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Synthesis of the evidence and contextualisation process

This study by Dr. Consuelo B. Gonzalez-Suarez explores contextualizing evidence-based guidelines for Philippine rehabilitation medicine. It delves into the challenges of inconsistent nomenclature and adapting recommendations to local patient journeys and workforce constraints. The PARM framework is utilized to synthesize and evaluate evidence, ensuring relevance and applicability. Evaluation parameters include evidence consistency, volume, age, and thought uniformity. Contextualization involves constructing PARM endorsements and considering service delivery elements for optimal care.

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Synthesis of the evidence and contextualisation process

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  1. Synthesis of the evidence and contextualisation process Consuelo B. Gonzalez-Suarez, MD, PhD University of Santo Tomas Philippine Academy of Rehabilitation Medicine

  2. Objectives • To be able to match the evidence from the guidelines to the part of the patient journey • To be able extract data (recommendations and references ) from guidelines • To be able to synthesize the recommendations using PARM Writing guide and Level of Evidence • To be understand the importance of Context Points • To be able to write Context Points

  3. Recognition of nomenclature and methodology issues • Inconsistent nomenclature, with guidelines, recommendations, care pathways and protocols • Adapting or Contextualising?????

  4. What constitutes contextualization? • Key elements • Typical Filipino patient journey • Typical Filipino workforce and service delivery available

  5. What constitutes contextualization? • Key Elements • Whether recommendations were available for each step of the journey and to workforce • What implementing recommendations meant in terms of healthcare workforce, resources, training and willingness to change practice

  6. What constitutes contextualisation? • PARM writing guide was established • Available evidence relative to the patient journey • Summarise different approaches to presenting the available evidence • Construct ‘PARM endorsements’ of the existing recommendations • Construct PARM Context Points

  7. Considered use of available tools • Did not “recreate the wheel” • Assess the generalisability and applicability • For any confusion or contradictory recommendation, group went back to the original references for clarification

  8. Parameters used for grading the Level of Evidence • Consistency of evidence levels • Volume of references • Age of references • Uniformity of thought

  9. Parameters used for grading the Level of Evidence

  10. PARM GUIDE FOR EVIDENCE RATING

  11. PARM GUIDE FOR EVIDENCE RATING

  12. PARM GUIDE FOR EVIDENCE RATING

  13. PARM GUIDE FOR EVIDENCE RATING

  14. PARM GUIDE FOR EVIDENCE RATING

  15. PARM GUIDE FOR EVIDENCE RATING

  16. PARM GUIDE FOR EVIDENCE RATING

  17. PARM guide for writing recommendations

  18. Example

  19. Example Therefore, PARM SUGGESTS therapeutic exercises in the management of patients with acute low back pain.

  20. Context Points • Generalizability and applicability are addressed • Provide a framework in which the PARM endorsed recommendation can be applied, considering local service delivery issues • Structure and Process are considered order to define the important elements of service delivery underpinning evidence-based care (practice context)

  21. Context Points • A standard framework was developed with minimum best-practice and advanced standard care were considered • Included essential equipment, standards and resources, training and workforce

  22. Evaluation of Non-specific low back pain

  23. MaramingSalamat Po!Thank you very much!

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