FAQ
Immediate answers to common inquiries.
What is a clinical practice guideline? Practice guidelines provide evidence-based recommendations for clinical practice, drawing upon systematic reviews, meta-analyses, and other high-quality studies, considering the benefits and harms of alternative care options. They aim to guide healthcare professionals in making informed decisions and providing optimal care to patients. (1) (1) National Institute of Health. 2016. What are clinical practice guidelines?. Available on https://www.ncbi.nlm.nih.gov/books/NBK390308/
What is the hierarchy of scientific literature? Where do clinical practice guidelines stand? The hierarchy of scientific literature refers to the differing levels of authority and credibility attached to different types of scientific articles. At the top of the hierarchy are clinical practice guideline, systematic reviews and meta-analyses, which summarize and analyze findings from multiple studies to provide a comprehensive overview of current research on a topic. Below this are randomized controlled trials, which provide high-quality evidence due to their design. Cohort studies and case control studies follow, offering insight into relationships between variables. Case reports and series sit lower in the hierarchy, describing individual or group cases but lacking generalizability. Lastly, we have animal research and in-vitro studies, which are crucial for early-stage research but need to be interpreted with caution when applying to humans, and expert opinion. (1) (1) Wallace, S. S., Barak, G., Truong, G., & Parker, M. W. (2022). Hierarchy of Evidence Within the Medical Literature. Hospital pediatrics, 12(8), 745–750. https://doi.org/10.1542/hpeds.2022-006690
What is Overview? Overview is a website for physiotherapy and healthcare professionals, which aims to objectively synthesize all the latest clinical practice guidelines in musculoskeletal rehabilitation, with complete visuals of recommendations by pathology.
What is the strength of recommendation? How can I interprete the strength of recommendation? The strength of recommendation in clinical practice guidelines represents the extent of confidence in which the benefits of the intervention outweigh the adverse effects (1). Other factors influencing the strength of recommendations include the presence of alternative intervention strategies, the quality and level of evidence, values and preferences (of both patient and clinician) and the use of resources. Thus, the strength of recommendations is different from the level of evidence. The strength of recommendation is classified on several available scales. For example, the GRADE scale divides recommendations as strong or weak, while the SORT scale classifies recommendations as (A) based on consistent and good-quality evidence, (B) based on conflicting evidence and/or low to moderate quality evidence, (B-) based on conflicting evidence and/or very low-quality evidence, (C) based on expert consensus. In order to group recommendations, it is necessary to standardize recommendation strength scales. As the 4-level scale (recommendations based on good practice, weak, moderate or strong) can, to a certain extent, group together the other scales, it has been used. Caution should therefore be exercised when comparing the strength of recommendations between clinical practice guidelines, as they are not all based on the same scale. Consultation of the scale used by the clinical practice guide is the priority reference. A strong recommendation implies that the authors of the guideline are confident that the benefits of the intervention outweigh the potential harms. In this case, clinicians are encouraged to follow this recommendation in the majority of cases. A moderate recommendation implies that the authors of the practice guide consider that the benefits of the intervention outweigh the potential disadvantages. In this case, clinicians can choose this intervention by considering the circumstances and preferences (of both patient and clinician). A weak recommendation implies that the authors of the clinical practice guideline are less certain about the balance between the potential benefits and harms of the intervention. This type of recommendation may be conditional on specific circumstances. Clinicians have more discretion in deciding whether or not to follow this recommendation. This recommendation is more influenced by preferences (of both patient and clinician), local variations in practice, availability of resources and feasibility. A recommendation based on best practice implies that the authors of the clinical practice guideline rely on expert opinion and local variations in practice, since the evidence is insufficient. These are the best practices suggested in this situation. Sometimes, practice guidelines cannot make a recommendation on an intervention because of insufficient, inconclusive or conflicting evidence. (1) Guyatt, G. H., Oxman, A. D., Kunz, R., Falck-Ytter, Y., Vist, G. E., Liberati, A., Schünemann, H. J., & GRADE Working Group (2008). Going from evidence to recommendations. BMJ (Clinical research ed.), 336(7652), 1049–1051. https://doi.org/10.1136/bmj.39493.646875.AE
How to interpret a visual overview? And its legend? A clinical practice guideline recommendation is represented by a point. A point is located at the intersection of a practice guide (in X) and a procedure (in Y). When a point is present, the practice guide has issued a recommendation for that procedure. If no dot is present, the practice guide has not issued a recommendation for this intervention. The color of the dot indicates two things: 1) whether or not the intervention is recommended; and 2) for whom the intervention is recommended. Specifically, a green dot represents a recommendation for all people with the condition. A yellow dot represents a recommendation for a specific sub-group of people with the condition (e.g. for all low-back pain sufferers with a high level of kinesiophobia). Information on the sub-group of the yellow dot can be found in the summary of the practice guide. A red dot represents a recommendation against intervention for all people with the condition. A grey dot represents no recommendation due to conflicting, insufficient or inconclusive evidence. In this case, the practice guide has stated that it is not possible to make a recommendation on the intervention in question at this stage. Interventions are classified by type of recommendation (all in green, some in yellow, not recommended in red). This classification also takes into account the number of practice guidelines that have issued a recommendation on this intervention, as well as the strength of the recommendation. Thus, a procedure that has been extensively studied and recommended for all by several guidelines will be at the top of the figure. A little-studied intervention will probably be in the middle of the figure. An intervention that has been extensively studied and not recommended for all by several clinical practice guidelines will be at the bottom of the figure. This classification is intended to facilitate interpretation of the overview.
What are Overview's limits? Overview does not evaluate the quality of the clinical practice guidelines presented. The healthcare professional consulting Overview must critically analyze the literature presented. Caution should be exercised when comparing the strength of recommendations between clinical practice guidelines, as they are not all based on the same scale. Consultation of the scale used by the clinical practice guide is the priority reference. While this is not a limitation in itself, Overview is not a substitute for the clinical judgment of a healthcare professional. See the disclaimer in the footer for more information.
Are visual overviews and summaries offered in both English and French? Absolutely! You can access all visual overviews and summaries in either English or French, depending on your preferred language option.
Why limit the overview to musculoskeletal pathologies? Our goal is to expand the range of included pathologies, such as neurological, cardiorespiratory, gerontological, and pediatric, in the coming years. We invite you to reach out to us to show your support for this feature. Let your voice be heard!
What is the search strategy? And what are the eligibility criteria for guidelines and recommendations? Overview's objective is to identify all clinical practice guidelines for musculoskeletal rehabilitation. To achieve this, Overview deploys a highly sensitive search strategy both in databases (PubMed, CINAHL, PeDRO) and on the sites of influential associations (e.g. those of the American Physical Therapy Association, the American Association of Orthopaedic Surgeons, and the National Institute for Health and Care Excellence, to name but a few). This search strategy follows the latest best practice recommendations in scientific research. It is relaunched every month. Screening of clinical practice guidelines is manual. Clinical practice guidelines are included if they are published within the last decade, focus on musculoskeletal rehabilitation, and address at least one musculoskeletal pathology. Some consensus statements are included if no clinical practice guidelines are available for a musculoskeletal pathology. Clinical practice guidelines are excluded if they are protocol only, offer no clear recommendations, or lack a methodology section. When a clinical practice guideline is included, recommendations are included when they relate to prevention, assessment, referral for imaging when relevant in the Quebec rehabilitation context, or conservative treatment. Recommendations are excluded when they concern pharmacology, invasive treatment (infiltrations, surgery), risk factors and prognostic factors.
Why can't I access the visual overview and summary sections? You need a subscription to access the visual overview and summary sections. Please visit the Get Started section to explore the available subscription options.