Updating contextualized clinical practice guidelines on stroke rehabilitation and low back pain management using a novel assessment framework that standardizes decisions

BMC Research Notes

Marcelle Theresa G. Zamora²  Ma. Eulalia J. Beredo²  Janine Margarita R. Dizon²  Carolina M. Valdecañas²  Karen A. Grimmer¹  Consuelo B. Gonzalez-Suarez²  Ephraim D. V. Gambito² 

[1] International Center for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, Australia;Philippine Academy of Rehabilitation Medicine (PARM), Quezon City, Philippines

关键词: PARM;    Evidence-based practice;    Updating guidelines;    Philippines;    Clinical practice guidelines;   

Others  :  1232825
DOI  :  10.1186/s13104-015-1588-8

 received in 2015-04-23, accepted in 2015-10-14,  发布年份 2015

【 摘 要 】

Background

Clinical practice guidelines need to be regularly updated with current literature in order to remain relevant. This paper reports on the approach taken by the Philippine Academy of Rehabilitation Medicine (PARM). This dovetails with its writing guide, which underpinned its foundational work in contextualizing guidelines for stroke and low back pain (LBP) in 2011.

Methods

Working groups of Filipino rehabilitation physicians and allied health practitioners met to reconsider and modify, where indicated, the ‘typical’ Filipino patient care pathways established in the foundation guidelines. New clinical guidelines on stroke and low back pain which had been published internationally in the last 3 years were identified using a search of electronic databases. The methodological quality of each guideline was assessed using the iCAHE Guideline Quality Checklist, and only those guidelines which provided full text references, evidence hierarchy and quality appraisal of the included literature, were included in the PARM update. Each of the PARM-endorsed recommendations was then reviewed, in light of new literature presented in the included clinical guidelines. A novel standard updating approach was developed based on the criteria reported by Johnston et al. (Int J Technol Assess Health Care 19(4):646–655, [2003]) and then modified to incorporate wording from the foundational PARM writing guide. The new updating tool was debated, pilot-tested and agreed upon by the PARM working groups, before being applied to the guideline updating process.

Results

Ten new guidelines on stroke and eleven for low back pain were identified. Guideline quality scores were moderate to good, however not all guidelines comprehensively linked the evidence body underpinning recommendations with the literature. Consequently only five stroke and four low back pain guidelines were included. The modified PARM updating guide was applied by all working groups to ensure standardization of the wording of updated recommendations and the underpinning evidence bases.

Conclusions

The updating tool provides a simple, standard and novel approach that incorporates evidence hierarchy and quality, and wordings of recommendations. It could be used efficiently by other guideline updaters particularly in developing countries, where resources for guideline development and updates are limited. When many people are involved in guideline writing, there is always the possibility of ‘slippage’ in use of wording and interpretation of evidence. The PARM updating tool provides a mechanism for maintaining a standard process for guideline updating processes that can be followed by clinicians with basic training in evidence-based practice principles.

【 授权许可】

   
2015 Gambito et al.

【 图 表 】

Fig.1.

Fig.2.

【 参考文献 】

• [1]Philippine Academy of Rehabilitation Medicine: Stroke guideline. 2012. http://www.eparm.org. Accessed 19 July 2014.
• [2]Philippine Academy of Rehabilitation Medicine: Low back pain guideline. 2012. http://www.eparm.org. Accessed 19 July 2014.
• [3]Gonzalez-Suarez C, Grimmer-Somers K, Dizon J, King E, Lorenzo S, Valdecanas C, et al.: Contextualizing Western guidelines for stroke and low back pain to a developing country (Philippines): an innovative approach to putting evidence into practice efficiently. J Healthc Leadersh 2012, 4:141-156.
• [4]Gonzalez-Suarez C, Dizon JMR, Grimmer K, Rafunan M, Estrada LL, Malleta A, et al.: Implementation of recommendations from the PARM stroke inpatient rehabilitation guideline: a plan of action. Clin Audit 2013, 5:77-89.
• [5]Gonzalez-Suarez CB, Dizon JNR, Grimmer KA, Estrada MS, Liao LAS, Malleta ARD, et al.: Protocol for the audit of current Filipino practice in stroke in-patient rehabilitation. J Multidiscip Healthc 2015, 8:127-138.
• [6]Martínez García L, Arévalo-Rodríguez I, Solà I, Brian Haynes R, Vandvik PO, Alonso-Coello P, Updating Guidelines Working Group. Strategies for monitoring and updating clinical practice guidelines: a systematic review. Implement Sci. 2012;7:109. doi:10.1186/1748-5908-7-109.
• [7]Alonso-Coello P, Martínez García L, Carrasco J, Solà I, Qureshi S, Burgers J, for the Updating Guidelines Working Group. The updating of clinical practice guidelines: insights from an international survey. Implement Sci. 2011;6:107.
• [8]Vernooij RWM, Sanabria AJ, Sola I, Alonso-Coello P, Martinez Garcia L. Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks. Implement Sci. 2014;9(3). doi:. 10.1186/1748-5908-9-3 webcite
• [9]Shekelle P, Ortiz E, Rhodes S, Morton SC, Eccles MP, Grimshaw JM, et al.: Validity of the agency for healthcare research and quality clinical practice guidelines: how quickly do guidelines become outdated? JAMA 2001, 286(12):1461-1467.
• [10]Johnston M, Brouwers M, Browman G: Keeping cancer guidelines current: results of a comprehensive prospective literature monitoring strategy for twenty clinical practice guidelines. Int J Technol Assess Health Care 2003, 19(4):646-655.
• [11]Eccles M, Rousseau N, Freemantle N: Updating evidence-based clinical guidelines. J Health Serv Res Policy. 2002, 7(2):98-103.
• [12]Newton S, Merlin T, Forbes D, Phelps A, Creamer M, Hiller J. Challenges in updating evidence-based clinical practice guidelines, Third Annual Meeting Health Technology Assessment International, Adelaide, Australia; 2006. p. 141.
• [13]Parmelli E, Papini D, Moja L, Bandieri E, Belfiglio M, Ciccone G, et al.: Updating clinical recommendations for breast, colorectal and lung cancer treatments: an opportunity to improve methodology and clinical relevance. Ann Oncol 2011, 22(1):188-194.
• [14]Becker M, Neugebauer EA, Eikermann M: Partial updating of clinical practice guidelines often makes more sense than full updating: a systematic review on methods and the development of an updating procedure. J Clin Epidemiol 2014, 67(1):33-45.
• [15]Grimmer K, Dizon J, Milanese S, King E, Beaton K, Thorpe O, et al. Efficient clinical evaluation of guideline quality: development and testing of a new tool. BMC Research Notes. 2014;14: 63.. http://www.biomedcentral.com/1471-2288/14/63 webcite
• [16]Hegmann K. Low back disorders. Occupational medicine practice guidelines: evaluation and management of common health problems and functional recovery in workers. 2nd ed. Elk Grove Village (IL): American College of Occupational and Environmental Medicine (ACOEM). 2007.
• [17]Michigan Quality Improvement Consortium Management of acute low back pain in adults. Southfield (MI): Michigan Quality Improvement Consortium. http://www.mqic.org/guidelines. Accessed 19 July 2014.
• [18]Japanese Orthopaedic Association. Clinical Practice Guideline for the Management of Low Back Pain. Tokyo: Nankodo Co., Ltd. http://www.joa.or.jp. Accessed 19 July 2014.
• [19]Livingston C, King V, Little A, Pettinari C, Thielke A, Gordon C. State of Oregon Evidence-based Clinical Guidelines Project. Evaluation and management of low back pain: A clinical practice guideline based on the joint practice guideline of the American College of Physicians and the American Pain Society (Diagnosis and treatment of low back pain). Salem: Office for Oregon Health Policy and Research, 2011. Available at:. http://www.oregon.gov/OHA/OHPR/HERC/Evidence-Based-Guidelines.shtml webcite
• [20]Wijdicks EFM, Sheth KN, Carter BS, Greer DM, Kasner SE, Kimberly WT, et al; on behalf of the American Heart Association Stroke Council. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:1222–38.
• [21]Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT et al; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Nursing, Council on Cardiovascular Surgery and Anesthesia, and Council on Clinical Cardiology. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43:1711–37.
• [22]Clinical practice guidelines, management of ischemic stroke, 2nd ed. Endorsed by Ministry of Health Malaysia, Academy of Medicine Malaysia, and Malaysian Society of Neurosciences. 2012. http://www.moh.gov.my/cpgs. Accessed 19 July 2014.
• [23]Intercollegiate Stroke Working Party. National clinical guideline for stroke, 4th edition. London: Royal College of Physicians, 2012. http://www.rcplondon.ac.uk/resources/stroke-guidelines. Accessed 19 July 2014.
• [24]Staal JB, Hendriks EJM, Heijmans M, Kiers H, Lutgers-Boomsma AM, Rutten G, et al. KNGF Clinical Practice Guideline for Physical Therapy in patients with low back pain. Royal Dutch Society for Physical Therapy (Koninklijk Nederlands Genootschap voor Fysiotherapie, KNGF); 2013. http://www/fysionet-evidencebased.nl. Accessed 19 July 2014.
• [25]Non-specific Back Pain Assessment, Management, and Follow-up Guideline. Group Health Cooperative. 2013. https://www.ghc.org/all-sites/guidelines/backPain.pdf. Accessed 19 July 2014.
• [26]Royal College of Chiropractors. Chiropractic Quality Standard: Chronic Low Back Pain. 2014. http://www.rcc-uk.org/quality-standards. Accessed 19 July 2015.
• [27]Delitto A, George SZ, Van Dillen LR, Whitman JM, Sowa G, Shekelle P, et al.: Low back pain: clinical practice guidelines linked to the international classification of functioning, disability, and health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther 2012, 42(4):A1-A57.
• [28]Goertz M, Thorson D, Bonsell J, Bonte B, Campbell R, Haake B, et al. Adult acute and subacute low back pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI). 2012. http://www.icsi.org/guidelines_more. Accessed 19 July 2014.
• [29]Brosseau L, Wells GA, Poitras S, Tugwell P, Casimiro L, Novikov M, et al.: Ottawa Panel evidence-based clinical practice guidelines on therapeutic massage for low back pain. J Bodyw Mov Ther. 2012, 16(4):424-455.
• [30]Toward Optimized Practice. Guideline for the evidence-informed primary care management of low back pain. Edmonton (AB): Toward Optimized Practice. 2011. http://www.topalbertadoctors.org/cpgs. Accessed 19 July 2014.
• [31]Bryer A, Connor MD, Haug P, Cheyip B, Staub H, Tipping B, et al.: South African guideline for management of ischaemic stroke and transient ischaemic attack 2010: a guideline from the South African Stroke Society (SASS) and the SASS Writing Committee. S Afr Med J 2010, 100:11.
• [32]Stroke Rehabilitation, long term rehabilitation after stroke, methods evidence and recommendations. 2013. Commissioned by the National Institute for Health and Care Excellence. http://www.nice.org.uk. Accessed 19 July 2014.
• [33]Stroke Foundation of New Zealand and New Zealand Guidelines Group. Clinical Guidelines for Stroke Management 2010. Wellington: Stroke Foundation of New Zealand. 2010. http://www.stroke.org.nz. Accessed 19 July 2014.
• [34]Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, et al; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Council for High Blood Pressure Research. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:1545–88.
• [35]Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:2160–236.
• [36]Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, et al; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, and Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947.
• [37]Hillier S, Grimmer-Somers K, Merlin T, Middleton P, Salisbury J, Tooher R, Weston A: FORM: an Australian method for grading recommendations in evidence-based clinical guidelines. BMC Methodol 2011, 11:23. BioMed Central Full Text
• [38]Grimmer-Somers K, Worley A: Practical Tips for Using and Developing Guidelines: An Allied Health Primer. UST Publishing House, Manila; 2010.
• [39]Gartlehner G, West SL, Lohr KN, et al.: Assessing the need to update prevention guidelines: a comparison of two methods. Int J Qual Health Care 2004, 16(5):399-406.