CPGS: what are they and how is APTA supporting the sections to develop them?posted: Aug-01-2014
The concept of clinical practice guidelines (CPG) has been around for thousands of years as a way to provide the best care for the patient. They exist for many disciplines in many forms, but in the US, the National Guidelines Clearinghouse is the primary repository for CPGs. Currently there are over 12,000 CPGs listed on this site, each intended to improve the effectiveness, safety, outcomes, and efficiency of healthcare.
As you might imagine, thinking around CPGs has evolved over the years. In the early 1990s the Institute of Medicine (IOM) released several reports on the use of a modern CPG. At that time, the focus of the CPG became more focused on using the best available evidence to develop graded recommendations.
As part of the ongoing effort to use evidence to improve the quality of CPGs IOM published Clinical Practice Guidelines We Can Trust in 2011. This document states that CPGs “are statements that include recommendations intended to optimize patient care.” They “assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.” Further, the IOM defines CPGs as ''systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances." They are graded recommendations on best practice for a specific condition or clinical question based on the systematic review and evaluation of the quality of the scientific literature. These documents are defined by a stringent methodology and formal process for development, although variation can exist all must meet standard criteria. Recently, the National Guidelines Clearinghouse announced that it would be adopting the IOM recommendations.
Physical therapy is a relative newcomer on the CPG scene, but we've been working hard to generate resources. In 2006, the Orthopaedic Section of APTA used the International Classification of Functioning and Disability (ICF) to develop evidence-based practice guidelines to enhance diagnosis, intervention, prognosis, and assessment of outcomes for a variety of musculoskeletal conditions commonly managed by physical therapists. The Orthopaedic Section currently has 10 CPGs completed, published, and made available as open access on their web site and are revising previously published guidelines. The Section on Pediatrics has also developed a CPG process and recently published its first clinical practice guideline, “Physical Therapy Management of Congenital Muscular Torticollis.”
Recognizing that the APTA’s sections represent the clinical expertise of the profession, APTA has taken the role to help facilitate the sections’ development of CPGs as an important tool to decrease unwarranted variation in practice by providing clinicians with the best available evidence so they can provide the best care to their patients and clients. This is supported by the APTA strategic plan, Goal 1, Effectiveness of Care, which states: “APTA will better enable physical therapists to consistently use best practice to improve the quality of life of their patients and clients." Under that goal, Objective A directs the association to increase the number of peer-reviewed clinical practice guidelines.
APTA’s has specifically responded to this goal and objective by initiating a program to provide support and funding for Sections to develop CPGs, a program that includes an annual CPG workshop. Since the program began, APTA has provided funding and support for the development of 7 CPGs. As part of this support, twice a year APTA issues a call for proposal submissions for the development of CPGs, and sponsors a workshop to provide CPG development guidance. The annual workshop provides training to support the Sections—the true content experts—for the development of CPGs. The event coordinates the knowledge and expertise of Joe Godges from the Orthopaedic Section and Sandra Kaplan from the Pediatric Section. Members identified by the Sections are nominated to attend the workshop, and priority for attendance to the workshop is given to nominees who meet the following criteria:
Demonstrate full support from the section's leadership
Have a clearly-identified clinical question or topic
Have initiated activities to address the identified question or topic
Have identified subject matter experts and confirmed participation of members to develop a clinical practice guideline
Through the training and the financial support, there are now 7 CPGs in development that are being funded by APTA. Those are:
September, 2012: Cardiovascular and Pulmonary and Acute Care
Clinical practice guidelines for the prevention, assessment of risk, and physical therapy management with lower or upper extremity venous thromboembolism (VTE)
September, 2012: Geriatrics
Development of a Clinical Guidance Statement for the Identification, Prevention, and Treatment of Falls in Community-dwelling Older Adults
Vestibular Rehabilitation for Peripheral Vestibular Hypofunction
September, 2012: Oncology
Management of Secondary Upper Quadrant Lymphedema
March, 2013: Geriatrics
GeriEDGE Evaluation of Fall Risk Assessment Tools and Fall Risk Abatement/Balance Outcome Measures
September, 2013: Acute Care
Clinical Practice Guideline for the Identification and Evaluation of Post-Intensive Care Syndrome
September. 2013: Neurology
Clinical Practice Guideline: Core Set of Outcome Measures for Patients with Neurologic Conditions
APTA will continue to work with the Sections to facilitate the development of CPGs and help share the important work that is being performed. If you have any questions, about APTA’s role and support of the sections, please contact Matt Elrod at firstname.lastname@example.org