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Clinical Practice Guidelines

Van Sant, Ann F. PT, PhD, FAPTA

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doi: 10.1097/01.pep.0000434374.92441.97

The long awaited Clinical Practice Guideline (CPG) for Congenital Muscular Torticollis (CMT) appears in this issue. The CPG represents a significant achievement for Kaplan, Coutler, and Fetters1 and for the Section on Pediatrics. As we strive to assure our clinical practice is based on available research evidence, contributions such as CPGs represent major contributions to knowledge translation. By orchestrating a process that gathered relevant research literature, rated the quality of that research, and digested that literature in a way that leads to effective statements for action, the authors have demonstrated knowledge translation at the highest level.

The document is noteworthy; not only for its size, but also for the organizational structure that Kaplan, Coulter, and Fetters have developed that will serve as a model for CPGs that will be developed in the future. Importantly this document is designed to serve as a reference for practicing clinicians. Clinical practice guidelines are unlike other articles in the journal that present a research study, a systematic review that addresses a specific clinical question, or a case study that demonstrates how a clinical colleague addressed an unusual situation. This is not the type of article that you sit down and read. Rather, as you encounter infants with CMT, please use the guideline to determine the appropriate actions to guide your efforts. I know how deeply the authors feel about encouraging readers to look into the document to better understand the strength of the evidence that supports the CPG's recommendations for action. And, as you continue to work with this population, I know you will become increasingly familiar with both the evidence and the clinical practice recommendations for action that are published here. Becoming familiar with the format and substance of this CPG will put you in good stead for future CPGs that the Section on Pediatrics will develop. Look carefully at the authors suggestions for implementation of the recommendations. And most of all, do your part in implementing the recommendations, helping others understand the CPG, and also providing feedback to the Section and the authors. Your thoughts will be welcomed.

Our profession has advanced significantly in the past few decades, as we now understand the need for and value of standardized processes in our examinations and interventions. As research evidence accumulates we can now recommend appropriate measures and interventions as well as processes for examining outcomes and providing follow up. I can only conclude that as a profession, we have come of age. We have moved past the practices of incomplete examinations and arguments that we don't know which interventions are effective, because we now know what types of measures are needed to document the changes we are producing through our management, and researchers have documented the effectiveness of intervention procedures. But the process of developing clinical guidelines also leads directly to the need for additional research efforts, and the work of Kaplan, Coulter, and Fetters has also resulted in a series of research recommendations that will guide our investigative efforts in the future.

Moreover, we understand that CPGs are dynamic documents that will change over time. As colleagues begin to investigate areas where there are gaps in our knowledge, and as we begin to discover even more effective practices, CPGs will evolve and the care we provide to infants with CMT will be even better than what we can offer today.

Each of us needs to do our part to assure that infants entrusted to our care receive the finest physical therapy we can offer. Use this resource and help ensure that action recommendations become our standard practice.

Ann F. Van Sant, PT, PhD, FAPTA



1. Kaplan S, Coulter C, Fetters L. Physical therapy management of congenital muscular torticollis: An evidence-based clinical practice guideline. Pediatr Phys Ther. 2013;25(4):348–394.
© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association.