Clinical Practice Guidelines Revisited

In the September 2011 issue, my editorial focused on the efforts by the APTA to facilitate the development of clinical practice guidelines by the Sections.¹ The purpose is to help clinicians make clinical decisions based on the best evidence, as synthesized and appraised by experts in the field. In the two years that have followed since I attended that first meeting, the awareness of guidelines and how they can help guide best practice has advanced.

This summer, I had the opportunity to again gather with members of other Sections to attend training on how to undertake the process of clinical practice guideline development, led by Joe Godges (Orthopedic Section) and Sandra Kaplan (Pediatrics Section) who have been the forerunners for our profession in this area. Understandably, the Sections varied in their awareness, capacity, and plans. However, I was impressed by the level of awareness from Section members and the topics that are being driven by the practicing clinicians. Certainly, new reimbursement rules regarding functional documentation is driving part of the process. As clinicians think about what functional outcome tools to best use, they naturally begin to ask other questions about diagnosis, prognosis, and interventions for their patients. They seem to be seeking guidance based on evidence, which they do not have time to synthesize.

Our Section has been active in the development of evidence-based guidance documents for several years. Our own dynamo, Ellen Hillegass, has been spearheading groups working on Oxygen Management by Physical Therapists and Mobilization for Patients with Venous Thromboembolism (jointly with the Acute Care Section). Hopefully, we will soon be sharing these documents with you in our Journal and on the Section web site. Ellen and her colleagues have been trailblazers and have certainly learned the scope and issues that must be addressed when trying to identify, categorize, grade, and synthesize the exploding volume of research articles that are published each month and year. Developing clinical practice guidelines is not a quick process, but it is one that can provide clinicians with our highest quality recommendations for their practice.

The involvement of the APTA and its Sections in clinical practice guideline development has also shown us that we cannot stop with the publication of a document. It is equally important, if not more important, that these guidelines are integrated into the care of patients. This challenge leads to a whole new area of scholarship and research—implementation and comparative outcomes studies. It is critical to identify barriers to implementation and to devise ways to reduce those barriers, so that our patients receive the best care we can provide. So, if you are a new researcher, a resident, or a student, you may find a fascinating research question or even career in this area.

Developing, revising, and implementing clinical practice guidelines will take the combined effort of all of us—clinicians to ask the clinical questions, people to find and grade evidence, a team to synthesize evidence into recommendations, editors to get these recommendations into reader-friendly formats, people to translate the recommendations for patients, payers and referring practitioners, and scholars to study the implementation and outcomes of guideline-based practice.

So, sometime in the near future, when you see a call for people to help in this process, please consider volunteering. There is a role for each of you!