Post-traumatic stress disorder (PTSD) guidelines review report

Post-traumatic stress

disorder (PTSD) guidelines review

report

July 2013

Contents

Executive Summary

Working Group Members

Project Support

Background

Introduction

Purpose

Methodology

Stage 1: Establishing working group

Stage 2: Undertaking the literature review

Stage 3: AGREE II survey development

Stage 4: Guideline review

Stage 5: Data analysis and results

Data definitions

5.1 Step A: AGREE II survey items

5.1.1 Comparing the rating average scores of the guidelines

5.1.2 Comparing mean, median and mode for the guidelines reviewed

5.1.3 Comparing average rating scores of guidelines for each domain

5.1.4 Comparing average rating scores of domains in each guideline

5.1.5 Comparing the rating average scores for AGREE II items for PTSD guidelines

5.2 Step B: Overall assessment

5.2.1 Comparing the overall quality of the guidelines

5.2.2 Percentage of reviewers recommending the guideline/s for use

Conclusion – Limitations of process

References

Appendices

1. PTSD Guidelines survey report

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Executive Summary

This report details the process, methodology and data analysis of the Post Traumatic Stress Disorder Clinical Guidelines Review Project.

The Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument formed a significant part of the appraisal process and was selected because of its ease of use as a standardized framework. AGREE II assesses the methodological rigour and transparency in which a guideline has been developed. The 23 key items in AGREE II are organized within 6 domains and each domain captures a unique dimension of the quality of the guideline.

It is worth acknowledging that the AGREE II tool focuses more strongly on certain aspects of guideline production such as breath of participation by consumers and carers and arguably less on scientific rigour of the guideline process. The reviewers also noted that the guidelines included were heterogenous in both the population of focus (e.g. veterans, military personnel) and the range of disorders for inclusion of PTSD. Given all these factors results are presented as raw data with simple descriptive statistics only. The following guidelines were reviewed:

1. Australian guidelines for the treatment of adults with Acute Stress Disorder and Posttraumatic Stress Disorder; Australian Centre for Posttraumatic Mental Health (ACPMH); 2013

2. Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder; Agency for Healthcare Research Quality (US Department of Health and Human Services (AHRQ); 2008

3. ‘The Last Frontier’ Practice guidelines for treatment of complex trauma and trauma informed care and service delivery; Adults Surviving Child Abuse (ASCA); 2012

4. The ISTSS Expert Consensus Treatment Guidelines For Complex PTSD In Adults; International Society for Traumatic Stress Studies (ISTSS); November 2012

5. Psychiatric Evaluation of Adults, Second Edition; American Psychiatric Association (APA) Practice Guidelines, November 2004 and a Guideline Watch; March 2009

6. VA/DoD clinical practice guideline for management of post-traumatic stress, Department of Veterans Affairs and Department of Defense ; October 2010

7. Effective treatments for PTSD: Second Edition; Practice guidelines from International Society for Traumatic Stress Studies (ISTSS); 2010

8. The management of PTSD in adults and children in primary and secondary care; National Institute for Clinical Excellence (NICE); March 2005

9. Management of Anxiety Disorder; Clinical practice guidelines; Canadian Journal of Psychiatry; Vol 51, Supplement 2 Chapter 8; July 2006

The conclusion of the working group is that all of the guidelines reviewed have utility and are appropriate for use. The Australian Centre for Posttraumatic Mental Health (ACPMH) guidelines are produced locally and this may be most relevant for the use in the Australian and New Zealand context. It is noteworthy that the evidence reviewed in all guidelines was broadly similar.

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Working Group Members

Professor Malcolm Hopwood (Chair)

Professor Alexander McFarlane (Sandy)

Professor Warwick Middleton

Professor Maurice Eisenbruch

Dr Brian White

Dr John Collier

Dr Man-Pui Eddie So

Dr Deborah Julie Wearne

Dr Bradley Ng

Mr Graham G. Roper (Consumer and Carer representative)

Ms. Janne McMahon (Consumer and Carer representative)

Mr Norm Wotherspoon (Consumer representative)

Mr Patrick Hardwick (Carer representative)

Project Support

Ms Joyce Goh, Manager Operations and Projects

Ms Rajneet Arora, Project Officer

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Background

Stressful life threatening events such as combat, interpersonal violence, traffic accidents, and disasters are a part of normal human experience. Occurrence of these events has long been associated with the onset of, or deterioration of mental health conditions. Amongst these conditions are those more specifically related to trauma including Posttraumatic Stress Disorder (PTSD). PTSD has historically been considered as one of the anxiety disorders but in most recent classification, DSM V it has been included in the new category Trauma and Stressor Related Disorders (APA 2013) that occurs following involvement in traumatic events which involve actual or threatened loss of life. The typical symptoms of PTSD include re-experiencing the traumatic event in the form of nightmares or flashbacks; hyper-arousal with symptoms such as anxiety, insomnia and irritability; together with the avoidance of reminders of the traumatic events. Symptoms of PTSD may vary dependent on the age, culture, and other challenges faced by the individual affected but are not necessarily different depending upon the nature of the trauma. PTSD is very frequently associated with comorbidities including depression and substance misuse.

PTSD has been discovered to be a relatively common disorder with recent Australian data suggesting a 12 month point prevalence in Australia of 6.4% (Slade et al, 2007). PTSD has also been shown to be associated with significant impairment of physical health, significant overall disability affecting areas such as relationship, employment and also is associated with the risk of tragic outcomes such as suicide (Kramer et, 1994).

Knowledge around the effective treatment for PTSD and related disorders has expanded dramatically since investigations began to evolve in the 1980s. This expansion has been reflected in the development of a broad range of international guidelines representing a range of interested organisations. In considering the approach of RANZCP to presenting a local prospective on treatment in this area, it was concluded that the most appropriate process was a review and summary of the utility of the existing guideline.

This was based on the principle that the College may be duplicating effort in producing RANZCP guidelines in all areas of mental health. After an initial scan to ascertain the existing guideline environment, it was decided that a Guideline Portal housed on the College website would be able to proactively provide psychiatrists with up-to-date, relevant information on appropriate practice without the financial and administrative burden of continual guideline development. This process has also been employed by the RANZCP in other therapeutic areas, including Adult ADHD and Self-harm.

Introduction

This report details the process and methodology used in the PTSD project.

The scope of this project initially was limited to guidelines on PTSD, however, it was then determined by the working group that the guidelines including Acute Stress Disorder (ASD) and Trauma and Complex PTSD should be included for review.

The Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument formed a significant part of the appraisal process and was selected because of its ease of use as a standardized framework that is applicable to all the above topic areas.

What is the AGREE II tool?

The Appraisal of Guidelines for Research & Evaluation II (AGREE II) is a tool that assesses the methodological rigour and transparency in which a guideline is developed. The purpose of the AGREE II is to provide a framework to:

assess the quality of guidelines;

provide a methodological strategy for the development of guidelines; and

inform what information and how information ought to be reported in guidelines. The AGREE II consists of 23 key items organized within 6 domains followed by 2 global rating items (“Overall Assessment”). Each domain captures a unique dimension of guideline quality.

Domain 1: Scope and Purpose is concerned with the overall aim of the guideline, the specific health questions, and the target population (items 1-3). Domain 2: Stakeholder Involvement focuses on the extent to which the guideline was developed by the appropriate stakeholders and represents the views of its intended users (items 4-6). Domain 3: Rigour of Development relates to the process used to gather and synthesize the evidence, the methods to formulate the recommendations, and to update them (items 7-14). Domain 4: Clarity of presentation deals with the language, structure, and format of the guideline (items 15-17). Domain 5: Applicability pertains to the likely barriers and facilitators to implementation, strategies to improve uptake, and resource implications of applying the guideline (items 18-21).

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Domain 6: Editorial Independence is concerned with the formulation of recommendations not being unduly biased with competing interests (items 22-23).

Overall assessment includes the rating of the quality of the guideline and whether the guideline would be recommended for use in practice.

Rating Scale Each of the AGREE II items and the two global rating items are rated on a 7-point scale (1–strongly disagree to 7–strongly agree).

Interpreting Domain Scores Although the domain scores are useful for comparing guidelines and will inform whether a guideline should be recommended for use, no minimum domain scores or patterns of scores have been set across domains to differentiate between high quality and poor quality guidelines. These decisions should be made by the user and guided by the context in which AGREE II is being used.

Overall Assessment Upon completing the 23 items, AGREE II users is required to provide 2 overall assessments of the guideline. The overall assessment requires the user to make a judgment as to the quality of the guideline, taking into account the criteria considered in the assessment process. The user is also asked whether he/she would recommend use of the guideline.

Purpose

The purpose of the PTSD project was to:

review and appraise existing Post-traumatic Stress Disorder (PTSD) guidelines using AGREE II to decide on the most appropriate guideline for Australian and New Zealand psychiatrists;

develop a factsheet based on the guideline endorsed to assist with implementation of the guidelines in an Australian and New Zealand context; and

develop a video to assist with implementation of the guidelines in an Australian and New Zealand context.

The PTSD project commenced in December 2012 and is due for its completion in August 2013.

Methodology

Stage 1: Establishing working group

Advertisements for Expressions of Interest from Fellows with expertise in Post-traumatic Stress Disorder (PTSD) were published in the College’s Psych-e bulletin and the College state branches’ bulletins. Expressions of interest were reviewed by the Committee for Therapeutic Intervention and Evidence Based Practice (CTIEBP) and ratified by the Practice and Partnerships Committee (PPC). Membership of the group was reported to the College Board via the PPC report.

The working group consisted of:

A Chair (nominated by the Chair CTIEBP)

Fellows of the College with specialist experience in the PTSD

Representatives from the community (people who have or have had lived experience of PTSD)

Representatives from the carer group (people in caring relationships with individuals who have or have had PTSD).

All members of the working group signed the College ‘Deed of Undertaking in Relation to Confidential Information and Conflict of Interest’.

The monthly meetings were held through teleconferences and WebEx.

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Stage 2: Undertaking the literature review

A literature search was conducted using the ‘Google’ search engine. The search terms included ‘guidelines for Post-traumatic Stress Disorder (PTSD)’, ‘guidelines for Acute Stress Disorder (ASD)’, ‘guidelines for Trauma and Complex PTSD’. The literature search identified nine national and international guidelines from a number of sources and all were selected for the guideline review process using AGREE II.

The selection criteria for guideline review, as developed by CTIEBP, included:

1. guidelines should be suitable for use in Australia and New Zealand or should have sufficient information attached to ensure they adhere to Australian standards

2. guidelines should be current (published within the last 5 years at the time of review)

3. the full guideline should be available to download with permission to link to the guideline portal

4. guidelines included in the portal should be from a reputable source (colleges, universities and standard bodies)

5. guidelines should be relevant to the practice of psychiatry, and will have been developed with input from consumers and carers

6. guidelines should be consistent with scientific literature and scientific evidence published in peer reviewed journals.

Disclaimer: RANZCP is not responsible for the content of the guideline and has not independently reviewed the impact of the guideline on successful treatment of patients beyond the requirements of the AGREE framework

List of the guidelines selected for review included:

1. Australian guidelines for the treatment of adults with Acute Stress Disorder and Posttraumatic Stress Disorder; Australian Centre for Posttraumatic Mental Health (ACPMH); 2013

2. Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder; Agency for Healthcare Research Quality (US Department of Health and Human Services (AHRQ); 2008

3. ‘The Last Frontier’ Practice guidelines for treatment of complex trauma and trauma informed care and service delivery; Adults Surviving Child Abuse (ASCA); 2012

4. The ISTSS Expert Consensus Treatment Guidelines For Complex PTSD In Adults; International Society for Traumatic Stress Studies (ISTSS); November 2012

5. Psychiatric Evaluation of Adults, Second Edition; American Psychiatric Association (APA) Practice Guidelines, November 2004 and a Guideline Watch; March 2009

6. VA/DoD clinical practice guideline for management of post-traumatic stress, Department of Veterans Affairs and Department of Defense ; October 2010

7. Effective treatments for PTSD: Second Edition; Practice guidelines from International Society for Traumatic Stress Studies (ISTSS); 2010

8. The management of PTSD in adults and children in primary and secondary care; National Institute for Clinical Excellence (NICE); March 2005

9. Management of Anxiety Disorder; Clinical practice guidelines; Canadian Journal of Psychiatry; Vol 51, Supplement 2 Chapter 8; July 2006

Although the selection criteria stated that the guidelines should be published within the last five years at the time of review (point 2, selection criteria), the working group decided to review all the PTSD guidelines for a broader comparison. NICE 2005 and Canadian 2006 are over the five-year stipulation.

Stage 3: AGREE II survey development

The AGREE II survey was developed using ‘survey monkey’ for each guideline selected for review. The surveys were opened on 7 March 2013 and closed on 28 May 2013. The survey included 23 key items of the AGREE II instrument followed by 2 global rating items (“Overall Assessment”).

Below is the AGREE II survey template:

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Please refer to the PDF "Appraisal of Guidelines For Research and Evaluation II" for comprehensive information on each of the items and explanation of the rating scale. Rating Scale Each of the AGREE II items and the two global rating items are rated on a 7point scale (1 Strongly Disagree to 7 Strongly Agree. Score 1 (Strongly Disagree) when there is no information that is relevant to the AGREE II item or if the concet is very poorly reported. Score 7 (Strongly Agree) when the quality of reporting is exceptional and where the full criteria and considerations have been met. Score between 2 and 6 when the reporting of the AGREE II item does not meet the full criteria or considerations. A score is assigned depending upon the completeness and quality of reporting. Scores increase as more criteria are met and considerations addressed. It is the responsibility of the appraiser to review the entire guideline and accompanying material(s) to ensure a fair evaluation.

Instructions for use

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Scope and Purpose (Items 13) is concerned with the overall objective(s)of the guideline, the specific clinical questions and the target population. Rating scale 1 Strongly Disagree, 2 Disagree, 3 Somewhat Disagree, 4Uncertain, 5 Somewhat Agree, 6 Agree, 7Strongly Agree.

1. The overall objective(s) of the guideline is (are) specifically described

2. The health question(s) covered by the guideline is(are) specifically described.

3. The population (patients, public, etc.) to whom the guideline is meant to apply are specifically described

DOMAIN 1: SCOPE AND PURPOSE

Strongly Disagree

DisagreeSomewhat Disagree

UncertainSomewhat Agree

Agree Strongly Agree

1 nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Strongly Disagree





Strongly Disagree

AgreeSomewhat Disagree




Comments

55

66

Comments

55

66

Comments

55

66

8

Stakeholder Involvement (items 46) focuses on the views and preferences sought from the target population and are clearly defined in the guideline. Rating scale 1 Strongly Disagree, 2 Disagree, 3 Somewhat Disagree, 4Uncertain, 5 Somewhat Agree, 6 Agree, 7Strongly Agree.

4. The guideline development group includes individuals from all the relevant professional groups

5. The views and preferences of the target population (patients, public, etc.) have been sought.

6. The target users of the guideline are clearly defined.

DOMAIN 2: STAKEHOLDER INVOLVEMENT

Strongly Disagree

AgreeSomewhat Disagree




Strongly Disagree





Strongly Disagree





Comments

55

66

Comments

55

66

Comments

55

66

9

Rigour of Development (Items 714) relates to the method and criteria used for gathering the evidence, to formulate the recommendations and procedures for updating the guideline. Rating scale 1 Strongly Disagree, 2 Disagree, 3 Somewhat Disagree, 4Uncertain, 5 Somewhat Agree, 6 Agree, 7Strongly Agree.

7. Systematic methods were used to search for evidence.

8. The criteria for selecting the evidence are clearly described.

9. The strengths and limitations of the body of evidence are clearly described.

10. The methods for formulating the recommendations are clearly described.

DOMAIN 3: RIGOUR OF DEVELOPMENT

Strongly Disagree





Strongly Disagree





Strongly Disagree

DisagreeSomewhat Disgree




Strongly Disagree





Comments

55

66

Comments

55

66

Comments

55

66

Comments

55

66

10

11. The health benefits, side effects and risks have been considered in formulating the recommendations.

12. There is an explicit link between the recommendations and the supporting evidence.

13. The guideline has been externally reviewed by experts prior to its publication.

14. A procdure for updating the guideline is provided.

Strongly Disagree





Strongly Disagree





Strongly Disagree





Strongly Disagree





Comments

55

66

Other (please specify)

55

66


55

66


55

66

11

Clarity of Presentation (items 1518) focuses on whether the recommendations are easily identifiable, are specific an clearly presented. Rating scale 1 Strongly Disagree, 2 Disagree, 3 Somewhat Disagree, 4Uncertain, 5 Somewhat Agree, 6 Agree, 7Strongly Agree. 15. The recommendations are specific and unambiguous

16. The different options for management of the condition or health issue are clearly presented.

17. Key recommendations are easily identifiable.

DOMAIN 4: CLARITY OF PRESENTATION

Strongly Disagree

DisagreeSomewhat disagree




Strongly Disagree





Strongly Disagree





Comments

55

66

Comments

55

66

Comments

55

66

12

Applicability (items 1821) pertains to any implications of applying the recommendations and advice on how the recommendations can be put into practice. Rating scale 1 Strongly Disagree, 2 Disagree, 3 Somewhat Disagree, 4Uncertain, 5 Somewhat Agree, 6 Agree, 7Strongly Agree.

18. The guideline describes facilitators and barriers to its applications

19. The guideline provides advice and/or tools on how the recommendations can be put into practice.

20. The potential resource implications of applying the recommendations have been considered.

21. The guideline presents monitoring and/or auditing criteria.

DOMAIN 5:APPLICABILITY

Strongly Disagree





Strongly Disagree





Strongly Disagree





Strongly Disagree





Comments

55

66

Comments

55

66

Comments

55

66

Comment

55

66

13

Editorial independence (items 2223) is pertains to any acknowledgment of possible conflict of interest from the guideline development group. Rating scale 1 Strongly Disagree, 2 Disagree, 3 Somewhat Disagree, 4Uncertain, 5 Somewhat Agree, 6 Agree, 7Strongly Agree.

22. The views of the funding body have not influenced the content of the guideline

23. Competing interests of guideline development group members have been recorded and addressed.

DOMAIN 6: EDITORIAL INDEPENDENCE

Strongly Disagree

DisagreeSomewhat disagree




Strongly Disagree





Comments

55

66

Comments

55

66

14

The overall assessment requires the AGREE II user to make a judgement as to the quality of the guideline.

24. Rate the overall quality of this guideline.

25. I would recommend this guideline for use.

26. Please enter your name

OVERALL GUIDELINE ASSESSMENT

Lowest possible quality

Lower Quality Low Quality Uncertain Good Quality Better QualityHighest Possible Quality


Yes Yes, with modifications No

25 nmlkj nmlkj nmlkj

55

66

Comments

55

66

Notes/Comments

55

66

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Stage 4: Guideline review

The Chair equitably allocated the guidelines to two review groups after taking into consideration the length of each of the guidelines.

The working group members who reviewed the international and national clinical practice guidelines on PTSD and critiqued guidelines for their inclusion on the portal included:

Professor Warwick Middleton

Dr John Collier

Dr Man-Pui Eddie So

Dr Deborah Julie Wearne

Dr Bradley Ng

Ms Janne McMahon (Consumer and Carer representative)

Mr Norm Wotherspoon (Consumer representative)

A minimum of three and a maximum of six reviewers examined each guidelines.

Strengths and weakness of the guideline review process

To mitigate potential conflicts of interest, members of the working group who have contributed to a guideline were excluded from reviewing that specific guideline.

During the process of review, the working group discussed the limits of the power of the AGREE II process when performed by a relatively small number of reviewers. The working group also noted that, with the few exceptions the spread of overall ratings and rating of specific guidance with the AGREE II was relatively narrow across the guidelines. It was thus considered most appropriate to present raw data without statistical analysis beyond expression of simple descriptive statistics. Further, it was felt appropriate to make available ratings of all guidelines rather than definitive statements of rank order.

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Stage 5: Data analysis and results

Data definitions

Box 1 below details the data analysis definitions and describes how the data were calculated

Box 1 1. RATING AVERAGE refers to the average/mean of the rating average.

Rating Scale: All AGREE II items are rated on the following 7-point scale:

1 - Strongly Disagree 2- Disagree 3- Somewhat Disagree 4- Uncertain

5- Somewhat Agree 6- Agree 7- Strongly Agree

e.g.

Rating Average = [Agree (6) * Number of people Agree] + [Strongly Agree (7) * Number of people strongly Agree] /Total Number of Respondents

= [6*1] + [7 *5]/6

= 6.83

Rating Average = [Uncertain (4) * Number of people Uncertain] + [Strongly Agree (7) * Number of people strongly Agree] /Total Number of Respondents = [4*3] + [7*3]/6

= 5.50

2. MEAN refers to the ‘average’ which is the sum of ‘Rating Average’ of all the AGREE II items divided by the total number of items in the survey (n=25).

3. MEDIAN refers to the ‘middle value’ which separates the higher half of the data from the lower half.

4. MODE refers to the value that is repeated ‘most often’.

5. Percentage of reviewers response was calculated as below:

% of reviewer = Number of respondents who said ‘Yes’ * 100 / Total number of respondents

= [5*100] /6 = 83.3% of reviewers recommend using the guideline % of reviewer = Number of respondents who said ‘NO’ * 100 / Total number of respondents

= [1*100] /6 = 16.7% of reviewers recommend using the guideline

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The AGREE II survey consists of 23 key items organized within 6 domains followed by 2 global rating items that are categorised under ‘Overall Assessment’, therefore the data for the appraisal of the guideline is analysed in two steps.

Step A: AGREE II survey items which included 23 key items (6 domains), and

Step B: Overall assessment which included the rating of the overall quality of the guideline and whether the guideline would be recommended for use in practice.

5.1 Step A: AGREE II survey items

5.1.1 Comparing the rating average scores of the guidelines Graph 1 shows the rating average scores of each of the nine guidelines.

Graph 1: Average scores of the guidelines

Comments

The overall rating average scores were recorded highest in ACPMH guideline (n= 5.94), followed by NICE guideline (n=5.87) and VD/DoD guideline (n= 5.56).

The lowest overall rating average score was recorded in ASCA guideline (n= 4.3).

5.94

4.9 4.97

4.3

5.22 4.89 4.77

5.87 5.56

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ACPMH AHRQ APA ASCA Canadian ISTSS Complex

PTSD

ISTSS PTSD NICE VD/DoD

Ave

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Average of Rating Average of AGREE II survey Questions

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5.1.2 Comparing mean, median and mode for the guidelines reviewed

Although the overall rating average scores (as in graph 1) were highest in the ACPMH guideline (n= 5.94), followed by NICE guideline (n=5.87) and by VD/DoD guideline (n= 5.56), the highest median value of n= 6.33 was recorded in VD/DoD, followed by ACPMH n=6.22 and NICE guideline (n=6.0).

Graph 2: Comparing mean, median and mode for the guidelines reviewed

Comments

The highest mean value of n=5.95 was recorded in ACPMH and NICE guidelines (n=5.9) followed by VD/DoD guideline (n=5.57).

The mode value of ≥ 6.5 occurs more frequently in VD/DoD guideline.

The mode value of ≥ 6.0 occurs more frequently in ACPMH, AHRQ, Canadian and NICE guideline.

The mode value of ≤ 5.0 occurs more frequently in ISTSS Complex PTSD and ASCA guideline.

ACPMH AHRQ APA ASCA Canadian ISTSS

Complex PTSD


Mean 5.95 4.91 4.99 4.34 5.22 4.93 4.79 5.9 5.57

Median 6.22 5.25 5.33 4.16 5.67 5 4.97 6 6.33

Mode 6.38 6.25 6 4.75 6.33 5 6 6.33 6.67

6.38 6.25 6

4.75

6.33

5

6 6.33

6.67

0

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5.1.3 Comparing average rating scores of guidelines for each domain

Graphs 1 and 2 compare the overall rating average scores of all 6 domains of the AGREE II tool and graph 3 compares the rating average scores of each domain in each guideline. The 23 items in AGREE II are organized within 6 domains and each domain captures a unique dimension of the quality of the guideline. Graph 3: Comparison of average rating scores of guidelines for each domain

Comments

The overall average scores for domain 1 which defines scope and purpose (items 1-3 in the AGREE II survey) is highest in ACPMH (n=6.83) and in VD/DoD (n= 6.67) and lowest in ASCA and ISTSS PTSD (n= 6.0) compared to all the guidelines.

The overall average scores for domain 2 which defines stakeholder involvement (items 4-6 in the AGREE II survey) is highest in ACPMH (n=6.22) and in ASCA and NICE (n=6.0). The stakeholder involvement has been found lowest in AHRQ guideline (n=4.08).

The overall average scores for domain 3 which defines the rigour of development of the guideline (items 7-14 in the AGREE II survey) is highest in ACPMH (n=6.48) and NICE (n=6.16) and lowest in ASCA guideline (n=3.71).

The overall average scores for domain 4 which defines the clarity in presentation of the guideline (items 15-17 in the AGREE II survey) is highest in ACPMH (n=6.45) and NICE (n=6.44) and lowest in ASCA guideline (n = 4.17).

The overall average scores for domain 5 which defines applicability (items 18- 21 in the AGREE II survey) is highest in NICE (n= 5.62), VD/DoD (n=5.5) and ACPMH (n= 5.25) and lowest in AHRQ (n=3.3).

The overall average scores for domain 6 which defines editorial independence (items 22- 23) is highest in NICE (n=6.0) and AHRQ (n=5.12) and lowest in ASCA (n=3.3), VD/DoD (n=3.59) and Canadian (n= 3.5).

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1

2

3

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Domain 1 Scope and Purpose

Domain 2 Stakeholder involvement

Domain 3 Rigour of development

Domain 4 Clarity Domain 5 Applicability Domain 6 Editorial Independence

ACPMH AHRQ APA ASCA Canadian ISTSS Complex PTSD ISTSS PTSD NICE VD/DoD

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5.1.4 Comparing average rating scores of domains in each guideline

Similar to graph 3, graph 4 compares the rating average scores of each domain against each guideline.

Graph 4: Comparison of average rating scores of domains in each guideline

Comments

The scores for the NICE guideline are consistently higher in all the domains (average score per domain ≥ 6.0) except in domain 5 (n= 5.6).

ACPMH scored high in domains 1- 4 (average score per domain > 6.0), domain 5 and 6 scored < 5.5.

AHRQ scored high in domain 1 (n=6.25), domain 3, 4 and 6 scored ≥ 5.0 per domain, whereas domains 2 scored ≤ 4.0. Domain 5 scored the lowest (n=3.3).

APA scored high in domain 1 (n=6.11), domain 3 and 4 scored > 5.0, whereas domain 2 and 5 scored < 5.0.

ASCA scored high in domains 1 and 2 (n=6.0), whereas domains 3- 5 scored ≤ 4.17 and domain 6 scored the lowest (n= 3.3).

Canadian guideline scored high in domains 1 and 4 (n=6.22), domains 2 and 3 scored ≤ 5.65, domain 5 scored 4.5 and domain 6 scored the lowest (n=3.5).

Domain 1 in ISTSS Complex PTSD guideline scored highest (n= 6.33) compared to domains 2- 6 which scored ≤ 5.22.

ISTSS PTSD scored high in domains 1 and 4 ≤ 6.0, domains 2 and 3 scored < 5.0 and domains 5 and 6 scored < 4.0.

VD/DoD scored high in domains 1, 3 and 4 (n ≥ 6.0), domain 2 and 5 scored ≤ 5.55 whereas domain 6 scored the lowest (n= 3.59).

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3

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ACPMH AHRQ APA ASCA Canadian ISTSS Complex PTSD


Ave

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rat

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sco

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Domain 1 Scope and Purpose Domain 2 Stakeholder involvement Domain 3 Rigour of development

Domain 4 Clarity Domain 5 Applicability Domain 6 Editorial Independence

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5.1.5 Comparing the rating average scores for AGREE II items for PTSD guidelines

The above graphs 3 & 4 compares the domains in each guideline, however, graph 5 below compares the rating average scores of each item (within domains) per guideline. Graph 5: Rating average score of AGREE II items per guideline

Comments

The rating average scores for ACPMH guideline items ranges from 7.0 – 4.33 (mode, n= 6.83).

The rating average scores for NICE guideline items ranges from 6.33 – 5.33 (mode, n= 6.33).

The rating average score for Canadian guideline items ranges from 6.33 – 3.33 (mode, n= 6.33).

The rating average scores VD/DoD guideline items ranges from 6.67 – 3.33 (mode, n= 6.67).

The rating average scores AHRQ guideline items ranges from 6.5 – 2.75 (mode, n= 6.25).

The rating average score for ISTSS PTSD guideline items ranges from 6.2 – 2.8 (mode, n= 6.0).

The rating average score for ISTSS Complex PTSD guideline items ranges from 6.33 – 3.33 (mode, n= 5.0).

The rating average score for APA guideline items ranges from 6.33 – 3.33 (mode, n= 6.0).

The rating average score for ASCA guideline items ranges from 6.5 – 3.0 (mode, n= 4.75).

Note: An elaborate ‘PTSD guideline review report is at Appendix 1.

The overall analysis of the graphs above indicates:

The top three guidelines (based on the rating average scores) are ACPMH, NICE and VD/DoD guidelines.

The lowest rated guideline is the ASCA guideline.

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6.83

6.5

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3.6

5.33

4.67

0

6.67

5.75

6

6

6.33

6

5.6

6.33

6.33

0

6.83

6.25

6

3.25

5.5

5.67

6

6

6.67

0

6.83

6.25

6

3.25

5.33

6

5

6

6.67

0

6.83

5.25

4.33

3

5.67

5.67

6

6.33

6.33

0

6.17

5

5.67

3.5

6

5.33

5.2

6.33

6.67

0

6.83

5.5

5.67

3.75

5.67

4.67

4.6

6

6.67

0

7

5.75

6

4.75

6

5

5.2

6

6.33

0

6.17

4.75

3.33

5.5

6.33

4

4.4

6.33

3.33

0

5.17

4.5

4.67

2.75

4.67

3.33

3.4

6.33

5.33

0

6.5

5.5

5.67

4.75

6.33

5.67

6

6

6.33

0

6.67

6

5.67

3

6

5

5.6

6

6.33

0

6.17

5.75

5.67

4.75

6.33

5

6.2

6.33

6.67

0

5.5

4

4.33

4.75

5

4.67

4.2

5.33

6.33

0

5.17

2.75

5.33

5.5

5.67

5

4.4

5.67

6.33

0

5.17

3.25

4

2.75

3.67

4

3.6

6

4.33

0

5.17

3.25

3.33

2.75

3.67

3.67

2.8

5.5

5

0

5.33

4.75

5.33

3.75

3.67

4.67

4.2

6.33

3.67

4.33

5.5

4

3

3.33

4.67

3.8

5.67

3.5

ACPMH

AHRQ

APA

ASCA

Canadian

ISTSS Complex PTSD

ISTSS PTSD

NICE

VD/DoD

Item 1 Item 2 Item 3 Item 4 Item 5 Item 6 Item 7 Item 8 Item 9 Item 10 Item 11 Item 12

Item 13 Item 14 Item 15 Item 16 Item 17 Item 18 Item 19 Item 20 Item 21 Item 22 Item 23

22

5.2 Step B: Overall assessment.

The above data and graphs depicted the rating per item, per domain and overall rating average score of the AGREE II tool, which proposed the top scored guidelines. Graphs 6 and 7 below emphasise the overall assessment which includes the rating of the overall quality of the guideline (Item 24) and whether the guideline should be recommended for use in practice (Item 25).

Item 24 (Rate the overall quality of the guideline) allowed the reviewer to make a judgement about the quality of the guideline and was rated on a 7-point scale ranging from lowest possible quality (1) to highest possible quality (7).

5.2.1 Comparing the overall quality of the guidelines

Graph 6, compares the rating average scores for item 24 in the AGREE II tool (‘Rate the overall quality of the guideline’).

Graph 6: Assessing the overall quality of the guidelines

Comments

The highest value of n= 6.17 was recorded for the ACPMH guideline, followed by the NICE guideline (n=6.0), and Canadian guideline (n=5.67).

The lowest value of n = 4.25 was recorded for the ASCA guideline.

6.17

5.25

5

4.25

5.67

5

5.2

6

5.33

ACPMH AHRQ APA ASCA Canadian ISTSS Complex PTSD ISTSS PTSD NICE VD/DoD

Domain ACPMH AHRQ APA ASCA Canadian

ISTSS

Complex ISTSS PTSD NICE VD/DoD

Item 24 6.17 5.25 5 4.25 5.67 5 5.2 6 5.33

23

Following the assessment of the quality of the guideline, item 25 required the reviewers’ opinion on guideline recommendation for use.

Item 25 (‘I would recommend this guideline for use’) required reviewers to respond as ‘Yes’, ‘No’, ‘Yes, with modifications’.

5.2.2 Percentage of reviewers recommending the guideline/s for use

Graph 7 compares the percentage of reviewers’ response in relation to whether they would recommend the guideline/s for use.The percentage was calculated based on the numbers of respondents for each guideline. Graph 7: Percentage of reviewers recommending guidelines for use

Note : n= To ta l num ber o f rev i ewers

Comments

100% of reviewers (n=3) determined that VD/DoD guideline can be recommended for use.

83.3% of reviewers (n=6) determined that ACPMH guideline can be recommended for use, whereas 16.7% (1 reviewer) did not suggest recommending this guideline for use.

66.7% of reviewers (n=3) determined that NICE guideline can be recommended for use, whereas 33.3% (1 reviewer) did not suggest recommending this guideline for use.

66.7% of reviewers (n=3) determined that ISTSS Complex PTSD guideline can be recommended for use, whereas 33.3% (1 reviewer) suggest recommending this guideline for use with modification.

60% of reviewers (n=5) determined that ISTSS PTSD guideline can be recommended for use, whereas 20% (1 reviewer) suggest recommending this guideline for use with modification, and 20% (1 reviewer) did not suggest recommending this guideline for use.

50% of reviewers (n=4) suggest recommending ASCA guideline for use with modification, whereas 50% (2 reviewers) did not suggest recommending this guideline for use.

33.3% of reviewers (n=3) determined that APA guideline can be recommended for use, whereas 66.7% (2 reviewers) did not suggest recommending this guideline for use.

33.3% of reviewers (n=3) determined that Canadian guideline can be recommended for use, whereas 66.7% (2 reviewers) suggest recommending this guideline for use with modification.

25% of reviewers (n=4) determined that AHRQ guideline can be recommended for use, 25% (1 reviewer) suggest recommending this guideline for use with modification, whereas 50% (2 reviewers) did not suggest recommending this guideline for use.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ACPMH AHRQ ASCA ISTSS PTSD

VD/DoD ISTSS Complex

PTSD

Canadian APA NICE

No (%) 16.7 50 50 20 0 0 0 66.7 33.3

Yes, with modification (%) 0 25 50 20 0 33.3 66.7 0 0

Yes (%) 83.3 25 0 60 100 66.7 33.3 33.3 66.7

Pe

rce

nta

ge o

f re

spo

nse

s

24

The overall analysis of the graphs (6 and 7) above indicates the top guidelines:

ACPMH, NICE and Canadian guidelines based on the quality of the guideline

VD/DoD, ACPMH and NICE and ISTSS Complex PTSD guidelines based on recommendation for use.

Conclusion

This review is limited by the scope of the review, particularly the number of reviewers involved. Also it was worth acknowledging that the AGREE II tool focuses more strongly on certain aspects of guideline production such as breath of participation by consumers and carers and arguably less on scientific rigour of the guideline process. The reviewers also noted that the guidelines included were heterogeneous in both the population of focus (eg veterans, military personnel) and the range of disorders for inclusion of PTSD. Given all these factors results are presented as raw data with simple descriptive statistics only.

The conclusion of the working group is that all of the guidelines reviewed have utility and are appropriate for use. It is noted that only the ACPMH guidelines are locally produced and this may be relevant for the use of Australian and New Zealand context. It is noteworthy that the evidence reviewed in all guidelines was broadly similar.

References

Slade T, Johnston A, Oakley Browne MA, Andrews G, Whiteford H; 2007 National Survey of Mental Health and Wellbeing: methods and key findings. Australian and New Zealand Journal of Psychiatry; 2009; 43: 594 - 605.

Kramer TL, Lindy JD, Green BL, Grace MC, Leonard AC; The comorbidity of post-traumatic stress disorder and suicidality in Vietnam veterans. Suicide Life Threat Behav; 1994; 24:58-67.

Appraisal of Guidelines for Research & Evaluation II Instrument (AGREE II); The AGREE Next Steps Consortium May 2009.

25

Appendices

1. PTSD Guidelines survey report

o AGREE II scoring - ACPMH

o AGREE II scoring – AHRQ

o AGREE II scoring – APA

o AGREE II scoring – ASCA

o AGREE II scoring – Canadian

o AGREE II scoring – ISTSS Complex PTSD

o AGREE II scoring – ISTSS PTSD

o AGREE II scoring – NICE

o AGREE II scoring – VD/DoD

26

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat

AgreeAgree Strongly Agree Rating Average

Response

Count

0 0 0 0 0 1 5 6.83 6

2

6

0

Number Response Date Comments Categories

1 May 24, 2013 5:42 AM Recommendation 1

2 Mar 18, 2013 4:49 AM Clear well described objectives

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 1 5 6.83 6

1

6

0


1 Mar 28, 2013 10:07 AM Common psychiatric co-morbidities as well as differentials are discussed comprehensively

Strongly

DisagreeAgree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 1 5 6.83 6

2

6

0


1 Mar 28, 2013 10:07 AM Verycomprehensive

2 Mar 18, 2013 4:49 AM Specific populations discussed relevant to the Australian context

Strongly

DisagreeAgree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 1 4 6.50 6

1

6

0


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1

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3


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2

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AGREE II scoring - ACPMH/ NHMRC

4

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27

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 3 0 0 3 5.50 6

2

6

0


1 Mar 28, 2013 10:12 AM Consumer representatives were consulted but studies on patient preferences do not appear to be in the guidelines

2 Mar 18, 2013 4:50 AM Yes information for consumers and families included

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 0 5 6.67 6

0

6

0

Strongly

DisagreeDisagree

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Somewhat


Response

Count

0 0 0 0 0 1 5 6.83 6

1

6

0


1 Mar 18, 2013 4:52 AM Good explanation of methods provided separately

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 1 5 6.83 6

0

6

0

6

8

Comments

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7

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5

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28

Strongly

DisagreeDisagree

Somewhat

DisgreeUncertain

Somewhat


Response

Count

0 0 0 0 0 1 5 6.83 6

0

6

0

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 1 0 2 3 6.17 6

1

6

0


1 May 20, 2013 11:26 PM review of evidence - not clear recommendations

Strongly

DisagreeDisagree

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DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 1 5 6.83 6

1

6

0


1 Mar 18, 2013 4:52 AM This section is well done

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 0 6 7.00 6

0

6

0

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12

9

11

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10

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29

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 3 2 6.17 6

0

6

0

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 3 1 0 2 5.17 6

1

6

0

Number Response DateOther (please

specify)Categories

1 Mar 18, 2013 4:52 AM I could not find this but it may reflect my limitations

Strongly

DisagreeDisagree

Somewhat

disagreeUncertain

Somewhat


Response

Count

0 0 0 1 0 0 5 6.50 6

2

6

0


1 May 20, 2013 11:27 PM Wot recommendations Literature review

2 Mar 18, 2013 4:53 AM Yes clear recommendations with clear links to evidence. Good summary of major points at the beginning

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 0 5 6.67 6

1

6

0


1 Mar 18, 2013 4:53 AM Well done but did not cover complex PTSD as well as other guidelines

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13

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16

14

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15

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15. The recommendations are specific and unambiguous

30

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 1 0 0 0 0 5 6.17 6

1

6

0


1 Mar 18, 2013 4:53 AM See summary

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 1 2 2 1 5.50 6

0

6

0

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 1 0 1 1 1 2 5.17 6

0

6

0

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 1 0 1 1 1 2 5.17 6

1

6

0


1 Mar 18, 2013 4:54 AM This was also well done

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18

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19

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17

Comments

20

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31

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 3 0 2 1 5.17 6

0

6

0

Strongly

DisagreeDisagree

Somewhat

disagreeUncertain

Somewhat


Response

Count

0 0 0 3 0 1 2 5.33 6

0

6

0

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 2 0 1 1 1 1 4.33 6

0

6

0

Lowest

possible qualityLower Quality Low Quality Uncertain Good Quality Better Quality

Highest

Possible

Quality

Rating AverageResponse

Count

0 0 0 1 0 2 3 6.17 6

1

6

0


1 Mar 18, 2013 4:56 AM This guideline in my opinion was the best by far of those I read. Very clear and well presented. Relevant to the Australian context.

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22



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23

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24

21

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32

YesYes, with

modificationsNo Rating Average

Response

Count

5 0 1 1.33 6

2

6

0

Number Response DateNotes/Commen

tsCategories

1 May 20, 2013 11:28 PM Not a guideline - it is literature review

2 Mar 18, 2013 4:56 AM I would use this guideline but include a separate guideline for complex PTSD as an adjuvant.

Response

Count

5

5

1

Number Response Date Response Text Categories

1 May 24, 2013 5:44 AM Norm Wotherspoon

2 May 20, 2013 11:28 PM DJ Wearne

3 May 20, 2013 12:24 PM EDDIE SO

4 May 17, 2013 2:25 AM dr john Collier Hamilton NZ

5 Mar 28, 2013 10:16 AM Bradley Ng


Notes/Comments

answered question

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25

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33

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 2 6.50 4

1

4

0


1 Mar 16, 2013 8:07 AM The style is staccato and abrupt. Although it covers all areas it does not seem particularly clinically helpful

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 2 1 6.00 4

1

4

0


1 Mar 28, 2013 10:49 AM Treatments only limited to medications and psychotherapy- does not address co-morbidities, community approaches to management and how to treat special populations

Strongly

DisagreeAgree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 1 2 6.25 4

2

4

0


1 May 20, 2013 12:45 PM implied

2 Mar 16, 2013 8:07 AM Brief, very staccato

Strongly

DisagreeAgree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

1 1 0 0 0 2 0 3.75 4

3

4

0


1 May 20, 2013 12:47 PM , other than supporting staf, all medicos

2 Mar 28, 2013 10:54 AM Restricted to medical professiona;s

3 Mar 16, 2013 8:09 AM Thorough group but the guidelines are quite old 2004

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2

AGREE II scoring - AHRQ

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3


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1

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4

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34

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

1 1 0 2 0 0 0 2.75 4

2

4

0


1 May 20, 2013 12:47 PM not invloved

2 Mar 28, 2013 10:54 AM No evidence to suggest so

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 2 1 1 5.75 4

2

4

0


1 May 20, 2013 12:47 PM any professional or volunteers involved in care of PTSD patient

2 Mar 16, 2013 8:09 AM Defined but abruptlyNot bery helpful

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 3 1 6.25 4

1

4

0


1 Mar 16, 2013 8:12 AM But evidence reads as old fashioned

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 3 1 6.25 4

0

4

0

answered question

6

answered question

Comments



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7

5


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8

35

Strongly

DisagreeDisagree

Somewhat

DisgreeUncertain

Somewhat


Response

Count

0 0 0 1 1 2 0 5.25 4

1

4

0


1 Mar 16, 2013 8:12 AM The weakness of the age of this document is not addressed, understandably. Evidence reads as old.

Strongly

DisagreeDisagree

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DisagreeUncertain

Somewhat


Response

Count

0 1 0 0 0 3 0 5.00 4

1

4

0


1 Mar 28, 2013 11:00 AM Expert concensus is too vague

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 2 2 0 5.50 4

3

4

0


1 May 20, 2013 12:55 PM not mentioned

2 Mar 28, 2013 11:00 AM General comments were made

3 Mar 16, 2013 8:12 AM It is done but is abrupt and not very helpful clinically being too short and overinclusive.

Strongly

DisagreeDisagree

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DisagreeUncertain

Somewhat


Response

Count

0 0 0 1 0 2 1 5.75 4

1

4

0


specify)Categories

1 Mar 16, 2013 8:12 AM This is done well

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11


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9

Comments



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12

10

36

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 2 1 1 0 4.75 4

1

4

0


specify)Categories

1 Mar 28, 2013 11:00 AM Says so, but not detailed

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 3 0 1 0 4.50 4

1

4

0


specify)Categories

1 Mar 16, 2013 8:12 AM It was reviewed in 2008

Strongly

DisagreeDisagree

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disagreeUncertain

Somewhat


Response

Count

0 0 1 0 1 0 2 5.50 4

1

4

0


1 Mar 16, 2013 8:15 AM The review seems to take a blanket approach where everything is covered but it is too broad to be helpful in actual management of cases.

The psychotherapy section I thought read as out of date compared to other guidelines

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 2 0 2 6.00 4

0

4

0

answered question


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16

13


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14

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15

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37

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 2 1 1 5.75 4

1

4

0


1 Mar 16, 2013 8:15 AM Again it all was too broad and seemed clinically unhelpful

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 1 0 2 0 1 0 4.00 4

0

4

0

Strongly

DisagreeDisagree

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DisagreeUncertain

Somewhat


Response

Count

1 0 2 1 0 0 0 2.75 4

3

4

0


1 May 20, 2013 12:57 PM there is a qualifying statement, somewhat address this requirement

2 Mar 28, 2013 11:02 AM Too brief and it's a summary of a guideline

3 Mar 16, 2013 8:16 AM It seems focused on the single practitioner and does not address systemic issues

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 1 1 2 0 0 0 3.25 4

1

4

0


1 Mar 16, 2013 8:16 AM As above

Comments

18


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20



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19

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17

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38

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 2 0 1 1 0 0 3.25 4

0

4

0

Strongly

DisagreeDisagree

Somewhat

disagreeUncertain

Somewhat


Response

Count

0 0 0 3 0 0 1 4.75 4

1

4

0


1 May 20, 2013 12:58 PM a concise declaration on the Financiak Disclosure / COI section

Strongly

DisagreeDisagree

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DisagreeUncertain

Somewhat


Response

Count

0 0 0 1 1 1 1 5.50 4

1

4

0


1 Mar 28, 2013 11:03 AM Not enough details

Lowest


Highest

Possible

Quality


Count

0 0 0 0 3 1 0 5.25 4

1

4

0


1 Mar 16, 2013 8:19 AM I thought it was out of date, too broad and not clinically useful.

Although it ticked many boxes on the Agree 2 document I felt other guidelines were more clinically useful

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22

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24

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21

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23

39

YesYes, with


Response

Count

1 1 2 2.25 4

2

4

0


tsCategories

1 May 20, 2013 1:00 PM a more practical guildline, likely to be better received and will be read by clinicians

2 Mar 28, 2013 11:05 AM I would not recommend this specific document as it is really just a commentary on another guideline, the APA one.

It does not add anything to the APA guideline.

Response

Count

4

4

0



2 May 20, 2013 1:00 PM EDDIE SO


4 Mar 16, 2013 8:19 AM Dr Deborah Wearne

25


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40

Strongly

DisagreeDisagree

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DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 1 1 6.00 3

0

3

0

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

0

Strongly

DisagreeAgree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 1 1 6.00 3

1

3

0


1 Mar 29, 2013 11:45 AM There is little background given about prevalence of PTSD, natural history, risk factors etc.

Strongly

DisagreeAgree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 1 1 1 0 0 4.00 3

2

3

0


1 Apr 17, 2013 5:36 AM There is a lack of patient/consumer input.

2 Mar 14, 2013 8:05 PM found qualifications but not profession

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1

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2

4

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3

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41

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 1 1 0 0 1 0 3.67 3

2

3

0


1 Apr 17, 2013 5:36 AM Again, it is difficult to see evidence of the patient/public has been sought.

2 Mar 14, 2013 8:05 PM not sure about consumer represesnetation

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 1 1 6.00 3

0

3

0

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 1 1 6.00 3

0

3

0

Strongly

DisagreeDisagree

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DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 1 1 6.00 3

0

3

0

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8

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6

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7

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5

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42

Strongly

DisagreeDisagree

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DisgreeUncertain

Somewhat


Response

Count

1 0 0 0 1 0 1 4.33 3

1

3

0


1 Apr 17, 2013 5:40 AM

Strongly

DisagreeDisagree

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DisagreeUncertain

Somewhat


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The Guidelines are 2004 and essentially out of date. The research and trials are considered to be outdated with a lot of research and

trials since. the Guideline Watch attests to this fact and in suggests the trials should not be used as a basis for treatment

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1 Apr 17, 2013 5:40 AM I could not find evidence of external review.

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The Guideline has been superseded with more recent trials and research so I don't think there is a procedure of updating the guideline

except reference to the Guideline watch

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1 Mar 14, 2013 8:09 PM Psychiatry funded and written

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1 Apr 17, 2013 5:41 AM good quality but essentially out of date.

2 Mar 29, 2013 11:52 AM Limited in scope and detail. E.G. no coverage of EMDR, group therapy, co-morbidity etc., etc.

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1 Apr 17, 2013 5:41 AM As above

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1 Apr 17, 2013 5:41 AM Janne McMahon

2 Mar 29, 2013 11:52 AM Warwick Middleton

3 Mar 14, 2013 8:09 PM john collier

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1 Apr 21, 2013 3:44 PM 2 related guild-lines.

2 Mar 16, 2013 5:17 AM The guidelines strength's is in its client focused approach to treatment and systems management. It was interesting to read and clinically useful.

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1 Apr 21, 2013 3:44 PM complex trauma' versus PTSD in its classical sense.currently no agreed definition of 'complex trauma'

2 Mar 16, 2013 5:17 AM The definition of complex PTSD is less widely accepted than the guidelines make clear.

Their manual appears directed at predominantly severe childhood sexual abuse victims which is quite a specific population.

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1 Apr 21, 2013 3:44 PM most comprehensive

2 Mar 16, 2013 5:17 AM As aboveNot sure how possible it is to generalise the information beyond severe sexual abuse in childhood although it is very useful for that group

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1 Apr 9, 2013 1:57 AM I am concerned that the guideline development group (advisory group) does not contain consumers and carers,

who I would suggest are professionals in respect of PTSD. This comment applies to all of the guidelines.

2 Mar 16, 2013 5:22 AM I like the strong involvement of people with lived experience. The researchers are a very specific group and may not represent a broad opinion.

Complex PTSD is not recognised by ICD or DSM diagnostic systems

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1 Apr 21, 2013 3:50 PM Mentioned involvement of survivors in page XXXIV, not apparent from the Endorsements section.

2 Mar 16, 2013 5:22 AM This is a real strength of the guidelines

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1 Mar 16, 2013 5:22 AM I thought the guidelines were really useful for people working with this specific patient group but

less generally helpful for psychiatrists working outside that area. The limitations were not really addressed

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1 Apr 21, 2013 4:05 PM

2 Mar 28, 2013 11:36 AM Nil methodology whatsoever described

3 Mar 16, 2013 5:29 AM Information was chosen to support the model not to question it at any level

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1 Apr 21, 2013 4:05 PM aa

Comments

Substantial reference list with supplementation from web based resources. It seems that there is no mentioning of the process whereby research

and clinical documents were being selected, nor prioritization on level of evidence.

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1 Mar 16, 2013 5:29 AM I worried that the limitations of evidence was not really discussed

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1 Mar 16, 2013 5:29 AM Opinions of major thinkers in this area was addressed but there was a lack of evidence based research

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1 Apr 21, 2013 4:05 PM

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1 Mar 28, 2013 11:36 AM The authors have slective use of evidence for their stance; so there is evidence, not just systematic evidence

2 Mar 16, 2013 5:29 AM


it seems that the guildlines strongly advocates on the necessity of treatment, the cost to society for failing to treat, but refrained from making

recommendations on specific kind of treatment, or treatment heirarchy.

I really found this guideline to be clinically helpful and interesting to read but I think that the limitations of the evidence based research and the use of

opinion were not explored

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1 Apr 21, 2013 4:08 PM limited discussiod on various treatment modalities

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1 Apr 21, 2013 4:08 PM limited

2 Mar 28, 2013 11:39 AM Focus on trauma psychotherapy and that's it

3 Mar 16, 2013 5:30 AM Does not present options


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1 Mar 16, 2013 5:30 AM These are really clear and helpful

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1 Apr 21, 2013 4:11 PM strength of the guildline(s)

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1 Mar 16, 2013 5:32 AM This is another strength focusing on service delivery in a patient focused framework

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1 Apr 21, 2013 4:11 PM absent

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Number Response Date Comment Categories

1 Apr 21, 2013 4:11 PM no apparent

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1 Apr 21, 2013 4:14 PM not mentioned

2 Mar 28, 2013 11:40 AM This guideline really reflects the main authors and the association that produced it- there is clear potential bias

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1 Apr 21, 2013 4:14 PM not mentioned

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1 Apr 21, 2013 4:18 PM it seemed more aptly classified as a position paper

2 Mar 16, 2013 5:37 AM It focuses on complex PTSD which is poorly defined, does not give clear evidence based research, and seems to focus on sexual abuse in childhood

especially. However it is clear, an interesting perspective and clinically useful in the area of CSA.

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1 Apr 21, 2013 4:18 PM limited application to clinical undertaking

2 Mar 28, 2013 11:44 AM

3 Mar 16, 2013 5:37 AM

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1 Apr 21, 2013 4:18 PM Eddie So

2 Apr 9, 2013 2:00 AM Norm Wotherspoon



This is not a guideline. This isa professional opinion about a particular disorder and treatment recommendations. Though it is referenced and there

probably is some evidence for the authors' views, it is not an evidence based guideline!

I thought it was useful but the information really does focus on childhood sexual abuse rather than a broader definition of PTSD. It was not boring or

repetitive which some guidelines can be.

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1 Apr 30, 2013 5:44 AM Although PTSD is just one of the numerous anxiety disorders discussed

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1 Apr 30, 2013 5:44 AM There was not a lot of detail although it did cover PTSD in other groups other than combat related PTSD

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1 Apr 30, 2013 5:46 AM There were no patients/consumers mentioned as part of the development group or external revieweres

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1 Apr 30, 2013 5:46 AM There did not seem to be any evidence of patients/public being consulted

2 Mar 29, 2013 12:45 PM They don't appear to have been included.

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1 Apr 30, 2013 5:47 AM There were RCT, meta analyses described

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8

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1 Apr 30, 2013 5:47 AM Although as noted previously, no patient/consumer/public review

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3

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19

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1 Apr 30, 2013 5:48 AM There appears to be no evidence

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1 Apr 30, 2013 5:48 AM There appears to be no evidence

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1 Mar 14, 2013 9:40 PM Glaxo wyeth Lundbeck and Janssen all provided funding

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1 Apr 30, 2013 5:49 AM No evidence

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1 Mar 29, 2013 12:49 PM The PTSD guidelines, while relatively brief, they are appropriately referenced and provide a succinct and up to date overview.

YesYes, with


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tsCategories

1 Apr 30, 2013 5:49 AM The guidelines are dated 2006 and in the PTSD space would consider these to now be outdated

2 Mar 29, 2013 12:49 PM For a short set of Guidelines they cover the main bases.

3 Mar 14, 2013 9:40 PM need to advise on drug company funding

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2 Mar 29, 2013 12:49 PM Warwick Middleton


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0 1 0 0 0 1 1 5.00 3

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1 Apr 17, 2013 5:00 AM No patient/consumer on the group

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1 Apr 17, 2013 5:00 AM

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There is no evidence that this has been undertaken and only 9 trials have been used as evidence. So the evidence is reasonably restricted though I note

that the research is recent

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1 Apr 17, 2013 5:02 AM

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3

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Limited research evidence available with phase based treatment approach recommended by the Expert Group with only 2 Level A

Randomised control studies evident

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1 Apr 17, 2013 5:02 AM Evidence limited as discussed previously

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1 Apr 17, 2013 5:02 AM No evidence that the guidelines have been externally reviewed

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3

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0 0 1 0 0 2 0 5.00 3

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3

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0 0 0 1 1 1 0 5.00 3

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3

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3

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1 Apr 17, 2013 5:04 AM

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0 0 0 2 0 1 0 4.67 3

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DisagreeUncertain

Somewhat


Response

Count

0 0 0 2 0 1 0 4.67 3

0

3

0

Comments

Answer Options

This will be compromised in apply to Aust as there is very little trauma informed care and practice in service provision except perhaps in

individual professional office based practice

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20

22

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23


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65

Lowest


Highest

Possible

Quality


Count

0 0 0 0 3 0 0 5.00 3

1

3

0


1 Mar 29, 2013 1:07 PM Compared to the ASCA Guidelines these are brief and fairly narrowly focussed. They provide a useful reference point.

YesYes, with


Response

Count

2 1 0 1.33 3

3

3

0


tsCategories

1 Apr 17, 2013 5:05 AM I think it is essential to have Complex PTSD as part of this project. It affects more people that say combat PTSD.

2 Mar 29, 2013 1:07 PM Useful, as far as they go.

3 Mar 14, 2013 9:47 PM caution around diagnosis and evidence based treatments

Response

Count

3

3

0






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25

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Comments


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24

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66

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 2 2 6.20 5

3

5

0


1 May 9, 2013 9:32 PM Guideline 1

2 Apr 21, 2013 4:32 PM specifically for complex PTSD

3 Mar 16, 2013 5:53 AM I thought goals and limitations were clear

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 1 1 1 2 5.80 5

2

5

0


1 Mar 29, 2013 12:20 PM Guideline not freely avaialbe in complete form

2 Mar 16, 2013 5:53 AM Yes management of complex PTSD

Strongly

DisagreeAgree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 3 1 6.00 5

2

5

0


1 Mar 29, 2013 12:20 PM Guideline not freely avaialbe in complete form, but what is avialble does appear to cover some specific populations

2 Mar 16, 2013 5:53 AM They acknowledge the problem of definition of complex PTSD and lack of usage in ICD and DSM systems

Strongly

DisagreeAgree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 2 2 1 0 4.80 5

2

5

0


1 Apr 21, 2013 4:34 PM limited identification


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1

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4

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2

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3

Comments

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AGREE II scoring - ISTSS PTSD

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67

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 1 0 4 0 0 0 3.60 5

3

5

0


1 Apr 21, 2013 4:34 PM not highlighted


3 Mar 16, 2013 5:54 AM I could not see clearly the input of clients

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 1 1 2 1 5.60 5

3

5

0


1 Apr 21, 2013 4:34 PM clinician specific


3 Mar 16, 2013 5:54 AM Implies those treating Complex PTSD

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 1 1 0 3 6.00 5

3

5

0


1 Apr 21, 2013 4:36 PM literature based

2 Mar 29, 2013 12:25 PM Guideline not freely available in complete form

3 Mar 16, 2013 5:58 AM There was a real effort to cover all research on the topic and to discuss limitations

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 1 0 1 0 2 1 5.00 5

2

5

0


1 Apr 21, 2013 4:36 PM not highlighted


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6

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7

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8

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5

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68

Strongly

DisagreeDisagree

Somewhat

DisgreeUncertain

Somewhat


Response

Count

0 0 0 0 2 1 2 6.00 5

3

5

0


1 Apr 21, 2013 4:36 PM tabulated


3 Mar 16, 2013 5:58 AM This was clear and well done acknowledging the problems

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 1 2 2 0 5.20 5

2

5

0


1 Apr 21, 2013 4:36 PM expert opinion based


Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 1 0 4 0 0 4.60 5

2

5

0


1 Apr 21, 2013 4:36 PM limited mentioning


Strongly

DisagreeDisagree

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DisagreeUncertain

Somewhat


Response

Count

0 0 0 1 3 0 1 5.20 5

2

5

0


specify)Categories

1 Apr 21, 2013 4:36 PM some mentioning


Comments

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Comments


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12


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10

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9

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11


Comments

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69

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DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 4 0 1 0 4.40 5

3

5

0


specify)Categories

1 Apr 21, 2013 4:36 PM expert penal implied


3 Mar 16, 2013 5:58 AM I was a little unclear on this point but it may reflect my own inexperience in reviewing. There seemed to be an experienced panel consulted

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 1 1 3 0 0 0 3.40 5

2

5

0


specify)Categories

1 Apr 21, 2013 4:36 PM not apparent


Strongly

DisagreeDisagree

Somewhat

disagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 2 1 6.00 4

1

4

1


1 Mar 16, 2013 6:00 AM I thought the recommendations were clear and clinically relevant.


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14

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Comments

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15


answered question

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13

70

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 3 1 1 5.60 5

1

5

0


1 Mar 16, 2013 6:00 AM There don't seem to be a lot of options but this probably accurately represents the field

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 2 2 6.20 5

1

5

0


1 Mar 16, 2013 6:00 AM This was formulated better in ASCA

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 1 2 2 0 0 4.20 5

2

5

0


1 Apr 21, 2013 4:39 PM limited to the clinical level


Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 1 1 3 0 0 4.40 5

1

5

0



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17


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Comments

16

19

Answer Options


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Comments

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18


Comments

71

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 3 1 1 0 0 3.60 5

3

5

0


1 Apr 21, 2013 4:39 PM few mentioning, other than acknowledging the limited data on evidence base treatment


3 Mar 16, 2013 6:02 AM It really looks at individual resource providers and does not examine systems issues

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 3 0 2 0 0 0 2.80 5

2

5

0




Strongly

DisagreeDisagree

Somewhat

disagreeUncertain

Somewhat


Response

Count

0 1 0 3 0 0 1 4.20 5

1

5

0


1 Apr 21, 2013 4:42 PM initiative of ISTAA. No mentioning of other funding arrangement

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 1 0 3 1 0 0 3.80 5

2

5

0




20

answered question

Comment

21

Comments

23

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22

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Comments


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72

Lowest


Highest

Possible

Quality


Count

0 0 0 1 2 2 0 5.20 5

1

5

0


1 Mar 16, 2013 6:06 AM

YesYes, with


Response

Count

3 1 1 1.60 5

4

5

0


tsCategories

1 May 10, 2013 4:20 AM I found it difficult to assess with regard to conflict of interest & relationship to the funding body

2 Apr 21, 2013 4:43 PM designed for and limited to clinician usage

3 Mar 29, 2013 12:30 PM Guideline not freely available in complete formTherefore very hard to assess as methodology not detailed

4 Mar 16, 2013 6:06 AM I thought it was the best for complex PTSD and would compliment a guideline on broad management of PTSD

Response

Count

5

5

0



2 May 9, 2013 9:36 PM Norm Wotherspoon

3 Apr 21, 2013 4:43 PM Eddie So

4 Mar 29, 2013 12:30 PM Bradley Ng



I thought this guideline was clear, unambiguous and clinically useful. It was weaker than ASCA in the system's area and client

involvement but stronger in a thorough research review, and recognising research limitations

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24

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answered question


Notes/Comments

25

73

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

0

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

0

Strongly

DisagreeAgree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

0

Strongly

DisagreeAgree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

1

3

0


1 Apr 17, 2013 5:58 AM Very pleased to see all relevant groups including patients/consumers represented

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 1 0 2 0 5.33 3

0

3

0

Answer Options

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4

1

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Comments

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2

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Comments

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AGREE II scoring - NICE

3

5

skipped question


Comments

Comments

74

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

0

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 1 1 6.00 3

1

3

0


1 Apr 17, 2013 6:00 AM NICE uses Consensus Statements or Good Practice Points in the absence of robust RCTs or trial evidence.

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 1 1 6.00 3

1

3

0


1 Mar 29, 2013 12:16 PM Evidence is limited and brief. no studies are referenced.

Strongly

DisagreeDisagree

Somewhat

DisgreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

0

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

answered question

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6

8

Comments

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Comments


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7

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Comments

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9

10

answered question

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answered question

Comments

Comments

75

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 1 1 6.00 3

0

3

0

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 1 1 6.00 3

0

3

0

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

1

3

0


specify)Categories

1 Apr 17, 2013 6:00 AM

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

1

3

0


specify)Categories

1 Apr 17, 2013 6:00 AM Every 4 years

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answered question

This is the only of the 4 I have reviewed which clearly identifies the external reviewers. These come from a variety of professions and

include patient/consumer reviewers (2)

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13

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11

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14



Comments

12

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answered question

76

Strongly

DisagreeDisagree

Somewhat

disagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 1 1 6.00 3

1

3

0


1 Mar 29, 2013 12:18 PM limited detail. Unreferenced.

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 1 1 6.00 3

1

3

0


1 Mar 29, 2013 12:18 PM Limited treatment options considered.

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

0

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 2 1 0 5.33 3

0

3

0

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 2 0 5.67 3

0

3

Comments


Comments

answered question

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18


16

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Comments


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Comments

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15

19

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Comments

answered question

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answered question

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17

answered question

77

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 1 1 6.00 3

1

3

0


1 Apr 17, 2013 6:02 AM

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 1 0 0 1 5.50 2

0

2

1

Strongly

DisagreeDisagree

Somewhat

disagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

0

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 1 2 0 5.67 3

0

3

0

Lowest


Highest

Possible

Quality


Count

0 0 0 1 0 0 2 6.00 3

1

3

0skipped question

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Comments

Whist the UK has a somewhat different health system to Aust it is more in line with NZ. Reference is made to trusts which are not

relevant in Aust but could be adapted to Aust psychiatric settings



Answer Options

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23

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Comment

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24

21

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22

Comments

20

78


1 Mar 29, 2013 12:21 PM Limited detail. Unreferenced.

YesYes, with


Response

Count

2 0 1 1.67 3

2

3

0


tsCategories

1 Apr 17, 2013 6:03 AM It is relatively recent, relevant, based on trial evidence or consensus of guideline expert developers or practice points.

I think this is the most applicable to the Aust content and ticks all boxes.

2 Mar 29, 2013 12:21 PM Not enough breadth, coverage, detail. Very oriented towards British primary care system.

Response

Count

3

3

0





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Notes/Comments


25

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79

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 1 2 6.67 3

1

3

1


1 Apr 17, 2013 4:34 AM Guidelines are 2010 so research and RCT although many are in the 1990's still many are more recent.

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 1 2 6.67 3

0

3

1

Strongly

DisagreeAgree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 1 2 6.67 3

0

3

1

Strongly

DisagreeAgree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 1 0 2 0 5.33 3

2

3

1


1 Mar 29, 2013 9:09 AM Dominated by the military, but understandble. It is a VA/DoD set of Guidelines

2 Mar 14, 2013 7:43 PM could nt locate professional titles or where they work

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1

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3



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4

answered question

Comments

answered question

AGREE II scoring - VA/DoD

2

skipped question


Comments

Comments

80

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 2 0 1 0 4.67 3

0

3

1

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

1

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 1 2 6.67 3

0

3

1

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 1 2 6.67 3

0

3

1

Strongly

DisagreeDisagree

Somewhat

DisgreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

1

Comments

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answered question

Comments

9

6

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Comments

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answered question

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7

Comments

Comments


answered question

answered question

5

8

81

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 1 2 6.67 3

0

3

1

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 1 2 6.67 3

0

3

1

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

1

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 1 0 2 0 0 0 3.33 3

2

3

1


specify)Categories

1 Mar 29, 2013 9:13 AM Two internal review meetings. i can't see evidence of an external review.

2 Mar 14, 2013 7:47 PM could not locate

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 1 0 2 0 5.33 3

0



12

14

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Comments

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13

10



Comments

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Answer Options

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11

skipped question

82

Strongly

DisagreeDisagree

Somewhat

disagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

1

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

1

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 1 2 6.67 3

0

3

1

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

1

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 0 0 2 1 6.33 3

0

3

1skipped question

answered question


Comments

Comments

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17

answered question

answered question

skipped question

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18

15


Comments

Answer Options

Answer Options

Comments

19

16

answered question

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Comments

Answer Options

Answer Options

answered question

83

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 2 1 0 0 4.33 3

0

3

1

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 0 0 1 1 1 0 5.00 3

1

3

1


1 Mar 29, 2013 9:15 AM Not sure exactly what is being asked here.

Strongly

DisagreeDisagree

Somewhat

disagreeUncertain

Somewhat


Response

Count

0 0 1 2 0 0 0 3.67 3

2

3

1


1 Apr 17, 2013 4:39 AM A number of people on the development group are military so one wonders.

2 Mar 29, 2013 9:16 AM A lot of focus on military PTSD from a group that is heavily military/VA.

Strongly

DisagreeDisagree

Somewhat

DisagreeUncertain

Somewhat


Response

Count

0 1 0 3 0 0 0 3.50 4

1

4

0


1 Apr 17, 2013 4:39 AM As above

20

22

answered question

Comment

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Comments

21

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23

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Comments

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84

Lowest


Highest

Possible

Quality


Count

0 0 0 0 2 1 0 5.33 3

0

3

1

YesYes, with


Response

Count

3 0 0 1.00 3

1

3

1


tsCategories

1 Apr 17, 2013 4:40 AM I think the research has been rigorous, clearly articulated treatment options, research and RCT of recent times.

Response

Count

3

3

1



2 Mar 29, 2013 11:55 AM Warwick Middleton


Comments

24

answered question


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Notes/Comments

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25

answered question

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85

Post-traumatic stress disorder (PTSD) guidelines review report

Documents

Transcript of Post-traumatic stress disorder (PTSD) guidelines review report