An explanation of PROSPECT methodology and Working Group processes can be found at the following link: http://esraeurope.org/prospect-methodology
For the tonsillectomy review, the Subgroup members were:
Tonsillectomy literature search
Assessments of the quality of study methodology and reporting
All included studies were assessed for quality according to PROSPECT methodology (Joshi 2019, http://esraeurope.org/prospect-methodology). The study quality assessments for tonsillectomy are summarised here: Quality assessments and level of evidence assigned to included trials.
Recommendations were made according to PROSPECT methodology (Joshi 2019, http://esraeurope.org/prospect-methodology). This involved a grading of A–D according to the overall level of evidence, as determined by the quality of studies included, consistency of evidence and study design: Relationship between quality of the study and levels of evidence and grades of recommendation.
The proposed recommendations were sent to the PROSPECT Working Group for review and comments and a modified Delphi approach was used. Once a consensus was achieved the lead authors drafted the final document, which was ultimately approved by the working group.
Some limitations of this review are related to the limitations of the individual studies included:
As it is not part of the methodology, recommendations were not weighted and dosage recommendations were not made.
Future adequately powered studies should assess the effects of analgesic interventions not only on pain, opioid consumption, opioid-related adverse events and complications associated with the intervention, but also outcome measures such as time to ambulation, length of hospital stay and everyday function after discharge. Another important aspect will be to bring patient-specific risk factors for postoperative pain into the studies.
The AGREE II instrument (Brouwers 2010) is used internationally to assess the methodological rigour and transparency of practice guidelines. As far as possible, the methodology of the PROSPECT Tonsillectomy review meets the requirements of ‘Domain 3: Rigour of development’ of the AGREE II instrument: