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Clinical Guidelines 2

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Rehab Naeem
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30 views17 pages

Clinical Guidelines 2

Uploaded by

Rehab Naeem
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Clinical guidelines as a resource

for evidence-based physiotherapy


WHERE CAN I FIND CLINICAL GUIDELINES?

• Only a minority of clinical guidelines are


published in journals, so the major databases
such as MEDLINE, EMBASE and CINAHL
provide a poor way of locating practice
guidelines.
• PEDro only archives evidence-based practice
guidelines.
EBP based PEDro guidelines
in which
• 1. a systematic review was performed during the guideline
development or the guidelines were based on a systematic
review published in the 4 years preceding publication of the
guideline, and
• 2. at least one randomized controlled trial related to
physiotherapy management is included in the review of
existing scientific evidence, and
• 3. the clinical practice guideline must contain systematically
developed statements that include recommendations,
strategies, or information that assists physiotherapists or
patients to make decisions about appropriate health care for
specific clinical circumstances.
HOW DO I KNOW IF I CAN TRUST THE
RECOMMENDATIONS IN A CLINICAL GUIDELINE?

• Studies conducted showed-Widespread quality


problems
• A checklist was developed containing 37 items (cluzeau
& littlejohns 1999, cluzeau et al 1999)
• Good reliability for the instrument and acceptable face
validity.
• Further developed and validated by an International
group of researchers from 13 countries, known as the
Appraisal of guidelines, research and evaluation
(AGREE) collaboration (The AGREE collaboration 2003).
six theoretical quality domains
1. Scope and purpose
2. Stakeholder involvement
3. Rigour of development
4. Clarity and presentation
5. Applicability
6. Editorial independence
www.agreecollaboration.org.
SCOPE AND PURPOSE
1. The overall objectives of the guideline are
specifically described
2. Clinical questions covered by the guideline
are specifically described
3. The patients to whom the guideline is
meant to apply are specifically described
The overall objectives of the guideline are
specifically described
• For developers …overall objective(s), including
the guideline’s potential impact on society and
populations of patients.
• A scoping document= background
epidemiology, target population, the health
care settings and the interventions that will
and will not be considered
• Available for consultation
Clinical questions covered by the guideline
are specifically described
• Clear and detailed description of the clinical
questions
• How questions were formulated?
• Benefits
1. More specific and detailed components.
2. Search strategies
The patients to whom the guideline is
meant to apply are specifically described
• Clear description of the population
Stakeholder involvement
• Mention all involved at some stage of the
development process.
1. The guideline development group includes
individuals from all relevant professional groups
2. Patients’ views and preferences have been sought
3. Target users of the guideline are clearly defined
4. The guideline has been piloted among target users
The guideline development group includes individuals
from all relevant professional groups

1. Expertise and range of experiences


2. Names of those who were involved in the
guideline development process may provide,
or compromise credibility.
• Representatives from a range of different
backgrounds
• Diverse values, perspectives and interests is
less likely to skew judgements.
• Description of process through which key
stakeholders and target population was
chosen
Participants in a guideline development
group
• Clinical experts:
• Patients
• Acknowledged experts
• Researchers
• Technical experts:
• Information scientists
• Systematic reviewers
• Project managers and group leaders
Patients’ views and preferences have been
sought
• Credibility for other patients
• Clinically effective health care
• Involvement throughout the whole process of
guideline development, from identifying the
topic to educating groups who interpret and
implement the guidelines.
• Questions more relevant to patients
• Better considered judgement
Target users of the guideline are clearly
defined
• Clear for which health professionals and
patients the guideline is relevant.
The guideline has been piloted among
target users
• Pilot process
• Test the feasibility and practicality of implementing
the guideline
• Understandability and effectiveness of presentation
of the guideline, as well as the acceptability of the
rationale for the recommendations
• Theoretical rather than a practical process
• Documentation of the process of piloting with
examples of comments and their impact on process

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