Why English? | Appraising AGREE-REX Recommendations Through Evidence, Values, Applicability, Implementability and Local Adoption

ORIENTATION

What this guide owns

Current fact check

AGREE-REX Version 1 contains nine items in three domains. It can assess individual recommendations, a cluster or all recommendations, and uses seven-point evaluation scales described in the manual.

Canonical boundary

This article owns AGREE-REX recommendation appraisal. The existing AGREE II article owns broader guideline development, rigour and editorial independence.

Worked example

Every chapter returns to a fictional guideline recommendation that schools offer a private route for students to request academic support. It is fictional, low-stakes and educational; it does not report a real school, clinical decision or guaranteed outcome.

Warm up with eduKate’s guides to explaining scientific evidence and asking better questions in class.

CHAPTER 1 OF 16

1. Choose the Recommendation and Unit of Appraisal

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Why this move matters

State whether the tool is applied to one recommendation, a cluster or the full guideline and explain why that unit fits the decision.

Separate evidence from recommendation

For choose the recommendation and unit of appraisal, identify the evidence statement, the value judgement and the action proposed. State whether the tool is applied to one recommendation, a cluster or the full guideline and explain why that unit fits the decision. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: The team appraises the private-help-route recommendation separately because adoption can occur independently. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: Different units can yield different impressions of quality and suitability. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Choose the Recommendation and Unit of Appraisal”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

CHAPTER 2 OF 16

2. Keep AGREE-REX Distinct From AGREE II

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Why this move matters

Use AGREE II for guideline-development domains and AGREE-REX for the quality and implementability of recommendations.

Separate evidence from recommendation

For keep agree-rex distinct from agree ii, identify the evidence statement, the value judgement and the action proposed. Use AGREE II for guideline-development domains and AGREE-REX for the quality and implementability of recommendations. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: A guideline may report rigorous searches yet still leave local implementation poorly considered. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: Neither tool proves that following a recommendation will produce a guaranteed outcome. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Keep AGREE-REX Distinct From AGREE II”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

CHAPTER 3 OF 16

3. Appraise the Evidence Behind the Recommendation

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Why this move matters

Look for risk of bias, consistency, directness, precision, benefits, harms, publication bias and relevant confounding.

Separate evidence from recommendation

For appraise the evidence behind the recommendation, identify the evidence statement, the value judgement and the action proposed. Look for risk of bias, consistency, directness, precision, benefits, harms, publication bias and relevant confounding. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: The recommendation links private access to evidence on help-seeking while naming uncertainty in school settings. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: Strong evidence for one outcome may not settle trade-offs among several outcomes. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Appraise the Evidence Behind the Recommendation”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

CHAPTER 4 OF 16

4. Check Applicability to Target Users

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Why this move matters

Ask whether the recommendation fits the knowledge, role, authority and workflow of people expected to act on it.

Separate evidence from recommendation

For check applicability to target users, identify the evidence statement, the value judgement and the action proposed. Ask whether the recommendation fits the knowledge, role, authority and workflow of people expected to act on it. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: Teachers can offer a private request route, but referral and safeguarding roles must be clear. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: Professional acceptance cannot substitute for patient or student values. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Check Applicability to Target Users”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

CHAPTER 5 OF 16

5. Check Applicability to Patients or Populations

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Why this move matters

Examine whether populations, benefits, harms, inequities and contextual differences match those affected locally.

Separate evidence from recommendation

For check applicability to patients or populations, identify the evidence statement, the value judgement and the action proposed. Examine whether populations, benefits, harms, inequities and contextual differences match those affected locally. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: The school checks access for students with disabilities, language needs and concerns about confidentiality. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: A broad population label may hide meaningful subgroup differences. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Check Applicability to Patients or Populations”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

CHAPTER 6 OF 16

6. Identify Target-User Values and Preferences

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Why this move matters

Report what professionals or implementers value, how these views were elicited and where they conflict.

Separate evidence from recommendation

For identify target-user values and preferences, identify the evidence statement, the value judgement and the action proposed. Report what professionals or implementers value, how these views were elicited and where they conflict. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: Teachers value responsiveness but differ on workload, documentation and role boundaries. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: A loud professional group should not be assumed to represent every target user. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Identify Target-User Values and Preferences”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

CHAPTER 7 OF 16

7. Identify Patient or Population Values and Preferences

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Why this move matters

Show which outcomes and trade-offs matter to affected people and how their views shaped wording or strength.

Separate evidence from recommendation

For identify patient or population values and preferences, identify the evidence statement, the value judgement and the action proposed. Show which outcomes and trade-offs matter to affected people and how their views shaped wording or strength. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: Students value privacy, rapid response and control over who receives their request. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: Consultation methods can exclude people who feel least safe participating. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Identify Patient or Population Values and Preferences”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

CHAPTER 8 OF 16

8. Identify Policy and Decision-Maker Values

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Why this move matters

Describe system goals, fairness, legal duties, resource stewardship and accountability without letting them erase individual needs.

Separate evidence from recommendation

For identify policy and decision-maker values, identify the evidence statement, the value judgement and the action proposed. Describe system goals, fairness, legal duties, resource stewardship and accountability without letting them erase individual needs. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: School leaders consider equitable access, safeguarding and sustainable staffing. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: Institutional convenience is not automatically the most important value. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Identify Policy and Decision-Maker Values”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

CHAPTER 9 OF 16

9. Identify Guideline-Developer Values

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Why this move matters

Make visible the assumptions, priorities, conflicts and deliberative choices of those who formulated the recommendation.

Separate evidence from recommendation

For identify guideline-developer values, identify the evidence statement, the value judgement and the action proposed. Make visible the assumptions, priorities, conflicts and deliberative choices of those who formulated the recommendation. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: Developers explain why dignity and access were weighted alongside workload evidence. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: Declaring values does not neutralise conflicts or guarantee balanced judgement. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Identify Guideline-Developer Values”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

CHAPTER 10 OF 16

10. Look for Alignment and Productive Tension

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Why this move matters

Compare evidence and stakeholder values rather than pretending every perspective naturally agrees.

Separate evidence from recommendation

For look for alignment and productive tension, identify the evidence statement, the value judgement and the action proposed. Compare evidence and stakeholder values rather than pretending every perspective naturally agrees. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: Students prefer anonymity while teachers need enough information to respond safely, so the recommendation specifies staged disclosure. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: A compromise may still disadvantage a less powerful group. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Look for Alignment and Productive Tension”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

CHAPTER 11 OF 16

11. Clarify the Purpose of the Recommendation

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Why this move matters

State the problem, desired change, intended users and expected benefit so implementation can be judged against a real purpose.

Separate evidence from recommendation

For clarify the purpose of the recommendation, identify the evidence statement, the value judgement and the action proposed. State the problem, desired change, intended users and expected benefit so implementation can be judged against a real purpose. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: The purpose is earlier access to academic support, not surveillance of student behaviour. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: A clear purpose does not prove that the recommended action is effective. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Clarify the Purpose of the Recommendation”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

CHAPTER 12 OF 16

12. Assess Local Application and Adoption

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Why this move matters

Examine resources, workflow, training, infrastructure, incentives, barriers, monitoring and adaptation in the intended setting.

Separate evidence from recommendation

For assess local application and adoption, identify the evidence statement, the value judgement and the action proposed. Examine resources, workflow, training, infrastructure, incentives, barriers, monitoring and adaptation in the intended setting. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: The school tests a secure request channel, response times and staff escalation before wider adoption. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: Local feasibility can change and may vary within the same organisation. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Assess Local Application and Adoption”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

CHAPTER 13 OF 16

13. Use the Seven-Point Ratings Transparently

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Why this move matters

Have appropriate appraisers use operational criteria, record rationales and interpret scores without inventing a universal pass mark.

Separate evidence from recommendation

For use the seven-point ratings transparently, identify the evidence statement, the value judgement and the action proposed. Have appropriate appraisers use operational criteria, record rationales and interpret scores without inventing a universal pass mark. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: Two appraisers explain why evidence scores well while local adoption needs modification. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: A number can conceal disagreement and should be read with comments and item evidence. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Use the Seven-Point Ratings Transparently”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

CHAPTER 14 OF 16

14. Separate Quality, Suitability and Final Adoption

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Why this move matters

Distinguish whether a recommendation was well formulated, whether it fits locally and whether authorities choose to adopt, adapt or reject it.

Separate evidence from recommendation

For separate quality, suitability and final adoption, identify the evidence statement, the value judgement and the action proposed. Distinguish whether a recommendation was well formulated, whether it fits locally and whether authorities choose to adopt, adapt or reject it. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: The team rates quality, proposes local modifications and leaves formal adoption to the authorised body. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: A favourable appraisal is not regulatory approval or a mandate. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Separate Quality, Suitability and Final Adoption”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

CHAPTER 15 OF 16

15. Use Multiple Appraisers and Resolve Differences

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Why this move matters

Report appraiser backgrounds, independence, training, item comments and how divergent ratings informed the final judgement.

Separate evidence from recommendation

For use multiple appraisers and resolve differences, identify the evidence statement, the value judgement and the action proposed. Report appraiser backgrounds, independence, training, item comments and how divergent ratings informed the final judgement. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: A practitioner, student-support lead and policy reviewer discuss why they interpret feasibility differently. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: Consensus among appraisers does not remove uncertainty in the underlying evidence. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Use Multiple Appraisers and Resolve Differences”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

CHAPTER 16 OF 16

16. Write a Bounded Recommendation Appraisal

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Why this move matters

Summarise evidence, values, implementability, unresolved concerns and the next local test without promising benefit.

Separate evidence from recommendation

For write a bounded recommendation appraisal, identify the evidence statement, the value judgement and the action proposed. Summarise evidence, values, implementability, unresolved concerns and the next local test without promising benefit. These are connected, but they are not the same kind of claim.

Open the stakeholder lens

Apply the item to the worked recommendation: The recommendation is judged credible but conditionally adoptable after privacy and response-capacity testing. Ask how target users, affected people, decision-makers and developers may value benefits, harms, feasibility and fairness differently.

Test local implementability

Describe the people, workflow, resources, authority, barriers and monitoring needed locally. Record whether adaptation changes the recommendation itself or only the way it is delivered.

Rate with reasons

Give the rating, evidence location, appraiser rationale and this boundary: A well-written appraisal cannot guarantee admission, employment, health or learning outcomes. Comments are essential when a single number would hide uncertainty or disagreement.

Student, parent and career transfer

Make one evidence card for “Write a Bounded Recommendation Appraisal”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports guideline appraisal, healthcare, education policy, public administration and evidence-informed implementation without promising a grade, admission, funding decision or job.

PRACTICE LAB

Build a recommendation decision trail

Student route

1. Choose one original report inside this guide’s scope.
2. Copy its objective and underline actor, action, context, evidence and intended decision.
3. Draw the specific reasoning chain used in this article.
4. Mark each step reported, inferred, contested or unknown.
5. Rewrite the conclusion so it preserves the narrowest important limitation.

Parent or teacher route

Ask the learner to explain read a recommendation as evidence plus values plus a real-world adoption decision twice: once to a classmate and once to a method specialist. Praise a precise correction and a well-stated unknown; both show disciplined attention to evidence.

Early-career route

Create a one-page agree_rex audit with source link, date checked, scope, method logic, decisive wording, contrary evidence, limit and next action. A colleague should be able to continue without guessing.

Continue with eduKate’s guides to reading course and career information and giving useful feedback in group projects.

USEFUL NEXT READING

Connect this narrow owner to its neighbour

Read the AGREE II guideline-appraisal guide for a related but different reader job. Return here when the question is specifically how to read a recommendation as evidence plus values plus a real-world adoption decision. This boundary keeps one canonical owner per intent.

For English practice across research, school and career communication, visit the Singapore English Tuition Centre learning site.

FREQUENTLY ASKED QUESTIONS

Questions students and parents often ask

How many AGREE-REX items are there?

Nine items across clinical applicability, values and preferences, and implementability.

Is AGREE-REX the same as AGREE II?

No. It complements AGREE II by focusing more specifically on recommendation excellence and local suitability.

Can it appraise one recommendation?

Yes. It can be applied to one recommendation, a cluster or an entire set.

Does AGREE-REX set a pass score?

The manual provides rating methods, but readers should not invent an unsupported universal pass mark.

Why are values part of appraisal?

Recommendations involve choices among outcomes, trade-offs and stakeholder priorities as well as evidence.

Does a high score mean adopt immediately?

No. Local suitability, authority, resources and further testing still matter.