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Evidence‐based clinical guidelines: a new system to better determine true strength of recommendation
Author(s) -
Roddy Edward,
Zhang Weiya,
Doherty Michael,
Arden Nigel K.,
Barlow Julie,
Birrell Fraser,
Carr Alison,
Chakravarty Kuntal,
Dickson John,
Hay Elaine,
Hosie Gillian,
Hurley Michael,
Jordan Kelsey M.,
McCarthy Christopher,
McMurdo Marion,
Mockett Simon,
O’Reilly Sheila,
Peat George,
Pendleton Adrian,
Richards Selwyn
Publication year - 2006
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/j.1365-2753.2006.00629.x
Subject(s) - grading (engineering) , medicine , delphi method , randomized controlled trial , visual analogue scale , delphi , expert opinion , physical therapy , evidence based medicine , variance (accounting) , alternative medicine , computer science , artificial intelligence , surgery , civil engineering , accounting , pathology , intensive care medicine , engineering , business , operating system
Rationale, aims and objectives Clinical practice guidelines often grade the ‘strength’ of their recommendations according to the robustness of the supporting research evidence. The existing methodology does not allow the strength of recommendation (SOR) to be upgraded for recommendations for which randomized controlled trials are impractical or unethical. The purpose of this study was to develop a new method of determining SOR, incorporating both research evidence and expert opinion. Methods A Delphi technique was employed to produce 10 recommendations for the role of exercise therapy in the management of osteoarthritis of the hip or knee. The SOR for each recommendation was determined by the traditional method, closely linked to the category of research evidence found on a systematic literature search, and on a visual analogue scale (VAS). Recommendations were grouped A‐D according to the traditional SOR allocated and the mean VAS calculated. Difference across the groups was assessed by one‐way anova variance analysis. Results Mean VAS scores for the traditional SOR groups A‐D and one proposition which was ‘not recommended’ showed significant linearity on one‐way anova . However, certain recommendations which, for practical reasons, could not assessed in randomized controlled trials and therefore could not be recommended strongly by the traditional methodology, were allocated a strong recommendation by VAS. Conclusions This new system of grading strength of SOR is less constrained than the traditional methodology and offers the advantage of allowing SOR for procedures which cannot be assessed in RCTs for practical or ethical reasons to be upgraded according to expert opinion.