CPG. Explicit and consistent reporting of the
level of research evidence supporting guideline recommendations,
external review by experts and the reporting of any competing
interests of groups members involved in the development of the
CPG would also enhance the credibility of all CPGs in this area.
Further areas in which the CPGs received low ratings included that
the health question was not specifically outlined and that the
methods for formulating recommendations were not clearly
described.
Conclusions
The AGREE II tool is a useful tool to compare different clinical
practice guidelines across a range of different domains. However,
as stated by Vlayen and colleagues [13], like all appraisal tools
developed to assess the quality of CPGs, the AGREE II tool
provides a way to critique the methodological quality of CPGs but
it does not provide a way to assess the clinical content of CPGs or
the quality of the research evidence informing the recommenda-
tions [13]. That is, a CPG could have a very high rating on the
AGREE II tool even though the research evidence is of very low
quality (for example, all expert opinion) and the clinical recom-
mendations are of little value. Therefore, whilst a high AGREE II
rating suggests the CPG has been developed with a high degree of
methodological rigour, judgment is still required to determine the
clinical value of the recommendations that are made.
The AGREE II tool provides a structure and direction for the
ongoing development of guidelines in the area of CAPD, particu-
larly in encouraging explicit linking of research evidence to
support recommendations. Well-written CPGs also provide direc-
tion for further research where there is a lack of research evidence
or conflicting research evidence. The development of high-quality
CPGs is essential, particularly in a field such as CAPD, which is
surrounded by different professional opinions. The availability of
CPGs in the area of CAPD may encourage clinicians to refer to
and implement them.
© 2015 John Wiley & Sons, Ltd.
C. Heine and R. O‘Halloran
Thus, whilst there are a few guidelines available in the area of
CAPD, there is no one standout guideline that in its present form,
without modification, successfully meets the six criteria of the
AGREE II tool. The BSA Position Statement guideline did,
however, receive the highest score and was recommended with
modification. The results of this review have identified the need for
ongoing development of CPGs in the area of CAPD so that clini-
cians can be better informed of evidence-based procedures and
practices when assessing and managing their clients with CAPD.
The AGREE II tool is useful to evaluate guidelines and can serve
as a tool to guide further guideline development in the area of
CAPD.
Acknowledgement
Ms Liora Symons is acknowledged for her contribution to the
updated database search.
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CAPD: an evaluation of clinical practice guidelines C. Heine and R. O‘Halloran

Appendix A
A (fictitious) worked example of calculating the domain score for the Domain: Scope and Purpose.
Item 2: The health ques- Item 3: The population to
Item 1: The overall objec- tions covered by the guide- whom the guideline is
tives of the guideline are line are specifically meant to apply is specifi-
specifically described. described. cally described. Total

Appraiser 1 2 2 6 10
Appraiser 2 2 1 4 7
Total 4 3 10 17

Maximum possible score = 7 (strongly agree) × 3 (items) × 2 (appraisers) = 42

Minimum possible score = 1 (strongly disagree) × 3 (items) × 2 (appraisers) = 6
The scaled domain score will be:
Obtained score – Minimum possible score
Maximum possible score – Minimum possible score

994 © 2015 John Wiley & Sons, Ltd.

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