Manitoba Bleeding Disorders Program, Children's Hospital, Winnipeg, MB, Canada.
Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
Haemophilia. 2021 Jul;27(4):674-682. doi: 10.1111/hae.14327. Epub 2021 Apr 29.
Several bleeding disorders are characterized by haemorrhage into joints and muscles. These conditions are best managed by interdisciplinary teams that include physiotherapists. In 1997, physiotherapists from haemophilia treatment centres in Canada formed the Canadian Physiotherapists in Hemophilia Care (CPHC). The guiding principles of the CPHC reflect a commitment to evidence-based practice, education and collaboration.
To describe the process used by CPHC to develop evidence-based clinical practice guidelines to inform best practice, guide decision-making and help educate physiotherapists, students, and other team members about the physiotherapy management of people with bleeding disorders.
We followed the procedures outlined in the American Physical Therapy Association's Clinical Practice Guideline Process Manual (2018). Namely, we selected a working group, determined the scope of the guidelines, performed a literature search, selected and appraised the evidence, drafted the guidelines as practice statements, assigned a strength of recommendation to each practice statement and disseminated the guidelines.
Thirty-nine practice statements were developed in nine practice areas. Strength of evidence was strong for two statements, moderate for one and weak for three. The remainder were graded as theoretical or best practice.
To our knowledge, these are the first evidence-based clinical practice guidelines that cover all aspects of physiotherapy management of people with bleeding disorders. Some areas, such as exercise and manual therapy, have been well investigated. However, the overall low levels of evidence and low strengths of recommendations highlight the need for more rigorous research with this population.
一些出血性疾病的特征是关节和肌肉出血。这些疾病最好由包括物理治疗师在内的跨学科团队来管理。1997 年，加拿大血友病治疗中心的物理治疗师成立了加拿大血友病护理物理治疗师协会（CPHC）。CPHC 的指导原则反映了对循证实践、教育和合作的承诺。
描述 CPHC 用于制定循证临床实践指南的过程，以为最佳实践提供信息、指导决策，并帮助教育物理治疗师、学生和其他团队成员了解出血性疾病患者的物理治疗管理。
我们遵循了美国物理治疗协会临床实践指南制定过程手册（2018 年）中概述的程序。即，我们选择了一个工作组，确定了指南的范围，进行了文献检索，选择和评估了证据，起草了作为实践陈述的指南，为每个实践陈述分配了推荐强度，并传播了指南。
在九个实践领域制定了 39 个实践陈述。有两个陈述的证据强度为强，一个为中，三个为弱。其余的则被评为理论或最佳实践。
据我们所知，这些是涵盖出血性疾病患者物理治疗管理所有方面的首批循证临床实践指南。有些领域，如运动和手法治疗，已经得到了很好的研究。然而，整体证据水平较低和推荐强度较低，突出表明需要对这一人群进行更严格的研究。
