An innovative method for clinical practice guideline contextualisation for chronic musculoskeletal pain in the South African context
Date
2019
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: Clinical guidelines produced in developed nations may not be appropriate in resource-constrained
environments, due to differences in cultural, societal, economic and policy contexts. The purpose of this article is to
describe an innovative and resource-efficient method to develop a clinical practice guideline (CPG), using the CPG
contextualisation approach.
Methods: The four phased contextualisation framework was applied to produce a contextualised, multidisciplinary
CPG for the primary health care of adults with chronic musculoskeletal pain (CMSP) in the South African context.
The four phases were: a contextual analysis, evidence synthesis, contextual integration and external evaluation.
Qualitative methodology was used to investigate context factors influencing health care in this environment. A
systematic review was conducted to identify current, high-quality CPGs on the topic, and to synthesise a core set of
clinical recommendations from the CPGs. Consensus methods were used to integrate context information with
recommendations. A multidisciplinary panel of local experts authenticated and contextualised recommendations.
The resultant CPG was externally reviewed using a survey.
Results: The results from the contextual analysis phase indicated a wide range of contextual factors that could
influence the applicability and implementability of the recommendations, including: the personal characteristics of the
patient and clinician, social and environmental circumstances, healthcare interventions available, and healthcare system
factors. During phase two, six existent high quality CPGs were identified and a core set of multidisciplinary
recommendations were sourced from them. The contextual integration phase produced the validated
recommendations, accompanied by its underpinning body of evidence and context specific information. The outcome
of phase four (external review) was that the recommendations were confirmed as relevant for the intended setting.
Conclusion: CPG contextualisation was found to be a practical approach to develop a contextualised multidisciplinary
CPG for the primary health care of adults with CMSP in a South African setting. The contextualisation approach
enhanced the integration of multiple stakeholder perspectives and highlighted the importance of considering clinical,
social and economic complexities during CPG development. Attention to contextual information is advocated to
enhance the uptake of CPG recommendations, particularly in resource constrained settings.
Description
CITATION: Ernstzen, D. V., Hillier, S. L. & Louw, Q. A. 2019. An innovative method for clinical practice guideline contextualisation for chronic musculoskeletal pain in the South African context. BMC Medical Research Methodology, 19:134, doi:10.1186/s12874-019-0771-3.
The original publication is available at https://bmcmedresmethodol.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
The original publication is available at https://bmcmedresmethodol.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
Keywords
Physiotherapy -- Practice -- South Africa, Medical protocols -- Planning -- South Africa, Musculoskeletal system -- Wounds and injuries -- Treatment -- South Africa, Chronic pain -- Treatment -- South Africa
Citation
Ernstzen, D. V., Hillier, S. L. & Louw, Q. A. 2019. An innovative method for clinical practice guideline contextualisation for chronic musculoskeletal pain in the South African context. BMC Medical Research Methodology, 19:134, doi:10.1186/s12874-019-0771-3