Clinical Guidelines

Introduction[edit | edit source]

The standard definition of Clinical Practice Guidelines (CPGs) is "systematically developed statements to assist practitioners and patient decisions about appropriate health care for specific circumstances"[1]. Guidelines are designed to support the decision-making processes in patient care. The content of a guideline is based on a systematic review of clinical evidence - the main source for evidence-based care.

The benefits of clinical practice guidelines include[2]:

  • Improve clinical outcomes[3]
  • Reduce variability in clinical practice[4]
  • Increase use of known effective interventions[3]
  • Provide greater cost effectiveness[3]
  • Increase transparency of evidence to justify interventions[2]
  • Legitimize profession in the eyes of external stakeholders[4]

Clinical Guidelines are important to physiotherapists because they[5]:

  • Provide quick access to the synthesis of evidence
  • Give the clinician direct access to the knowledge-base of the experts
  • Allow one to self-assess their current practice
  • Assist with developing direction of future clinical research

Clinical Guidelines can be found at:

The Canadian Medical Association (CMA) released a handbook regarding CPG development, implementation, and evaluation and can be found here.

Published Clinical Practice Guidelines by Speciality[edit | edit source]

Internationalisation[edit | edit source]

It is easy to find evidence-based guidelines for physiotherapy practice (e.g. using PEDro) and there are many evidence-based guidelines for physiotherapy practice but there appears to be too much replication. In 2011 an international collaboration for the development of evidence-based recommendations for physiotherapy diagnosis and treatment was proposed[6] and presented at the World Physical Therapy Congress. The rationale for this was:

  • Rapid growth of body of knowledge for evidence-based physiotherapy
  • Translation of evidence into recommendations for clinical practice in guidelines by several professional bodies
  • International collaboration in the Guidelines International network (G-I-N)
  • International collaboration in physical therapy is still limited

For internationally accepted clinical guidelines to be relevant, “room” must be made for those that don’t fit into the “developed world” model. The “developing world” has unique challenges that need to be considered and become part of internationally relevant guidelines[7]. It is important that we remember the limitations in the practice setting, delivery, competency and several other issues faced in places where the physiotherapy profession is in evolution[8]. Research suggests high patient burden per doctor, poor technological advancement, poor data recording, insufficient funding or grants, and an absence of research-friendly government or institutional policies may contribute to poor research culture in low-income and middle-income countries[9]. Therefore, funders and researchers from high-income countries should focus on research activities in the low-income and middle-income countries involving the local researchers to promote a positive research culture that would help improve global health and benefit people living in these countries from evidence-based medicine and health services.[9]

References[edit | edit source]

  1. Field MJ, Lohr KN (Eds). Clinical Practice Guidelines: Directions for a New Program, Institute of Medicine, Washington, DC: National Academy Press, 1990.
  2. 2.0 2.1 Moore, A. Development of evidence statements for physical therapy diagnosis and treatment: What are evidence statements and how do they fit in with the policy of professional bodies? WPT Congress, June 2011, Amsterdam.
  3. 3.0 3.1 3.2 Potential Benefits, Limitations and Harms of Clinical Guidelines. Woolf SH, Grol G, Hutchinson A, Eccles M, Grimshaw J. BMJ, 1999; 318(7182): 527–530.
  4. 4.0 4.1 Clinical Practice Guidelines - Do they Enhance Value for Money in Health Care? Grimshaw JM, Hutchinson A. Br Med Bull, 1995; 51: 927-940.
  5. Christopher M Powers. Development of Evidence-Based Practice Guidelines for the Treatment of Common Musculoskeletal Conditions: Experiences of the Orthopaedic Section of the APTA. WPT Congress, June 2011, Amsterdam.
  6. Development of Clinical Guidelines in Physical Therapy: Perspective for International Collaboration. Van der Wees PJ, Moore AP, Powers CM, Stewart A, Nijhuis-van der Sanden MWG, de Bie RA. Physical Therapy, 2011; 91(10): 1551-1563.
  7. Aimee Stewart. Applicability of existing evidence in low and middle-income countries. Focused Symposia, WPY Congress, June 2011, Amsterdam.
  8. Srikesavan Sabapathy. In conversation via the Physiopedia Facebook page, March 2012.
  9. 9.0 9.1 Adhikari S. Evidence-based medicine in low-income and middle-income countries. The Lancet Global Health. 2021 Jul 1;9(7):e903-4.