Abstract | INTRODUCTION: A structured and rigorous methodology was developed for the formulation of evidence-based clinical practice guidelines (EBCPGs), then was used to develop EBCPGs for selected rehabilitation interventions for the management of knee pain. METHODS: Evidence from randomized controlled trials (RCTs) and observational studies were identified and synthesized using methods defined by the Cochrane Collaboration that minimize bias by using a systematic approach to literature search, study selection, data extraction, and data synthesis. Meta-analysis was conducted where possible. The strength of evidence was graded as level I for RCTs or level II for nonrandomized studies. DEVELOPING RECOMMENDATIONS: An expert panel was formed by inviting stakeholder professional organizations to nominate a representative. This panel developed a set of criteria for grading the strength of both the evidence and the recommendation. The panel decided that evidence of clinically important benefit (defined as 15% greater relative to a control based on panel expertise and empiric results) in patient-important outcomes was required for a recommendation. Statistical significance was also required but was insufficient alone. Patient-important outcomes were decided by consensus as being pain, function, patient global assessment, quality of life, and return to work, providing that these outcomes were assessed with a scale for which measurement reliability and validity have been established. VALIDATING THE RECOMMENDATIONS: A feedback survey questionnaire was sent to 324 practitioners from 6 professional organizations. The response rate was 51%. RESULTS: CONCLUSIONS: This methodology of developing EBCPGs provides a structured approach to assessing the literature and developing EBCPGs that incorporates clinicians' feedback and is widely acceptable to practicing clinicians. Further well-designed RCTs are warranted regarding the use of several interventions for patients with knee pain where evidence was insufficient to make recommendations.
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Authors | Philadelphia Panel |
Journal | Physical therapy
(Phys Ther)
Vol. 81
Issue 10
Pg. 1675-700
(Oct 2001)
ISSN: 0031-9023 [Print] United States |
PMID | 11589643
(Publication Type: Consensus Development Conference, Guideline, Journal Article, Meta-Analysis, Practice Guideline, Research Support, Non-U.S. Gov't, Review)
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Topics |
- Arthralgia
(rehabilitation)
- Humans
- Knee Joint
- Osteoarthritis, Knee
(rehabilitation)
- Physical Therapy Modalities
(standards)
- Tendinopathy
(rehabilitation)
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