What is the difference between clinical practice guidelines and systematic reviews?
Which U.S. government database can be used to search for clinical practice guidelines?
List two characteristics to assess when searching for clinical practice guidelines.
List two important appraisal questions for assessing a guideline's applicability, quality, and clinical utility.
What is a grade of recommendation?
Why do clinical practice guideline recommendations tend to be vague?
What Are Clinical Practice Guidelines?
Clinical practice guidelines (CPGs) are systematically developed statements designed to facilitate evidence based decision making for the management of specific health conditions, such as knee osteoarthritis or stroke.1 CPGs incorporate evidence from research, clinical expertise, and, ideally, patient perspectives. They can be developed to meet the needs of various stakeholders including clinicians (from a single discipline or interdisciplinary teams), patients, payers, legislators, public health authorities, and the general public (Fig. 8.1).
Clinical practice guidelines should be appraised for applicability and quality.
Government health-care agencies and professional associations fund the development of most CPGs. For example, the Agency for Healthcare Research and Quality (AHRQ), a U.S. government agency, produces CPGs targeted at American health-care providers and the public.2 Special interest sections of the American Physical Therapy Association (APTA) create guidelines for physical therapy, targeted at physical therapists, policy makers, and insurance companies in the United States.3
If you are not familiar with CPGs, it may be difficult to discern the difference between a systematic review (see Chapter 7) and a CPG. A high-quality CPG includes both a systematic review of research evidence and explicit recommendations regarding clinical decisions. CPGs also tend to be broader than systematic reviews, addressing multiple aspects of care (i.e., diagnosis, prognosis, and interventions) associated with a particular health condition. Table 8.1 illustrates the similarities and differences between CPGs and systematic reviews.
TABLE 8.1Comparison of CPGs and Systematic Reviews ||Download (.pdf) TABLE 8.1 Comparison of CPGs and Systematic Reviews
| ||HIGH-QUALITY CLINICAL PRACTICE GUIDELINES ||HIGH-QUALITY SYSTEMATIC REVIEWS |
|Purpose ||To make recommendations for best clinical practice based on the best available research evidence, clinical expertise, and patient perspectives for a relatively broad set of clinical questions associated with a specific health condition. ||To summarize the research on a specific question, or specific set of questions, by systematically reviewing and summarizing existing research evidence. |
|Literature search ||Comprehensive search of numerous databases with pre-set inclusion and exclusion criteria. ||Comprehensive search of numerous databases with pre-set inclusion and exclusion criteria. |
|Research appraisal ||Conducted using a standardized method by > 1 independent reviewer. ||Conducted using a standardized method by > 1 independent reviewer. |
|Research analysis ||Includes meta-analysis as possible. ||Includes a meta-analysis as possible. |
|Clinical expertise ||Experts are consulted to facilitate interpretation of research evidence ...|