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Clinical Guidelines and Systematic Reviews

Van Sant, Ann F. PT, PhD, FAPTA

Pediatric Physical Therapy: Fall 2013 - Volume 25 - Issue 3 - p 231
doi: 10.1097/PEP.0b013e318299cd9c


The Editor declares no conflicts of interest.

This issue includes a special communication from the Guideline Development Group of the APTA Section on Pediatrics. This contribution by Kaplan et al1 represents a manual for those who would develop clinical guideline documents. The procedures to plan and conduct systematic reviews of the literature that support clinical guidelines, the development and writing of the guidelines, the review of the guidelines by appropriate audiences, and the dissemination of the work are explained in a step-by-step manner. This contribution, developed as they work to produce a set of clinical guidelines, should be extremely helpful to those who will work in the future to develop clinical guidelines for our profession.

Clinical guidelines are among the most influential documents that we publish. The work of Sweeney and colleagues,2,3 who produced the Neonatal Intensive Care Unit Guidelines for the Section on Pediatrics, continues to be an international resource that guides physical therapists’ interventions with this vulnerable population of infants. Guidelines are built on research evidence and the expertise of our finest clinicians, and we look forward to the forthcoming guideline on congenital muscular torticollis in the next issue of Pediatric Physical Therapy.

Also, among our most influential documents are the systematic reviews that we publish. A well-constructed systematic review of dosage in standing programs for children also appears in this issue. Paleg and colleagues4 conducted a clearly reported literature search and organized their findings, using the World Health Organization's International Classification of Functioning, Disability, and Health–Child and Youth version (ICF-CY) framework. They reported their findings with reference to components of body structure, body function, activities, and participation. That extra step makes their work more accessible for clinicians who use standing programs to achieve different goals.

A systematic review demands not only a well-identified search strategy but also judicious use of scales to evaluate the rigor of the studies that were located in the literature search. It is on the basis of those scales that Paleg et al4 evaluated the strength of the evidence. Importantly, they also used their expertise and knowledge gained from reading related literature to provide additional clinical recommendations, where strong evidence is lacking. After reading Paleg et al, I recommend that you then embark on reading the work of Damcott and coauthors.5 Serendipity is operating again, allowing an original research report on the topic of a standing program to appear in the same issue as the systematic review. But the article by Damcott et al5 serves not only as additional information at this point in time but also as a reminder that systematic reviews must be repeated and updated periodically. That task is made much easier when the original review provides the level of detail that Paleg and colleagues4 reported.

Ann F. Van Sant, PT, PhD, FAPTA


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1. Kaplan SL, Coulter C, Fetters L. Developing evidence-based physical therapy clinical practice guidelines. Pediatr Phys Ther. 2013;25(3):257–270.
2. Sweeney JK, Heriza CB, Blanchard Y. Neonatal physical therapy. Part I: clinical competencies and neonatal intensive care unit clinical training models. Pediatr Phys Ther. 2009;21(4):296–307.
3. Sweeney JK, Heriza CB, Blanchard Y, Dusing S. Neonatal physical therapy. Part II: practice frameworks and evidence-based practice guidelines. Pediatr Phys Ther 2010;22(1):2–16.
4. Paleg GS, Smith BA, Glickman LB. Systematic review and evidence-based clinical recommendations for dosing of pediatric supported standing programs. Pediatr Phys Ther 2013;25(3):232–247.
5. Damcott M, Blochlinger S, Foulds R. Effects of passive versus dynamic loading interventions on bone health in children who are non-ambulatory. Pediatr Phys Ther 2013;25(3):248–255.
© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association.