Chapter 8: Appraising Clinical Practice Guidelines

Pre-Test

1. What is the difference between clinical practice guidelines and systematic reviews?

2. Which U.S. government database can be used to search for clinical practice guidelines?

3. List two characteristics to assess when searching for clinical practice guidelines.

4. List two important appraisal questions for assessing a guideline's applicability, quality, and clinical utility.

5. What is a grade of recommendation?

6. Why do clinical practice guideline recommendations tend to be vague?

Introduction

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).

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.