Clinical Practice Guidelines Flashcards
“Statements that include recommendations intended to optimize patient care. They are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.”
Clinical Practice Guidelines
CPGs reflect findings from ________, as well as expert clinical judgment and health care consumer opinion or perspective.
best evidence
Two formats of CPG.
Healthcare professional & general public
Primary source for CPG.
Agency for Healthcare Research and Quality
AHRQ
Give an example of a CPG entailing the management of conditions.
Guideline for stroke rehabilitation and recovery.
“ATS statement: guidelines for the 6-minute walk test” is an example of an __________.
Agency for Healthcare Research and Quality
AHRQ
Where can we locate CPGs?
➤ PubMed (by U.S. National Library of Medicine)
➤ Physiotherapy Evidence Database (PEDro)
➤ www.guideline.gov (by AHRQ)
➤ PTNow (by American Physical Therapy Association)
T or F
The second step in creating an evidence based CPG is to identify and refine the topic and scope of the CPGs.
F (First step…)
T or F
In creating evidence based CPG, one needs to identify and convene the appropriate stakeholders—such as clinicians, patients, caregivers, researchers, and technical support staff—to participate.
T
Conducting a systematic review of the evidence is the third step in creating evidence based CPG.
T
(4) Develop recommendations based on the _____, as interpreted by clinical expertise and patient experience, as well as on feasibility issues such as
cost.
systematic review
This is the last step in creating evidence based CPG.
Submit the CPG for external review
T or F
Evidence from at least one other type of quasi-experimental study is classified as 2b under the Category of Evidence.
T
Evidence for meta-analysis of randomized controlled trials is classified as 1b under the Category of Evidence.
F (1a)
Evidence from at least one randomized controlled trial is classified as 1b under the Category of Evidence.
T
Evidence from nonexperimental descriptive studies (comparative studies, correlation studies, and case-control studies) ranks as 2a under the Category of Evidence.
F (3)
Evidence from at least one controlled study without randomization.
Classified as 2a
This is the lowest rank under the Category of Evidence (4).
Evidence from expert committee reports or opinions or clinical experience of respected authorities or both.
_____ quality of evidence is characterized by further research being very unlikely to change the confidence in the estimate of effect.
High
T or F
Low quality of evidence is characterized by further research being likely to have an important impact on the confidence in the estimate of effect and may change the estimate.
F (Moderate)
_______ quality of evidence is characterized by any estimate of effect being very uncertain.
Very low
_____ quality of evidence is characterized by further research being very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate.
Low
This are the questions that the appraisal aims to answer.
Is the guideline VALID?
Is the Guideline applicable?
Due to the introduction of new patient/client management techniques, there is a possibility that CGPs may become _____.
outdated
Give 4 reasons why CPGs may become outdated (Shekelle et al. 2001).
- New evidence clarifying beneficial or harmful consequences of current patient/client management techniques.
- Changes in which outcomes of care are considered important clinically and socially.
- Full compliance with current CPGs, thus no longer necessitating their use.
- Changes in health care resources
CPGs should be reviewed every ____ and updated as
necessary
3 years
_____ should consider whether the age of the product makes its application unreasonable or inappropriate in the current practice environment.
EBPTs
T or F
According to Hasenfeld & Shekelle, older CPGs did not meet most of the quality criteria.
F (newer)
International standard for reporting the development and evaluation of CPGs.
Appraisal of Guidelines Research and Evaluation Collaboration (AGREE) II,
2010
Give the 6 Domains of AGREE II.
- Scope and purpose
- Stakeholders involvement
- Rigor of development
- Clarity and presentation
- Applicability
- Editorial independence
______: high prevalence rate, seriousness of the
consequences
Impact
The condition of interest covered by the CPG should have ______.
enough impact
The decision to implement the guideline depends on the ______ of its recommendations, which is achieved by use of particular patient/client management techniques.
specificity
Physical therapists must consider the _____ between a CPGs recommendations and the individual patient or client’s preference and values.
congruence
T or F
If the anticipated outcomes are only incrementally
better than current practice, then adoption of the CPG
may not be worthwhile
T
Adoption of CPG should be considered in terms of the ______ relative to the investment made.
outcomes achieved
Successful CPG implementation depends on the _______ of those involved to change their current behaviors and practice.
willingness
What are potential barriers to change?
Provider preferences,
habits, and concerns regarding the loss of autonomy.
