REHABILITATION

■ 1st round voting ■ Carried out by email ■ Over a 2 week time period

■ Consensus statements written where consensus was achieved (ie. 75% or more agreement)

expert opinion from over 20 UK leaders in this field

■ By grading the recommendations the strength of the evidence on which they are based is made clear

■ Discussion about each remaining statement (where less than 75% agreement) ■ Mean agreement/disagreement of the group was indicated for each question ■ Carried out by an electronic conferencing system ■ Over a 2 week time period

■ They give important detail about phys- iotherapy that is not considered in multi-professional guidelines (eg. (1)

■ The CSP team has worked to disseminate these guidelines, eg. through conference presentations (12), distribution of flyers, and through direct communication with contacts throughout the world

■ 2nd round voting ■ Carried out by email ■ Over a 2 week time period

Figure 3: Outline of the consensus methods

Thus the consensus evidence was pro- duced in a transparent, reproducible and thus scientific way. Further using elec- tronic methods for the two rounds of vot- ing and the consensus conference made the process cost effective and efficient. For example, there were no travel costs and consensus group members could join the discussion at their own convenience.

Formulating the recommendations The GDG met by telephone conference to begin to draft the recommendations. Following this the recommendations were gradually refined, using electronic communication, until GDG members agreed with the wording.

By grading the recommendations A, C or D the GDG make clear the extent to which we are sure about each recommendation (figure 4) eg. grade A recommendations

are derived from high quality research and grade C recommendations from scientifi- cally generated consensus evidence, we are most certain of the former.

Giving recommendations that are graded C or D makes the guidelines more complete and user friendly. However users should note the grading system and be aware that in the future these lower grade recommendations may be amended as further research is published.

SOME THOUGHTS ABOUT

THESE GUIDELINES ■ They are tools for practice not recipes for practice. They stress the need for individual assessment and clinical reasoning to negotiate individual treatment packages

■ The recommendations for best practice are based on a systematic literature review and scientifically developed

FIGURE 4: GRADING GUIDELINE RECOMMENDATIONS (11) Grade Evidence A

B C D

■ Consensus statements written where consensus was achieved (ie. 75% or more agreement)

■ They are an invaluable tool to enable practitioners to demonstrate the effectiveness of their services to commissioners (13)

■ They give recommendations for best practice at the time of publication; regular updating is necessary and is scheduled for 2011.

AS A PRACTITIONER HOW CAN I USE THE GUIDELINES? The main documents ie. part 1 exercise and part 2 manual therapy in figure 2, provide the theoretical background and explain where the recommendations come from. To help you use the guidelines in practice they are produced with two additional documents: ■ a quick reference guide which is an aide memoire to remind you of the recommendations at work

■ an audit tool that enables you and your colleagues to assess the extent to which you are following these national guidelines.

The GDG encourage you to: ■ carry out an audit of practice in your department

■ submit your audit results to sportEX for consideration for publication and further discussion

At least one RCT of overall higher quality and consistency addressing the specific recommendation

Well-conducted clinical studies but not RCTs on the topic of the recommendation

Evidence from the nominal group technique or other expert committee reports. This indicates that directly applicable clinical studies or higher quality are absent

Recommended good practice based on the clinical experience of the GDG

Note: for pragmatic reasons (ie. the volume of literature and time available) the GDG did not consider clinical studies other than RCTs hence there are no grade B recommendations in these guidelines.

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■ amend your practice if this is indicated by the audit.

Further CSP members can discuss their audits and experiences in implementing the guidelines with colleagues on the interactive CSP networks. Non-CSP members are encouraged to feedback directly to the GDG via the author of this paper.

THE CHALLENGE FOR PRACTITIONERS Use these guidelines as a tool for clinical

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