Gender composition of spasticity-related clinical practice guideline authorship positions.

Abstract

Background: The authors of clinical practice guidelines (CPGs) are considered topic experts and specialists. Studies to date have disproportionately found that women are underrepresented in CPG authorship, but no studies have investigated CPGs on spasticity published in the recent literature.

Objective: To determine the gender composition of author positions on spasticity-related CPGs published from 2014 to 2023.

Design: Retrospective review of literature.

Setting: Systematic literature search using PubMed, SCOPUS, and CINAHL databases for spasticity-related CPGs available in English and published between 2014 and 2023.

Participants: Authorship positions on spasticity-related CPGs published during the defined study period.

Interventions: Not applicable.

Main outcome measures: Gender composition of all author positions and physician author positions on spasticity-related CPGs published from 2014 to 2023 were compared with parity and equity benchmarks. The binomial test was used to assess for a difference in the observed versus expected distribution (parity) and the N - 1 χ² test was used to compare the gender proportions of authorship positions with the gender proportions of the equity benchmarks.

Results: Six CPGs on spasticity were published during the study period. Most author positions were held by women (54.5%), whereas most physician author positions were held by men physicians (63%). Men physicians held significantly more positions compared with parity (p = .016). Women were overrepresented among all author positions compared with equity using total U.S. academic medicine faculty in neurology/physical medicine and rehabilitation (PM&R) at all benchmark years (95% confidence interval [CI]: 2014: 7.7-23.5; 2018: 4.2-20.0; 2022: 1.4-17.2). There was no difference in the gender composition of physician authors compared with academic medicine physicians in neurology/PM&R for any benchmark year (95% CI: 2014: -8.3 to 11.6; 2018: -2.0 to 7.9; 2022: -4.7 to 5.2).

Conclusions: Physician authorship of recent spasticity-related CPGs comprises mostly men, a significant difference from parity but not from equity benchmarks. Women are overrepresented among total authorship positions (including nonphysicians) compared with equity, but not parity. Editorial boards should actively promote authorship diversity of these influential guidelines to minimize gender bias in health care delivery.