Development and implementation of clinical practice guidelines:

2.1 Development

Introduction to the method of guideline development

The development of national practice guidelines (NPG's) is an issue of much concern in healtcare policies world-wide to guarantee and to improve the quality and effiency of care. The development and implementation of NPG's constitutes an important part of the quality of care policy of the Royal Dutch Physiotherapy Association (KNGF). This interest is due to pressure from society (policy-makers, healtcare managers, financiers and patients) on physiotherapists to ensure quality of care and to justify our position in the healthcare system.

The development of NPG's can also be seen as a logical step in the process of professionalisation and quality assurance by physiotherapists.

An NPG is described as a systematically developed statement, drafted by epxerts and directed at one aspect of the treathment of a health problem belonging to the domain of the profession.

NPG's are based on the different stages of the physiotherapy care process, the availible clinical evidence and expert consensus. Priority is given to a cost-effective approuch and multidisciplinary consensus on diagnosis, treatment and primary or secondary prevention.

Recommendations are based on the result of new or recorded systematic reviews or meta-analysis.

NPG's are important state-of-the-art documents, wich can guide professionals in their daily practice and make explicit to other relevant people what professionals can do in a certain situation or with a specific condition, and why they do it. NPG's have important functions, including supporting physiotherapists in their decision-making process; they are a frame of reference for orientation and educational purposes, they provide criteria for slef-evaluation and peer review, and can initiate changes in established practice patterns.

* Definition of Fiels & Lohr

2.2 Implementation

Development and Implementation of clinical Practice guidelines in Physiotherapy:

A Prospect for Continuous Quality Improvement in Physical therapy

Introduction to the methode of guideline implementation

Quality assurance and cost-effectiveness are important issues in modern-day healthcare. They are of great concern to the Royal Dutch  Society for Physical Therapy (KNGF). One strategy for improving the quality of physical therapy (physiotherapy) is to minimize undesirable variability in clinical practice by developing and implementing evidence-based clinical pratice guidelines. However, even well establisched guidelines will not contribute to improving quality unless they are imbedded in effective implementation programs.

This review article outlines current knowledge toward the field of physical therapy. It deals with guideline effectiveness and required strategies for implementing clinical practive guidelines.

In general, the provision of explicit clinical practice guidelines supported by reinforcement strategies will improve practitioners' performance and, in certain situations, also patients' health outcomes. Multiple implementation strategies are more likely to be effective than single strategies, and interactive workshops and audit and feedback seem to be the most effective interventions. Interactive strategies serve also to change the individual practitioner's behavior in a constantly altering evidence-based practice enviroment. Since implementation is is expected to occur as a result of interaction between innovators and professionals working in the field, the professional needs to be involved in the process of guidelines development and implementation. Key components of the development of a strategy for implementing clinical practice guidelines in physical therapy are the active inviolvement of physical therapists in both the development and implementation of guidelines, the use of multiple strategies including interactive strategies and the investigation and reduction of barriers for implementation.

Key Messages

- Effective implementation programs are necessary to improve the quality of care

- For better implementation of clinical practice guidelines

- Multiple and interactive interventions have the highest chance on succes

- Interventions should aim to overcome the barriers for implementation