Standardising evidence strength grading for recommendations from multiple clinical practice guidelines : a South African case study
Date
2018-08-29
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: Significant resources are required to write de novo clinical practice guidelines (CPGs). There are many
freely-available CPGs internationally, for many health conditions. Developing countries rarely have the resources for
de novo CPGs, and there could be efficiencies in using CPGs developed elsewhere. This paper outlines a novel
process developed and tested in a resource-constrained country (South Africa) to synthesise findings from multiple
international CPGs on allied health (AH) stroke rehabilitation.
Methods: Methodologists, policy-makers, content experts and consumers collaborated to describe the pathway of
an ‘average’ stroke patient through the South African public healthcare system and pose questions about bestpractice
stroke rehabilitation along this pathway. A comprehensive search identified international guidance
documents published since January 2010. These were scanned for relevance to the South African AH stroke
rehabilitation questions and critically appraised for methodological quality. Recommendations were extracted from
guidance documents for each question. Strength of the body of evidence (SoBE) gradings underpinning
recommendations were standardised, and composite recommendations were developed using qualitative synthesis.
An algorithm was developed to guide assignment of overall SoBE gradings to composite recommendations.
Results: Sixteen CPGs were identified, and all were included, as they answered different project questions differently.
Methodological quality varied and was unrelated to currency. Seven clusters, outlining 20 composite recommendations
were proposed (organise for best practice rehabilitation, operationalise strategies for best practice communication
throughout the patient journey, admit to an acute hospital, refer to inpatient rehabilitation, action inpatient
rehabilitation, discharge from inpatient rehabilitation and longer-term community-based rehabilitation).
Conclusion: The methodological development process, tested by writing a South African AH stroke rehabilitation
guideline from existing evidence sources, took 9 months. The process was efficient, collaborative, effective, rewarding
and positive. Using the proposed methods, similar synthesis of existing evidence could be conducted in shorter time
periods, in other resource-constrained countries, avoiding the need for expensive and time-consuming de novo CPG
development.
Description
CITATION: Grimmer, K., et al. 2018. Standardising evidence strength grading for recommendations from multiple clinical practice guidelines : a South African case study. Implementation Science, 13:117, doi:10.1186/s13012-018-0803-0.
The original publication is available at https://implementationscience.biomedcentral.com
The original publication is available at https://implementationscience.biomedcentral.com
Keywords
Clinical practice guidelines
Citation
Grimmer, K., et al. 2018. Standardising evidence strength grading for recommendations from multiple clinical practice guidelines : a South African case study. Implementation Science, 13:117, doi:10.1186/s13012-018-0803-0