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      South African primary health care allied health clinical practice guidelines: the big picture

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          Abstract

          Background

          Good quality clinical practice guidelines (CPGs) are a vehicle to implementing evidence into allied health (AH) care. This paper reports on the current ‘state of play’ of CPGs in a lower-to-middle-income country (South Africa), where primary healthcare (PHC) AH activities face significant challenges in terms of ensuring quality service delivery in the face of huge PHC need.

          Methods

          A qualitative study was conducted, using semi-structured interviews with purposively-sampled individuals involved in AH PHC CPGs in South Africa. They included national and state government policy-makers, academics and educators, service managers, clinicians, representatives of professional associations, technical writers, and members of informal professional networks. The interview data was transcribed and de-identified, and analysed descriptively by hand-coding. The COREQ statement guided study conduct and reporting. A framework to guide research in other countries into perspectives of AH PHC CPG activities was established.

          Results

          Of the 32 invited, 29 people participated: of these 25 were interviewed and four provided meeting notes. Most participants had multiple professional roles, being engaged concurrently in clinical practice, academia, professional associations and / or government. Key themes comprised Players (sub-themes of sampling frame, participants, advice, role players and collaboration); Guidance (sub-themes of nomenclature, drivers, purpose, evidence sources) and Role of AH in PHC (sub-themes of discipline groupings, disability and rehabilitation, AH recognition).

          Conclusion

          There was consistently-expressed desire for quality guidance to support better quality AH PHC activities around the country. However no international CPGs were used, and there were no South African CPGs specific to local PHC AH practice. The guidance gap was filled by non-evidence-based documents produced often without training, to deal with specific clinical situations. This led to frustration, duplication and fragmentation of effort, confusing nomenclature, and an urgent need for standardised and agreed guidance. We provided a standardised framework to capture perspectives on CPGs activities in other AH PHC settings.

          Electronic supplementary material

          The online version of this article (10.1186/s12913-018-2837-z) contains supplementary material, which is available to authorized users.

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          Most cited references17

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          Qualitative research and evaluation methods.

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            Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise.

            Although several tools to evaluate the credibility of health care guidelines exist, guidance on practical steps for developing guidelines is lacking. We systematically compiled a comprehensive checklist of items linked to relevant resources and tools that guideline developers could consider, without the expectation that every guideline would address each item. We searched data sources, including manuals of international guideline developers, literature on guidelines for guidelines (with a focus on methodology reports from international and national agencies, and professional societies) and recent articles providing systematic guidance. We reviewed these sources in duplicate, extracted items for the checklist using a sensitive approach and developed overarching topics relevant to guidelines. In an iterative process, we reviewed items for duplication and omissions and involved experts in guideline development for revisions and suggestions for items to be added. We developed a checklist with 18 topics and 146 items and a webpage to facilitate its use by guideline developers. The topics and included items cover all stages of the guideline enterprise, from the planning and formulation of guidelines, to their implementation and evaluation. The final checklist includes links to training materials as well as resources with suggested methodology for applying the items. The checklist will serve as a resource for guideline developers. Consideration of items on the checklist will support the development, implementation and evaluation of guidelines. We will use crowdsourcing to revise the checklist and keep it up to date.
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              Low back pain.

              The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF). The purpose of these low back pain clinical practice guidelines, in particular, is to describe the peer-reviewed literature and make recommendations related to (1) treatment matched to low back pain subgroup responder categories, (2) treatments that have evidence to prevent recurrence of low back pain, and (3) treatments that have evidence to influence the progression from acute to chronic low back pain and disability.
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                Author and article information

                Contributors
                janine.dizon@unisa.edu.au
                ubiquitous598@hotmail.com
                shingai.machingaidze@mrc.ac.za
                qalouw@sun.ac.za
                hparker@sun.ac.za
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                29 January 2018
                29 January 2018
                2018
                : 18
                : 48
                Affiliations
                [1 ]ISNI 0000 0000 8994 5086, GRID grid.1026.5, International Centre for Allied Health Evidence, , University of South Australia, ; Adelaide, 5000 Australia
                [2 ]ISNI 0000 0001 2214 904X, GRID grid.11956.3a, Centre for Evidence-Based Health Care (CEBHC), Faculty of Medicine and Health Sciences, , Stellenbosch University, ; Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
                [3 ]ISNI 0000 0001 2214 904X, GRID grid.11956.3a, Department of Physiotherapy, Faculty of Medicine and Health Sciences, , Stellenbosch University, ; Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
                [4 ]ISNI 0000 0000 9155 0024, GRID grid.415021.3, Cochrane South Africa, , South African Medical Research Council, ; Francie van Zijl Drive, Parow Valley, Cape Town, 7505 South Africa
                Author information
                http://orcid.org/0000-0002-4892-7310
                Article
                2837
                10.1186/s12913-018-2837-z
                5789688
                29378586
                e3323c50-de0f-40a1-8828-152fa14a340d
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 8 April 2016
                : 11 January 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001322, South African Medical Research Council;
                Award ID: 131122
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Health & Social care
                Health & Social care

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