Journal of Rehabilitation Medicine 51-11 | Page 27

J Rehabil Med 2019; 51: 841–846 SPECIAL REPORT INCORPORATING EVIDENCE-BASED REHABILITATION INTO CLINICAL PRACTICE GUIDELINES Mari HONKANEN, MSocSci 1 , Jari AROKOSKI, MD, PhD 2 , Raija SIPILÄ, MD, PhD 1 , Katriina KUKKONEN-HARJULA, MD, PhD 1,3 , Antti MALMIVAARA, MD, PhD 1,4 and Jorma KOMULAINEN, MD, PhD 1 From the 1 Current Care Guidelines, The Finnish Medical Society Duodecim, Helsinki, Finland, 2 Department of Physical and Rehabilitation Medicine, Helsinki University Hospital, Helsinki, Finland and University of Helsinki, Helsinki, Finland, 3 Rehabilitation, South Karelia Social and Health Care District (Eksote), Lappeenranta, Finland, and 4 Centre for Health and Welfare Economics, National Institute for Health and Welfare, Helsinki, Finland Objective: Rehabilitation is often neglected in clini- cal practice guidelines, even when there is evidence for its effectiveness. The Current Rehabilitation de- velopment project, documented in this article, aimed to develop processes and structures to incorporate evidence and good practice on rehabilitation and functional capacity into the Finnish national Current Care Guidelines. Design: Descriptive assessment. Methods: The 3-year Current Rehabilitation develop- ment project was launched in 2012. It began with an assessment of existing rehabilitation evidence on the Current Care Guideline database and a query to Finnish rehabilitation experts. The project group de- veloped and compiled tools for Current Care editors and guideline panels. The editorial team continued to monitor changes in rehabilitation evidence in the guidelines. Results: During the years 2012–2014, a total of 54 guidelines were published, and rehabilitation was incorporated into 31 of them. The number of rehabi- litation-related evidence summaries increased from 49 to 164. During the next 3 years an additional 41 guidelines were published. Rehabilitation was incor- porated to 24 of them, and the number of rehabilita- tion-related evidence summaries increased from 78 to 136. Conclusion: The level of evidence criteria used for rehabilitative interventions were the same as for symptomatic or curative interventions. Evidence showing the effectiveness of rehabilitation increased substantially during the project. Key words: rehabilitation; clinical practice guidelines; evi- dence-based medicine. Accepted Sep 10, 2019; Epub ahead of print Sep 20, 2019 J Rehabil Med 2019; 51: 841–846 Correspondence address: Mari Honkanen, The Finnish Medical Society Duodecim, Current Care Guidelines, P.O. Box 713, FI-00101 Helsinki, Finland. E-mail: [email protected] C urrent Care Guidelines (CCGs) are evidence-based clinical practice guidelines (CPGs) for healthcare in Finland, produced by the Finnish Medical Society Duodecim since 1994 (1, 2). A detailed process des- cription is required for developing CPGs using uniform guideline standards. The national CCGs cover medical LAY ABSTRACT Current Care Guidelines are national clinical practice guidelines produced in Finland for the use of health- care professionals and lay people. This article describes the 3-year “Current Rehabilitation” development pro- ject, which aimed to develop processes and structures to include rehabilitation in Current Care Guidelines. The results of the project were monitored for a further 3 years. The project group developed tools and provided training for guideline editors and guideline panels. The guideline panels drafted new or updated guidelines and included rehabilitation, when appropriate, with the help of the new tools. A total of 54 guidelines were published during the 3-year project, and 31 included a chapter on rehabilitation. The number of evidence summaries increased by 115 (from 49 to 164). This project shows that, through targeted action, more evidence of rehabi- litation interventions can be included in clinical practice guidelines. treatment as well as diagnostics and prevention of diseases. CCGs are intended as a basis for treatment decisions, and can be used by physicians, other health­ care professionals and citizens. Although the need for rehabilitation increases when striving to improve impaired functional and work capa- city, rehabilitation has traditionally not been an essential part of CPGs in Finland or globally. This is due to the common belief that the effects of rehabilitation have seldom been studied with randomized controlled trials (RCTs). However, the methodology of evidence-based medicine (EBM) provides assessment processes for many types of studies in addition to RCTs. Furthermore, the number of RCTs in the field of rehabilitation has increased during the past decades, although the metho- dological quality of these RCTs varies (3–5). Because rehabilitation has been a neglected field in CPGs, targeted efforts are needed. In 2012–2014, the Current Care editorial team carried out a development project entitled “Current Rehabilitation”, supported by the Social Insurance Institution of Finland. The main objective of the project was to incorporate rehabilita- tion and functional capacity into CCGs. During 2015– 2017 we monitored how evidence on rehabilitation and functional capacity continued to be incorporated into CCGs after the project. This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2607