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Martin FC, Quinn TJ, Straus SE, Anand S, van der Velde N, Harwood RH. New horizons in clinical practice guidelines for use with older people. Age Ageing 2024; 53:afae158. [PMID: 39046117 PMCID: PMC11267466 DOI: 10.1093/ageing/afae158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 03/12/2024] [Accepted: 07/12/2024] [Indexed: 07/25/2024] Open
Abstract
Globally, more people are living into advanced old age, with age-associated frailty, disability and multimorbidity. Achieving equity for all ages necessitates adapting healthcare systems. Clinical practice guidelines (CPGs) have an important place in adapting evidence-based medicine and clinical care to reflect these changing needs. CPGs can facilitate better and more systematic care for older people. But they can also present a challenge to patient-centred care and shared decision-making when clinical and/or socioeconomic heterogeneity or personal priorities are not reflected in recommendations or in their application. Indeed, evidence is often lacking to enable this variability to be reflected in guidance. Evidence is more likely to be lacking about some sections of the population. Many older adults are at the intersection of many factors associated with exclusion from traditional clinical evidence sources with higher incidence of multimorbidity and disability compounded by poorer healthcare access and ultimately worse outcomes. We describe these challenges and illustrate how they can adversely affect CPG scope, the evidence available and its summation, the content of CPG recommendations and their patient-centred implementation. In all of this, we take older adults as our focus, but much of what we say will be applicable to other marginalised groups. Then, using the established process of formulating a CPG as a framework, we consider how these challenges can be mitigated, with particular attention to applicability and implementation. We consider why CPG recommendations on the same clinical areas may be inconsistent and describe approaches to ensuring that CPGs remain up to date.
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Affiliation(s)
- Finbarr C Martin
- Population Health Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Sharon E Straus
- Department of Medicine, University of Toronto and Li Ka Shing Knowledge Institute of St. Michael’s, Toronto, Ontario, Canada
| | - Sonia Anand
- Departments of Medicine and Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute (Aging and Later Life), Amsterdam, The Netherlands
| | - Rowan H Harwood
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Rodríguez-Orozco JE, Martínez-Rubio CF, Moreno-Vargas E, Peña-Ortiz A, Pizarro-Peñaranda MC, Rojo-Bustamante E, Villarreal-García DE, Bayona-Ortiz HF. Comparative global analysis of stroke rehabilitation recommendations across income levels. J Clin Epidemiol 2024; 170:111334. [PMID: 38548231 DOI: 10.1016/j.jclinepi.2024.111334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/06/2024] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Successful implementation of stroke rehabilitation guidelines demands high-quality practice standards tailored to targeted sociodemographic contexts. The primary objective is to determine the quality differences in post-stroke rehabilitation practice guidelines (PGs), when comparing high-income countries (HIC) and low or middle-income countries (LMIC). STUDY DESIGN AND SETTING We conducted a scoping review of PGs in English or Spanish, published between 2012 and 2021, and providing recommendations on post-stroke rehabilitation. We used Search engines, databases, guideline libraries, gray literature, and references from previous reviews on post-stroke rehabilitation as sources of evidence. Quality assessment of PGs was performed using 6P's, ELSE, IOM, and AGREE II instruments. We evaluated each item using a scale between 0 to 3, based on the confidence of adherence to the standard. For AGREE II, we followed the instruction manual for scoring. At least two reviewers were independently involved in every step of the process. A cloud-based spreadsheet was used to chart data. We compared the results of PGs originating from HIC with those from LMIC. RESULTS The inclusion criteria were met by 35 documents, which were subjected to evaluation. The study included 21 documents from HIC and 14 from middle-income countries (MIC). No manuscripts from low-income countries were available for inclusion in the study. The quality of PGs from MIC was found to be lower, in terms of methodological rigor and adherence to international recommendations for guidelines development. PGs from both groups of countries failed to include all target audiences and stakeholders (according to the 6P's criteria) and integration of ethical, legal, social, and economic considerations. CONCLUSION There are gaps in the quality and availability of stroke rehabilitation guidelines worldwide, especially in LMIC. Designing and providing financial support for the implementation of high-quality guidelines will contribute to more effective implementation strategies in stroke rehabilitation programs and lead to improved patient outcomes.
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Affiliation(s)
| | - Carlos Fernando Martínez-Rubio
- Neurology Department, Hospital Universitario Fundación Santa Fe de Bogotá, Cra. 7 #117 -15, Bogotá, Colombia; Universidad de los Andes, Cra. 7 #116-5, Bogotá, Colombia; Universidad El Bosque, Ak. 9 #131a-2, Bogotá, Colombia
| | - Eder Moreno-Vargas
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 #18-49, Cali, Valle del Cauca, Colombia
| | - Angélica Peña-Ortiz
- Neurology Department, Hospital Universitario Fundación Santa Fe de Bogotá, Cra. 7 #117 -15, Bogotá, Colombia; Universidad de los Andes, Cra. 7 #116-5, Bogotá, Colombia
| | | | - Estefanía Rojo-Bustamante
- Neurology Department, Hospital Universitario Fundación Santa Fe de Bogotá, Cra. 7 #117 -15, Bogotá, Colombia; Universidad El Bosque, Ak. 9 #131a-2, Bogotá, Colombia
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Ramos Salas X, Saquimux Contreras MA, Breen C, Preiss Y, Hussey B, Forhan M, Wharton S, Campbell-Scherer D, Vallis M, Brown J, Pedersen SD, Sharma AM, Woodward E, Patton I, Pearce N. Review of an international pilot project to adapt the Canadian Adult Obesity Clinical Practice Guideline. OBESITY PILLARS (ONLINE) 2023; 8:100090. [PMID: 38125658 PMCID: PMC10728699 DOI: 10.1016/j.obpill.2023.100090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 12/23/2023]
Abstract
Background The evidence-based Canadian Adult Obesity Clinical Practice Guideline (CPG) released in August 2020 were developed through a systematic literature review and patient-oriented research process. This CPG is considered a paradigm shift for obesity care as it introduced a new obesity definition that is based on health not body size, incorporates lived experiences of people affected by obesity, and addresses the pervasive weight bias and stigma that patients face in healthcare systems. The purpose of this pilot project was to assess the feasibility of adapting the Canadian CPG in Chile and Ireland. Methods An International Clinical Practice Guideline Adaptation Committee was established to oversee the project. The project was conducted through four interrelated phases: 1) planning and preparation; 2) pilot project application process; 3) adaptation; and 4) launch, dissemination, and implementation. Ireland used the GRADE-ADAPTE framework and Chile used the GRADE-ADOLOPMENT approach. Results Chile and Ireland developed their adapted guidelines in one third of the time it took to develop the Canadian guidelines. In Ireland, 18 chapters, which underpin the 80 key recommendations, were contextually adapted. Chile adopted 18 chapters and 76 recommendations, adapted one recommendation, and developed 12 new recommendations.
. Conclusion The pilot project demonstrated it is feasible to adapt the Canadian CPG for use in other countries with different healthcare systems, languages, and cultural contexts, while retaining the Canadian CPG's key principles and values such as the treatment of obesity as a chronic disease, adoption of new clinical assessment approaches that go beyond anthropometric measurements, elimination of weight bias and stigma, shifting obesity care outcomes to improved health and well-being rather than weight loss alone, and the use of patient-centred, collaborative and shared-decision clinical care approaches.
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Affiliation(s)
| | - Miguel Alejandro Saquimux Contreras
- Universidade Estadual de Campinas - UNICAMP, Centro de Pesquisas em Saúde Reprodutiva de Campinas – CEMICAMP, Rua Vital Brasil, 200 Cidade Universitária, Campinas, SP, 13083-888, Brazil
| | - Cathy Breen
- Association for the Study of Obesity on the island of Ireland, Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Yudith Preiss
- Sociedad Chilena de Cirugía Bariátrica y Metabólica, Centro Medico Novamed, Lo Fontecilla 101, oficina 201-202, Las Condes, RM, Chile
| | - Brad Hussey
- Replica Communications, 156 Melville Street, Dundas, Ontario, L9H 2A8, Canada
| | - Mary Forhan
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160 – 500 University Ave., 9th floor, Toronto, ON, M5G 1V7, Canada
| | - Sean Wharton
- McMaster University, Wharton Medical Clinic, 2951 Walkers Line, Burlington, Ontario, L7M 4Y1, Canada
| | - Denise Campbell-Scherer
- University of Alberta, 2-590B Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada
| | - Michael Vallis
- Dalhousie University Family Medicine, 1465 Brenton Street, Suite 402, Halifax, Nova Scotia, B3J 3T4, Canada
| | - Jennifer Brown
- Obesity Canada, 2-126 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada
| | - Sue D. Pedersen
- C-ENDO Diabetes and Endocrinology Clinic, Rockyview Health Centre II, Suite 210, 1016-68 Avenue SW, Calgary, Alberta, T2V 4J2, Canada
| | - Arya M. Sharma
- University of Alberta, Faculty of Medicine & Dentistry, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Euan Woodward
- European Association for the Study of Obesity, Level 2, 8 Waldergrave Road, Teddington, Middlesex, TW11 8GT, United Kingdom
| | - Ian Patton
- Obesity Canada, 2-126 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada
| | - Nicole Pearce
- Obesity Canada, 2-126 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada
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Al Zoubi FM, Wong AYL, Cheing GLY, Cheung JPY, Fu SN, Tsang HHL, Law RKY, So BCL, Tsang R, Tsang S, Wen C, Wong M, Yau YC, Bussières AE. Adapting a Clinical Practice Guideline for Management of Patients with Knee and Hip Osteoarthritis by Hong Kong Physiotherapists. Healthcare (Basel) 2023; 11:2964. [PMID: 37998457 PMCID: PMC10671134 DOI: 10.3390/healthcare11222964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/11/2023] [Accepted: 11/11/2023] [Indexed: 11/25/2023] Open
Abstract
Knee and hip osteoarthritis are common disabling conditions globally. Although numerous international clinical practice guidelines exist to guide physiotherapy management, not all recommendations issued from these guidelines can be translated to other contexts without considering the cultural acceptability and clinical implementability of targeted countries. Because the ADAPTE framework provides a robust methodology to adapt guidelines to the local context, this study used its methodology to adapt high-quality guideline recommendations to promote optimal physiotherapy care for knee and hip osteoarthritis in Hong Kong. The ADAPTE framework was used and modified to complete the adaptation process. International clinical practice guidelines were identified from eight guideline clearinghouses and six electronic databases. Two independent reviewers critically appraised the eligible guidelines using the AGREE II tool. We extracted and tabulated recommendations from high-quality guidelines. A voting-based consensus among interdisciplinary experts was conducted to decide on suitable recommendations for the Hong Kong context and whether there was a need to modify them. Pertinent recommendations were then translated into the traditional Chinese language. Our team members suggested modifying four tools and adding one to explore the patient's feedback on the recommendations, to the ADAPTE framework. The adaptation was performed on three high-quality guidelines. We adapted 28 and 20 recommendations for treating knee and hip osteoarthritis, respectively. We recommend a multimodal treatment for managing knee and hip osteoarthritis. Land- and aquatic-based exercises, patient education, and self-management were strongly recommended for patients with knee osteoarthritis. Land- and aquatic-based exercises were strongly recommended for patients with hip osteoarthritis. This is the first adaptation study in Hong Kong. It provides guidance to local physiotherapists on managing patients with knee and hip osteoarthritis. Future studies should test the effectiveness of implementing this adapted guideline to improve local physiotherapy care in Hong Kong.
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Affiliation(s)
- Fadi M. Al Zoubi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Arnold Y. L. Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Gladys L. Y. Cheing
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Jason P. Y. Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China;
| | - Siu Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Helen H. L. Tsang
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Rainbow K. Y. Law
- Physiotherapy Centre, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
| | - Billy Chun Lung So
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Raymond Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
- Hong Kong Physiotherapy Association, Hong Kong SAR, China
- Physiotherapy Department, MacLehose Medical Rehabilitation Centre, Hong Kong SAR, China
| | - Sharon Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Chunyi Wen
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Michael Wong
- Rehabilitation Clinic, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Yim Ching Yau
- Nursing Mixed Surgical Ward, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China;
| | - André E. Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G 2M1, Canada;
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada
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Hurtado MM, Quemada C, García-Herrera JM, Morales-Asencio JM. Use of the ADAPTE method to develop a clinical guideline for the improvement of psychoses and schizophrenia care: Example of involvement and participation of patients and family caregivers. Health Expect 2021; 24:516-524. [PMID: 33621426 PMCID: PMC8077137 DOI: 10.1111/hex.13193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 12/12/2020] [Accepted: 12/24/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction The aim of this study is to analyse different ways of participation during the development of a clinical guideline to improve the early detection of psychosis and to deploy a comprehensive treatment plan to improve prognosis and social integration. Materials and method The clinical guideline was developed using the ADAPTE method with the participation of 40 authors and 80 external reviewers. The process was divided into three major phases: set up, adaptation and finalization. During adaptation and completion, a total of 44 patients and 18 family caregivers were involved. Results and conclusions The different roles assumed by the patients and their family caregivers were described, depending on the panel in which they participated, with diverse grades of complexity: a user as author, integration of the results of qualitative research with the participation of local users and family caregivers, 13 users as individual external reviewers and the participation of users and caregiver organizations in the external review. In the guideline, contributions from patients during the qualitative research were included in an innovative way, placing them just behind the recommendations. On the other hand, the results of the family caregivers’ study were included in a specific area of uncertainty. Further, the expressed point of view was considered as the collective demands of users and family caregivers’ organizations in the cost‐benefit analysis made by the organizing committee. There were diverse ways to conduct direct patient participation during the guideline development, ensuring that their individual experiences contributed significantly to the final version.
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Affiliation(s)
- María M Hurtado
- Mental Health Unit, Regional University Hospital, Málaga, Spain.,Institute of Biomedical Research of Málaga (IBIMA), Málaga, Spain
| | - Casta Quemada
- Mental Health Unit, Regional University Hospital, Málaga, Spain.,Institute of Biomedical Research of Málaga (IBIMA), Málaga, Spain
| | | | - José Miguel Morales-Asencio
- Institute of Biomedical Research of Málaga (IBIMA), Málaga, Spain.,Faculty of Health Sciences, University of Málaga, Málaga, Spain
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