Tetreault Lindsay A, Skelly Andrea C, Dettori Joseph R, Wilson Jefferson R, Martin Allan R, Fehlings Michael G
Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
University College Cork, Cork, Ireland.
Global Spine J. 2017 Sep;7(3 Suppl):8S-20S. doi: 10.1177/2192568217701715. Epub 2017 Sep 5.
The Institute of Medicine defines clinical practice guidelines as "statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options." Guidelines help clinicians implement best evidence into practice and encourage informed shared decision making with patients. Guidelines are intended to enhance the quality of patient care by discouraging ineffective and potentially harmful interventions and standardizing practice. Standards for the development and appraisal of guidelines, such as those proposed by the Institute of Medicine and other organizations, help assure guideline quality and credibility. Primary standards include establishing transparency, managing conflicts of interest, forming a multidisciplinary guideline development group, conducting methodologically sound systematic reviews, developing evidence-based recommendations, balancing risks and harms, and rating the strength of recommendations based on the confidence in the evidence. Furthermore, the guideline document must be appraised internally and externally and updated when new evidence arises. The Grading of Recommendation, Assessment, Development and Evaluation process helps appraise the existing body of evidence as well as provide an interactive framework for weighing the benefits and harms of treatment options and translating evidence to recommendations. This article summarizes the methodology used to develop clinical practice guidelines for the management of degenerative cervical myelopathy and acute spinal cord injury.
美国医学研究所将临床实践指南定义为“包含旨在优化患者护理的建议的声明，这些建议基于对证据的系统评价以及对替代护理方案的利弊评估”。指南有助于临床医生将最佳证据应用于实践，并鼓励与患者进行明智的共同决策。指南旨在通过摒弃无效和潜在有害的干预措施并规范实践来提高患者护理质量。指南制定和评估的标准，如美国医学研究所及其他组织提出的标准，有助于确保指南的质量和可信度。主要标准包括建立透明度、管理利益冲突、组建多学科指南制定小组、进行方法合理的系统评价、制定基于证据的建议、平衡风险和危害以及根据对证据的置信度对建议的强度进行评级。此外，指南文件必须进行内部和外部评估，并在出现新证据时进行更新。推荐分级、评估、制定与评价（GRADE）过程有助于评估现有证据体系，并为权衡治疗方案的利弊以及将证据转化为建议提供一个交互式框架。本文总结了用于制定退行性颈椎脊髓病和急性脊髓损伤管理临床实践指南的方法。
