Journal of Rehabilitation Medicine 51-11 | Page 31

During the follow-up in 2015–2017, an additional 41
CCGs were published (mostly updates), and in 24 of
these rehabilitation and functional capacity was incor-
porated (Table III). The number of evidence summaries
on rehabilitation in those guidelines increased by 58,
from 78 to 136 (Table IV). For a detailed description of
CCGs published during 2012–2017 and rehabilitation-
related evidence summaries in them, see Table SII 1 .
DISCUSSION
With a carefully planned and targeted development
project, it is possible to systematically incorporate
evidence of effectiveness of rehabilitation into relevant
CPGs. Furthermore, the project results were sustained
for 3 subsequent years.
Drafting and updating a CPG is a process of 1–2
years, and therefore it has taken time for the methods
developed during this project to be implemented in
relevant CCGs. The first year of the development
project was used for planning, as well as developing
tools for the guideline panels. This explains why there
were fewer new rehabilitation chapters and evidence
summaries in the first 2 years of the Current Rehabi-
litation project compared with year 2014.
There are several reasons for the success of this
project. First, management was highly committed to
the project. Both time and personnel resources were
allocated, and the aims and achievements of the project
were highlighted repeatedly to CC editors and guide-
line panels. Secondly, the turnover of the editorial team
during the project was minimal, allowing the whole
team to commit to the project. Thirdly, the practical
tools developed for the CC editors and guideline panels
made it easier to change practices. According to the
experiences of the CC editorial team, discussions in
the guideline panels about similarities and differences
between medical care and rehabilitation helped to influ
of rehabilitation into CCGs. Furthermore, rehabilita-
tion has become a more discussed topic in recent years
in health sciences (9).
One of the main results on the Current Rehabilitation
project is the increase in the number of rehabilitation-
related evidence summaries in the CCGs. Critically
appraised rehabilitation evidence was compiled or up-
dated for 31 CCGs, and rehabilitation is now an equal
topic with prevention, diagnostics and treatment. Ten
of the 24 CCGs that the Finnish rehabilitation experts
considered to lack a rehabilitation chapter or evidence
summaries were updated during the development work.
845
Rehabilitation was incorporated into 7 of these. It was
left out of 3 CCGs due to timetable issues, i.e. these
CCGs had mainly been drafted before the project
started. During the follow-up in 2015–2017, another
8 CCGs out of the 24 were updated and rehabilita-
tion was incorporated into 5 more. At present, 4 more
are being updated and 2 have been withdrawn from
publication.
During 2012–2014, the level of evidence was asses-
sed as high (A) to moderate (B) in nearly half (47%)
of rehabilitation-related evidence summaries (Table
IV). The proportion was further increased during the
follow-up in 2015–2017, when in 55% of the 300
rehabilitation-related evidence summaries the evidence
was graded as high or moderate. This reflects an in-
crease in high-quality RCTs in the field of rehabilita-
tion. It also demonstrates that efficacy of rehabilitation
interventions should be assessed with similar criteria
to other interventions in healthcare.
It has been discussed whether the RCT is the optimal
study type to examine the effectiveness of rehabilita-
tion interventions and processes (10, 11). Without
changing our methods in assessing the quality of
evidence, we found no major problems in grading the
level of evidence for rehabilitation-related recommen-
dations. The policy of the CCGs is to include high-level
observational studies in evidence summaries where
justified after critical assessment.
This is a case study of a development project. The
aim of this publication is to share experiences and offer
ideas for further work. We have shown that it is pos-
sible for CPG producers to systemically incorporate
assessment and recommendations regarding rehabilita-
tion into guidelines.
The care of many, if not most, chronic health
problems consists of diagnosis, medical or surgical
treatment, rehabilitation and follow-up. Furthermore,
seamless care pathways including all these components
are needed to achieve high-quality healthcare services.
Thus, rehabilitation needs to be incorporated as an es-
sential component in CPGs.
Conclusion
With a carefully planned and targeted procedure,
including targeted literature searches and critical as-
sessment of studies, CPGs can be extended to include
rehabilitation. The efficacy of rehabilitation interven-
tions can be assessed with similar methods to those
used with treatment interventions. The evidence base
for rehabilitation will increase substantially.
Incorporating evidence-based rehabilitation into CPGs
J Rehabil Med 51, 2019