Recommended Clinical Guidelines and Protocols

Guidelines are systematically developed by a group of experts to support doctors and patients in making decisions concerning appropriate care for specific health problems. They are intended to promote quality, transparency and the transfer of scientific knowledge into routine clinical practice.

In the last 2 decades, the profession physiotherapy as medical science has rapidly increased its body of knowledge, and the introduction of evidence-based clinical guidelines was a logical step in this respect. In 2007, the Physiotherapy Evidence Database (PEDro) contained 478 evidence-based clinical guidelines.  At the international level, the World Confederation for Physical Therapy (WCPT) has prioritized the development and implementation of clinical guidelines in its policy. The European Region of WCPT (ER-WCPT) has developed a framework for the development of clinical guidelines, and its database shows that, in 2010, eight European countries had physical therapy–specific guideline programs.

There are specific problems related to the use of guidelines by physical therapists in low- and middle-income countries. Physical therapy management is confronted with a high patient-to-physical therapist ratio, low accessibility to health care, lack of facilities and equipment, and short hospital stays. In addition, cultural and language differences mean that well-known outcome measures developed within a Western model are not suitable locally. Furthermore, roles and responsibilities of physical therapists may be different, with consequences for physical therapy diagnosis and decisions for treatment modalities or prevention. There is a need to develop an appropriate local body of evidence to address the specific circumstances. By so doing, suitable clinical guidelines can either be adapted from existing ones or established for low- and middle-income countries.

International Collaboration
The growing body of knowledge in the field of clinical guidelines has provided opportunities for international collaboration. In  2002, the Guidelines International Network (G-I-N) was founded to provide a network and partnerships for guideline organisations, implementer, researchers, and other stakeholders in health care. The G-I-N seeks to improve the quality of health care by promoting systematic development of guidelines and their application to practice. In the field of physical therapy, international collaboration in producing guidelines and harmonizing guideline methods is limited. Despite the existence of several national programs for guideline development, to date they have not resulted in a structured international debate on the specific characteristics of clinical guidelines in physical therapy and possible consequences for methods of guideline development.

The purposes of this article are:
(1) to explore methodological considerations for guideline developers and researchers in addressing specific physical therapy–related issues when developing guidelines for physical therapy diagnosis and treatment and
(2) to provide a perspective for further harmonisation of methods for guideline development, shared use of resources, and production of international evidence statements for physical therapist practice. These evidence statements would include considerations for formulating recommendations at the national level, with a specific focus on the identified challenges in low- and middle-income countries