Exam Two - Clinical Practice Guidelines

Question 1

What are some common barriers to applying EBP

Answer 1

• lack of time
• poor confidence in skills to identify and critically appraise research
• insufficient access to evidence

Question 2

what are CPGs used for?

Answer 2

to bridge the research to practice gap and facilitate EBP
- systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances

Question 3

T of F: CPGs use the PICO framework

Answer 3

false - typically topical (more broad)

Question 4

the purpose of CPG is to….

Answer 4

make a recommendation

Question 5

what is the outline of a CPG?

Answer 5

pretty much a table of contents, tells you where to find stuff

Question 6

what is the recommendation portion of a CPG?

Answer 6

pretty much the juicy findings, what you need to know all summarized in an easy to understand way

Question 7

what is the diagnosis and risk factor, as well as the examination, and intervention portion of the CPG?

Answer 7

much farther into the article, gives more information about which articles they used to provide those recommendations and what level of evidence those articles are rated as

Question 8

where do CPGs fall on the level of evidence chart?

Answer 8

don’t really know, it depends on the number and quality of research articles used to reach the conclusion

Question 9

T or F: all clinicians know what a CPG is, where to find them, and can easily access them

Answer 9

lol false

Question 10

where can you access CPG?

Answer 10

Pubmed (term AND practice guideline), PEDro, and APTA (membership required for APTA)

Question 11

what is the problem with CPG (historically)

Answer 11

• theres no overt reward or penalty for using/not using them
• and, there was limited guideline dissemination

Question 12

what is the result of the historical problems with CPGs?

Answer 12

selective adoption of practices that reflect preferences and prejudices rather than evidence-based judgements (which isn’t EBP)

Question 13

many CPGs were developed without appraisal of the development process or consideration for the quality of evidence used. What was the result of these issues?

Answer 13

• little/no transparency
• opportunity for panel bias
• subjective recommendations

Question 14

What are the six domains of the AGREE II form

Answer 14

1 - scope and purpose
2 - stakeholder involvement
3 - rigor of development
4 - clarity and presentation
5 - applicability
6 - editorial independence

Question 15

what is the purpose of the AGREE II form?

Answer 15

provide critical appraisal of CPGs

Question 16

1 - scope and purpose

Answer 16

• objectives (of the guideline) stated
• target pop defined

Question 17

2 - stakeholder invovlement

Answer 17

• views and preferences of patients represented
• target audience clearly defined
• development panel includes professionals from all relevant groups

Question 18

3 - rigor of development

Answer 18

• systematic methods used to search for evidence
• selection criteria for evidence is described
• methods to formulate recommendations described
• both benefits and risks have been considered
• explicit link between evidence and recommendation
• guideline has been externally reviewed prior to publication

Question 19

4 - clarity and presentation

Answer 19

• recommendations are specific and not ambiguous
• key recommendations are easily identifiable
• supported with tools for application (like outcome measures, billing codes, handouts for patients, and clinical algorithm/decision tree)

Question 20

5 - applicability

Answer 20

• barriers to application discussed
• cost implications discussed or considered

Question 21

6 - editorial independence

Answer 21

• role of funding body clearly stated
• conflicts of interest of panel members recorded (reporting any bias)

Question 22

what is one question you should ask before applying a CPG?

Answer 22

how current is it? good RCT articles may have been published after this CPG was published and therefore weren’t included.

Question 23

_________ are systematically developed statements to assist the practitioner and patient make decisions about appropriate health care for specific circumstances

Answer 23

CPGs

Question 24

CPGs intent to improve efficiency and effectiveness of health care is based on….

Answer 24

current best evidence and expert judgement

Question 25

T or F: critical appraisal is still necessary when using CPG

Answer 25

true, duh!