Phys Ther 2001 Oct;81(10):1701-17 Related Articles, Books, LinkOut


Philadelphia Panel evidence-based clinical practice guidelines on selected
rehabilitation interventions for neck pain.

Philadelphia Panel.

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 neck pain. METHODS: Evidence from randomized controlled trials
(RCTs) and observational studies was 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: For neck pain, therapeutic exercises were the only
intervention with clinically important benefit relative to a control (grade
A for pain and function, grade B for patient global assessment). There was
good agreement with this recommendation from practitioners (93%). For
several interventions and indications (eg, thermotherapy, therapeutic
ultrasound, massage, electrical stimulation), there was a lack of evidence
regarding efficacy. CONCLUSIONS: This methodology of developing EBCPGs
provides a structured approach to assessing the literature and developing
guidelines 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 neck pain where evidence
was insufficient to make recommendations.

Publication Types:
  a.. Consensus Development Conference
  b.. Guideline
  c.. Meta-Analysis
  d.. Practice Guideline
  e.. Review

PMID: 11589644 [PubMed - indexed for MEDLINE]

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        2: Phys Ther 2001 Oct;81(10):1641-74 Related Articles, Books,
LinkOut


  Philadelphia Panel evidence-based clinical practice guidelines on selected
rehabilitation interventions for low back pain.

  Philadelphia Panel.

  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 low back pain. METHODS: Evidence from randomized controlled
trials (RCTs) and observational studies was 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: Four positive
recommendations of clinical benefit were developed. Therapeutic exercises
were found to be beneficial for chronic, subacute, and postsurgery low back
pain. Continuation of normal activities was the only intervention with
beneficial effects for acute low back pain. These recommendations were
mainly in agreement with previous EBCPGs, although some were not covered by
other EBCPGs. There was wide agreement with these recommendations from
practitioners (greater than 85%). For several interventions and indications
(eg, thermotherapy, therapeutic ultrasound, massage, electrical
stimulation), there was a lack of evidence regarding efficacy. CONCLUSIONS:
This methodology of developing EBCPGs provides a structured approach to
assessing the literature and developing guidelines 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 low back pain where evidence was
insufficient to make recommendations.

  Publication Types:
    a.. Consensus Development Conference
    b.. Guideline
    c.. Meta-Analysis
    d.. Practice Guideline
    e.. Review

  PMID: 11589642 [PubMed - indexed for MEDLINE]
*******************************************************
Douglas M. White, PT, OCS
Physical Therapist, Consultant
191 Blue Hills Parkway
Milton, MA USA 02186
P: 617.696.1974
[log in to unmask]
http://DouglasWhite.tripod.com

----- Original Message -----
From: "Mike Mulrooney" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, February 14, 2002 11:41 AM
Subject: [PHYSIO] Traction information


| Hi all,
| Have to do a presentation for the department on mechanical traction
| (guidlines, proposed effects, clinical effectiveness). Does anyone have
any
| ideas on up to date journal articles or sources of info. Thanks in
advance.
|
| MIKE
|
| _________________________________________________________________
| Chat with friends online, try MSN Messenger: http://messenger.msn.com
|