this lecture will help students to be familiar with evidence based practice in physiotherapy.

1. CLINICAL GUIDELINES
DR. MUHAMMAD ADNAN
MS-MSK (KMU) DPT (KMU)
LECTURER
ABASYN UNIVERSITY PESHAWAR

2. WHAT ARE CLINICAL GUIDELINES?

3. The purpose of a clinical guideline is to
provide a ready-made resource of high quality
information for both practitioner and patient,
so they can discuss together the different
options for treatment and the different
degrees of benefit or risk that interventions
may have for that patient. A shared and
informed decision can then be made about
how to proceed with treatment.

4. Clinical guidelines are systematically
developed statements to assist practitioner
and patient decisions about appropriate
health for specific circumstances.

5. • The systematic reviews provide a way of
synthesizing evidence. There are some
similarities between systematic reviews and
clinical guidelines. At the heart of both is a
comprehensive, rigorous review of high
quality clinical research.

7. HISTORY OF CLINICAL GUIDELINES
AND WHY THEY ARE IMPORTANT

8. • The introduction of the notion of ‘evidence-
based’ clinical guidelines links closely to the
development of evidence-based medicine and
evidence-based practice.
• This led to a greater awareness of the importance
of utilizing the results of high quality clinical
research in practice.
• Clinical guidelines, which provide summaries of
high quality clinical research, patient views and
clinical expertise, provide a more manageable
resource for busy practitioners.

9. • There was a common view about the ke
processes required in the development of a good
guideline (Grimshaw & Russell 1993, Grimshaw et
al 1995):
•The scientific evidence is assembled in a
systematic fashion.
•The panel that develops the guideline includes
representatives of
most, if not all, relevant disciplines.
•The recommendations are explicitly linked to the
evidence from which they are derived.

10. • Developments in methods have, more recently, tended to
focus on the difficult problem of formulating
recommendations where there is limited research evidence
– a situation that most guideline developers find
themselves in.
• Methodological initiatives have focused on the impact of
people on guideline development, as opposed to the
research literature focus of the 1990s.
• For example, important recent initiatives have concerned
guidelinedevelopment group dynamics, the beliefs and
values of participants in the development process, and how
these can impact on making appropriate judgements as
free from bias as possible.

11. WHERE CAN I FIND CLINICAL
GUIDELINES?

12. • Only a minority of clinical guidelines are
published in journals, so the major databases
such as MEDLINE, EMBASE and CINAHL
provide a poor way of locating practice
guidelines. The most complete database of
evidence based practice guidelines relevant to
physiotherapy is PEDro.

13. • PEDro only archives evidence-based practice guidelines. Evidence
based practice guidelines are defined by the makers of PEDro as
guidelines in which:
• 1. A systematic review was performed during the guideline
development or the guidelines were based on a systematic review
published in the 4 years preceding publication of the guideline, and
• 2. At least one randomized controlled trial related to physiotherapy
management is included in the review of existing scientific
evidence, and
• 3. The clinical practice guideline must contain systematically
developed statements that include recommendations, strategies, or
information that assists physiotherapists or patients to make
decisions about appropriate health care for specific clinical
circumstances.

14. HOW DO I KNOW IF I CAN TRUST THE
RECOMMENDATIONS
IN A CLINICAL GUIDELINE?