DEVELOPING CLINICAL PRACTICE GUIDELINES USING GENERIC RECOMMENDATIONS ADDRESSING MULTIPLE CONDITIONS: AN INNOVATIVE METHOD IN PHYSICAL THERAPY

M. van Doormaal¹, K. Heijblom¹, R. Ostelo², M. Stuiver³, G. Meerhoff¹, P. van der Wees⁴

Background: Clinical practice guidelines play an important role in improving quality of care in physical therapy (PT). Usually, guidelines in PT are developed for the treatment of patients with a specific medical condition. However, specific guidelines do not fully reflect PT practice, in which the consequences of a condition are treatable traits and not merely the medical condition itself. In addition, patients may have multiple conditions which would require the use of multiple guidelines. At the same time, different conditions may cause the comparable problems in physical functioning and guidelines for treating these problems are likely similar across conditions. Thus, guideline development and maintenance for each specific condition is not only expensive and time consuming  but also inefficient. The Dutch government funded a project to explore a more efficient way of guideline development in PT, through more generic recommendations that apply to multiple conditions. This project will be carried out by the Royal Dutch Society for Physical Therapy (KNGF) and a consortium of partners between September 2020 and August 2021.

Purpose: The purpose of this project is to conduct a pilot in developing two generic guidelines, Self-management and Oncology, and to evaluate this innovative method in the context of PT practice.

Methods: The project consists of three subprojects, which will be carried out in parallel. In the first subproject, the regular method for guideline development of the KNGF will be adjusted, resulting in an addendum to develop guidelines based on a general subject, instead of a specific medical condition. Challenges in this project will be the performance of a literature research and the formulation of considerations on a general level. In the second subproject, a guideline Self-management is developed, in which recommendations will be formulated which are applicable for all patients, independent of their medical condition. In the third subproject, a guideline Oncology is developed, in which recommendations will be formulated which are applicable to patients with a large variety of oncological conditions. In the final phase, an evaluation is performed based on the development of both guidelines. The guidelines will be developed according to international standards, such as  GRADE, AGREE II and G-I-N, in close collaboration with a wide variety of clinical experts and stakeholders, including physical therapists, physicians and patients.

Results: In April 2021, preliminary results can be presented on the feasibility of the development of general recommendations. Moreover, the first draft recommendations on Self-management and Oncology can be presented to illustrate the concept of this innovative method.

Conclusion(s): This method has the potential to increase the efficiency of guideline development in PT, because it might no longer be necessary to develop extensive guidelines for each medical condition. Moreover, these guideline recommendations will match the principle of treating the consequences of a condition and not the condition itself, which provides a  better fit with PT practices.

Implications: If this method for guideline development is feasible, it is a promising solution for PT associations worldwide whose ambition is to develop clinical practice guidelines in an efficient way, while still adhering to international guideline standards.

Funding, acknowledgements: Government of the Netherlands

Keywords: Guideline, Self-management, Oncology

Topic: Research methodology, knowledge translation & implementation science

Did this work require ethics approval? No

Institution: N/A

Committee: N/A

Reason: addresses new and unique developments in guideline development