Evidence-Based Physiotherapy Clinical Guidelines

Evidence-Based Clinical Guidelines

• Integrate high-quality clinical research with contributions from clinical experts and patients to formulate reliable recommendations for practice.
• Provide a single source of information about the management of clinical conditions.
• Are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific circumstances.

Characteristics of Clinical Guidelines

• Based on strong and relevant evidence.
• Recommendations should be implemented unless there is a patient-related reason.
• Take into account co-morbidity or social situations.
• Patients may want a different approach or specific treatment.

Differences between Systematic Reviews and Clinical Guidelines

• Systematic reviews have a small scope, while clinical guidelines have a broad scope that may include many systematic reviews.
• Systematic reviews are based on research alone, while clinical guidelines are based on research plus expert opinion, patient experience, and consensus views.
• Systematic reviews have a limited role of patient, while clinical guidelines have a key role of patients.
• Systematic reviews focus on methodological rigor, while clinical guidelines focus on methodological rigor plus judgments made by the guideline development group.
• Systematic reviews are quick, while clinical guidelines require a longer time frame.
• Systematic reviews are typically published for health professionals, while clinical guidelines are published for health professionals and patients.

History of Clinical Guidelines

• Links closely to the development of evidence-based medicine and evidence-based practice.
• Increasing volume of published literature makes clinical guidelines a more manageable resource for busy practitioners.
• Consistency in the provision of health care ensures same (excellent) health care everywhere.
• Recommendations for practice need to be developed in a systematic, reliable, and credible way to be applied across a whole population.

Importance of Clinical Guidelines

• Insurance companies and patients benefit from knowing best treatment options.
• Physical therapists can follow 'best practice' guidelines.
• Many 'guidelines' are based on informal consensus, which in turn is based on a combination of opinion and shared experience.

Key Processes in Developing Clinical Guidelines

• The scientific evidence is assembled in a systematic fashion.
• The panel that develops the guideline includes representatives of most relevant disciplines.
• The recommendations are explicitly linked to the evidence from which they are derived.
• Non-systematic literature reviews may suffer from bias and provide 'false reassurance'.
• A more systematic approach to guideline development methodology has been used since 2000.

Challenges in Guideline Development

• Formulating recommendations where there is limited research evidence.
• The impact of people on guideline development.