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  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 used to assess a guideline’s applicability, quality, and clinical utility.

  5. What is a GRADE recommendation?


This chapter will help you understand the following:

  • The purpose of clinical practice guidelines (CPGs)

  • Special search considerations for CPGs

  • Appraisal of CPGs for applicability, quality, and clinical utility


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. 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.

In this chapter, you will also learn the appraisal process for clinical practice guidelines. Just as with intervention and diagnostic studies, systematic reviews, or any other type of research study, the quality of the study must be appraised before it can be appropriately applied in practice.

We use the Appraisal of Guidelines Research and Evaluation II (AGREE II).1 AGREE II is an established tool for CPG appraisal (Fig. 8.1). AGREE II is the product of the AGREE Enterprise (, supported by the Canadian Institutes of Health Research. AGREE II consists of 23 items to consider in the appraisal process organized into six domains:

  1. Scope and purpose

  2. Stakeholder involvement

  3. Rigor of development

  4. Clarity of presentation

  5. Applicability

  6. Editorial independence


CPG appraisal requires consideration of the CPG's applicability, quality, and clinical utility.

We have modified these appraisal items into questions that pertain to parts A through D of the appraisal process used throughout this book.

What Are Clinical Practice Guidelines?

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 components 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 ...

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