Journal of Rehabilitation Medicine 51-11 | Page 28

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M. Honkanen et al.
The aim of this paper is to report the results and
experience gained from this development work.
METHODS
Project objectives and stakeholders
Project planning started in 2011, also consisting of plans for
evaluation and communication. The main objective was to
develop processes and structures to incorporate evidence and
good practices of rehabilitation and functional capacity into
CCGs, and to use those methods in developing and updating
the CCGs. The project roadmap is described in Fig. 1.
A project group of 10 members was compiled from the CC
editorial team and its partners, the Social Insurance Institution
of Finland and the Finnish Association of Physiotherapists.
A steering group of 6 members was nominated, consisting of
representatives of the Finnish Medical Society Duodecim and
the Social Insurance Institution of Finland.
CC editors (as evidence-based medicine (EBM) methodology
experts) and members of the voluntary guideline panels (usually
approximately 10 clinicians), who compose and update CCGs
with support from the editorial team, were identified as the
main target groups of this development work. Development of
a CCG usually lasts for 2 years. The need for updating a CCG
is evaluated approximately every 3 years, and the updating
process usually lasts for 1 year (detailed process descriptions
are available from the CCG website: https://www.kaypahoito.
fi/en/about-current-care-guidelines/process-descriptions).
Project methods and development actions
Using the CCG database, the project group first surveyed how
rehabilitation and functional capacity were incorporated to the
existing 101 CCGs. In addition, the project group contacted 15
Finnish rehabilitation experts through a web survey to survey
their views on the need for rehabilitation-related evidence in
those CCGs that were lacking it.
The definition of rehabilitation was discussed at length in
the project and steering groups, as well as in the guideline
panels. The World Health Organization (WHO) definition, “...
appropriate measures, including through peer support, to enable
Table I. Questions for Current Care Guideline panels when
considering if rehabilitation is relevant for the guideline contents
1a. Does improvement in functional capacity
require the person’s own activity?
1b. Does improvement in functional capacity
require some technical aid or special measures
directed at the person’s environment?
2. Does the person need guidance from healthcare
professionals for planning the contents of these
measures?
3. Does the person need healthcare professionals
for carrying out these measures?
No Somewhat A lot
No Somewhat A lot
No Somewhat A lot
No Somewhat A lot
persons with disabilities to attain and maintain their maximum
independence, full physical, mental, social and vocational abi-
lity, and full inclusion and participation in all aspects of life”
(6), was modified. To be more suitable for the needs of guideline
panels, the definition of rehabilitation was phrased as “… all
measures that help patients (or persons with reduced functional
capacity) to help themselves, in comparison to pharmacotherapy
or surgery where the patient is a passive recipient of care”.
A web-based handbook for guideline panel members was
updated to include rehabilitation-related evidence, where app-
licable, in the CCG development process. Also, evidence table
templates for rehabilitation trials were added.
The key statements of a CCG are supported by evidence
summaries of the best available research. The PICO framework
(Patient, Intervention, Control intervention, Outcome) is used (7),
and depending on the quality of the original studies, the quality of
evidence of the key statements is graded from A (high) to D (very
low) (2). A detailed process description for developing CCGs
can be found at the CCG website: https://www.kaypahoito.fi/en/
about-current-care-guidelines/process-descriptions.
Training of the CC editors and guideline panels consisted of
critical appraisal of rehabilitation studies and writing evidence
summaries. The project group offered CC editors a set of tools
to use when informing and training guideline panels about the
project. The tools included a definition of rehabilitation for
CCGs, a list of questions to be answered when considering
the relevance of rehabilitation to the guideline topic (Table I),
information on how the CC information specialists conduct the
literature searches focusing on rehabilitation, training on critical
appraisal of rehabilitation studies and a process description flow
chart for incorporating rehabilitation to CCGs (Fig. 2).
Rehabilitation and functional capacity in CCGs
Tools for incorporating rehabilitation and functional capacity to CCGs
Training of Current Care editors and guideline panel members
Structures and processes for including rehabilitation to CCGs
Planning
Year 2011
2012
2013
2014
Fig. 1. Roadmap describing different phases of Current Rehabilitation development project on incorporating rehabilitation-related evidence into
Current Care Guidelines (CCGs).
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