Guidelines, position papers and critical reviews: differences and similarities

Reiner, Željko

doi:10.1177/2047487312460190

Cited by 9 publications

(7 citation statements)

References 13 publications

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“…While these publications do provide broad evidence-based recommendations for exercise-based cardiac rehabilitation, clinicians requiring specific guidance about the “how to” of translating exercise training interventions into practice, would most likely need to source this information from other types of guidance document. The role of publications such as scientific statements in providing the “how to” of evidence translation has previously been acknowledged [1, 4]. Given their potentially greater clinical usefulness, the large gap in methodological quality we observed between these types publications and clinical guidelines is disparaging.…”

Section: Discussionmentioning

confidence: 91%

“…Unlike guidelines, other forms of guidance do not necessarily use a systematic review and grading of the relevant evidence. Instead they are more likely to provide the collective opinion of an expert multidisciplinary panel concerning evidence-based approaches to advancing patient care in particular areas [4, 32, 33]. Additionally, while many professional associations provide methodology manuals for the transparent and systematic development of clinical guidelines [32, 34], such publications for other types of guidance are generally lacking.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, clinical guidelines are generally designed to provide recommendations where there is a strong evidence base, while guidance such as consensus statements may be developed to inform clinical practice where the evidence is less clear or still evolving [4]. For example, the broad recommendation for referral to exercise-based cardiac rehabilitation that was noted in a large number of guidelines stems from the well documented benefits of this intervention in randomised control trials and systematic reviews [35].…”

Section: Discussionmentioning

confidence: 99%

“…These types of publications, often produced by professional associations, are useful to clinicians as they are typically designed to provide more detailed information about topics (such as exercise training) which are considered too specific to address in broader disease focused clinical guidelines [4]. Until recently it was common for these documents to also be badged as guidelines [1].…”

Section: Introductionmentioning

confidence: 99%

“…Until recently it was common for these documents to also be badged as guidelines [1]. It is now recognised however, that these various publications differ from clinical guidelines in their development processes and incorporation of evidence, which may impact upon methodological quality [1, 4]. Consequently, while these other forms of ‘clinical guidance’ are often of value to clinicians, they should be distinguished from more methodologically rigorous, evidence-based ‘clinical practice guidelines’ [1].…”

Section: Introductionmentioning

confidence: 99%

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Exploration of the methodological quality and clinical usefulness of a cross-sectional sample of published guidance about exercise training and physical activity for the secondary prevention of coronary heart disease

Abell¹,

Glasziou²,

Hoffmann³

2017

BMC Cardiovasc Disord

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BackgroundClinicians are encouraged to use guidelines to assist in providing evidence-based secondary prevention to patients with coronary heart disease. However, the expanding number of publications providing guidance about exercise training may confuse cardiac rehabilitation clinicians. We therefore sought to explore the number, scope, publication characteristics, methodological quality, and clinical usefulness of published exercise-based cardiac rehabilitation guidance.MethodsWe included publications recommending physical activity, exercise or cardiac rehabilitation for patients with coronary heart disease. These included systematically developed clinical practice guidelines, as well as other publications intended to support clinician decision making, such as position papers or consensus statements. Publications were obtained via electronic searches of preventive cardiology societies, guideline databases and PubMed, to November 2016. Publication characteristics were extracted, and two independent assessors evaluated quality using the 23-item Appraisal of Guidelines Research and Evaluation II (AGREE) tool.ResultsFifty-four international publications from 1994 to 2016 were identified. Most were found on preventive cardiology association websites (n = 35; 65%) and were freely accessible (n = 50; 93%). Thirty (56%) publications contained only broad recommendations for physical activity and cardiac rehabilitation referral, while 24 (44%) contained the necessary detailed exercise training recommendations. Many were labelled as “guidelines”, however publications with other titles (e.g. scientific statements) were common (n = 24; 44%). This latter group of publications contained a significantly greater proportion of detailed exercise training recommendations than clinical guidelines (p = 0.017). Wide variation in quality also existed, with ‘applicability’ the worst scoring AGREE II domain for clinical guidelines (mean score 53%) and ‘rigour of development’ rated lowest for other guidance types (mean score 33%).ConclusionsWhile a large number of guidance documents provide recommendations for exercise-based cardiac rehabilitation, most have limitations in either methodological quality or clinical usefulness. The lack of rigorously developed guidelines which also contain necessary detail about exercise training remains a substantial problem for clinicians.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0589-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Exploration of the methodological quality and clinical usefulness of a cross-sectional sample of published guidance about exercise training and physical activity for the secondary prevention of coronary heart disease

Abell¹,

Glasziou²,

Hoffmann³

2017

BMC Cardiovasc Disord

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A Systematic Review of Clinical Practice Guidelines and Consensus Statements for Cardiac Rehabilitation Delivery: Consensus, Divergence, and Important Knowledge Gaps

Cotie,

Vanzella,

Pakosh

et al. 2024

Canadian Journal of Cardiology

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Statins in the primary prevention of cardiovascular disease

2013

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Statins are widely used in the evidence-based lowering of cardiovascular disease (CVD) risk. The use of these drugs for secondary prevention of CVD is well founded, but their expanding use in primary prevention--in individuals without documented CVD--has raised some concerns. Firstly, evidence suggests that, in primary prevention, statins substantially decrease CVD morbidity, but only moderately reduce CVD mortality. Secondly, long-term statin use might cause adverse effects, such as incident diabetes mellitus. Thirdly, the cost-effectiveness of such a strategy is unclear, and has to be balanced against the risk of 'overmedicating' the general population. Data clearly support the use of statins for primary prevention in high-risk individuals, in whom the strategy is cost-effective and the benefits exceed the risks. Whether primary prevention is beneficial in individuals at low or moderate risk is not certain. Therefore, the prescription of statins for primary prevention should be individualized on the basis of clinical judgment, particularly for low-risk individuals. In appropriately selected individuals, statins should also be used for primary prevention of ischaemic stroke and transient ischaemic attack.

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Guidelines, position papers and critical reviews: differences and similarities

Cited by 9 publications

References 13 publications

Exploration of the methodological quality and clinical usefulness of a cross-sectional sample of published guidance about exercise training and physical activity for the secondary prevention of coronary heart disease

Exploration of the methodological quality and clinical usefulness of a cross-sectional sample of published guidance about exercise training and physical activity for the secondary prevention of coronary heart disease

A Systematic Review of Clinical Practice Guidelines and Consensus Statements for Cardiac Rehabilitation Delivery: Consensus, Divergence, and Important Knowledge Gaps

Statins in the primary prevention of cardiovascular disease

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