More research is needed into clinical guidelines

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Issue: 04 July 2007
Author: Tracey Jager

The development of clinical guidelines can benefit practitioners and patients, a workshop heard. Participants called for the creation of opportunities for international collaboration to develop physiotherapy-specific guidelines and for improved access to clinical guidelines.

There were more than 7,000 studies in the physiotherapy field, according to Erik Hendriks of the Netherlands, and guidelines could help make that information relevant, he believed.

Philip Van der Wees, also of the Netherlands, said: 'Over the last 10 to 15 years, clinical guidelines development has been growing in all disciplines.'

 Systematically developed guidelines could help practitioners and patients to make decisions, assist clinicians in self-evaluation and increase the effectiveness of the physiotherapy profession overall, he added. Several resources related to clinical guidelines were available, including through the World Confederation for Physical Therapy website.

Concurrent with the increase in guidelines had been growth in knowledge about how to best develop them, according to methodology expert Erik Hendriks. Of the possible approaches, evidence-based appeared to be most effective, he said, adding that the evidence had to be robust and the guidelines should consider patients' perspectives.

The UK's Judy Mead spoke of the value and limitations of multidisciplinary and unidisciplinary (for example, physiotherapy-specific) guidelines. One drawback to the development of all guidelines, she said, was that they tended to ignore qualitative research.

Australia's Trudy Rebbeck said there were few studies evaluating the effectiveness of implementing clinical guidelines. She called for the development of implementation strategies, as there were a number of barriers to effective implementation. These barriers were structural and organisational, as well as individual, and could involve time, money, physiotherapists' perceptions and access to information, and patient expectations.

From the research on guideline implementation, there appeared to be moderate effects on influencing professional behaviour, but little effect on other outcomes, Ms Rebbeck said.

One study found that the use of clinical guidelines helped reduce patients' fears and avoidance of treatment.

 'However, few of such studies have considered patient outcomes,' she said.