Study Design 101: Practice Guideline

Definition

A statement produced by a panel of experts that outlines current best practice to inform health care professionals and patients in making clinical decisions. The statement is produced after an extensive review of the literature and is typically created by professional associations, government agencies, and/or public or private organizations.

Good guidelines clearly define the topic; appraise and summarize the best evidence regarding prevention, diagnosis, prognosis, therapy, harm, and cost-effectiveness; and identify the decision points where this information should be integrated with clinical experience and patient wishes to determine practice. Practice guidelines should be reviewed frequently and updated as necessary for continued accuracy and relevancy.

Practice guidelines are also known as "Evidence-based guidelines" and "Clinical guidelines."

Advantages

• Created by panels of experts
• Based on professional published literature
• Practical guidance for clinicians
• Considered an evidence-based resource

Disadvantages

• Slow to change or be updated
• Not always available, especially for controversial topics
• Expensive and time-consuming to produce
• Recommendations might be affected by the type of organization creating the guideline

Design pitfalls to look out for

The panel should be composed of a variety of experts with assorted affiliations.

Is the panel composed of members from a variety of professional associations, government agencies and/or institutes? Does one organization/association predominate?

Fictitious Example

A practice guideline focusing on the best way to prevent sunburn when wearing sunscreen involved forming a multidisciplinary panel of experts (dermatologists, oncologists, sunscreen chemists, etc.). These experts searched the literature and identified 123 research articles on sunscreen and sunburn prevention for appraisal. The research was then reviewed by a member of the panel with critical appraisal experience in order to identify only those high-quality research articles that permit making recommendations. Ninety-seven high-quality studies were selected. These articles were read and synthesized by the panel to create a formal guideline recommendation. Based on the literature, the guideline recommended that the best way to prevent sunburn is to wear UVA blocking sunscreen daily. However, there was insufficient evidence in the literature to make any recommendations about newer sunscreen formulations. This identified the need for further research on this topic.

Real-life Examples

Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., Weimer, M., ... Brodt, E. (2017). Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians clinical practice guideline. Annals Of Internal Medicine, 166(7), 493-+. https://doi.org/10.7326/M16-2459

A group from The American College of Physicians reviewed the current evidence to determine which nonpharmacologic options are effective in treating low back pain (both acute and chronic). New treatment options appeared in the literature since 2007 (prior guideline on this topic) and several show "small to moderate, usually short-term effect on pain" including tai chi, mindfulness-based stress reduction, yoga as well as continued support for prior treatment recommendations including exercise, psychological therapies, multidisciplinary rehabilitation, spinal manipulation, massage, and acupuncture. There were greater effects on pain than on function, and the strength of evidence for several of these interventions is low.

Lennon, S., Dellavalle, D., Rodder, S., Prest, M., Sinley, R., Hoy, M., & Papoutsakis, C. (2017). 2015 Evidence Analysis Library evidence-based nutrition practice guideline for the management of hypertension in adults. Journal of the Academy of Nutrition and Dietetics, 117(9), 1445-1458.e17. https://doi.org/10.1016/j.jand.2017.04.008

This guideline addresses the role of nutrition in managing hypertension in adults. Seventy studies were evaluated, resulting in eight recommendations to reduce blood pressure in adults with hypertension, based on moderate levels of evidence: "provision of medical nutrition therapy by an RDN [registered dietitian nutritionist], adoption of the Dietary Approaches to Stop Hypertension dietary pattern, calcium supplementation, physical activity as a component of a healthy lifestyle, reduction in dietary sodium intake, and reduction of alcohol consumption in heavy drinkers. Increased intake of dietary potassium and calcium as well as supplementation with potassium and magnesium for lowering BP are also recommended."

Related Terms

National Guideline Clearinghouse (NGC)

The National Guideline Clearinghouse was a public resource for evidence-based clinical practice guidelines maintained by the Agency for Healthcare Research and Quality (AHRQ). It was taken offline in 2018 after federal funding ended.