Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Division of Health Sciences, University of South Australia, Adelaide, Australia.
J Eval Clin Pract. 2022 Jun;28(3):454-467. doi: 10.1111/jep.13644. Epub 2021 Dec 16.
The prevalence of chronic musculoskeletal pain (CMSP) is high and rising. The multidimensional impact of CMSP on individuals necessitates multidisciplinary evidence-based strategies to prevent and manage chronic pain. Primary health care (PHC) is the first point of care in many healthcare systems and evidence implementation at this point is important. We aim to describe the process of development of a comprehensive list of evidence-based recommendations derived from different high-quality clinical practice guidelines (CPGs) to inform the PHC healthcare of adults with CMSP.
A systematic review was conducted of CPGs that focussed on PHC management of CMSP in adults. CPGs were identified by searching 13 guideline clearinghouses and five online databases. Eligible CPGs were critically appraised using Appraisal of Guidelines Research and Evaluation, Version II (AGREE II). A stepwise systematic process was followed to identify a core set of recommendations. This process comprised the following: extract recommendations; analyze recommendations; synthesize recommendations by assimilating similar recommendations; determine the strength of the body of evidence underpinning the recommendations and produce a list of synthesized recommendations.
Six high-quality CPGs were identified, providing 156 recommendations. These were condensed to 42 statements covering topics about the approach to care, assessment, advice and education, referral, pharmacological management, physical therapy, electrotherapy, psychological therapy, complementary therapy and self-management. The set of recommendations encompasses a person-centered approach, collaborative decision making, a biopsychosocial approach, patient education and empowerment towards self-management.
The process of developing composite recommendations from multiple CPGs enables end-users to access comprehensive information on managing CMSP in PHC settings that is not available from one singular CPG. The content and evidence base for recommendations varied between CPGs. A similar stepwise process may be used to develop a core set of recommendations for other health conditions, where multiple, diverse CPGs exist.
慢性肌肉骨骼疼痛（CMSP）的患病率很高且呈上升趋势。CMSP 对个体的多维度影响需要多学科循证策略来预防和管理慢性疼痛。初级保健（PHC）是许多医疗保健系统中的第一保健点，在此实施证据非常重要。我们旨在描述从不同高质量临床实践指南（CPG）中得出的综合循证建议清单的开发过程，以告知 PHC 保健提供者管理 CMSP 的成年患者。
对聚焦于 PHC 管理 CMSP 的成人的 CPG 进行了系统综述。通过搜索 13 个指南清理中心和 5 个在线数据库来确定 CPG。使用评估指南研究和评估，第二版（AGREE II）对合格的 CPG 进行了批判性评估。按照逐步系统的过程确定了核心建议集。该过程包括以下步骤：提取建议；分析建议；通过同化相似的建议综合建议；确定支持建议的证据体的强度并生成综合建议清单。
确定了 6 项高质量的 CPG，提供了 156 项建议。这些建议被压缩到 42 条陈述，涵盖了关于护理方法、评估、建议和教育、转诊、药物治疗、物理治疗、电疗、心理治疗、补充治疗和自我管理的主题。这组建议包含以患者为中心的方法、协作决策、生物心理社会方法、患者教育和自我管理的赋权。
从多个 CPG 中开发综合建议的过程使最终用户能够访问关于在 PHC 环境中管理 CMSP 的综合信息，而这些信息无法从一个 CPG 获得。CPG 之间的建议内容和证据基础有所不同。对于存在多个不同 CPG 的其他健康状况，可以使用类似的逐步过程来开发核心建议集。
