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

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 w...

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Autores principales: Gambito, Ephraim D. V., Gonzalez-Suarez, Consuelo B., Grimmer, Karen A., Valdecañas, Carolina M., Dizon, Janine Margarita R., Beredo, Ma. Eulalia J., Zamora, Marcelle Theresa G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632672/
https://www.ncbi.nlm.nih.gov/pubmed/26537008
http://dx.doi.org/10.1186/s13104-015-1588-8
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author Gambito, Ephraim D. V.
Gonzalez-Suarez, Consuelo B.
Grimmer, Karen A.
Valdecañas, Carolina M.
Dizon, Janine Margarita R.
Beredo, Ma. Eulalia J.
Zamora, Marcelle Theresa G.
author_facet Gambito, Ephraim D. V.
Gonzalez-Suarez, Consuelo B.
Grimmer, Karen A.
Valdecañas, Carolina M.
Dizon, Janine Margarita R.
Beredo, Ma. Eulalia J.
Zamora, Marcelle Theresa G.
author_sort Gambito, Ephraim D. V.
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13104-015-1588-8) contains supplementary material, which is available to authorized users.
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spelling pubmed-46326722015-11-05 Updating contextualized clinical practice guidelines on stroke rehabilitation and low back pain management using a novel assessment framework that standardizes decisions Gambito, Ephraim D. V. Gonzalez-Suarez, Consuelo B. Grimmer, Karen A. Valdecañas, Carolina M. Dizon, Janine Margarita R. Beredo, Ma. Eulalia J. Zamora, Marcelle Theresa G. BMC Res Notes Research Article 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13104-015-1588-8) contains supplementary material, which is available to authorized users. BioMed Central 2015-11-04 /pmc/articles/PMC4632672/ /pubmed/26537008 http://dx.doi.org/10.1186/s13104-015-1588-8 Text en © Gambito et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Gambito, Ephraim D. V.
Gonzalez-Suarez, Consuelo B.
Grimmer, Karen A.
Valdecañas, Carolina M.
Dizon, Janine Margarita R.
Beredo, Ma. Eulalia J.
Zamora, Marcelle Theresa G.
Updating contextualized clinical practice guidelines on stroke rehabilitation and low back pain management using a novel assessment framework that standardizes decisions
title Updating contextualized clinical practice guidelines on stroke rehabilitation and low back pain management using a novel assessment framework that standardizes decisions
title_full Updating contextualized clinical practice guidelines on stroke rehabilitation and low back pain management using a novel assessment framework that standardizes decisions
title_fullStr Updating contextualized clinical practice guidelines on stroke rehabilitation and low back pain management using a novel assessment framework that standardizes decisions
title_full_unstemmed Updating contextualized clinical practice guidelines on stroke rehabilitation and low back pain management using a novel assessment framework that standardizes decisions
title_short Updating contextualized clinical practice guidelines on stroke rehabilitation and low back pain management using a novel assessment framework that standardizes decisions
title_sort updating contextualized clinical practice guidelines on stroke rehabilitation and low back pain management using a novel assessment framework that standardizes decisions
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632672/
https://www.ncbi.nlm.nih.gov/pubmed/26537008
http://dx.doi.org/10.1186/s13104-015-1588-8
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