Research article

Comparison of international guideline programs to evaluate and update the Dutch program for clinical guideline development in physical therapy

Philip J Van der Wees^1,2 , Erik JM Hendriks^1,3 , Jan WH Custers² , Jako S Burgers⁴ , Joost Dekker⁵ and Rob A de Bie¹

¹Department of Epidemiology, Center for Evidence based Physiotherapy and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands

²Royal Dutch Society for Physical Therapy (KNGF), Amersfoort, The Netherlands

³Dutch Institute for Allied Health Care (NPi), Amersfoort, The Netherlands

⁴Dutch Institute for Health Care Improvement (CBO), Utrecht, The Netherlands

⁵Department of Rehabilitation Medicine, EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands

author email corresponding author email

BMC Health Services Research 2007, 7:191doi:10.1186/1472-6963-7-191

Published:	23 November 2007

Abstract

Background

Clinical guidelines are considered important instruments to improve quality in health care. Since 1998 the Royal Dutch Society for Physical Therapy (KNGF) produced evidence-based clinical guidelines, based on a standardized program. New developments in the field of guideline research raised the need to evaluate and update the KNGF guideline program.

Purpose of this study is to compare different guideline development programs and review the KNGF guideline program for physical therapy in the Netherlands, in order to update the program.

Method

Six international guideline development programs were selected, and the 23 criteria of the AGREE Instrument were used to evaluate the guideline programs. Information about the programs was retrieved from published handbooks of the organizations. Also, the Dutch program for guideline development in physical therapy was evaluated using the AGREE criteria. Further comparison the six guideline programs was carried out using the following elements of the guideline development processes: Structure and organization; Preparation and initiation; Development; Validation; Dissemination and implementation; Evaluation and update.

Results

Compliance with the AGREE criteria of the guideline programs was high. Four programs addressed 22 AGREE criteria, and two programs addressed 20 AGREE criteria. The previous Dutch program for guideline development in physical therapy lacked in compliance with the AGREE criteria, meeting only 13 criteria.

Further comparison showed that all guideline programs perform systematic literature searches to identify the available evidence. Recommendations are formulated and graded, based on evidence and other relevant factors. It is not clear how decisions in the development process are made. In particular, the process of translating evidence into practice recommendations can be improved.

Conclusion

As a result of international developments and consensus, the described processes for developing clinical practice guidelines have much in common. The AGREE criteria are common basis for the development of guidelines, although it is not clear how final decisions are made. Detailed comparison of the different guideline programs was used for updating the Dutch program. As a result the updated KNGF program complied with 22 AGREE criteria. International discussion is continuing and will be used for further improvement of the program.