Clinical practice guidelines (FS-02)

CLINICAL PRACTICE GUIDELINES IN PHYSICAL THERAPY: CURRENT STATE OF PLAY

Grimmer K1, Dizon JM2, Louw Q3, Bernhardsson S4
1University of South Australia, Adelaide, Australia, 2University of Santo Tomas, Manila, Philippines, 3Stellenbosch University, Faculty of Medicine & Health Sciences, Cape Town, South Africa, 4Linköping University, Linköping, Sweden

Learning objectives

  1. To present perspectives of physical therapists regarding clinical practice guidelines.
  2. To discuss physical therapists’ perception of CPG development, relevance, uptake and implementation.
  3. To discuss barriers and enablers in CPG activities in physical therapy and propose strategies as a way forward.

Description

The increasing number of individuals suffering from the burden of chronic diseases demands focus on improving prevention, rehabilitation and management strategies. Strategies to address these concerns are therefore essential to improve quality and safety in healthcare and health systems globally. The use of evidence-based clinical practice guidelines (CPGs) is one of the strategies to address these concerns. CPGs are defined as 'statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. CPGs are developed using standard internationally agreed principles and are based on the best current evidence. Internationally established guideline groups have developed CPGs for conditions relevant to their local needs and setting. Whilst CPGs are generally available at no cost for many health conditions, challenges to consistent use and uptake of CPGs in rehabilitation have been consistently reported. These are lack of relevant CPGs for a particular condition, lack of relevant CPGs for a particular setting, lack of time and resources to conduct training in CPG work and limited capacity in developing CPGs, to name a few.

To understand the current state of play of CPGs amongst physical therapists, we looked into the perspectives of physical therapists regarding CPG awareness, uptake, implementation, barriers and enablers in countries with different economic status health systems and practices. Physical therapists from high income countries such as Australia and Sweden are knowledgeable of CPG development processes and have available time, resources and capacity to undertake CPG activities. Thus, CPGs are generally available for use in these countries. However, physical therapists from low and middle income countries such as the Philippines and South Africa are less aware of, and knowledgeable in, the CPG development process. Thus, they develop and use other forms of 'guidance documents' which may not be based on best evidence and are not considered as 'proper CPGs'. Fragmentation issues, lack of time, resources and capacity further challenge the development of 'proper CPGs' in these country settings. Across all settings, the uptake and implementation of CPGs continue to be a challenge. Opportunities to improve CPG activities such as training and capacity building in CPG development and other methodological approaches, identifying local setting drivers and focusing on appropriate implementation strategies are just some of the strategies to improve CPG activities.

Implications / Conclusions

Improving quality and safety in healthcare in rehabilitation continue to be a challenging area. Understanding perspectives of physical therapists regarding CPGs and the local needs, identifying barriers and enablers and framing a plan for directed and focused activities would lead to improved CPG uptake and subsequently improved healthcare.

Keywords

  1. physical therapy
  2. clinical practice guidelines
  3. quality improvement

Funding acknowledgements

  • South African Guideline Evaluation (SAGE) project
  • Philippine Academy of Rehabilitation Medicine (PARM)

Relevance to physical therapy globally

The increasing burden of chronic diseases has become a challenge in physical therapy and rehabilitation globally. Clinical practice guidelines are widely used to guide best practice strategies to improve patient outcomes and healthcare systems. Thus, this symposia will provide a bigger picture of the similarities and differences in clinical practice guideline activities internationally and a clearer understanding of what needs to be undertaken to direct future activities in physical therapy practice.

Target audience

Physical therapists, guideline developers, policy makers, managers

 

Programme subject to change

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