Development of Evidence-Based Recommendations for Physical Therapy Diagnosis and Treatment

van der Wees P.^1,2,3, Herbert R.⁴, Powers C.⁵, Stewart A.⁶, Moore A.P.⁷

¹Royal Dutch Society for Physical Therapy (KNGF), Quality & Implementation, Amersfoort, Netherlands, ²Maastricht University, Caphri Research Institute, Maastricht, Netherlands, ³Radboud University Nijmegen Medical Center, IQ healthcare, Nijmegen, Netherlands, ⁴The George Institute for International Health, Musculoskeletal Division, Sydney, Australia,  ⁵University of South California, Division of Biokinesiology & Physical Therapy, Los Angeles, United States of America, ⁶University of the Witwatersrand, Faculty of Health Sciences, School of Therapeutic Sciences, Department of Physiotherapy, Johannesburg, South Africa, ⁷University of Brighton, Clinical Research Centre for Health Professions, Eastbourne, United Kingdom

Learning objectives:

1. To develop and publish evidence-based recommendations for physical therapy practice 2. To expand the international body of knowledge of clinical guideline development in physical therapy 3. To strengthen the existing network of clinical guideline developers in Physical Therapy, by creating an international collaborative program.

Description:

Background
Clinical guidelines are important tools to improve quality in health care by providing evidence-based recommendations for daily practice. In some countries clinical guidelines for physical therapists are being developed, and physical therapy treatment is sometimes included in multidisciplinary guidelines. In many other countries clinical guidelines are nonexistent, because of lack of resources for physical therapy guidelines, or because of lack of position for participation in multidisciplinary guidelines.

Outline
In this focused symposium we aim to explore possibilities for an international collaborative program to develop and publish concise evidence-based recommendations for daily physical therapy practice. We aim to establish an international network of researchers, clinical guideline developers and practitioners that will collaborate in producing these evidence-based recommendations.The evidence-based recommendations will be derived from current high quality clinical guidelines and systematic reviews. The recommendations should be concise (2-3 pages), and provide decision support for physical therapy diagnosis and treatment.

The recommendations may include relevant information regarding screening in case of self-referral of patients (direct access) and treatment objectives in terms of function, activities and participation, based on the International Classification of Functioning (ICF). We aim to address the unique difficulties experienced in under-resourced health care systems. This necessitates the development of specific/adapted clinical guidelines using the existing evidence, but making appropriate changes to suit the unique situation of these health care systems.We will also look for ways to address language barriers, e.g. by translating the recommendations to multiple languages.

Rationale
At the WCPT congress in 2007 a workshop was held to stimulate international collaboration for development and implementation of clinical guidelines in physical therapy. The conclusion of that workshop was that the body of knowledge for clinical guideline development in physical therapy is accumulating, with an intent to further strengthen the existing network of clinical guideline developers. In the follow-up it appeared that the complexity of a full guideline development procedure and formal adaptation of existing guidelines hindered joint international activities.

Program
In the introduction the objectives of the session will be explained, and the need will be stressed for active participation of all participants to establish an international collaborative program to develop evidence-based recommendations. Brief presentations will provide information about relevant activities in different countries that can be useful for the collaborative program:

• Using the PEDro database (Australia)
• Connecting to the 'Hooked on Evidence' program (USA)
• Involvement of low resource health care systems (South Africa)
• Developing Evidence-based statements (UK)

The main body of the symposium will be formed by an interactive discussion with the audience to explore possibilities and commitment for the program and to formulate a strategy to make the necessary further steps. We will explore options for the development of evidence-based recommendations for physical therapy practice, and will identify possible barriers and facilitators. Elements of the exploration will be the involvement of low resource countries and how to address language barriers. We will conclude the symposium by formulating a clear assignment for a working group that should be installed to ensure a successful follow-up.

Implications / Conclusions:

At the symposium we aim to reach consensus to start an international program to develop concise evidence-based recommendations as an alternative to collaboration in full guideline development. A working group will be installed to work out the strategy for a collaborative program, including necessary resources and time investment. The working group will stay in contact with the participants and will seek for possible liaisons with the World Confederation for Physical Therapy.  

Keywords:

Evidence-based recommendations; Clinical guidelines; Implementation

Funding acknowledgements:

Associate Professor Rob Herbert has a Senior Research Fellowship from the National Health Medical Research Council of Australia. 

Relevance to WCPT and expected audience:

Evidence-based practice is a central theme within WCPT policy, and resulted in the publication of several keynote papers. Clinical guidelines can play an important role in stimulating evidence-based practice. The proposed transition from full guidelines to concise evidence-based recommendations will make information easy accessible and aims to stimulate implementation.

Target audience:

The target audience will be researchers, clinical guideline developers, practitioners and policy makers. The combined effort of these target groups makes a collaborative program possible. 

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